class1	0	augmentation mentoplasty using mersilene mesh  
class1	0	many different materials are available for augmentation mentoplasty  
class1	0	however  the optimal implant material for chin implantation has yet to be found  
class1	0	during the past several years  a number of experienced surgeons have turned to the use of mersilene mesh  
class1	0	mersilene mesh is a non absorbable dacron polyester fiber that can be conformed easily into layers to achieve tailored dimensions and shape  
class1	0	at the mccollough plastic surgery clinic pa  birmingham  ala  277 patients over a 10 year period underwent chin augmentation with mersilene mesh implants  
class1	0	the material provides excellent tensile strength  durability  and surgical adaptability  
class1	0	the overall complication rate was 3 2   nine patients   infection rate  2 5   seven patients   and removal secondary to infection  1 7   five patients   
class1	0	based on this 10 year experience  mersilene mesh remains our material of choice for chin augmentation  
class1	1	multiple intracranial mucoceles associated with phaeohyphomycosis of the paranasal sinuses  
class1	1	the purpose of this article is to alert clinicians to a new pathogenic fungus of the paranasal sinuses called exserohilum rostratum  
class1	1	exserohilum species are one of the etiologic agents of phaeohyphomycosis  a constellation of entities caused by dematiaceous fungi  
class1	1	this class of fungal sinus infection has emerged only in the past decade  it occurs primarily in immunocompetent individuals and produces a tenacious  progressive pansinusitis  
class1	1	to our knowledge  this study describes the first case of multiple intracranial mucoceles secondary to e rostratum  
class1	1	the diagnostic workup includes computed tomography and magnetic resonance imaging followed by direct microscopic examination of tissue biopsy specimens  
class1	1	a craniotomy followed by a bilateral external ethmoidectomy was necessary for complete extirpation of the infected mucoceles  
class1	1	aggressive surgical management of this mycotic infection is described  
class1	2	replacement of an aortic valve cusp after neonatal endocarditis  
class1	2	septic arthritis developed in a neonate after an infection of her hand  
class1	2	despite medical and surgical treatment endocarditis of her aortic valve developed and the resultant regurgitation required emergency surgery  
class1	2	at operation a new valve cusp was fashioned from preserved calf pericardium  
class1	2	nine years later she was well and had full exercise tolerance with minimal aortic regurgitation  
class1	3	the value of indium 111 leukocyte scanning in the evaluation of painful or infected total knee arthroplasties  
class1	3	evaluation of painful total knee arthroplasties  tkas  for infection can be difficult  
class1	3	indium 111  111in  leukocyte bone scanning provides a minimally invasive technique for evaluation of possible infection  
class1	3	thirty eight patients with a painful tka who had surgical exploration after 111in leukocyte scanning were reviewed  
class1	3	the scan had an accuracy of 84   a sensitivity of 83   and a specificity of 85   
class1	3	the 111in leukocyte scans must be interpreted in conjunction with the clinical evaluation of the patient because they are less accurate for study of tkas than of total hip arthroplasties  
class1	4	febrile infants less than eight weeks old  predictors of infection  
class1	4	febrile infants less than eight weeks old frequently are admitted and receive parenteral antibiotics for treatment of possible sepsis  
class1	4	the authors assess 52 infants less than eight weeks old with a rectal temperature of 38 1 degrees c or higher as having either a readily identifiable focus of infection by physical examination  appearing  toxic  without a focus  or appearing well  
class1	4	the authors screened patients by using white blood cell  wbc  counts  erythrocyte sedimentation rate  esr   c reactive protein  crp   and chest radiographs in addition to blood  cerebrospinal fluid and urine cultures  
class1	4	the authors found a 9 6  incidence of bacteria in the 52 infants evaluated  with a 4 3  incidence in those febrile infants who appeared well  
class1	4	five patients had positive blood cultures with group b b hemolytic streptococcus  four patients   and viridans streptococcus  one patient   
class1	4	a clinical assessment of toxicity and a total band count greater than or equal to 0 5 x 10 3  cells ul together were sensitive indicators of bacteremia  as were toxicity and a positive crp  
class1	4	a  toxic  appearance  a wbc count greater than or equal to 15 x 10 3  cells ul and an esr greater than 30 were specific indicators of bacteria  
class1	4	based on these data  identification of bacteremia in febrile infants may be possible with clinical assessment and screening laboratory tests  
class1	4	because of the relatively small sampling size of this study  the authors feel that evaluation of a larger number of patients is warranted to evaluate these sensitivities in a more diffuse patient population  
class1	5	superficial cultures in neonatal sepsis evaluations  impact on antibiotic decision making  
class1	5	the authors performed a retrospective analysis of neonatal superficial cultures and their effect on antimicrobial decision making during a nine month period at nashville general hospital  
class1	5	they obtained and reviewed charts of infants  n   66  having paired superficial  skin and or gastric aspirate  and deep  blood and cerebrospinal fluid  cultures for the evaluation of early onset sepsis  
class1	5	superficial cultures were positive for pathogens  any streptococcus or enteric gram negative  in 15   10 66  of cases  
class1	5	antimicrobial decision making was affected in only one of these cases  and in a seemingly inappropriate manner  
class1	5	in summary  there was no evidence or review that superficial cultures used in sepsis evaluation influenced physician antimicrobial decision making  in one case they may have led to unnecessary antibiotic exposure  
class1	6	sepsis related cardiogenic shock  
class1	6	to further define cardiovascular abnormalities in patients with septic shock  serial conventional hemodynamic measurements combined with two dimensional echocardiographic studies were performed at the bedside in 21 patients admitted for an acute episode of sepsis related circulatory failure  
class1	6	measurements obtained during the first hours of hospitalization revealed a group of six patients  group 1  with markedly depressed left ventricular function  as evidenced by a low cardiac index  ci   2 2     0 8 l min m2   reduced left ventricular ejection fraction  lvef   21     8    and an increased arterial venous oxygen content difference  
class1	6	right ventricular systolic function was also severely depressed  
class1	6	these patients were characterized as having sepsis related cardiogenic shock secondary to profound myocardial depression  which was reversible within 24 to 48 h with inotropic support  
class1	6	the 15 remaining patients  group 2  exhibited an initially increased ci  4 9     1 8 l min m2   with a low systemic vascular resistance  
class1	6	in group 2  lvef remained within the normal range despite abnormally low peripheral vascular resistance  
class1	6	this finding would suggest the presence of slight to moderate depression of left ventricular systolic function  
class1	6	all patients in this series had a normal left ventricular end diastolic volume  whether profound myocardial depression was present or not  
class1	7	catheter related sepsis  prospective  randomized study of three methods of long term catheter maintenance  
class1	7	we studied the infectious risk of different methods of managing vascular catheters during long term use  
class1	7	consecutive surgical icu patients requiring triple lumen catheters  pulmonary artery catheters  or arterial catheters for greater than 7 days were prospectively randomized to one of three management groups  a  percutaneous  perc  puncture with every 7 day catheter change at a new site  b  no weekly change  nwc  with a new site when changed  or c  guidewire exchange  gwx  with every 7 day catheter change at the same site  
class1	7	in all groups  a catheter change was mandatory for a positive blood culture  skin site infection  or sepsis without a likely source  
class1	7	cultures were obtained when clinically indicated and at the time of every catheter change  
class1	7	catheter related sepsis  crs  was defined as a positive blood culture and catheter culture with the same organism  
class1	7	a total of 112 patients met evaluation criteria  
class1	7	there were no intergroup differences in age  primary diagnosis  severity of injury or illness  number of study days  number of protocol violations  route of catheterization  number of catheters present patient day  catheter sepsis rate  or bacteremia rate  
class1	7	the nwc group demonstrated an increased number of days catheter  fewer catheter subcutaneous tract segment cultures patient  and a reduced incidence of catheter tip colonization  
class1	7	these results occurred in a setting where the number of crs episodes patient was 0 17 for gwx  0 22 for perc  and 0 16 for nwc  
class1	7	we conclude that there is no difference in infectious risk between these three methods of long term catheter management  
class1	7	the method with the least complications and expense should be used  
class1	8	effect of blood transfusion on oxygen consumption in pediatric septic shock  
class1	8	treatment plans for pediatric septic shock advocate increasing oxygen consumption  vo2   
class1	8	recent studies in septic shock indicate that improving oxygen delivery  do2  by increasing blood flow will increase vo2  
class1	8	we prospectively examined the effect on vo2 of improving do2 by increasing oxygen content  co2  with blood transfusion in eight hemodynamically stable septic shock patients  
class1	8	transfusion consisted of 8 to 10 ml kg of packed rbc over 1 to 2 h  
class1	8	hemodynamic and oxygen transport measurements were obtained before and after blood transfusion  
class1	8	transfusion significantly  p less than  05  increased hgb and hct from 10 2     0 8 g dl and 30     2  to 13 2     1 4 g dl and 39     4   respectively  mean     sd   
class1	8	do2 significantly  p less than  05  increased after transfusion  599     65 to 818     189 ml min m2   but vo2 did not change  166     68 to 176     74 ml min m2  ns   
class1	8	in pediatric septic shock patients  increasing co2 by blood transfusion may not increase vo2  
class1	9	resolution of the adult respiratory distress syndrome following colectomy and liver transplantation  
class1	9	a 32 year old woman with liver failure from end stage cirrhosis and ulcerative colitis developed septicemia and severe ards  
class1	9	subtotal colectomy and a successful liver transplantation resulted in complete resolution of the ards  
class1	10	effects of epinephrine on hemodynamics and oxygen metabolism in dopamine resistant septic shock  
class1	10	the hemodynamic effects of epinephrine were prospectively studied in 13 patients with septic shock who remained hypotensive after both fluid loading and dopamine  
class1	10	hemodynamic measurements were performed before and one hour after the start of epinephrine infusion  
class1	10	systolic  diastolic  and mean arterial pressure increased in all patients  p less than 0 01   
class1	10	cardiac index and systemic vascular resistance increased by 34 and 32 percent  respectively  p less than 0 05   but heart rate and pulmonary vascular resistance remained unchanged  
class1	10	there was a concomitant increase in oxygen delivery  p less than 0 01  and oxygen consumption  p less than 0 05   the magnitude of the latter being related to baseline lactacidemia  p less than 0 01   
class1	10	in view of the generally recognized physiologic goals of septic shock management  we conclude that epinephrine could be an appropriate alternative where fluid loading and dopamine have failed  
class1	11	short term chemoprophylaxis with ceftizoxime vs  five day aminoglycoside with metronidazole in  contaminated  lower gastrointestinal surgery  
class1	11	in a prospective  open  randomized controlled trial  173 patients requiring surgery for potentially  contaminated  lower gastrointestinal surgery were allocated to receive either two doses of ceftizoxime  2 gm  with one dose of metronidazole  1 5 gm  or gentamicin 3 mg kg day for five days with one dose of metronidazole  1 5 gm   
class1	11	eighty nine patients received ceftizoxime and 84 patients received gentamicin  
class1	11	the groups were comparable with respect to diagnosis  procedure  type of anastomosis  and wound closure  
class1	11	the incidence of withdrawal due to failure to respond to the study drug  11 5 percent  was equivalent in the two groups  
class1	11	there was no difference in the overall incidence of postsurgical infection between the ceftizoxime and metronidazole group  22 2 percent  and the gentamicin and metronidazole group  25 7 percent   
class1	11	the incidence of wound infection  ceftizoxime and metronidazole  6 9 percent  gentamicin and metronidazole  10 percent  and deep sepsis  ceftizoxime and metronidazole  15 3 percent  gentamicin and metronidazole  15 7 percent  was similar  
class1	12	gastrointestinal tuberculosis  report of four cases  
class1	12	gastrointestinal tuberculosis is a rare disease in the united states  
class1	12	correct identification is often delayed because it is not considered early on in the differential diagnosis  
class1	12	four patients with gastrointestinal tuberculosis and the symptoms  diagnosis  complications  and treatment of the disease are discussed  
class1	12	gastrointestinal tuberculosis should be considered in asian immigrant patients who present with symptoms and signs of inflammatory bowel disease  
class1	13	a small animal model of human helicobacter pylori active chronic gastritis  
class1	13	isolation of a spiral shaped bacterium closely related to helicobacter pylori from the cat stomach made it possible to investigate new small animal models of gastric infection  
class1	13	pure cultures of this bacterium  provisionally named  helicobacter felis   were fed to germ free mice  
class1	13	the organism colonized the stomach in large numbers in mucus and deep in the gastric pits and showed the same gastric trophism found with h  
class1	13	pylori  
class1	13	significant histopathology was seen in all h  
class1	13	felis infected mice  
class1	13	at 2 weeks postinfection  an acute inflammatory response was seen composed primarily of eosinophils and neutrophils  
class1	13	at 3 weeks  the polymorphonuclear response was more pronounced with large numbers of neutrophils in some areas forming small microabscesses  
class1	13	lymphocytes also increased in number  
class1	13	by 8 weeks  several relatively large lymphoid nodules were present in the submucosa  
class1	13	multiple small microabscesses were still present in the pyloric mucosa  
class1	13	this is the first animal model of bacterial gastritis to be described that shows progression from acute inflammation to persistent acute on chronic inflammation  active chronic  as is seen in human infection with h  
class1	13	pylori  
class1	14	prevention of necrotizing enterocolitis in the rat with prenatal cortisone  
class1	14	cortisone acetate is known to accelerate maturation of the immature intestine  
class1	14	the effect of prenatal administration of cortisone acetate on the morbidity and mortality of necrotizing enterocolitis was examined in a rat pup model  
class1	14	pregnant rats were administered cortisone acetate  20 mg 100 g of body weight  or normal saline by daily ip injection from day 18 21 of gestation  
class1	14	rat pups were taken from the mothers before suckling was initiated  fed a simulated rat milk formula  and subjected to daily ischemic insults to produce an animal model of necrotizing enterocolitis  
class1	14	both morbidity and the mortality rates were significantly improved with prenatal cortisone treatment  
class1	14	maturation of the intestinal mucosal barrier was accelerated with the cortisone treatment as measured by decreased serum concentrations of a fed antigen  ovalbumin  
class1	14	aerobic bacterial colonization of the small intestine and translocation of bacteria to the liver were decreased in the pups pretreated with steroids  
class1	14	these changes observed in a rat model of necrotizing enterocolitis may explain the decreased incidence of necrotizing enterocolitis in human infants born to mothers who received corticosteroids late in gestation  
class1	15	reduction of gastric ulcer recurrence after suppression of helicobacter pylori by cefixime  
class1	15	the effect on the recurrence of gastric ulcers after suppression of helicobacter pylori by combined treatment with cimetidine and the antimicrobial drug cefixime was investigated  
class1	15	twenty one of 43 patients with endoscopically proved gastric ulcer and h pylori infection were randomly assigned to receive cimetidine 800 mg daily for 12 weeks  the remaining 22 patients received cimetidine 800 mg daily for 12 weeks plus cefixime 100 mg daily for the last two weeks  
class1	15	after treatment  88  of 17 patients on cimetidine only remained h pylori positive  whereas combined administration of cimetidine and cefixime had suppressed h pylori in 78  of 18 patients  p less than 0 05   
class1	15	seventeen patients in the former group whose ulcers healed but who remained h pylori positive and 18 patients in the latter group whose ulcers healed and who were no longer infected with h pylori continued to be followed after treatment  
class1	15	these patients underwent endoscopy to detect ulcer recurrence if symptomatic  or at 12 and 24 weeks if asymptomatic  
class1	15	at 12 weeks  recurrence was observed in seven of 15  47   patients in whom h pylori persisted  but in only one of 14  7   patients in whom h pylori had been suppressed  p less than 0 05   
class1	15	at 24 weeks  however  recurrence rates were similar between the two groups  
class1	15	these findings indicate that h pylori infection may be closely related to early ulcer recurrence  
class1	16	adjuvant antibiotic therapy in duodenal ulcers treated with colloidal bismuth subcitrate  
class1	16	persistence of helicobacter pylori after duodenal ulcer healing is associated with high rates of ulcer relapse  
class1	16	we compared colloidal bismuth subcitrate alone with cbs combined with one of four antibiotic regimens in the treatment of duodenal ulcers  
class1	16	endoscopy and antral biopsies were performed before treatment and four weeks afterwards  
class1	16	biopsy specimens were examined for histological evidence of gastritis and by gram stain and culture for h pylori infection  
class1	16	altogether 141 patients were allocated to one of five treatment groups  
class1	16	giving cbs and metronidazole  400 mg tid for 7 days  with and without amoxycillin  500 mg tid  achieved higher clearance rates of h pylori than treatment with cbs alone  p less than 0 01   
class1	16	these two combinations also achieved higher rates of antral gastritis healing than cbs alone  p less than 0 01 and p less than 0 05 respectively   
class1	16	susceptibility to metronidazole was tested in 29 isolates before and in seven isolates after treatment with metronidazole by disc diffusion test and minimum inhibitory concentration assay  
class1	16	twenty seven  93   of the isolates were sensitive before treatment while six of seven  86   were resistant afterwards  
class1	16	four of the six resistant strains had acquired resistance during treatment and one of these had acquired metronidazole resistance despite concomitant treatment with amoxycillin  to which it remained sensitive  
class1	16	cbs with adjuvant metronidazole at a dose of 400 mg tid for seven days significantly improves the eradication of h pylori compared with cbs alone  
class1	16	acquired metronidazole resistance  however  seems to be an important cause of failure to eradicate h pylori  
class1	17	monomicrobial nonneutrocytic bacterascites  a variant of spontaneous bacterial peritonitis  
class1	17	spontaneous bacterial peritonitis is diagnosed when  a  the ascitic fluid culture is positive   b  the ascitic fluid neutrophil count is greater than or equal to 250 cells mm3 and  c  there is no evident intraabdominal surgically treatable source for infection  
class1	17	few details are available regarding the variant of ascitic fluid infection in which the culture grows bacteria  pure growth of a single type of organism   but the neutrophil count is less than 250 cells mm3  
class1	17	in this prospective study of 138 episodes of culture positive spontaneously infected ascites detected in 105 patients  44  31 9   were episodes of  monomicrobial nonneutrocytic bacterascites  compared with 94  68 1   episodes of spontaneous bacterial peritonitis  
class1	17	seventeen patients had both types of infection  
class1	17	the infection related mortality and hospitalization mortality were similar between the two groups  
class1	17	patients with bacterascites appeared to have less severe liver disease  
class1	17	in 62  of bacterascites episodes in which a second paracentesis was performed before any treatment the fluid spontaneously became sterile without development of ascitic fluid neutrocytosis  
class1	17	thirty eight percent of patients with bacterascites  who underwent a second paracentesis before treatment was started  progressed to spontaneous bacterial peritonitis  sometimes within a few hours  
class1	17	the concentration of the chemoattractant c5a was not decreased in the ascitic fluid of the bacterascites patients  this excludes ascitic fluid c5a deficiency as the explanation of the lack of neutrocytosis  
class1	17	monomicrobial nonneutrocytic bacterascites is a common variant of ascitic fluid infection that may resolve without treatment or may progress to spontaneous bacterial peritonitis  
class1	18	norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis  results of a double blind  placebo controlled trial  
class1	18	eighty cirrhotic patients who had recovered from an episode of spontaneous bacterial peritonitis were included in a multicenter  double blind trial aimed at comparing long term norfloxacin administration  400 mg day  40 patients  vs  
class1	18	placebo  40 patients  in the prevention of spontaneous bacterial peritonitis recurrence  
class1	18	at entry  both groups were similar with respect to clinical and laboratory data  ascitic fluid protein and polymorphonuclear concentrations  number of previous episodes of spontaneous bacterial peritonitis and causative organisms of the index spontaneous bacterial peritonitis  
class1	18	norfloxacin administration produced a selective intestinal decontamination  elimination of aerobic gram negative bacilli from the fecal flora without significant changes in other microorganisms  throughout the study in six patients in whom the effect of norfloxacin on the fecal flora was periodically assessed  
class1	18	fourteen patients from the placebo group  35   and five from the norfloxacin group  12   developed spontaneous bacterial peritonitis recurrence during follow up  chi 2   5 97  p   0 014   mean follow up period   6 4     0 6 mo  range   1 to 19 mo   
class1	18	ten of the 14 spontaneous bacterial peritonitis recurrences in the placebo group and only one of the five spontaneous bacterial peritonitis recurrences in the norfloxacin group were caused by aerobic gram negative bacilli  chi 2   8 87  p   0 0029   
class1	18	the overall probability of spontaneous bacterial peritonitis recurrence at 1 yr of follow up was 20  in the norfloxacin group and 68  in the placebo group  p   0 0063  and the probability of spontaneous bacterial peritonitis recurrence caused by aerobic gram negative bacilli at 1 yr of follow up was 3  and 60   respectively  p   0 0013   
class1	19	review of hepatic imaging and a problem oriented approach to liver masses  
class1	19	we believe that imaging of the liver is complicated  
class1	19	the sporadic appearance of incidental benign lesions and variability in scanning techniques  equipment and artifacts add difficulties to the evaluation of liver masses  
class1	19	therefore we emphasize the need to define the problem for which the patient is being imaged  
class1	19	this information helps in choosing the procedure of choice and the technique needed to give the most expedient  accurate answer  
class1	19	this will also help apply the lowest risk and most cost efficient care  
class1	19	imaging algorithms vary depending on the suspected pathological conditions  
class1	19	dynamic bolus enhanced ct is the modality of choice in most situations  
class1	19	tc99m sulfur colloid liver spleen scans are helpful in patients with suspected fnh  and tc99m tagged rbc spect scans are recommended to confirm cavernous hemangiomas  
class1	19	cysts are easily confirmed by us  
class1	19	although mri is competitive with ct  it has not become a primary modality because of cost  availability  patient selection and variability of scanner capabilities among the many manufacturers and models  
class1	19	it is hard to predict what future development of imaging techniques will bring  
class1	19	many feel that significant advances have plateaued  
class1	19	time and money will more likely be concentrated on improving image resolution  speed of scanning and ability to transfer this information to sites outside of the radiology department  
class1	19	in addition to faster scanning  we expect to soon have available safe intravenous and enteric contrast agents for mri  
class1	19	certainly this will lead to a new round of investigations to compare mri with ct scanning  
class1	20	mechanical cardiopulmonary support for refractory cardiogenic shock  
class1	20	from february 1982 to february 1990  38 patients  30 male patients and 8 female patients  ranging in age from 10 to 78 years  mean 49 4 years  have been supported with arteriovenous extracorporeal membrane oxygenation  ecmo  at st  
class1	20	louis university medical center as a resuscitative system for cardiac arrest or cardiogenic shock  
class1	20	all patients were unresponsive to conventional resuscitative measures including an intraaortic balloon pump in 25 patients  
class1	20	patients were resuscitated in the intensive care unit  cardiac catheterization laboratory  or the emergency department  
class1	20	diagnosis varied from acute myocardial infarctions  12 patients   ischemic disease  15 patients   end stage cardiomyopathy  7 patients   congenital heart disease  3 patients   or postoperative cardiac transplant graft rejection  1 patient   
class1	20	three patients could not be resuscitated with ecmo because of low flow  but the remaining 35  92   achieved hemodynamic stability with ecmo flows greater than 2 l min m2  
class1	20	duration of support ranged from 0 5 to 130 hours  mean 28 hours   
class1	20	twenty four patients were successfully weaned from ecmo support after coronary artery bypass  five patients   cardiac transplantation  two patients   or ventricular assist device insertion  eight patients   or with inotropic support  nine patients   
class1	20	of the 14 patients not weaned  three were inadequately resuscitated  two had percutaneous transluminal coronary angioplasty while receiving ecmo  and nine were not candidates for further intervention  
class1	20	nine  24   patients were discharged and are long term survivors  
class1	20	our results indicate that resuscitative ecmo is useful for intervals of 12 to 24 hours and can best be applied with  1  patients younger than 60 years of age   2  patients having acute events  failed percutaneous transluminal coronary angioplasty  amenable to surgical intervention  and  3  candidates for cardiac transplantation who could be switched to more sophisticated devices within 12 to 24 hours of ecmo insertion  
class1	20	with these criteria  ecmo  when used as a resuscitative system  can result in increased survival in selected patients with refractory cardiogenic shock or cardiac arrest  
class1	21	fungal pseudomeningitis superimposed on escherichia coli meningitis  
class1	21	pseudomeningitis is the demonstration of microorganisms from the cerebrospinal fluid by stain or culture in a patient with symptoms suggesting meningitis  
class1	21	this is a report of fungal pseudomeningitis superimposed on a case of nosocomial escherichia coli meningitis resulting from a neurosurgical procedure  
class1	21	critical care personnel need to be aware of the possibility of pseudomeningitis with or without associated meningitis in the appropriate setting  
class1	22	the hastings bipolar hemiarthroplasty for subcapital fractures of the femoral neck  a 10 year prospective study  
class1	22	in a 10 year prospective study  561 displaced subcapital fractures of the femoral neck in 546 patients were treated with the hastings bipolar hemiarthroplasty  
class1	22	within six months of their operations  148 patients had died  
class1	22	in 322 hips followed up  243 with adequate serial radiographs separated by more than one year  only 14  5 6   showed acetabular erosion  
class1	22	a group of 91 had been reviewed for between three and nine years  mean  4 years 10 months  and of these  95  had no pain or slight pain only  
class1	22	comparison with an earlier series of conventional hemiarthroplasties reported from this institution showed that the clinical results were similar  but that the erosion rate had been halved  
class1	23	external fixation for type iii open tibial fractures  
class1	23	an analysis of 51 type iii open tibial fractures treated by external skeletal fixation is presented  
class1	23	the fractures are subdivided according to the classification of gustilo  mendoza and williams  1984  into types iiia  iiib and iiic  
class1	23	the different prognoses of these fracture subtypes is examined  
class1	23	the use of the hoffmann and hughes external fixators in the management of type iii open tibial fractures is presented and it is suggested that the prognosis is independent of the type of fixator used  
class1	24	neonatal osteomyelitis  
class1	24	thirty four neonates with osteomyelitis were reviewed  
class1	24	the hip  19  was the most common site involved  
class1	24	swelling and pseudoparalysis were the most significant local signs  
class1	24	radiographic abnormalities  such as metaphyseal rarefaction and or joint subluxation were found on the initial radiographs in 18 of the 19 hips involved  
class1	24	all patients were treated with antibiotics and all infections involving joints were drained surgically  
class1	24	good results were achieved in 75  of all sites and in 68  of hips  
class1	25	denatured muscle grafts for nerve repair  an experimental model of nerve damage in leprosy 
class1	25	about 20  of patients with leprosy develop localised granulomatous lesions in peripheral nerves  
class1	25	we report experiments in guinea pigs in which freeze thawed autogenous muscle grafts were used for the treatment of such mycobacterial granulomas  
class1	25	granulomas were induced in guinea pig tibial nerves and the animals were left for 7 to 100 days in order to assess maximal damage  
class1	25	the local area of nerve damage was then excised and the gap filled with denatured muscle grafts  
class1	25	clinical assessment after periods up to 150 days showed good sensory and motor recovery which correlated well with the histological findings  
class1	25	the muscle graft technique may be of value for the treatment of chronic nerve lesions in selected cases of leprosy  
class1	26	the modified schollner costoplasty  
class1	26	the modified schollner costoplasty is a cosmetic procedure for the correction of rib prominence deformity in scoliosis  
class1	26	we present the results of the procedure in 21 patients who had previously undergone spinal fusion for scoliosis  
class1	26	we found the procedure to be well tolerated without major complications  
class1	26	objective cosmetic improvement was achieved in all but one case  
class1	26	all but one patient considered the procedure to have been of cosmetic benefit  
class1	27	selection of antibiotic coverage in vascular patients undergoing cystoscopy  
class1	27	bacteremic seeding of prosthetic vascular grafts represents a cause for graft infection  transurethral procedures account for one source of bacteremia  
class1	27	therefore  a prospective study of 200 patients undergoing cystoscopy was conducted to identify the incidence of bacteruria and factors associated with it  organisms involved and their antibiotic sensitivities  
class1	27	positive cultures were found in 21   
class1	27	the incidence was 64  in in patients and 8  in out patients  
class1	27	positive cultures were found in 12  of patients who received antibiotics and 29  who did not  
class1	27	four percent showed signs of bacteremia  
class1	27	the cultures identified both gram positive and negative organisms  multiple organisms grew in 22   
class1	27	gram negative organisms were more common in in patients  
class1	27	candida grew in 8   
class1	27	the gram positive organisms were sensitive to ampicillin  92    sulfatrimethoprim  75   and cefazolin  60    gram negative to aminoglycosides  100   and cefazolin  92    
class1	27	in view of the unpredictable and multiple organisms  it is recommended that pre cystoscopy cultures be performed and specific antibiotic coverage be based on the sensitivities  
class1	28	possible role of bacterial siderophores in inflammation  iron bound to the pseudomonas siderophore pyochelin can function as a hydroxyl radical catalyst  
class1	28	tissue injury has been linked to neutrophil associated hydroxyl radical   oh  generation  a process that requires an exogenous transition metal catalyst such as iron  
class1	28	in vivo most iron is bound in a noncatalytic form  
class1	28	to obtain iron required for growth  many bacteria secrete iron chelators  siderophores   
class1	28	since pseudomonas aeruginosa infections are associated with considerable tissue destruction  we examined whether iron bound to the pseudomonas siderophores pyochelin  pch  and pyoverdin  pvd  could act as  oh catalysts  
class1	28	purified pch and pvd were iron loaded  fe pch  fe pvd  and added to a hypoxanthine xanthine oxidase superoxide    o2   and hydrogen peroxide  h2o2  generating system  
class1	28	evidence for  oh generation was then sought using two different spin trapping agents  5 5 dimethyl pyrroline 1 oxide or n t butyl alpha phenylnitrone   as well as the deoxyribose oxidation assay  
class1	28	regardless of methodology   oh generation was detected in the presence of fe pch but not fe pvd  
class1	28	inhibition of the process by catalase and or sod suggested  oh formation with fe pch occurred via the haber weiss reaction  
class1	28	similar results were obtained when stimulated neutrophils were used as the source of  o2  and h2o2  
class1	28	addition of fe pch but not fe pvd to stimulated neutrophils yielded  oh as detected by the above assay systems  
class1	28	since pch and pvd bind ferric  fe3   but not ferrous  fe2   iron   oh catalysis with fe pch would likely involve  o2    mediated reduction of fe3  to fe2  with subsequent release of  free  fe2   
class1	28	this was confirmed by measuring formation of the fe2    ferrozine complex after exposure of fe pch  but not fe pvd  to enzymatically generated  o2   
class1	28	these data show that fe pch  but not fe pvd  is capable of catalyzing generation of  oh  
class1	28	such a process could represent as yet another mechanism of tissue injury at sites of infection with p  
class1	28	aeruginosa  
class1	29	antigen specific serum antibody response to chlamydia trachomatis in patients with acute pelvic inflammatory disease  
class1	29	sera from 35 patients with acute pelvic inflammatory disease  pid  with and without chlamydia trachomatis confirmed by culture and sera from 19 control patients with neither evidence of pelvic infection nor c trachomatis infection were studied for the presence of serum igg  iga  and igm antibodies to c trachomatis using enzyme immunoassay  eia  and immunoblotting techniques  
class1	29	there was no correlation between the antibody concentrations in the eia and the spread of chlamydial infection  as determined by cervical  endometrial  and laparoscopic sampling for chlamydia  
class1	29	the immunoblot analysis showed antibodies to the major outer membrane protein  momp  of c trachomatis elementary bodies in all patients who had had c trachomatis isolated  
class1	29	reactivity was also frequently observed against the 68  62  60  45  and 31 kilodalton antigens  
class1	29	about 20 antigenic polypeptides were identified  
class1	29	differences in antibody prevalence to specific chlamydial antigens  however  were not related to the site of chlamydial isolation or serum antibody concentrations observed with the eia  
class1	29	the results indicate that patients with pid with and without upper genital tract infection with c trachomatis cannot be differentiated by reactivity of sera to specific chlamydial polypeptide antigens  
class1	29	the determination of a specific serum iga antibody response by eia was the most effective single test to discriminate between patients with and without acute chlamydial infection  
class1	30	serum pepsinogen i and gastrin concentrations in children positive for helicobacter pylori  
class1	30	serum pepsinogen i  serum gastrin concentration  and inflammatory scores were measured in a population of 71 children undergoing upper gastrointestinal endoscopy for investigation of upper abdominal pain  
class1	30	forty four were initially colonised with helicobacter pylori  
class1	30	the indices were measured before treatment  in 71 children   one month  in 41 children   and six months  in 21 children  after stopping treatment  
class1	30	before treatment there was a significant correlation between serum pepsinogen concentration  total inflammatory score  and h pylori state  but no correlation between serum gastrin concentrations and h pylori state  
class1	30	similarly  the total inflammatory score and serum pepsinogen concentrations were significantly correlated  
class1	30	there was no such correlation in children negative for h pylori  
class1	30	after treatment the inflammatory score improved in those patients in whom h pylori had been eradicated  
class1	30	there was also a significant fall in serum pepsinogen i and serum gastrin concentration in those patients in whom h pylori had been eradicated  
class1	30	these results were similar to those found six months after treatment had been stopped  
class1	30	these findings suggest that the serum pepsinogen i concentration could be considered a useful marker for gastritis and can be used as an index of severity of gastritis in h pylori positive subjects  
class1	30	the measurement of serum gastrin concentrations does not give useful information  
class1	31	effect of sample volume on yield of positive blood cultures from adult patients with haematological malignancy  
class1	31	six hundred and sixteen blood samples from patients with haematological malignancy were each distributed equally among three identical cells in a malthus microbiological growth analyser  
class1	31	the mean  sd  volumes inoculated into sets in which one  two  or three of the three bottles were positive were 37 7  10 1  ml  37 4  12 9  ml  and 37 7  10 5  ml  respectively  
class1	31	overall  clinically important organisms were isolated from one bottle only with 18 cultures  from two bottles only with 19 cultures  and from all three bottles in a set with 104 cultures  
class1	31	if the yield from a single bottle inoculated with a mean volume of 12 6 ml blood is taken as 100   the yield from 25 2 ml in two bottles was 110 7  and the yield from 37 7 ml in three bottles was 115 6   
class1	31	the increased yield from increased volume was considerably lower than that reported from unselected groups of patients  which suggests that the magnitude of bacteriaemia is greater in patients with neutropenia  
class1	31	the isolation of infecting organisms from the blood of patients with neutropenia is  however  particularly important in directing chemotherapy and consequently 45 ml blood samples from these patients continue to be requested  
class1	32	the many faces and phases of borreliosis  i  lyme disease  published erratum appears in j am acad dermatol 1991 apr 24 4  663  
class1	32	lyme disease is increasingly being reported throughout the united states and many parts of the world  
class1	32	borrelia burgdorferi  the etiologic agent of lyme disease  is a spirochete that  not unlike the treponema of syphilis  can cause a spectrum of disease from the initial skin lesion  through widely varied symptoms and signs  to chronic neurologic and arthritic disability  
class1	32	the borrelial spirochete and lyme disease are the subject of this review  
class1	32	a subsequent article will review other definite and possible cutaneous manifestations of borreliosis  
class1	33	skin pigmentation from clofazimine therapy in leprosy patients  a reappraisal  
class1	33	skin biopsy specimens from two lepromatous leprosy patients with dark brown pigmentation who were receiving long term clofazimine therapy were studied  
class1	33	ceroid lipofuscin pigment was demonstrated inside macrophages that contained numerous phagolysosomes  
class1	33	these contained lipids and clofazimine that appeared as electron lucent vacuoles and a lipofuscin pigment that was electron dense  granular  and lamellated  
class1	33	although the presence of the drug in tissues contributed to the skin pigmentation  the main cause was a drug induced  reversible ceroid lipofuscinosis  
class1	34	the many faces and phases of borreliosis ii  
class1	34	borrelia burgdorferi  the etiologic agent of lyme disease  has also been associated with other cutaneous conditions  
class1	34	acrodermatitis chronica atrophicans and lymphadenosis benigna cutis are also caused by b  
class1	34	burgdorferi  
class1	34	recent evidence links some cases of progressive facial hemiatrophy of parry romberg  benign lymphocytic infiltrate of the skin  jessner kanof   lichen sclerosus et atrophicus  morphea  and shulman syndrome with borreliae  
class1	34	this article reviews the manifestations of the diseases definitely linked to borreliosis and the evidence linking borreliae to progressive facial hemiatrophy  benign lymphocytic infiltrate  lichen sclerosus et atrophicus  morphea  and shulman syndrome  
class1	35	cutaneous lesions of disseminated histoplasmosis in human immunodeficiency virus infected patients  
class1	35	disseminated histoplasmosis is being diagnosed more frequently in persons infected with the human immunodeficiency virus and is often the initial manifestation of the acquired immunodeficiency syndrome  aids   
class1	35	disease related cutaneous features of hiv associated disseminated histoplasmosis are defined as mucocutaneous lesions from which fungal organisms were either cultured or demonstrated histopathologically  
class1	35	we report four hiv seropositive patients with disseminated histoplasmosis who had culture positive skin or oral lesions of histoplasmosis and review the specific cutaneous manifestations of hiv associated disseminated histoplasmosis  
class1	35	including our patients  disease related skin and or mucosal lesions were present in 11  of patients  26  of 239  with hiv associated disseminated histoplasmosis  
class1	35	the possibility of disseminated histoplasmosis should be considered in all hiv infected persons and in persons with aids risk factors who have fever  weight loss  hepatosplenomegaly  and new cutaneous lesions  
class1	35	an early skin or mucosal biopsy specimen for crushed tissue preparation  histologic evaluation  and fungal culture is a simple  rapid diagnostic procedure  
class1	36	treatment of fungal skin infections  state of the art  
class1	36	the number of cases of mycotic infections are increasing  presenting physicians today with an unprecedented challenge in handling the treatment and prophylactic control of these disorders  
class1	36	the increase in mycotic disorders is due to many factors  such as longer life span  organ transplantation  and the acquired immunodeficiency syndrome  
class1	36	the pharmaceutical industry is providing physicians with newer  more potent drugs to manage mycoses  
class1	36	an overview of current practice in the use of topical and oral agents  especially ketoconazole  are given in the following specific mycoses  tinea capitis  pityriasis versicolor  seborrheic dermatitis  trichophyton rubrum infections  vaginal candidiasis  and moist intertriginous tineas  
class1	36	the efficacy of ketoconazole in various vehicles and dosage schedules and of traditional agents such as griseofulvin are discussed with relation to each of the mycoses  
class1	37	itraconazole in tinea versicolor  a review  
class1	37	itraconazole  a new orally active triazole antifungal  has been tested in patients with pityriasis versicolor  
class1	37	a number of studies have shown that itraconazole is effective for this mild fungal skin disease  
class1	37	the total dose required for effective treatment is 1000 mg  and it has been given as 200 mg for 5 days or 7 days  
class1	37	the organisms disappear slowly from the skin  even when dead  and the results should be assessed clinically and mycologically at around 3 to 4 weeks after treatment  
class1	37	numerous studies have shown that itraconazole is superior to placebo and as effective as selenium sulfide  clotrimazole  and ciclopirox olamine  
class1	37	it is also better tolerated by patients than selenium sulfide  
class1	38	itraconazole in common dermatophyte infections of the skin  fixed treatment schedules  
class1	38	itraconazole is an effective medication against the most common dermatophytoses  
class1	38	it has been shown to be more active than griseofulvin and ketoconazole  
class1	38	ease of use  affinity for keratinized tissues  lack of toxicity  continued activity after discontinuation  and the possibility of using fixed schedules are advantages of itraconazole  
class1	38	the fixed schedules indicated by pharmacokinetics and clinical studies are one 100 mg capsule daily for 15 days in cases of tinea corporis and tinea cruris and the same dosage for 30 days in cases of tinea pedis and tinea manuum  
class1	38	these fixed treatments have some limitations  and they are not recommended for treating tinea capitis and tinea unguium  
class1	38	the drug is well tolerated  
class1	39	itraconazole in the management of chronic dermatophytosis  
class1	39	fifty five patients with griseofulvin unresponsive dermatophytosis caused by trichophyton rubrum were treated with itraconazole  
class1	39	they had either tinea corporis or  dry type  infections of the palms  soles  or nails  
class1	39	the following sites were affected  trunk  12 infections   soles  47   toe webs  52   palms  26   fingernails  29   and toenails  42   
class1	39	patients were treated with oral itraconazole until clinical and mycologic remission were achieved  
class1	39	response rates and mean times to recovery were as follows  trunk  100   1 5 months  soles  83   6 7 months  toe webs  90   7 2 months  palms  96   4 6 months  fingernails  90   5 4 months  and toenails  76   10 3 months   
class1	39	in a 6 month follow up period 7 of 30 patients with toenail infections who had responded to treatment had a clinical and mycologic relapse  usually of one nail  
class1	39	side effects were minimal but included abdominal discomfort  three patients   headache  one   and weight gain  two   
class1	39	no persistent abnormalities in blood biochemistry were seen  even in patients who received itraconazole for more than 9 months  
class1	40	treatment of oral candidosis with itraconazole  a review  
class1	40	oral candidosis is a common infection in infants  elderly persons  patients receiving immunosuppressive therapy  and patients with acquired immunodeficiency syndrome  aids   
class1	40	the orally active antifungal agent itraconazole has been evaluated in a number of different patient populations with oral and oropharyngeal candidosis  
class1	40	initial studies have shown that itraconazole  100 or 200 mg day for 14 days  is more active than placebo in treating oral candidosis  
class1	40	a comparative study between itraconazole capsules  200 mg once daily  and clotrimazole troches  10 mg five times daily  showed equivalent results at the end of therapy but a significantly faster response to itraconazole and a faster relapse rate with clotrimazole  
class1	40	a study in aids patients with oropharyngeal candidosis demonstrated that itraconazole  200 mg day  and ketoconazole  400 mg day  for 4 weeks give equivalent clinical cure rates and similar relapse rates  
class1	40	a pilot study with an oral solution of itraconazole has given an impressive 100  clinical and mycological response rate within 1 week of treatment  
class1	40	in conclusion  itraconazole in capsule or in solution form may constitute a major addition to the armamentarium of drugs against oropharyngeal candidosis  
class1	41	treatment of vaginal candidiasis  orally or vaginally  
class1	41	vaginal candidiasis continues to be the most common cause of vaginal discharge  
class1	41	a large variety of topical drugs and a selection of orally active antifungals are currently available  
class1	41	the choice between the use of oral drugs or intravaginal agents will depend on the therapeutic results obtained with the different agents  side effects  pregnancy status  and patient preference  
class1	41	the results obtained in the maria hospital  tilburg  the netherlands  and a review of foreign data suggest the following   1  for acute infection oral and topical agents produce equivalent results  
class1	41	 2  for chronic infections oral medication is preferred  
class1	41	 3  oral therapy should not be given to pregnant patients or to patients not using reliable contraceptive measures  
class1	41	 4  half the patients prefer oral medication  only 5  prefer intravaginal therapy  and the others had no clear preference  
class1	42	individualizing treatment of vaginal candidiasis  
class1	42	clinicians have a vast array of effective antimycotics for the treatment of vaginal candidiasis  
class1	42	multiple topical formulations are available  yet there is little evidence to suggest that formulation per se influences outcome  
class1	42	a growing number of highly effective oral systemic antimycotic agents provide the practitioner with additional options  
class1	42	treatment regimens have also changed with the introduction of shorter  often single day single dose courses of therapy  
class1	42	not all therapeutic agents have the same activity against vaginal fungal pathogens in that topical azoles tend to be more active than nystatin  
class1	42	differences in patient characteristics  however  are more important than the differences between antimycotic agents and therapeutic regimens in determining selection of the appropriate antimycotic  
class1	42	patients with vaginal candidiasis vary with regard to duration and severity of symptoms and past frequency of attacks  distribution of inflammation  and pregnancy status  
class1	42	the clinician should consider all these variables both in selecting the appropriate antimycotic agent and the route of administration and in planning the duration of therapy  
class1	42	individualized therapy offers additional benefits to patients  who may then enjoy the maximum advantages of antimycotics now available  
class1	43	itraconazole treatment of phaeohyphomycosis  
class1	43	nineteen patients with phaeohyphomycosis were treated with itraconazole  
class1	43	of these  17 were assessable for clinical outcome  
class1	43	of these  two had received no prior therapy  five had failed amphotericin b therapy  four had failed ketoconazole or miconazole therapy  and five had failed both amphotericin b and azole therapy  
class1	43	one patient had received only prior surgical intervention  
class1	43	fungi of seven different genera caused disease of the skin in nine patients  soft tissue in nine  sinuses in eight  bone in five  joints in two  and lungs in two  
class1	43	itraconazole was given in dosages ranging from 50 to 600 mg day for 1 to 48 months  
class1	43	clinical improvement or remission occurred in nine patients  
class1	43	two patients have had stabilization of disease  
class1	43	six patients failed treatment  one had a relapse after initially successful treatment  
class1	43	itraconazole appears to be highly effective in some patients with phaeohyphomycosis  including patients refractory to other antifungal agents  
class1	44	european experience with itraconazole in systemic mycoses  
class1	44	since january 1985 more than 100 patients with deep fungal infections have been treated with itraconazole  200 to 400 mg day  in northern italy  
class1	44	evaluation of the drug efficacy and tolerance was possible in one patient with sporotrichosis  in 34 with aspergillosis  and in 36 with cryptococcosis  mainly patients positive for human immunodeficiency virus   
class1	44	response to itraconazole alone was obtained in the case of sporotrichosis and in 24 of 34 patients with different forms of aspergillosis  of the 18 patients with invasive pulmonary aspergillosis  15 were cured   
class1	44	patients with cryptococcosis received itraconazole for active infection and or for prevention of relapse  
class1	44	active infection was treated successfully with itraconazole alone in 9 of 12 patients and with itraconazole plus flucytosine in 8 of 10 patients  
class1	44	of the 31 patients who received itraconazole maintenance therapy for up to 27 months  4  13   had relapses  14  45   did not have relapses  and decline of serum antigen was detected in 12 of them  and 13  42   were completely cured  serum antigen titer dropped to zero   
class1	44	with the exception of hypokalemia in one patient  itraconazole was well tolerated even in patients who received the drug for several months or years  
class1	45	itraconazole therapy for nonmeningeal coccidioidomycosis  clinical and laboratory observations  
class1	45	itraconazole  a new oral triazole antifungal agent  was administered in 75 courses to patients with chronic coccidioidomycosis at dosages of 50 to 400 mg day for a median duration of 10 months  
class1	45	assessment of efficacy was made with a standardized scoring system  
class1	45	responses were seen in 42 of 58 assessable courses  72    
class1	45	nonresponse occurred exclusively in patients who had failed previous therapy and was most common in pulmonary disease  
class1	45	toxicity was minimal at the doses studied  
class1	45	pharmacokinetic analysis of itraconazole in serum at steady state showed negligible circadian variation  differences in serum concentrations among patients were large  
class1	45	clinical isolates of coccidioides immitis showed uniform in vitro susceptibility to itraconazole  
class1	45	itraconazole shows impressive activity in this series of patients with refractory coccidioidomycosis  
class1	45	further evaluation of itraconazole in this and in other systemic mycoses is in order  
class1	46	itraconazole in opportunistic mycoses  cryptococcosis and aspergillosis  
class1	46	striking results were obtained with oral itraconazole therapy in two opportunistic mycoses  
class1	46	of 28 patients with cryptococcal meningitis  18 achieved complete responses  including 16 of 24 patients with acquired immunodeficiency syndrome  
class1	46	other manifestations of cryptococcosis were similarly responsive  
class1	46	in aspergillosis 12 of 15 patients responded  including 8 of 10 immunocompromised hosts  
class1	46	these patients included those with invasive pulmonary disease  4 5   skeletal disease  2 2   pleural disease  1 2   and pericardial  sinus  mastoid  hepatosplenic  or nail disease  1 1   
class1	46	these results with itraconazole compare favorably to conventional  parenteral  therapy  and toxicity was minimal  
class1	46	this suggests that comparative trials are now in order  
class1	47	itraconazole therapy in aspergillosis  study in 49 patients  
class1	47	itraconazole  200 to 400 mg once daily  was administered to 49 patients with different types of aspergillosis  pulmonary aspergilloma  14 patients   chronic necrotizing pulmonary aspergillosis  14   and invasive aspergillosis  21   
class1	47	itraconazole was prescribed alone or in combination or after treatment with amphotericin b and flucytosine  
class1	47	of 14 aspergilloma patients  2 were cured and 8 had symptomatic improvement  
class1	47	in chronic necrotizing pulmonary aspergillosis  7 of 14 patients were cured and 6 improved significantly  
class1	47	in invasive aspergillosis treatment failed in 6 patients and 15 were cured  
class1	47	itraconazole can be an alternative to amphotericin b in the treatment of invasive aspergillosis and chronic necrotizing pulmonary aspergillosis  
class1	47	in aspergilloma itraconazole may be useful in inoperable cases  
class1	48	an external urine collection device for incontinent women  evaluation of long term use  
class1	48	urinary incontinence is common in aged women  may precipitate nursing home admission  and may prompt use of a urine collection device  usually an indwelling urethral catheter  
class1	48	the safety and efficacy of a new external urine collection device for women that is affixed to the perineum by an adhesive developed for ostomy bags was evaluated  
class1	48	applied to 26 aged women  78  of 2 264 devices were leak free for 24 hours and 49  for 48 hours  
class1	48	the incidence of new bacteriuria was less than half that found in our earlier studies of long term urethral catheters in the same institution  
class1	48	perineal erythema was infrequent and preexisting decubitus ulcers improved or did not change  
class1	48	four patients were withdrawn  one each because of periurethral itching  diminished urine output  recurrent wetness  and fracture of the proximal femur associated with severe osteoporosis  
class1	48	this device may offer an alternative to urethral catheters for management of urinary incontinence but should not be used on women with urine retention and should be used with care on women with severe osteoporosis  
class1	48	controlled trials must determine effects upon bacteriologic complications and health care costs  
class1	49	possible role of leukotrienes in gastritis associated with campylobacter pylori  
class1	49	this study was done to evaluate the role of leukotrienes  lts  in gastritis associated with campylobacter pylori  
class1	49	biopsy specimens of gastric mucosa were obtained endoscopically from 18 patients with nonulcer dyspepsia for bacteriological and histological examination and extraction of lts  
class1	49	there was correlation between the ltb4 level in the mucosa and the degree of gastritis evaluated histologically  
class1	49	the level was higher when infiltration of neutrophils in the gastric mucosa was more extensive  
class1	49	the ltb4 level in mucosa infected with c  
class1	49	pylori was higher than that in noninfected mucosa  
class1	49	these findings suggest that endogenous lts may be related to the pathogenesis of gastritis associated with c  
class1	49	pylori  
class1	50	evidence for gastric mucosal cell invasion by c  pylori  an ultrastructural study  
class1	50	it is now generally accepted that campylobacter pylori is closely associated with peptic ulcer disease and chronic type b gastritis  
class1	50	whether c  
class1	50	pylori is the direct etiologic cause of either or both of these illnesses remains unclear  
class1	50	possible pathophysiologic effects of c  
class1	50	pylori are still a matter of debate and conjecture  
class1	50	utilizing a small group of patients with gastric ulcers and chronic gastritis  we examined the ultrastructural relationship between c  
class1	50	pylori and gastric cells  
class1	50	forty eight percent of our gastric ulcer patients and 57  of our chronic gastritis patients had c  
class1	50	pylori in their lower corpus mucosa  
class1	50	examination with the transmission electron microscope indicated a very close proximation by c  
class1	50	pylori to the surface epithelial cells strongly suggesting adherence  
class1	50	we also describe for the first time the invasion of gastric cells by c  
class1	50	pylori  
class1	50	although an uncommon occurrence  we had repeated observations of c  
class1	50	pylori invading surface epithelial cells  parietal cells  and chief cells  
class1	50	most of the intracellular c  
class1	50	pylori were intact but other forms appearing to be degenerating organisms were also seen  
class1	50	we suggest that cell invasion may be one mechanism by which c  
class1	50	pylori causes pathologic changes in the gastric mucosa  
class1	50	these observations may also explain why c  
class1	50	pylori chronically infects gastric cells and frequently recurs after treatment  
class1	51	a case of unexpected pasteurella multocida bacteremia  
class1	51	a case of pasteurella multocida bacteremia in a previously healthy hospital employee is presented  
class1	51	the patient had sustained a scratch from his dog four days prior to being seen in the emergency department with adequate healing and no evidence of localized infection  
class1	51	he presented with an acute febrile illness  and was discharged from the emergency department with a diagnosis of viral syndrome  
class1	51	he was asked to return to the hospital the next day when a bacteriology report of gram negative rods in both aerobic and anaerobic blood culture bottles was received in the emergency department  
class1	51	pasteurella multocida bacteremia septicemia is seen most frequently in immunocompromised patients but the diagnosis should be considered in any patient with a febrile illness and exposure to cats or dogs  
class1	52	assessing the risk of occupational acquisition of the human immunodeficiency virus  implications for hospital policy  
class1	52	in determining infection control policy  it is essential to quantitatively assess the risk of transmission of human immunodeficiency virus  hiv  to health care workers and their families  
class1	52	the risk should be placed in perspective by comparing it with other occupational hazards  
class1	52	the risk of seroconversion from a needlestick injury can be calculated from the probability of a needlestick occurrence  the probability that the source patient is infected  and the probability of seroconversion  given an exposure  
class1	52	the risk of seroconversion due to drawing 1000 blood specimens from seropositive patients is between 86 and 470 in 100 000  
class1	52	the risk to surgeons from performing 25 operations on infected patients is approximately 272 in 100 000  
class1	52	the risk of fatal injury in the course of one year s work on a louisiana oil rig is between 188 and 283 per 100 000  
class1	53	duplex doppler examination of a perinephric abscess in a renal transplant  
class1	53	perinephric abscess has no characteristic ultrasonic appearance or location  
class1	53	differentiation from urinoma  lymphocele  or hematoma depends on clinical and laboratory findings  
class1	53	therapy consists of percutaneous catheter drainage  surgical drainage  and antibiotic therapy  
class1	53	acute rejection is the most common cause of decreased diastolic flow during the immediate postoperative period  
class1	53	acute tubular necrosis does not usually alter blood flow unless it is severe  
class1	53	duplex doppler ultrasonic assessment of the renal transplant during the immediate postoperative period may provide a valuable baseline for comparison if complications develop  
class1	53	baseline and follow up ultrasonography to evaluate diastolic flow can help determine whether a posttransplant patient should receive emergency or conservative therapy for complications  
class1	54	broad spectrum penicillin as an adequate therapy for acute cholangitis  
class1	54	in a previous study of patients with acute cholecystitis  we demonstrated equal efficacy with a broad spectrum penicillin  piperacillin  and a penicillin plus amino glycoside combination  
class1	54	whether a single agent broad spectrum penicillin is adequate treatment for more severe infections  such as acute cholangitis  however  is still unclear  
class1	54	we  therefore  conducted a three center  prospective  randomized trial to determine whether or not a broad spectrum penicillin alone is adequate therapy for patients with acute cholangitis  
class1	54	during a 36 month period  96 patients with sepsis and biliary obstruction were randomly assigned to receive either piperacillin  n   49  or ampicillin plus tobramycin  n   47   
class1	54	the two groups receiving antibiotics were similar with respect to all clinical and laboratory parameters  
class1	54	the incidence of blood cultures with positive results  20 versus 21 per cent  and underlying malignant lesions  51 versus 62 per cent  was also similar between the two groups  
class1	54	the percentage of patients with a clinical cure or significant improvement was the same in the two groups  69 versus 70 per cent   
class1	54	however  there was a significant difference in the cure rate between patients with benign and malignant biliary obstructions  83 versus 59 per cent  p less than 0 01   
class1	54	no significant differences were noted between the two antibiotic groups with respect to drug toxicity  but patients with malignant conditions were more prone to antibiotic related toxicities  2 versus 19 per cent  p less than 0 05   
class1	54	these data suggest that outcome of treatment in patients with acute cholangitis is similar with either a broad spectrum penicillin or a penicillin plus aminoglycoside combination and is dependent upon the nature of the biliary obstruction  
class1	55	ascending cholangitis  surgery versus endoscopic or percutaneous drainage  
class1	55	a retrospective review of 61 patients with calculous cholangitis was carried out  
class1	55	there were 31 men and 30 women and their mean age was 75 8 years  
class1	55	all patients had abdominal pain  87  had chills and fever  65  had clinical jaundice  23  were in shock  and 54  had positive blood cultures  
class1	55	because intravenous hydration and antibiotics did not help  33 patients underwent surgery  25 patients underwent endoscopic papillotomy  ep   and three patients underwent percutaneous transhepatic drainage of the common bile duct  ptd   
class1	55	morbidity in the surgery group included two wound infections  one respiratory failure  and one renal failure  
class1	55	morbidity in the ep ptd group was one case of arterial bleeding requiring surgery and one of pancreatitis treated conservatively  
class1	55	two patients  6   died in the surgery group  one of sepsis and the other of cardiorespiratory arrest  
class1	55	in the ep ptd group nine patients  32   died of sepsis and multisystem organ failure  
class1	55	these patients were considered too ill to undergo surgery and thus repeat ep ptd was carried out  
class1	55	cholangitis persisted  and retained common bile duct stones with sepsis was the cause of death  
class1	55	thus when initial ep or ptd is unsuccessful  surgical exploration of the common bile duct should be carried out to control sepsis  
class1	56	the hyperimmunoglobulinaemia e and recurrent infections syndrome in an adult  published erratum appears in thorax 1990 dec 45 12  984  
class1	56	a 27 year old white woman with a history of chronic eczema and episodes of serious infection of the chest  skin  and bone presented with acute respiratory failure  
class1	56	she was found to have a spontaneous right pneumothorax and a pneumatocele in the left upper lobe  
class1	56	despite a left upper lobectomy she was left with chronic respiratory failure  bullous lung disease  and bilateral bronchiectasis  
class1	56	the hyperimmunoglobulinaemia e and recurrent infections syndrome was diagnosed only in adult life  
class1	57	pulmonary disease following intravesical bcg treatment  
class1	57	bacillus calmette guerin  bcg  is an attenuated strain of mycobacterium bovis that has been used in the treatment of malignant disease for over 20 years and for the treatment of bladder cancer since 1976  
class1	57	major complications of this treatment are infrequent  
class1	57	we report two cases of systemic illness with pulmonary manifestations after treatment with intravesical bcg  
class1	58	renal abscess in children  
class1	58	three cases of renal abscesses in children are described to illustrate the variable presenting features  
class1	58	an additional 23 pediatric cases  reported over the past ten years  were reviewed for clinical features and therapy  
class1	58	fever  loin pain  and leukocytosis were common presenting features  but less than half of all abscesses were associated with either an abnormal urinalysis or a positive urine culture  
class1	58	the presenting features were sometimes confused with appendicitis  peritonitis  or a wilms tumor  
class1	58	an organism was identified in 17 cases  escherichia coli in 9 children and staphylococcus aureus in 8 children  
class1	58	the majority of e  
class1	58	coli infections occurred in girls and the majority of s  
class1	58	aureus infections occurred in boys  
class1	58	reflux was documented in 5 patients  and 2 children had a possible extrarenal source of infection  
class1	58	antibiotics alone produced a cure in 10 children  38    but 16 children  62   required a surgical procedure  
class1	59	pleuropulmonary manifestations of hepatic amebiasis 
class1	59	pleuropulmonary manifestations of hepatic amebiasis occurred in 30 patients  18  60   presented with at least 1 pulmonary complaint and 10  33   had multiple pulmonary symptoms  
class1	59	in 14 patients  47    abnormalities were found on examination of the chest  
class1	59	in 16 chest roentgenograms  53    there was at least 1 abnormality  right sided pleural effusion  9 patients  and elevated right hemidiaphragm  8 patients  were the most common  
class1	59	all patients were treated with metronidazole  flagyl  and had resolution of the amebic liver abscess and pulmonary disease  
class1	59	pleuropulmonary disease is a common complication of amebic liver abscess  
class1	59	the clinical presentation and chest roentgenograms are virtually diagnostic and obviate the need for invasive procedures to confirm the diagnosis  
class1	59	pleuropulmonary disease resolves with amebicidal treatment of the hepatic abscess  
class1	60	disc space infection  a case report with mri diagnosis  
class1	60	vertebral disc space infection is an uncommon cause of back pain  
class1	60	physical findings may be unimpressive and laboratory evaluation may only disclose an elevated erythrocyte sedimentation rate  
class1	60	magnetic resonance imaging is particularly useful  since it reveals abnormalities earlier than plain radiographs and is more precise than bone scan  
class1	61	clostridium difficile invasion and toxin circulation in fatal pediatric pseudomembranous colitis  
class1	61	the direct involvement of clostridium difficile in the lesional tissue of pseudomembranous colitis has not been demonstrated  the organism s effects have been assumed to be strictly toxin mediated  
class1	61	because c  
class1	61	difficile cytotoxin may be found incidentally in the intestinal lumina of asymptomatic infants  the role of the organism in a variety of pediatric intestinal diseases is uncertain  
class1	61	the authors studied seven cases of fatal pediatric pseudomembranous colitis in which the presence of c  
class1	61	difficile was uniformly demonstrable in lesional tissues with the use of both an intestinal spore stain and a specific immunostain  
class1	61	the patients had either underlying hirschsprung s disease or hematologic malignancy  the striking pathologic features peculiar to these patients were altered mucosal mucin and immunologic barriers in the former group and neutropenia in the latter  
class1	61	two patients had demonstrable circulating cytotoxin in serum or ascitic fluid  and c  
class1	61	difficile was identified invading colonic mucosa or submucosa  
class1	61	such phenomena did not occur in control pediatric patients with multiple other intestinal lesions  
class1	61	altered host factors may be responsible for the intestinal invasion of c  
class1	61	difficile and its systemic toxin circulation in cases of fatal pediatric pseudomembranous colitis  
class1	62	cerebrospinal fluid changes after 48 hours of effective therapy for hemophilus influenzae type b meningitis  
class1	62	interval cerebrospinal fluid  csf  analysis is often performed to assess efficacy of treatment for bacterial meningitis  
class1	62	the authors reviewed 101 cases of pediatric bacterial meningitis resulting from hemophilus influenzae type b in which analysis of csf occurred on admission and between 48 and 72 hours after initiation of parenteral antibiotic therapy  of these  only one patient had a positive repeat csf culture  
class1	62	of the 100 cases with sterile csf on repeat culture  there was no instance of recrudescence of infection during hospitalization  
class1	62	the following characterized the interval changes in csf profile of this group  100  100   with persistence of pleocytosis  14  14   with differential cell count conversion from polymorphonuclear neutrophil leukocyte  pmn  predominance to relative lymphocytosis  96 of 98  98   with initial positive gram stained smear with negative results for organisms  53 of 75  71   with normalization of initial hypoglycorrhachia  and 10 of 94  11   with normalization of initial abnormally elevated protein levels  
class1	62	the differences in mean values of csf total white blood cell counts  percentage pmns  and glucose and protein concentrations on presentation and between 48 72 hours of therapy were highly significant  p less than 0 0001   
class1	62	after 48 hours of effective antibiotic therapy for h  
class1	62	influenzae type b meningitis  csf pleocytosis and abnormally elevated protein concentration are usually preserved  whereas hypoglycorrhachia usually resolves  it is not uncommon for the differential cell count to convert from a pmn predominance to a relative lymphocytosis  
class1	62	significant alteration in all csf parameters associated with h  
class1	62	influenzae type b meningitis can occur after 48 hours of effective parenteral antibiotic therapy  
class1	63	percutaneous transhepatic cholecystostomy for acute complicated cholecystitis in elderly patients  
class1	63	we report our experience with percutaneous transhepatic cholecystostomy in 10 elderly patients with acute cholecystitis  complicated by empyema formation  
class1	63	most of these patients has severe underlying disease  rendering them at high risk for surgical intervention  
class1	63	in all patients  the percutaneous procedure was followed by a rapid regression of clinical symptoms and of radiologic abnormalities  
class1	63	six were considered inoperable  
class1	63	three of these remain free of biliary symptoms  respectively 22  10  and 7 months after percutaneous cholecystostomy  
class1	63	three others died of nonbiliary disease 1 4 months after cholecystostomy  
class1	63	three patients underwent successful elective cholecystostomy 1 5 wk after percutaneous cholecystostomy  
class1	63	in one patient  cholecystectomy had to be performed because of recurrence of hydrops  1 wk after catheter removal  
class1	63	in our opinion  percutaneous transhepatic cholecystostomy is a safe and effective procedure in the treatment of elderly patients with acute complicated cholecystitis  
class1	63	it can be followed by elective cholecystectomy in good surgical candidates  or by an expectant conservative management in high surgical risk patients  
class1	64	hyperplastic gastric polyps associated with persistent helicobacter pylori infection and active gastritis  
class1	64	we report two cases of patients with 3 yr histories of upper gastrointestinal symptoms  hyperplastic gastric polyps  and active chronic gastritis  
class1	64	biopsies retrospectively stained with giemsa revealed the persistent presence of helicobacter pylori  hp  in gastric biopsies of both patients throughout the 3 yr  
class1	64	after treatment with amoxicillin and bismuth subsalicylate  both became asymptomatic  one demonstrating disappearance and recurrence of the gastric polyps in conjunction with the hp  
class1	64	these cases demonstrate 3 yr of hyperplastic gastric polyps associated with hp and active gastritis  
class1	65	disseminated  nonmeningeal gastrointestinal cryptococcal infection in an hiv negative patient  
class1	65	gastrointestinal cryptococcosis is extremely rare  especially in patients with no involvement of the central nervous system  
class1	65	we describe a 63 yr old man undergoing prednisone therapy for chronic hepatitis and cirrhosis who presented with peritonitis  colitis  and skin lesions  
class1	65	pathological studies revealed necrosis and numerous cryptococcal organisms in the colon  omentum  and skin  and cultures yielded cryptococcus neoformans  
class1	65	the patient died of multisystem organ failure following emergency exploratory surgery performed when he had onset of symptoms of a bowel perforation after an endoscopic biopsy  
class1	65	clinicians should be aware that gastrointestinal cryptococcosis can occur in the absence of infection of the central nervous system or lungs  and that it may affect relatively healthy patients who are immunocompromised because of splenectomy  chronic liver disease  or steroid therapy  
class1	66	streptococcus mitis sepsis in bone marrow transplant patients receiving oral antimicrobial prophylaxis  
class1	66	purpose  streptococcal infection has increasingly become a problem in neutropenic patients  
class1	66	we report on an outbreak of streptococcus mitis sepsis in six bone marrow transplant patients receiving oral antimicrobial prophylaxis  
class1	66	patients and methods  we performed an epidemiologic study of all patients in our bone marrow transplant program from 1986 to 1988  
class1	66	the hospital and microbiology records for all patients were reviewed  
class1	66	all bone marrow patients were treated according to specified protocols  including an oral prophylactic antimicrobial regimen that was changed in late 1987 from vancomycin polymyxin tobramycin to norfloxacin  
class1	66	identification  susceptibility testing  and whole cell protein analysis of streptococcal isolates were performed at the reference and antimicrobial investigations laboratories at the centers for disease control  
class1	66	results  we detected six cases of s  
class1	66	mitis sepsis among 21 patients undergoing bone marrow transplantation  
class1	66	no other concurrent pathogen was isolated from any patient at the time of the s  
class1	66	mitis bacteremia  
class1	66	bacteremia developed within 72 hours of transplant in five of six patients and was associated with severe mucositis in four patients  
class1	66	an environmental study failed to reveal any common source for the outbreak  and whole cell protein analysis of all six s  
class1	66	mitis isolates revealed each to be distinct  
class1	66	of 12 patients receiving oral vancomycin polymyxin tobramycin  one developed s  
class1	66	mitis bacteremia  versus five of nine patients receiving norfloxacin  p less than 0 03   
class1	66	conclusion  we believe s  
class1	66	mitis bacteremia is a potential complication of bone marrow transplantation and is associated with antimicrobial prophylaxis with norfloxacin  especially in the setting of mucositis  
class1	67	pleuritis as a manifestation of reactivation tuberculosis  
class1	67	purpose  the purpose of this study was to determine the frequency with which tuberculous pleuritis is a manifestation of reactivation tuberculosis and to compare the clinical manifestations of reactivation tuberculous pleuritis with  classic  tuberculous pleuritis  in which chest roentgenograms reveal no parenchymal infiltrates  
class1	67	patients and methods  we evaluated the medical records of 59 patients in whom tuberculous pleuritis was confirmed by histologic findings or mycobacterial culture  
class1	67	twenty seven patients  46   had typical chest roentgenographic findings of reactivation tuberculosis  whereas 32  54   had classic tuberculous pleuritis  
class1	67	the clinical and laboratory features of these two groups were compared  
class1	67	results  symptoms were more prolonged and pleural fluid glucose and lactate dehydrogenase concentrations were more markedly abnormal in patients with reactivation pleuritis than in those with classic pleuritis  suggesting a more chronic inflammatory process in the former group  
class1	67	compared with patients with classic tuberculous pleuritis  those with reactivation pleuritis had a lower frequency of reactive tuberculin skin tests  61  versus 88   and granulomatous pleural inflammation  25  versus 72    but a higher bacillary burden  manifest by a higher frequency of positive sputum smears for acid fast bacilli  50  versus 0   and positive mycobacterial cultures from sputum  60  versus 23   and pleural fluid  91  versus 66    
class1	67	conclusions  in contrast to previous reports  tuberculous pleuritis was a manifestation of reactivation tuberculosis in 46   27 of 59  of patients  
class1	67	tuberculous pleuritis is a more chronic process in patients with reactivation disease than in those with classic pleuritis  
class1	67	the lower frequency of reactive tuberculin skin tests and granuloma formation  combined with the higher bacillary burden in patients with reactivation pleuritis  suggest that these patients mount a less effective immune response to mycobacterium tuberculosis infection than do patients with the classic form of tuberculous pleuritis  
class1	68	association of helicobacter pylori infection with dyspeptic symptoms in patients undergoing gastroduodenoscopy  
class1	68	purpose  to determine the prevalence of helicobacter pylori in patients with non ulcer dyspepsia and ulcer disease as well as in a control population undergoing endoscopic retrograde cholangiopancreatography  ercp  for suspected pancreatic or biliary disease  
class1	68	patients and methods  forty six eligible patients undergoing upper endoscopy at massachusetts general hospital were studied over a period of 18 months  as well as 24 patients undergoing ercp for presumed pancreatic or biliary disease  
class1	68	two biopsy specimens from the fundus and two from the antrum were taken for microbiologic and histopathologic analysis  
class1	68	sera were examined by enzyme linked immunoabsorbent assay  
class1	68	all specimens were processed in a blind fashion  
class1	68	chi square test with yates  correction was used for statistical analysis  
class1	68	results  h  
class1	68	pylori was found in 31 of 46  67   study patients and in six of 24  25   control patients  by microbiologic or histologic techniques   p less than 0 01   
class1	68	h  
class1	68	pylori was found in all patients with peptic ulcer disease and in 60  of patients without ulcers  
class1	68	no association between h  
class1	68	pylori and any specific gastrointestinal symptom was observed  
class1	68	h  
class1	68	pylori was identified in the fundus as often as in the antrum  although in the antrum the organism was more often associated with histologic gastritis  
class1	68	compared with histology  serologic assays for igg and iga antibodies to h  
class1	68	pylori had sensitivities of 100  and 94   and specificities of 86  and 76   respectively  
class1	68	reexamination of selected specimens without knowledge of their identity revealed that the specificity of serology exceeded 94  while the sensitivity of histologic and microbiologic studies may have been closer to 80   
class1	68	conclusions  h  
class1	68	pylori was more common in dyspeptic patients than in our control subjects undergoing ercp  
class1	68	multiple biopsy sites from fundus and antrum are required to exclude infection  
class1	68	serologies of igg and iga were sensitive and specific for h  
class1	68	pylori  suggesting a possible role for non endoscopic diagnosis of this infection  
class1	68	the frequent association of h  
class1	68	pylori with active inflammation rather than with quiescent gastritis is consistent with a pathologic role of this organism  
class1	69	evidence of subclinical blastomycosis in forestry workers in northern minnesota and northern wisconsin  
class1	69	purpose  to investigate the incidence of remote subclinical blastomycosis in a high risk population of forestry workers  
class1	69	patients and methods  the study consisted of 39 male forestry workers from northern minnesota and northern wisconsin  areas endemic for blastomycosis but not for histoplasmosis  
class1	69	all subjects were histoplasmin skin test negative  and none had ever been diagnosed with blastomycosis or pneumonia  
class1	69	an antigen specific lymphocyte stimulation assay was performed to determine the presence of blastomycosis  
class1	69	results  peripheral blood lymphocytes from 12 of 39 subjects demonstrated specific antigen induced proliferation when stimulated with a purified alkali  and water soluble antigen derived from the cell wall of blastomyces dermatitidis  
class1	69	conclusion  the finding that 30  of these men had evidence of previous blastomycosis suggests that subclinical cases do occur sporadically  and are probably more common than diagnosed symptomatic cases  
class1	69	this is similar to histoplasmosis  in which the majority of infections are subclinical  
class1	69	however  the reservoir of persons with previous undiagnosed blastomycosis is probably small compared to the huge number of persons  perhaps 30 million  with prior histoplasmosis  
class1	70	sexually transmitted diseases and human immunodeficiency virus infection among women with pelvic inflammatory disease  
class1	70	both human immunodeficiency virus infections and pelvic inflammatory diseases are sexually acquired illnesses of great consequence to women  
class1	70	this study was undertaken to determine if women hospitalized with pelvic inflammatory disease  in a community endemic for human immunodeficiency virus  were at high risk to be infected with human immunodeficiency virus and if human immunodeficiency virus infections altered their hospital course  
class1	70	one hundred ten women hospitalized with pelvic inflammatory disease in brooklyn  in a hospital in which 2  of parturients are human immunodeficiency virus seropositive  agreed to human immunodeficiency virus testing  15  13 6   were found to be seropositive  
class1	70	seropositive women were significantly more likely to have an admission white blood cell count less than 10 000 mm3  p   0 001   
class1	70	human immunodeficiency virus seropositivity was not associated with a higher frequency of other sexually transmitted diseases although there was a trend toward more cases of syphilis among human immunodeficiency virus infected women  
class1	70	similarly  although there was no significant difference in rates of operative intervention  26 6  among seropositive and 8 4  among seronegative  p   0 058   there was a trend toward more surgery among those who were human immunodeficiency virus infected  
class1	70	women hospitalized with pelvic inflammatory disease  in a community endemic for human immunodeficiency virus  are at high risk for human immunodeficiency virus infection  
class1	70	more research is needed to verify a trend toward more refractory infections among human immunodeficiency virus infected women  
class1	71	postpartum osteomyelitis caused by group b streptococcus  
class1	71	postpartum infections caused by group b streptococci are generally limited in scope  
class1	71	we report a case of vaginal colonization with group b streptococcus that progressed in the postpartum period to osteomyelitis that necessitated total hip replacement  
class1	71	the patient had no risk factors predisposing to streptococcal osteomyelitis  
class1	71	an altered immune status in pregnancy and intrapartum bacteremia may be involved in the pathogenesis of this infection  
class1	72	high infectious morbidity in pregnant women with insulin dependent diabetes  an understated complication  
class1	72	patients with insulin dependent diabetes are prone to infection  possibly related to poor metabolic control  
class1	72	relative immune deficiency exists in pregnancy  
class1	72	we hypothesized that pregnant patients with insulin dependent diabetes are at an increased risk for infection and that infection is related to poor glycemic control  
class1	72	we matched 65 pregnant women with insulin dependent diabetes to 65 nondiabetic pregnant controls  
class1	72	at least one episode of infection before delivery occurred in 83  of the women with insulin dependent diabetes  26  in control group   
class1	72	the rate of postpartum infection was five times higher in the group with insulin dependent diabetes and they were susceptible to more kinds of infections  
class1	72	although there was no overall difference among the indices of glycemic control  hemoglobin a1 obtained before the infection was higher than during infection  
class1	72	we conclude that a high rate of infection exists in pregnant women with diabetes  infection and poor glycemic control may be associated  but it is unclear whether improvement in metabolic control will reduce this high infection rate  
class1	73	intraamniotic infection in the very early phase of the second trimester  
class1	73	a total of 157 consecutive patients were studied in an effort to examine prospectively the incidence of asymptomatic intraamniotic infection in the early phase of the second trimester  
class1	73	all patients were referred for amniotic fluid karyotyping  
class1	73	in addition  the amniotic fluids were examined for gram stain and were directly cultured on blood agar and macconkey agar as well as in thioglycollate broth  
class1	73	we found positive amniotic fluid cultures in eight cases  5 09    however  results of gram stain examinations were negative in all amniotic fluid samples  
class1	73	the data indicate that there is no correlation between white blood cells in the amniotic fluid and positive amniotic fluid culture results  
class1	73	only one pregnancy with positive amniotic fluid culture resulted in a septic abortion  
class1	73	therefore we can suggest that intraamniotic infection can exist early in pregnancy  even with intact membranes  and in most cases without any clinical symptoms  
class1	74	oral contraceptives and myocardial infarction  
class1	74	the risk of myocardial infarction in contraceptive users is limited to women over 35 years of age who smoke  
class1	74	the cause of myocardial infarction in oral contraceptive users is thrombotic and not atherosclerotic  
class1	74	minor lipid changes have no clinical relevance to myocardial infarction in contraceptive pill users and do not appear to increase coronary plaques  
class1	75	lyme borreliosis in the severe combined immunodeficiency  scid  mouse manifests predominantly in the joints  heart  and liver  
class1	75	the authors describe the histopathologic evolution of lyme disease in severe combined immunodeficiency  scid  and normal c b 17 and c57bl 6 mice inoculated with borrelia burgdorferi  
class1	75	starting on day 7 after inoculation  all scid mice infected subcutaneously in the tail with a low passage european tick isolate of b  
class1	75	burgdorferi had clinical evidence of arthritis characterized by reddening and swelling of tibiotarsal joints  
class1	75	later on  other joints  ie  metatarsal and ulnacarpal joints were also affected  
class1	75	the infection of scid mice resulted in a persistent spirochetemia and the development of a multisystem disease with chronic progressive inflammation of joints  heart  and liver  
class1	75	major histopathologic alterations included 1  severe joint lesions  characterized by the presence of hyperplastic inflamed synovial lining cells associated with the erosion and destruction of cartilage and or bone  2  pancarditis with infiltrations of mononuclear cells in the endocardium  myocardium  and pericardium  and 3  hepatitis with mononuclear cell infiltrations confined to the portal field and central vein  granulomatous reactions  and eventually the development of liver fibrosis  
class1	75	in addition  smaller more confined lesions were found in kidneys  lung  brain  and striated muscle  
class1	75	the inflammatory infiltrates in the various organs were associated mostly with mac 1  cells  largely monocytes and macrophages  as well as some polymorphonuclear leukocytes  but not b and t lymphocytes  
class1	75	infective spirochetes could be readily isolated from blood and joints and were found at the site of inoculum and the myocardium  
class1	75	in contrast  subcutaneous inoculation of normal c b 17 or c57bl 6 mice with spirochetes in general did not result in clinical signs of arthritis  
class1	75	only 10  to 20  of the c57bl 6 mice  but none of the c b 17 mice  showed clinical evidence of oligoarthritis  which appeared not before day 36 after inoculation  
class1	75	in general  the infection of normal mice resulted in minimal lesions in various organs  and no spirochetes could be visualized or reisolated from their tissues  
class1	75	the data demonstrate that lyme borreliosis may develop in mice in the absence of detectable specific b and t cells and thus suggest an immunologic control of the disease in this species  
class1	75	the scid mouse model therefore can be used to define the components of the immune system responsible for the suppression and or the progression of the disease  
class1	76	hemofiltration reverses left ventricular dysfunction during sepsis in dogs  
class1	76	depressed left ventricular  lv  contractility in sepsis has been ascribed to the presence of circulating cardiodepressant substance  filterable cardiodepressant factor in sepsis  fcs    however  this finding is controversial  
class1	76	the authors hypothesized that if a decrease in lv contractility indeed occurred due to a circulating depressant substance  then removal of this substance by hemofiltration would reverse by dysfunction  
class1	76	in this study  lv mechanics were examined before and after hemofiltration in anesthetized dogs during continuous intravenous infusion of live escherichia coli  
class1	76	left ventricular anterior posterior and apex base dimensions were measured by subendocardial ultrasonic crystal transducers implanted 4 weeks before the experiments  
class1	76	left ventricular contractility was determined from the end systolic pressure dimension relationship  
class1	76	the slope of this relationship  emax  is an index of contractility  
class1	76	after 4 h of sepsis  emax was reduced by one half  
class1	76	hemofiltration resulted in a return of emax to control values  
class1	76	the fcs activity in the plasma was also assessed by the percent reduction in isometric contraction of electrically stimulated  isolated right ventricular trabeculae obtained from nonseptic dogs  
class1	76	the fcs activity reached a peak 4 h after sepsis and was reduced after 2 h of hemofiltration  
class1	76	the results show that during experimental sepsis  a circulating substance of less than 30 000 d produces a decrease in lv contractility and that this lv dysfunction may be improved by hemofiltration  
class1	77	epidemiology of infection by nontuberculous mycobacteria ix  evidence for two dna homology groups among small plasmids in mycobacterium avium  mycobacterium intracellulare  and mycobacterium scrofulaceum  
class1	77	a 12 9 kb plasmid  pvt2  from a clinical mycobacterium avium isolate  md1  was cloned and radiolabeled for use as a dna probe to examine the relatedness of plasmids in m  
class1	77	avium complex  
class1	77	that probe hybridized with plasmids isolated from m  
class1	77	avium complex strains from the environment  7 of 16  and from non acquired immunodeficiency syndrome  aids   10 of 17  and aids  5 of 6  clinical isolates  
class1	77	the similarity of plasmids from the environment with those from patients supports the hypothesis that the environment is a source of human m  
class1	77	avium complex infection  
class1	77	more striking was the observation that pvt2 hybridized with every plasmid  13 of 13 clinical and 5 of 5 environmental isolates  of 13 5 kb or smaller  
class1	77	a second probe  consisting of a 15 3 kb plasmid  plr7  from another clinical isolate of the m  
class1	77	avium complex  hybridized with plasmids of 15 3 to 25 kb from environmental and clinical  aids and non aids  isolates  
class1	77	there was no hybridization between pvt2 and plr7  
class1	77	thus  these two probes define two different groups of small mycobacterial plasmids  
class1	78	manual ventilation bags as a source for bacterial colonization of intubated patients  
class1	78	a group of 14 intensive care unit  icu  patients were studied to determine if manual ventilation bags  mvb  could serve as a source of bacterial or fungal pathogens that could colonize the respiratory tract of intubated patients  
class1	78	a total of 51 cultures were simultaneously obtained of patient s sputum  the exterior mvb surface  mvb port  and mvb interior  postexhalation valve   
class1	78	pathogens colonizing or infecting the respiratory tract of intubated icu patients were frequently simultaneously present on the exterior surface of the mvb and inside the mvb port used to connect the mvb with the endotracheal tube  
class1	78	in addition  coagulase negative staphylococci and yeast were frequently present on the exterior surface of the mvb  
class1	78	the interior of the mvb was usually sterile  
class1	78	in three instances pathogens were isolated from the mvb before isolation from the patient s sputum  
class1	78	mvb may serve as a source for colonizing the respiratory tract of intubated icu patients and or the hands of medical personnel  
class1	78	the exterior surface and port of mvb should be cleaned of visible debris and disinfected at least once a day  
class1	79	toxic shock syndrome after inguinal hernia repair  report of a case with patient survival  
class1	79	a 40 year old man developed fulminant multisystem failure several days after elective repair of an inguinal hernia  
class1	79	toxic shock syndrome  tss  was diagnosed  
class1	79	there was  however  no evidence of wound infection at the time of multisystem failure  
class1	79	only later in his hospital course did the wound drain  
class1	79	staphylococcus aureus was cultured from the wound and was the presumed etiologic agent in the patient s life threatening illness  
class1	79	the patient recovered fully with supportive care  antibiotics  and surgical debridement of the inguinal hernia site  
class1	79	this case is discussed in the context of existing literature on the toxic shock syndrome  
class1	79	the site of infection is typically nonsuppurative  but the systemic manifestations are typically life threatening  
class1	79	the responsible organism is commonly believed to be a strain of s  
class1	79	aureus that expresses a toxin  tss toxin 1  that effects multisystem failure  but which also diminishes the local inflammatory response and explains the benign appearance of the wound  
class1	79	although this is a rare clinical entity  elective surgical procedures complicated by fatal tss have been reported  
class1	79	surgeons should understand this disease and the management necessary to avert mortality  
class1	80	ceftazidime clindamycin versus tobramycin clindamycin in the treatment of intra abdominal infections  
class1	80	in order to assess the efficacy and toxicity of ceftazidime as a substitute for aminoglycosides in the treatment of intra abdominal sepsis  a prospective randomized trial was conducted  
class1	80	ninety four patients  49  trauma  were randomized to receive ceftazidime clindamycin  caz c   n   47  or tobramycin clindamycin  t c   n   47   
class1	80	caz  2 0 gm  and c  0 9 gm  were administered intravenously every 8 hours while t dosage was adjusted to maintain peak  5 8 mg l  and trough  less than 2 mg l  concentrations  
class1	80	age  sex  baseline serum creatinine  and etiology of infection were comparable in the two groups  
class1	80	clinical cure was similar in culture positive and culture negative patients who received caz c  94  vs 88    
class1	80	the clinical cure rate however was significantly lower in the t c culture positive  73   than in the culture negative patients  100    p   0 016   
class1	80	pathogenic organisms were eradicated in 100   30 30  and 76   13 17  of caz c and t c patients  respectively  p   0 0006   
class1	80	nephrotoxicity nephrotoxicity or ototoxicity was observed in none of the caz c patients and in one and two t c patients  respectively  
class1	80	caz c more effectively eradicated the bacteria isolated from these patients and no significant difference in clinical response was observed in culture positive patients  
class1	80	these findings plus the lack of toxicity suggest that caz c is an effective alternative for treatment of iai  
class1	81	effects of method of hemostasis on wound infection rate  
class1	81	adequate hemostasis is important in preventing postoperative wound infection  
class1	81	this study compared four methods of hemostasis  specific pinpoint vessel electrocautery  spc   specific vessel ligation with 4 0 vicryl  svl   nonspecific electrocautery of vessel plus excessive surrounding tissue  nsc   and nonspecific ligation of vessel and excessive surrounding tissue with 4 0 vicryl  nsl   on the rate of wound infection in rabbits that were contaminated with 10 6  staphylococcus aureus  
class1	81	there was no statistical significant increase in the rate of wound sepsis when electrocautery was used in a fashion producing minimal nonviable tissue compared to specific vessel ligation  
class1	81	electrocautery use for specific vessel hemostasis does not result in a higher wound infection rate in contaminated wounds  
class1	82	congenital insensitivity to pain with neuroparalytic keratitis  
class1	82	congenital insensitivity to pain is a well defined entity in the group of sensory deficiency syndromes  
class1	82	to the best of our knowledge  unilateral neuroparalytic keratitis associated with congenital insensitivity to pain has not been reported  
class1	82	we report such a case to alert clinicians to this potentially blinding problem  
class1	83	relapse of infant botulism  
class1	83	we report on 3 infants who had relapse of infant botulism after apparent resolution of clinical symptoms  
class1	83	this group represented 5  of the infants with confirmed infant botulism who were treated at our institution since 1976  
class1	83	the exact cause for these relapses was unclear  but three potential mechanisms are examined  
class1	83	there were no historical  clinical  or electrophysiological predictors of relapse  
class1	83	although at the time of writing recovery from relapse appeared complete  close follow up of patients recovering from a bout of infant botulism is necessary  
class1	84	in vitro evaluation of nicotinamide riboside analogs against haemophilus influenzae  
class1	84	exogenous nad  nicotinamide mononucleotide  or nicotinamide riboside is required for the growth of haemophilus influenzae  
class1	84	these compounds have been defined as the v factor growth requirement  
class1	84	we have previously shown that the internalization of nicotinamide riboside is energy dependent and carrier mediated with saturation kinetics  
class1	84	thionicotinamide riboside  3 pyridinealdehyde riboside  3 acetylpyridine riboside  and 3 aminopyridine riboside were prepared from their corresponding nad analogs  
class1	84	these compounds and several other nicotinamide riboside analogs were evaluated for their ability to support the growth of h  
class1	84	influenzae and for their ability to block the uptake of  carbonyl 14c nicotinamide riboside by h  
class1	84	influenzae  
class1	84	3 aminopyridine riboside blocked the uptake of  carbonyl 14c nicotinamide riboside and inhibited the growth of h  
class1	84	influenzae when nad  nicotinamide mononucleotide  or nicotinamide riboside served as the v factor  
class1	84	the antibacterial activity of 3 aminopyridine riboside was found to be specific for h  
class1	84	influenzae but had no effect on the growth of staphylococcus aureus or escherichia coli  
class1	84	in additional experiments by reversed phase high performance liquid chromatography  it was determined that whole cells of h  
class1	84	influenzae degrade 3 aminopyridine adenine dinucleotide to 3 aminopyridine riboside  which is then internalized  
class1	84	inside the cell  3 aminopyridine riboside has the ability to interfere with the growth of h  
class1	84	influenzae by an undetermined mechanism  
class1	85	activities of clarithromycin  sulfisoxazole  and rifabutin against mycobacterium avium complex multiplication within human macrophages  
class1	85	the activities of clarithromycin  sulfisoxazole  and rifabutin against three virulent strains of mycobacterium avium complex isolated from patients with acquired immunodeficiency syndrome were evaluated in a model of intracellular infection  
class1	85	human monocyte derived macrophages were infected at day 6 of culture with m  
class1	85	avium complex  
class1	85	intracellular bacteria were counted 60 min after inoculation  
class1	85	extra  and intracellular bacteria were counted at days 4 and 7 after inoculation  
class1	85	the concentrations used were 4 micrograms of clarithromycin per ml  mics for the three strains  4  4  and 4 micrograms ml   50 micrograms of sulfisoxazole per ml  mics  50  25  and 25 micrograms ml   and 0 5 micrograms of rifabutin per ml  mics  2  0 5  and 0 5 micrograms ml   
class1	85	compared with controls  clarithromycin and rifabutin slowed the intracellular replication of the three strains  at day 7 after inoculation  p was less than 0 01 for the first strain and less than 0 001 for the two others   
class1	85	sulfisoxazole was ineffective against the three strains  
class1	85	clarithromycin was as effective as rifabutin  
class1	85	clarithromycin plus rifabutin was as effective as each single agent  
class1	85	clarithromycin plus sulfisoxazole was as effective as clarithromycin alone  
class1	86	beta lactamase production and susceptibilities to amoxicillin  amoxicillin clavulanate  ticarcillin  ticarcillin clavulanate  cefoxitin  imipenem  and metronidazole of 320 non bacteroides fragilis bacteroides isolates and 129 fusobacteria from 28 u s  centers  
class1	86	beta lactamase production  nitrocefin disk method  and agar dilution susceptibility of amoxicillin  amoxicillin clavulanate  ticarcillin  ticarcillin clavulanate  cefoxitin  imipenem  and metronidazole were determined for 320 bacteroides species  not bacteroides fragilis group  and 129 fusobacteria from 28 u s  
class1	86	centers  
class1	86	overall  64 7  of bacteroides species and 41 1  of fusobacteria were beta lactamase positive  
class1	86	among the bacteroides species  positivity rates were highest for b  
class1	86	bivius  85 0    followed by b  
class1	86	splanchnicus  83 3    b  
class1	86	eggerthii  77 8    and b  
class1	86	oralis  77 1    54 5  of black pigmented bacteroides species were beta lactamase positive  
class1	86	among the fusobacteria  fusobacterium mortiferum showed the highest rate of beta lactamase positivity  76 9    
class1	86	mics of amoxicillin  128 micrograms ml  and ticarcillin  64 micrograms ml  for 90  of all beta lactamase positive strains were reduced to 4 and 2 micrograms ml  respectively  with the addition of clavulanate  
class1	86	mics of amoxicillin and ticarcillin for 90  of all beta lactamase negative strains were 1 and 4 micrograms ml  respectively  and greater than or equal to 98 4  of the strains were susceptible to the beta lactams tested  
class1	86	of the beta lactamase producing strains  45 9  were susceptible to amoxicillin at less than or equal to 4 micrograms ml and 93 4  were susceptible to ticarcillin at less than or equal to 64 micrograms ml  the addition of clavulanate raised the rates to 90 4 and 100   respectively  
class1	86	all strains were susceptible to cefoxitin  imipenem  and metronidazole  
class1	86	the activity of amoxicillin against 29 beta lactamase producing strains  10 bacteroides species and 19 fusobacteria  was not enhanced by the addition of clavulanate  however  82 7  of these strains were susceptible to amoxicillin  and all were susceptible to ticarcillin  
class1	87	sch 39304 in prevention and treatment of disseminated candidiasis in persistently granulocytopenic rabbits  
class1	87	to investigate the potential use of sch 39304 for the prevention and treatment of disseminated candidiasis in granulocytopenic patients  we studied its in vivo antifungal activity as preventive  early  and late treatments in three models  acute  subacute  and chronic  of disseminated candidiasis in persistently granulocytopenic rabbits  
class1	87	sch 39304 was an effective as amphotericin b alone and fluconazole alone for the prevention of disseminated candidiasis  
class1	87	sch 39304 alone and fluconazole alone were as effective as amphotericin b plus flucytosine for early treatment of subacute disseminated candidiasis  
class1	87	when treatment was delayed for 5 days to establish chronic disseminated candidiasis  sch 39304 was less effective than amphotericin b plus flucytosine  
class1	87	in comparison with different treatment regimens  sch 39304 was more effective in early and preventive treatment  
class1	87	thus  sch 39304 was comparable to treatment control regimens in prevention and early treatment of subacute disseminated candidiasis  
class1	87	sch 39304 also was most effective in granulocytopenic rabbits with disseminated candidiasis when used for prevention or early treatment  
class1	88	activity of compound g2 isolated from alfalfa roots in experimental dermatophyte infection  
class1	88	compound g2 isolated from alfalfa roots was applied topically to skin lesions of guinea pigs experimentally infected with the dermatophyte trichophyton mentagrophytes var  
class1	88	granulare  
class1	88	after 12 to 15 applications  80  of the infected lesions were cured  as judged by clinical and microbial criteria  compared with 20  of the untreated lesions which healed spontaneously  p less than 0 01   
class1	89	in vitro susceptibility of xanthomonas  pseudomonas  maltophilia to newer antimicrobial agents  
class1	89	the susceptibilities of 45 clinical and 3 environmental isolates of xanthomonas maltophilia to 14 antimicrobial agents was determined by broth microdilution  
class1	89	the newer quinolones pd117596  pd117558  pd127391  a 56620  amifloxacin  and fleroxacin were the most active agents tested  with 70 to 99  of isolates being susceptible to these agents  
class1	89	all isolates were resistant to trospectomycin  
class1	89	the new aminoglycosides sch24120 and sch22591 were active against 12 and 1  of isolates  respectively  
class1	90	comparison of cilofungin and amphotericin b for therapy of murine candidiasis  
class1	90	we compared the efficacies of cilofungin and amphotericin b treatment in a murine model of disseminated candidiasis  
class1	90	three different dosages of each drug plus controls were evaluated  
class1	90	statistically improved survival was noted only among mice treated with 1 mg of amphotericin b per kg of body weight  p less than 0 05   
class1	90	while all amphotericin b regimens and the two lower dosage cilofungin regimens significantly reduced yeast cell counts in kidneys compared with the controls  the amphotericin b treated mice had a significantly higher percentage of sterile kidneys following therapy compared with those treated with cilofungin  p   0 0001   
class1	91	management of gastroenteritis  
class1	91	childhood gastroenteritis remains a common reason for admission to british paediatric units  although the severity of the disease appears to be diminishing in recent years  
class1	91	we studied 215 infants and children with gastroenteritis admitted consecutively to four paediatric units in south wales in order to determine the severity of the disease  the organisms isolated  the frequency of complications  and the adequacy of management before admission  
class1	91	stool pathogens were isolated in 125  58   patients  viruses in 65  bacteria in 30  and protozoa in 19  with multiple infection found in 11   
class1	91	there was a low incidence of morbidity and complications  but prolonged diarrhoea  postenteritis syndrome  was present in 24  11   cases and 77  36   had received inappropriate treatment before admission  
class1	91	contemporary gastroenteritis is thus a relatively mild disease in the acute phase  but management before admission to hospital is often inadequate  and prolonged diarrhoea may be a feature in a considerable number of cases  
class1	92	an unusual cause of thoracic mass  
class1	92	a previously well 10 year old boy presented with scoliosis  a mass in the chest wall  and a pleural effusion  
class1	92	chest radiography showed the triad of chronic consolidation  pleural effusion  and rib periostitis  
class1	92	investigations confirmed thoracic actinomycosis  
class1	92	tissue spread was evaluated by computed tomography  
class1	92	it was successfully treated with benzylpenicillin  which was later replaced by clindamycin  
class1	93	the process of microbial translocation  
class1	93	the process of microbial translocation was studied using candida albicans  escherichia coli  or endotoxin instilled into thiry vella loops of thermally injured guinea pigs and rats  
class1	93	translocation of c  
class1	93	albicans occurred by direct penetration of enterocytes by a unique process different from classical phagocytosis  
class1	93	translocation between enterocytes was not observed  
class1	93	internalization was associated with a disturbance of the plasma membrane and brush border  but most internalized organisms were not surrounded by a plasma membrane  
class1	93	passage of the candida into the lamina propria appeared to be associated with disruption of the basal membrane with extrusion of cytoplasm of the cell and candida  
class1	93	organisms in the lamina propria were commonly phagocytized by macrophages but also were found free in lymphatics and blood vessels  
class1	93	translocation of e  
class1	93	coli and endotoxin also occurred directly through enterocytes rather than between them  but translocated endotoxin diffused through the lamina propria and muscular wall of the bowel wall by passing between rather than through the myocytes  
class1	93	these descriptive phenomena provide new insight into the role of the enterocyte and intestinal immune cells in the translocation process  
class1	94	the prevalence of helicobacter pylori in nonulcer dyspepsia  importance of stratification according to age 
class1	94	helicobacter pylori  formerly campylobacter pylori  is causally related to active antral gastritis and is highly associated with duodenal and gastric ulcers  
class1	94	however  the relationship of h pylori to nonulcer dyspepsia is less clear  
class1	94	we determined the presence of h pylori in unselected patients who were undergoing upper gastrointestinal tract endoscopy  and we found a prevalence of 37  in 110 patients with nonulcer dyspepsia that was similar to previous data  
class1	94	patients with nonulcer dyspepsia who had h pylori were found to be significantly older than patients with nonulcer dyspepsia who did not have h pylori  
class1	94	in addition  when stratified according to age  we detected an increased prevalence of h pylori in patients with nonulcer dyspepsia with increasing age  similar to that reported for asymptomatic control populations  
class1	94	this finding casts doubt as to the causal role of h pylori for most patients with nonulcer dyspepsia and stresses the importance of considering epidemiologic factors  such as age  when evaluating the role of h pylori in specific disease states  
class1	95	emergence of ciprofloxacin resistance in nosocomial methicillin resistant staphylococcus aureus isolates  resistance during ciprofloxacin plus rifampin therapy for methicillin resistant s aureus colonization  
class1	95	we initiated a randomized  single blinded trial of ciprofloxacin plus rifampin vs sulfamethoxazole and trimethoprim plus rifampin in the therapy for patients who underwent colonization with methicillin resistant staphylococcus aureus  mrsa   
class1	95	patients who were colonized with mrsa received 2 weeks of either regimen  
class1	95	the study was terminated after the enrollment of 21 subjects due to the recognition of ciprofloxacin resistance in 10 of 21 new mrsa isolates during the last 2 months of the study  
class1	95	five of the 10 patients with ciprofloxacin resistant mrsa isolates had never received ciprofloxacin  
class1	95	long term  6 month  eradication had been achieved in only three of 11 ciprofloxacin plus rifampin and four of 10 sulfamethoxazole and trimethoprim plus rifampin recipients  
class1	95	the use of this new fluoroquinolone for the eradication of mrsa colonization is usually not effective and may risk the development of ciprofloxacin resistance in mrsa within the hospital environment  
class1	96	desensitization in the management of vancomycin hypersensitivity  
class1	96	vancomycin is the preferred antimicrobial agent in the treatment of methicillin resistant staphylococcal infections  
class1	96	one of the well known hypersensitivity reactions to this agent is the  red man syndrome   which is believed to involve drug induced histamine release in certain individuals  
class1	96	although rate and or dose reductions may be effective in some cases  some hypersensitivity reactions necessitate the discontinuation of vancomycin  
class1	96	in this article one patient is described who developed vancomycin associated reactions consistent with the red man syndrome despite having tolerated vancomycin administration previously  
class1	96	this case was managed by sequential increments in vancomycin administration over several days that allowed for therapeutic doses of the drug to be administered  
class1	96	prior to desensitization  vancomycin administration at a lowered rate and dose was unsuccessfully attempted  despite the presence of combination antihistamine therapy  
class1	96	a loss of skin prick test reactivity to vancomycin was demonstrated after successful desensitization  
class1	96	this desensitization method may be useful in managing certain refractory cases of vancomycin hypersensitivity  
class1	97	immediate breast reconstruction following mastectomy is as safe as mastectomy alone  
class1	97	we evaluated wound complications and potential risk factors after mastectomy with immediate breast reconstruction and compared them with similar data after modified radical mastectomy  
class1	97	the incidences of infection  seroma  hematoma  and epidermolysis were compared among 395 patients  305 with modified radical mastectomies and 90 with mastectomy with immediate breast reconstruction  from virginia mason medical center  seattle  wash  between 1983 and 1989  
class1	97	obesity  age  60 years or older   smoking  antibiotics  and wound drainage were examined as possible risk factors  
class1	97	there were more wound complications in the modified radical mastectomy group  48  vs 31    and specifically  more seromas  30  vs 13    
class1	97	in the modified radical mastectomy group  age of 60 years or older was associated with seroma and infection  drainage greater than 30 ml per day  at time of drain removal  with seroma  and smoking with epidermolysis  
class1	97	in the mastectomy with immediate breast reconstruction group  obesity was associated with seroma and epidermolysis  
class1	97	we conclude that mastectomy with immediate breast reconstruction appears to be as safe as modified radical mastectomy alone with respect to wound complications  
class1	98	reoperative surgery for the morbidly obese  a university experience  
class1	98	patients who undergo surgery for morbid obesity are often subjected to reoperation for a wide array of indications  
class1	98	to evaluate outcome following revisional procedures  we reviewed the records of 32 such patients treated at ucla between april 1986 and may 1989  
class1	98	twenty five women  78   and 7 men  22   with a mean age of 44 years underwent 76 reoperations  2 4 per patient  for complications of prior obesity surgery  
class1	98	indications for initial surgical revision consisted primarily of metabolic derangements  12 patients  and weight related problems  11 patients   
class1	98	in contrast  indications for the patients  final surgical procedure were commonly for bowel obstruction  41    intra abdominal sepsis  12    and gastrointestinal bleeding  6    
class1	98	following initial revision  23 patients  71 8   required further surgery for major complications and four patients died  12 5    
class1	98	while initial revisions are frequently indicated for metabolic problems  final reoperations are more frequently undertaken for urgent  life threatening complications  
class1	98	revisional procedures for morbid obesity should be carefully considered  and the potential for major complications and or death should be weighted heavily against proposed benefits  
class1	99	buccal cellulitis  
class1	99	buccal cellulitis  bc  is an innocuous appearing infection of the cheek that is found in children and has a high incidence of concomitant bacteremia  
class1	99	typically  the child is younger than 12 months and has a 2 to 8 hour prodrome of coryza and fever before developing the cellulitis on the cheek  
class1	99	a purplish hue on the cellulitic region is highly suggestive of hemophilus influenzae bacteremia  
class1	99	the differential diagnosis is reviewed  
class1	99	a complete blood count  blood culture  and cellulitis aspirate culture  should be obtained on all patients with bc  
class1	99	meningitis may be present despite the lack of meningeal signs  
class1	99	a lumbar puncture should be performed on all children at risk for bacteremic bc  
class1	99	the vast majority of these children are bacteremic and require parenteral antibiotics  
class1	99	a typical case of bc is presented and its management is reviewed  
class1	100	intraocular pressure changes and postural changes of intraocular pressure in experimentally induced hansen s disease of rhesus  mangabey  and african green monkeys  
class1	100	in our long term evaluation of patients with hansen s disease we have frequently found reduction of their intraocular pressure  
class1	100	furthermore  we noted changes in their intraocular pressure on change of posture  
class1	100	to determine if these changes have any significance we measured the intraocular pressures of 24 experimentally infected and 39 control monkeys in both sitting and reclining positions  
class1	100	we found significant reduction of intraocular pressure in 66 7  compared with controls in the sitting position  and a significant increase in intraocular pressure in 79  when checked first in the sitting then in the reclining position  
class1	100	we offer a possible pathophysiological explanation as to why the changes occur  
class1	101	seven day administration of recombinant human granulocyte colony stimulating factor to newborn rats  modulation of neonatal neutrophilia  myelopoiesis  and group b streptococcus sepsis  
class1	101	single pulse administration of rhg colony stimulating factor  csf  to neonatal rats was previously demonstrated to induce peripheral neutrophilia and modulate bone marrow  bm  neutrophil storage and proliferative pools  nsp   npp   
class1	101	in this study  we investigated the prolonged effects of 7 days of rhg csf therapy  5 micrograms kg per day   
class1	101	sprague dawley newborn rats  less than or equal to 24 hours  were injected intraperitoneally  ip   daily for 7 days  with rhg csf or phosphate buffered saline human serum albumin  pbs hsa   
class1	101	rhg csf induced a significant early and late peripheral neutrophilia  6 905     1 625  day 1  and 9 223     515 microl  day 7  v 1 275     90 microl  p less than or equal to  0001   
class1	101	in addition  7 days of rhg csf resulted in a significant increase in the bm nsp  3 247     190 microl v 1 677     339 microl  p less than or equal to  001   
class1	101	there was  however  no depletion or significant change in the bm npp  
class1	101	seven days of rhg csf also induced a mild increase in bm cfu gm colony formation  p less than or equal to  01   
class1	101	there was  however  no significant change in liver spleen cfu gm colonies or in the cfu gm proliferative rate in either the bm or liver spleen cultures  
class1	101	finally  7 days of prophylactic rhg csf therapy resulted in a synergistic response with antibiotic therapy and significantly modulated the mortality rate during experimental group b streptococcal sepsis  gbs   100  v 50    gvsc   p less than or equal to  001   
class1	101	pulse rhg csf administered at 6 hours or 18 hours after gbs inoculation  however  failed to act synergistically with antibiotics to improve survival or prevent peripheral neutropenia  
class1	101	this study suggests that 7 days of prophylactic rhg csf therapy induces peripheral neutrophilia  myeloid maturation  increases neutrophil bm reserves and also may provide immunologic enhancement of neonatal host defense during experimental gbs in term neonatal rats  
class1	102	effect of granulocyte colony stimulating factor on neutropenia due to chemotherapy for non hodgkin s lymphoma  
class1	102	the authors administered recombinant human granulocyte colony stimulating factor  rhg csf  to 16 patients with advanced non hodgkin s lymphoma treated with combination chemotherapy  
class1	102	groups of three to five patients were treated with 50  100  200  and 400 micrograms m2 per day of rhg csf by intravenous infusion for 14 days  beginning 3 days after chemotherapy  
class1	102	there was a strong linear relationship between the dose and the area under the curve over this dose range  
class1	102	the rhg csf was rapidly cleared from serum  with a mean half life of 5 97 hours for the second phase  t1 2   
class1	102	in patients treated with a dose of more than 100 micrograms m2 per day  the duration of neutropenia  p less than 0 01  and the duration of fever  p less than 0 05  were significantly decreased  
class1	102	the rhg csf was well tolerated and the only clinical observation that appeared relating to rhg csf administration was slight bone pain  
class1	102	this study strongly suggests that an optimum dose of rhg csf in patients after chemotherapy is 100 to 200 micrograms m2  
class1	102	our study shows that rhg csf is a clinically useful drug for patients treated with myelosuppressive chemotherapy  
class1	103	unusual case of pacemaker lead migration  
class1	103	pulmonary artery migration of pacemaker lead is rare and may result in pulmonary emboli originating from the thrombus around the infected catheter and causing multiple pulmonary infarcts  
class1	103	we report an unusual case of pacemaker lead migration to the right pulmonary artery with septic pulmonary embolism  
class1	103	while being treated with intravenous cefuroxamine  the patient had spontaneous migration of the lead to the left pulmonary artery with subsequent left pulmonary embolism  
class1	104	splenic septic emboli in endocarditis  
class1	104	the significance of septic emboli to the spleen is inferred by the frequency of septic emboli in general seen in patients with left sided infective endocarditis who are referred for valve replacement  
class1	104	to determine the proper management of splenic infarcts and abscess due to septic emboli  we retrospectively reviewed the records of 108 patients with left sided endocarditis who underwent valvular surgery at the university of illinois hospital from 1980 through 1988  
class1	104	intravenous drug abuse was the etiology in 68   n   73   
class1	104	the incidence of splenic infarcts and abscess was 19   n   20   but an incidental finding of splenic infarcts was found in 38   n   11  of 29 asymptomatic patients who had computed tomograms  
class1	104	streptococci and staphylococci were the causative organisms in 85   n   17   
class1	104	localized findings were absent in 90  of splenic infarcts and abscesses  
class1	104	abdominal computed tomograms were diagnostic of the sequelae of splenic septic emboli in 100   
class1	104	no patient had intra abdominal bleeding complications associated with cardiopulmonary bypass  
class1	104	splenectomy was performed in 50   n   10  of patients 3 24 days  mean  11 2 days  after valve replacement  
class1	104	indications for splenectomy included persistent sepsis in 60   n   6   large  greater than 2 cm  and peripheral lesions in 30   n   3   and splenic rupture in 10   n   1   
class1	104	perioperative mortality of patients who underwent splenectomy was 30   n   3   
class1	104	the following conclusions can be drawn  1  splenic septic embolus is common in endocarditis  
class1	104	2  abdominal computed tomography should be performed for all patients  
class1	105	total knee arthroplasty in diabetes mellitus  
class1	105	a retrospective study was done of 59 total knee arthroplasties  tkas  in 40 patients diagnosed with diabetes mellitus  
class1	105	the overall infection rate was 7   with an overall revision rate of 10  and an average follow up period of 4 3 years  
class1	105	wound complications were present in 12  of the tkas  
class1	105	the rate of deep joint infections in diabetic patients was statistically higher than the reported incidence of sepsis in nondiabetic patients  
class1	105	therefore  maximum precautions should be taken for diabetic patients having tka to minimize both wound complications and joint sepsis  
class1	106	prevention of nosocomial lung infection in ventilated patients  use of an antimicrobial pharyngeal nonabsorbable paste  
class1	106	a comparative  prospective study was made of the incidence of infection in the lower airway  purulent tracheobronchitis and pneumonia  in long term patients who were mechanically ventilated due to respiratory failure of noninfectious origin  
class1	106	twenty eight patients were randomly allocated into a study group  a  n   13  in which a nonabsorbable paste containing 2  tobramycin  2  amphotericin b  and 2  polymyxin e was administered locally to decontaminate the oropharynx  and a control group  b  n   15  in which a paste without antibiotics was also applied to the oropharynx  
class1	106	we studied the effectiveness of the prophylactic technique in decontaminating the oropharynx and trachea of organisms potentially pathogenic for the respiratory system  
class1	106	decontamination was successful in ten of 13 patients in group a vs  
class1	106	one of 15 patients in group b  p less than  001   
class1	106	the results demonstrated a lower rate of infection in the lower respiratory tract in the study group  three patients with tracheobronchitis and no pneumonias  than in the control group  three patients with tracheobronchitis and 11 with pneumonia   the difference between both being highly significant  p less than  001   
class1	106	two  15   patients in group b developed sepsis of pulmonary origin  
class1	106	none of the patients on prophylactic treatment developed this complication  
class1	106	although the overall mortality was similar in both groups  group a  30  vs  
class1	106	group b  33    we believe that infection contributed to a great extent to the death of two of five patients in group b  
class1	106	we conclude that nosocomial pneumonia  which is a frequent complication in critically ill patients on mechanical ventilation  could be prevented by local application of nonabsorbable antibiotics to the oropharynx  
class1	107	ringer s acetate and dextran 70 with or without hypertonic saline in endotoxin induced shock in pigs  
class1	107	the effects of ringer s acetate  6  dextran 70  7 5  nacl  and the combination of 7 5  nacl and dextran 70 were tested in resuscitation from endotoxin shock induced by continuous iv infusion of escherichia coli endotoxin in pigs  
class1	107	after about 3 h  a reproducible shock state was achieved and treatment was started  governed by the left atrial pressure  
class1	107	the hypertonic solutions  7 5  nacl and 7 5  nacl in dextran 70  did not show any overall advantages over the isotonic solutions  ringer s acetate and dextran 70   
class1	107	only transient beneficial hemodynamic effects lasting less than 30 min after infusion were seen  
class1	107	when dextran 70 was administered  cardiovascular function was markedly improved and oxygen delivery  do2  and survival were significantly higher compared with the crystalloid groups  ringer s acetate and 7 5  nacl   
class1	107	administration of large amounts of ringer s acetate resulted in an immediate deterioration of pulmonary function  
class1	107	it was difficult to elevate left atrial pressure or even to keep it at baseline level  and cardiac index was only transiently increased  
class1	107	the overall result was a deterioration of do2 and poor survival compared with the dextran 70 treated pigs  
class1	107	we conclude that dextran 70 is superior to ringer s acetate in resuscitation from endotoxin induced shock in pigs  
class1	107	furthermore  we found no role for the use of hypertonic saline  alone or in combination with dextran  in the treatment of this type of prolonged endotoxin shock  
class1	108	pulmonary manifestations of disseminated cryptococcosis in patients with aids  
class1	108	forty eight patients with disseminated cryptococcosis and aids were retrospectively studied to define the pulmonary manifestations  
class1	108	cryptococcus neoformans  cn  was first isolated from a pulmonary site in 12 patients  
class1	108	disseminated disease was subsequently documented in all these patients  
class1	108	symptoms and roentgenographic manifestations  normal  nodular circumscribed infiltrates  pleural effusions  lobar consolidation  were diverse  
class1	108	interstitial infiltrates predicted the presence of another opportunistic lung infection besides cryptococcosis in five patients  three untreated and two treated patients   
class1	108	infectious causes other than cryptococcosis were established by culture and clinical course in five of the ten patients who developed chest roentgenographic abnormalities during amphotericin b therapy  
class1	108	endobronchial abnormalities were identified in four patients at bronchoscopy  
class1	108	bronchoalveolar lavage  9 9  and pleural fluid  3 3  cultures were sensitive tests for detection of pulmonary involvement with cn  
class1	109	quality of well being before and after antibiotic treatment of pulmonary exacerbation in patients with cystic fibrosis  
class1	109	general quality of life has only recently been measured with an objective tool in patients with cystic fibrosis  cf   and there have been no reported attempts to document changes in patients  overall well being over time  as patients deteriorate or respond to intervention  
class1	109	we applied the quality of well being scale  qwb  in 28 patients with cf before and after a two week course of oral ciprofloxacin used to treat pulmonary exacerbations  
class1	109	there were significant correlations between changes in qwb and various pulmonary function test results  qwb vs fev1  r   0 4  p less than 0 03  qwb vs fvc  r   0 5  p less than 0 01  and qwb vs sao2  r   0 4  p less than 0 05  
class1	109	thus  the qwb can track changes in general well being in cf patients over a brief time and detect changes associated with pulmonary exacerbation and its treatment  
class1	110	subpleural mononuclear cell infiltration  significance in the differential diagnosis of pleuritis showing nonspecific histologic findings  
class1	110	to determine if patients who had lymphocyte rich pleural effusion and a pleural biopsy without any specific findings could be histopathologically differentiated between those with tuberculous and nontuberculous pleuritis  we histologically re evaluated the pleural biopsies of all patients whose pleural effusion was predominant with lymphocytes and contained no malignant cells  
class1	110	a total of 40 patients with a nonspecific histologic findings of pleural biopsy specimen were categorized based on their ultimate diagnosis as having tuberculous  n   15   carcinomatous  n   10  or nontuberculous  benign pleuritis  n   15   
class1	110	the pleural biopsy specimen of patients with nontuberculous  benign pleuritis frequently showed a band like infiltration of mononuclear cells in the subpleural adipose tissue with minimal pleural inflammatory infiltrate  10 out of 15 patients   while the same finding was infrequent in those with tuberculous pleuritis  0 out of 15  p   0 0001  and pleuritis associated with carcinoma  three out of 10  p   0 082   
class1	110	based on these results  the presence of band like infiltration of mononuclear cells in the subpleural adipose tissue with minimal pleural inflammatory infiltrate in pleural biopsy specimens of patients with lymphocyte rich pleural effusion suggests that the pleuritis is nontuberculous in its nature  
class1	111	anti kveim monoclonal antibody  new monoclonal antibody reacting to epithelioid cells in sarcoid granulomas  
class1	111	a monoclonal antibody to the sarcoid granulomagenic agent contained in kveim suspension was prepared by immunizing mice with kveim suspension  
class1	111	one monoclonal antibody  ihy 1  that reacted with the epithelioid cells in sarcoid granulomas on immunoperoxidase technique was selected  
class1	111	the immunoperoxidase technique was used to compare this monoclonal antibody s binding to sarcoidosis  or tuberculosis affected lymph nodes  
class1	111	ihy 1 is a monoclonal antibody of igm class  
class1	111	this antibody did not react to erythrocytes  lymphocytes  monocytes  alveolar macrophages  or the macrophage derived cell lines such as u 973 and kg 1  
class1	111	it reacted to granuloma epithelioid cells of sarcoidosis affected lymph nodes  
class1	111	the monoclonal antibody also reacted positively to epithelioid cells in tuberculous granulomas although the reaction was not as strong  
class1	111	since ihy 1 was found to bind to both types of granulomas  this suggests that the epithelioid cells in sarcoidosis have antigenicity common to the epithelioid cells in tuberculosis  
class1	112	occult fatal pulmonary embolism with disseminated intravascular coagulation  an unusual case masquerading as miliary tuberculosis  
class1	112	we report a fatal case of occult pulmonary embolism complicating bronchogenic carcinoma which presented with rapidly progressive pulmonary miliary shadows and respiratory failure  
class1	112	a clotting profile abnormality compatible with disseminated intravascular coagulation was noted  
class1	112	postmortem examination showed extensive clots occluding the major pulmonary vessels and areas of pulmonary infarcts  
class1	112	histologic examination revealed fibrin deposition in the microvasculature compatible with dic  
class1	112	cases of pulmonary embolism with dic have previously been reported  but this is the first case with pathologic confirmation  
class1	112	thus  unusual presentation with diffuse lung shadow and dic should not deter the clinician from correct diagnosis so that appropriate treatment can be promptly started  
class1	113	septic pulmonary emboli  a rare cause of bilateral pneumothorax in drug abusers  
class1	113	an intravenous drug abuser presented with bilateral pneumothorax  
class1	113	this is a previously unreported  to our knowledge  complication of septic pulmonary emboli secondary to right sided endocarditis  
class1	113	this possibility must be considered in the differential diagnosis of pneumothorax in drug addicts  
class1	114	yersinia enterocolitica abscess of the transverse colon  report of a case  
class1	114	yersinia enterocolitica abscess of the bowel is a rare entity  
class1	114	only five cases have previously been reported  none in the surgical literature  
class1	114	a unique presentation for yersinia infection  abscess of the transverse colon  is described  and the literature of y  
class1	114	enterocolitica intestinal perforation and abscess is reviewed  
class1	115	infections in alcoholic patients  
class1	115	alcoholic patients have an increased susceptibility to certain bacterial infections  
class1	115	among the more important of these infections are pneumonia  tuberculosis  spontaneous peritonitis  and bacteremia  
class1	115	this susceptibility is caused by alteration of immune function and mechanical defenses and are the sequel of chronic alcoholism  most notably cirrhosis  
class1	115	in many infections  morbidity is increased in alcoholics  with the course of the illness being more severe and complications more frequent  
class1	115	assessment of the alcoholic patient with suspected infection should  therefore  be thorough and treatment prompt  
class1	116	host response to mycobacterial infection in the alcoholic rat  
class1	116	animals  chronically treated with alcohol  were inoculated with mycobacteria  bacillus calmette guerin  10 2 x 10 6  organisms  into the spleen to produce a granulomatous hepatitis  
class1	116	before infection  chronic alcohol ingestion was associated with a depressed skin test response to phytohemagglutinin  71 7  of baseline  p   0 009   
class1	116	mycobacterial  bacillus calmette guerin  infection stimulated phytohemagglutinin skin test response to 417  of baseline in controls and 299  in alcoholics  p less than 0 001   
class1	116	the hepatic granuloma response was altered with smaller but more numerous granulomas  mean     sem  81 2     1 5 microns2 of area with a frequency of 1 8 granulomas per field in alcoholics vs  
class1	116	129 8     5 71 microns2 and 1 2 granulomas per field in controls  p less than 0 001   
class1	116	these changes were associated with a 10 fold increase in colony forming units per gram of liver  54 5     18 2 in alcoholics vs  
class1	116	5 6     1 83 in controls  p   0 0006   
class1	116	this model offers precise parameters for host response to infection and indicates that alcohol significantly impairs the clearing capacity for mycobacteria from the liver  
class1	117	infection control in the nursing home  the physician s role  
class1	117	infection control in the nursing home or long term care facility is an increasingly complex activity  
class1	117	the high rates  approximately 15   and special risks  group activities  crowding  for nosocomial infection demand special attention by attending physicians  
class1	117	some specific responsibilities include  recognition of infection  knowledge and use of basic infection control principles  appropriate antibiotic use  review of immunizations  facilitation of communications among office  hospital  and long term care facility  and involvement with infection control program s   
class1	118	transfusion risks  
class1	118	hepatitis remains the most serious transfusion risk  in terms of incidence and severity  
class1	118	transfusion associated aids  hemolytic reactions  trali  and anaphylaxis are severe problems that occur relatively rarely  while febrile reactions and mild allergic reactions are common but not serious  
class1	118	the key to avoiding all these complications is autotransfusion  see the article  autologous transfusion  in this issue   
class1	118	although intraoperative scavenging became available in many centers in the united states in the 1980s  it is hoped that pre deposit autotransfusion will also become widely utilized in the next decade  
class1	119	the patellofemoral joint after total knee arthroplasty without patellar resurfacing  
class1	119	one hundred total knee replacements with a total condylar prosthesis and without patellar resurfacing were followed for a minimum of two years  
class1	119	eighty four per cent of the knees were affected by osteoarthrosis  
class1	119	graded according to the knee rating system of the hospital for special surgery  there were eighteen excellent  fifty three good  eighteen fair  and eleven poor results  
class1	119	at the most recent follow up  twenty nine knees  29 per cent   nine of which were affected by rheumatoid arthritis  were still painful in the patellofemoral area  
class1	119	the height and weight of the patient definitely influenced the amount of patellofemoral pain postoperatively  
class1	119	small patients who had osteoarthrosis were exceptionally free of pain  regardless of sex  age  or level of activity  
class1	119	it seems that the best approach to patellofemoral replacement includes resurfacing of the patella in all patients who have rheumatoid arthritis and in patients who have osteoarthrosis if they have preoperative patellofemoral pain  are more than 160 centimeters tall  weigh more than sixty kilograms  and have advanced changes in the patella at the time of the operation  
class1	120	treatment of infection after total knee arthroplasty by debridement with retention of the components  
class1	120	thirty one total knee arthroplasties were followed by infection in twenty seven patients who were subsequently treated with debridement  retention of the components  and intravenous administration of antibiotics  
class1	120	the results were reviewed retrospectively in an effort to evaluate the function of the prostheses that had been salvaged successfully and to identify the causes of failure of those around which an infection had recurred  
class1	120	at the most recent follow up  average duration  8 8 years   infection had recurred around twenty four  77 per cent  of the thirty one arthroplasties  
class1	120	seven knees  23 per cent  remained free of infection  
class1	120	function remained satisfactory  although revision was subsequently needed in two knees for reasons other than infection  
class1	120	one cause of failure was the duration of the infection before debridement  
class1	120	this averaged twenty one days for the seven knees in which the prosthetic arthroplasty had been salvaged and thirty six days for the twenty four knees in which treatment had failed  
class1	120	another cause of failure was the type of organism  staphylococcus aureus had caused the infection in fourteen  58 per cent  of the twenty four knees in which the treatment failed but in only two of the seven knees in which the prosthetic arthroplasty was salvaged  
class1	120	in addition  eight infections in the first group were resistant to penicillin  whereas both infections in the second group were sensitive to penicillin  
class1	120	the four infections with gram negative organisms in the series were all in knees in which the treatment failed  
class1	120	all six hinged prostheses that were used failed  
class1	121	amputation or limb lengthening for partial or total absence of the fibula  
class1	121	thirty two patients who had ablation of the foot by the syme or boyd technique for partial or total absence of the fibula  with subsequent fitting of a prosthesis  were compared with eleven patients who had lengthening of the lower limb by the wagner method  to assess the long term results of each procedure  
class1	121	the final results were evaluated on the basis of pain  limp  limb length discrepancy  level of physical activity  and satisfaction of the patient  
class1	121	of the thirty two patients who had an amputation  twenty eight  88 per cent  had a satisfactory result  compared with only six  55 per cent  of the eleven patients who had limb lengthening  
class1	121	the amount of inequality between the lower limbs was classified as follows  group i  the foot of the shorter extremity was at the distal third of the contralateral  normal limb  and the percentage of shortening was 15 per cent or less  group ii  the foot of the shorter extremity was at the level of the middle third of the contralateral  normal limb  and the percentage of shortening was between 16 and 25 per cent  and group iii  the foot of the shorter extremity was at the level of the proximal third of the contralateral  normal limb  and the percentage of shortening was greater than 26 per cent  
class1	121	lengthening was best suited for patients in group i who had stable hips  knees  and ankles and a plantigrade foot  
class1	121	patients in groups ii and iii were best served by ablation of the foot and fitting of a prosthesis  
class1	122	an unusual late complication following surgical repair of tetralogy of fallot  
class1	122	a case is presented of extrusion of right ventricular outflow tract patch material through a mediastino cutaneous fistula occurring five years after repair of tetralogy of fallot  
class1	122	the focus of the mediastinal infection was an infected epicardial pacemaker electrode placed at the time of initial surgery  
class1	122	subsequent echocardiographic studies showed minimal right ventricular outflow tract or pulmonary arterial dilatation  and  with no further surgery  the child is well after two and a half years follow up  
class1	123	use of latex agglutination technique for detecting legionella pneumophila  serogroup 1  antibodies  
class1	123	following the outbreak of legionnaires  disease in stafford in 1985  500 serum samples were submitted to the indirect immunofluorescence antibody test and a latex agglutination  
class1	123	latex agglutination using ultrasonically disrupted legionella pneumophila antigens coupled to latex particles  proved a rapid  simple method for detecting circulating antibodies to l pneumophila in a one minute slide latex agglutination test  
class1	123	there was good correlation with the indirect immunofluorescence antibody test  ifat   and the specificity and sensitivity with respect to a diagnostic result were 98 3  and 97 6   respectively  using a series of well characterised sera  
class1	123	the latex agglutination test seems well suited as a screening test for presumptive cases of legionnaires  disease  the latex reagent is easy to prepare and seems to remain stable at 4 degrees c for up to six months  
class1	124	history of antifungals  
class1	124	until two to three decades ago  only a few drugs were available for the treatment of fungal infections  
class1	124	the status of antifungal therapy changed dramatically in the late 1960s with the introduction of newer broader spectrum agents  such as the iodinated trichlorophenols and the imidazoles  that acted by disruption of the fungal cell membrane  
class1	124	some of the more recently developed broad spectrum antifungal drugs include the triazoles terconazole  itraconazole  and fluconazole and the dimethylmorpholine amorolfine  
class1	124	the allylamines represent one of the newest classes of compounds shown to be effective in the management of fungal disorders  
class1	124	the two members of this unique chemical class that have been studied clinically  naftifine and terbinafine  are effective against a wide spectrum of fungal organisms  
class1	124	terbinafine has the added advantage of both topical and oral activity  
class1	125	problems of resistant dermatophytes  
class1	125	recalcitrant fungal infections are defined as infections that are difficult or impossible to eradicate despite seemingly adequate treatment with appropriate oral or parenteral antibiotics  
class1	125	relative or absolute microbial resistance is only one of the many causes of recalcitrance  
class1	125	others include failure of the patient to comply with the prescribed treatment regimen  drug degradation in the liver  drug drug interactions  reabsorption or washout of the drug from the stratum corneum  and failure of the drug to reach the stratum corneum  
class1	125	excretion in the eccrine sweat is the principal pathway by which griseofulvin and ketoconazole  the two currently available oral antifungal agents  are delivered to the stratum corneum  
class1	125	measures that promote delivery of these drugs to this site by enhancing sweating and minimizing drug run off and absorption onto clothing may aid in optimizing the therapeutic response to these agents  
class1	126	treatment of chronic tinea pedis  athlete s foot type  with topical terbinafine  
class1	126	twenty seven patients with chronic tinea pedis  athlete s foot type  were enrolled in a randomized  double blind trial of topical treatment with terbinafine 1  cream versus its vehicle  placebo   
class1	126	patients were examined weekly during 4 weeks of twice daily treatment and at follow up 2 weeks after the conclusion of therapy  
class1	126	no adverse events were reported in either treatment group  
class1	126	drug efficacy was evaluated in 22 patients  of whom nine  41   were treated with terbinafine and 13  59   with placebo  
class1	126	analysis of combined mycologic and clinical results showed that terbinafine was significantly more effective than placebo at the end of therapy  78  vs zero  and at the 2 week follow up  89  vs zero   p less than or equal to 0 001 at both intervals  
class1	127	a clinical trial of topical terbinafine  a new allylamine antifungal  in the treatment of tinea pedis  
class1	127	twenty three patients were enrolled in a randomized  double blind trial of terbinafine 1  cream compared with placebo vehicle in the treatment of tinea pedis  
class1	127	of the 20 patients who were evaluated for efficacy  10 received terbinafine and 10 received placebo  
class1	127	except for the terbinafine treated patients being an average of 11 years older than the patients receiving placebo and the median duration of disease being 6 weeks longer in the placebo group  the two groups were demographically and clinically similar  
class1	127	results of mycologic tests and clinical findings showed terbinafine to be significantly more effective than placebo in the treatment of tinea pedis  
class1	127	significantly more terbinafine treated patients than placebo treated patients showed conversion to negative culture and microscopy at end of therapy and a significant reduction in scored signs and symptoms  
class1	127	overall efficacy at follow up  combined mycologic and clinical findings  was also significantly greater in the terbinafine group  78   than in the placebo group  zero   p less than 0 001   
class1	127	unexplained elevation of liver function test results was noted in three placebo treated patients and in one terbinafine treated patient  but these changes were not considered clinically relevant or drug related  
class1	128	efficacy and tolerability of topical terbinafine in the treatment of tinea cruris  
class1	128	thirty men with clinical and mycologic evidence of tinea cruris were enrolled in a controlled  randomized  double blind trial comparing terbinafine 1  cream and its cream vehicle as placebo  
class1	128	patients applied the test medications to the affected area twice daily for 2 weeks  
class1	128	therapeutic response was evaluable in 18 patients after each week of treatment and at a follow up visit 2 weeks after therapy ended  
class1	128	at each visit  terbinafine was found to be more effective than the cream vehicle in the reduction of the signs and symptoms of infection and in the conversion of culture and microscopy findings to negative or normal  
class1	128	at the end of treatment  therapy was effective in 67  of the nine terbinafine treated patients compared with only 11  of the nine placebo treated patients  
class1	128	at the follow up examination  efficacy rates were 78  in the terbinafine treatment group and 33  in the placebo group  a difference of borderline statistical significance  p   0 077   
class1	128	possible reasons for this result may include the higher incidence of chronic disease in the terbinafine group and the large number of patients who were classified as delayed exclusions because of negative initial culture for dermatophytes  
class1	128	no side effects or significant alterations in laboratory or hematologic tests were observed in either treatment group  
class1	129	treatment of tinea cruris with topical terbinafine  
class1	129	twenty three patients were enrolled in a randomized  double blind trial of terbinafine 1  cream versus its vehicle  placebo  in the treatment of tinea cruris  
class1	129	one patient had a negative initial culture and was excluded  and two patients were dropouts  one because of poor study compliance  terbinafine  and one because of an adverse event  placebo   
class1	129	twenty patients were examined for efficacy of treatment  9 terbinafine treated  11 placebo treated   
class1	129	both groups were similar in age  sex  duration of disease  prior therapy  size and location of lesion  infecting organism  and predisposing factors  
class1	129	terbinafine 1  cream was more effective than vehicle cream in the reduction of the signs and symptoms of tinea cruris  
class1	129	in addition  there was a higher conversion rate to negative culture and normal microscopy findings in the terbinafine treated group  
class1	129	clinical results combined with evaluation of mycologic tests at end of therapy showed terbinafine to be a rapid and significantly more effective treatment for tinea cruris than placebo  78  vs 18  cure rate  respectively   
class1	129	follow up cure rates confirmed these findings  89  and 18   respectively   
class1	129	no significant adverse events occurred during terbinafine treatment  
class1	130	treatment of chronic moccasin type tinea pedis with terbinafine  a double blind  placebo controlled trial  
class1	130	terbinafine is an orally and topically active fungicidal drug of the allylamine series  
class1	130	its oral efficacy at 125 mg taken twice daily was evaluated in a randomized  double blind  placebo controlled study in moccasin type tinea pedis  
class1	130	the study was conducted simultaneously in two centers and consisted of 41 evaluable cases  23 terbinafine  18 placebo   
class1	130	mycologic cure and near to complete clearing of signs and symptoms were obtained in 59  of the terbinafine treated patients after 6 weeks of treatment and in 65  at 2 weeks after treatment  
class1	130	corresponding efficacy for placebo treated patients was zero at both evaluations  
class1	130	side effects in both groups were minimal  
class1	130	we conclude that terbinafine is well tolerated and highly effective in moccasin type tinea pedis  
class1	131	oral terbinafine versus griseofulvin in the treatment of moccasin type tinea pedis  
class1	131	the safety and effectiveness of oral terbinafine  125 mg twice daily  and griseofulvin  250 mg twice daily  in patients with moccasin type tinea pedis were examined in a double blind randomized trial  
class1	131	at the end of the 6 week treatment period  both a clinical and mycologic cure or a mycologic cure with minimal signs of infection was noted in 12  75   of the 16 terbinafine treated patients compared with only 3  27   of the 12 patients treated with griseofulvin  
class1	131	the overall response rate 2 weeks after the completion of treatment was 88  in the terbinafine treated group and 45  in the griseofulvin treated group  
class1	131	when contacted again 6 to 15 months after completion of the study  94  of the terbinafine treated patients reported sustained clearing of tinea pedis  and 88  of those with nail involvement at the time of treatment reported improvement  
class1	131	in contrast  tinea pedis remained cured in only 30  of the patients who had received griseofulvin  and onychomycosis improved in only 14   
class1	132	eosinophilic pustular folliculitis  fungal folliculitis  
class1	132	eosinophilic pustular folliculitis is a rare condition with no known cause  
class1	132	however  a fungal cause is suggested by  1  tinea like annular lesions   2  initial clinical consideration of fungal folliculitis in many reported cases   3  an association with the acquired immunodeficiency syndrome  and  4  an association with scaly and vesiculopustular lesions of palms and soles  
class1	132	we report a case histologically identical to eosinophilic pustular folliculitis but in which hyphal fungal organisms were demonstrated in one of the involved hair follicles  
class1	133	leprotic involvement of peripheral nerves in the absence of skin lesions  case report and literature review  
class1	133	in the absence of clinically apparent cutaneous lesions  primarily neural leprosy is uncommon  
class1	133	primarily neural leprosy presents clinically as a peripheral neuropathy that most frequently affects motor nerves and that occasionally involves sensory nerves as well  
class1	133	the long incubation period for leprosy and its occurrence outside endemic areas often lead to delayed diagnosis  
class1	133	we present a case of glove and stocking hypoesthesia  weakness of the flexor muscle of the right great toe  palpable thickening of the right popliteal nerve  and hypoesthetic but normal appearing areas on the back  which developed in a trinidadian immigrant who lived in canada for 16 years  
class1	133	a skin biopsy specimen obtained from a visibly normal but hypoesthetic area on the back demonstrated a few acid fast bacteria in small dermal nerves  in arrector pili smooth muscle  and in rare perivascular histiocytes  associated with a sparse mixed inflammatory cell infiltrate  
class1	133	the patient responded well to therapy with dapsone  rifampin  and clofazamine  
class1	133	a classification and review of primarily neural leprosy is presented  
class1	133	our patient represents the first reported case of primarily neural borderline lepromatous leprosy in canada  
class1	134	miliary tuberculosis presenting as skin lesions in a patient with acquired immunodeficiency syndrome  
class1	134	acute miliary tuberculosis of the skin is an extremely rare infection that occurs in immunocompromised persons  
class1	134	we report an intravenous drug abuser with human immunodeficiency virus infection in whom erythematous papules developed on the trunk and proximal aspect of the extremities  
class1	134	visceral lesions of unsuspected miliary tuberculosis were discovered at autopsy  and the cutaneous papules were found to contain mycobacterium tuberculosis  
class1	134	this is the first reported case of this cutaneous infection in a patient with the acquired immunodeficiency syndrome  
class1	135	bioaerosols  prevalence and health effects in the indoor environment  
class1	135	assessing the role of bioaerosols in residence related symptoms involves  1  determining that symptoms are related to the residence by medical examination and careful questioning   2  connecting reported symptoms with known or hypothesized effects of bioaerosols   3  examining the residence for bioaerosol risk factors such as overcrowding poor ventilation  inappropriate outdoor air intrusion  and dampness standing water   4  and finally  if no obvious risk factors are present  air sampling  
class1	135	air sampling should always be a last resort and should use a reliable volumetric method  
class1	135	particulate samplers  such as the burkard personal spore trap  are inexpensive alternatives to viable particle samplers and will provide data on most organisms implicated in hypersensitivity diseases  
class1	135	interpretation of residential bioaerosol sample data requires both qualitative and quantitative comparison with adjacent outdoor air and examination of aerosol changes related to domestic activities  
class1	135	recommendations that should lead to a decrease in indoor bioaerosols include the use of air conditioning to allow limitation of outdoor aerosols  prevention of dampness or moisture intrusion  and discouraging the use of humidifying devices other than steam  
class1	135	bioaerosol assessment in the workplace is often more complex than for residences  
class1	135	because the symptomatic subjects are not in charge of the environment  such situations often lead to difficult employee management relations and occasionally to litigation  
class1	135	it is essential that each step in workplace bioaerosol assessment be defensible and that the best possible methods are used  
class1	135	the approach is similar to the approach used for residences  but on a larger scale  
class1	135	symptom assessment must include stress and ergonomic factors  
class1	135	air sampling  if this is necessary  must usually be extensive with controls for ventilation rates  occupancy  and spatial variation  
class1	136	tuberculous peritonitis  a study comparing cirrhotic and noncirrhotic patients  
class1	136	tuberculous peritonitis is a rare disease  which often goes unrecognized because of the subtle clinical clues and its insidous onset  
class1	136	we retrospectively analyzed the records of 37 cases of tuberculous peritonitis diagnosed over a 15 year period  and compared the clinical and diagnostic features of cirrhotic and noncirrhotic patients  
class1	136	in cirrhotic patients  tuberculous peritonitis can simulate ascites from liver disease or spontaneous bacterial peritonitis  
class1	136	the diagnosis is difficult in these patients because the ascitic fluid may not be of the exudative type as a result of the low albumin level in serum  and lymphocytes do not predominate in all cases  
class1	136	adenosine deaminase  ada  activity in ascitic fluid was elevated  higher than 40 u l  in all 11 patients  four patients with hepatic cirrhosis   
class1	136	the time required to achieve a correct diagnosis was significantly longer in cirrhotic than in noncirrhotic patients  
class1	136	the overall mortality was 13   with deaths occurring exclusively among cirrhotic patients  
class1	136	we emphasize that tuberculous peritonitis in cirrhotic patients can present an atypical picture  
class1	136	a considerable element of suspicion is necessary  
class1	137	the role of human immunodeficiency virus infection in pneumococcal bacteremia in san francisco residents  
class1	137	human immunodeficiency virus  hiv  is an important risk factor for invasive pneumococcal disease  but information on clinical course and infecting serotypes is limited  
class1	137	to help develop strategies to reduce the morbidity due to invasive pneumococcal disease  episodes of pneumococcal bacteremia were identified by retrospective review of microbiology records  november 1983 november 1987  at 10 san francisco hospitals and  for patients 20 55 years old living in san francisco  hiv antibody status was determined by review of medical records  
class1	137	pneumococcal isolates from one hospital were serotyped  
class1	137	of 294 patients with pneumococcal bacteremia identified  32  11   had aids at the time pneumococcal bacteremia was diagnosed and another 43  15   were hiv infected but did not have aids  12 hiv infected patients developed aids after the episode of pneumococcal bacteremia  
class1	137	the rate of pneumococcal bacteremia in aids patients was estimated to be 9 4 1000 patient years  
class1	137	serotypes of 27  82   of 33 pneumococcal isolates from hiv infected patients and 107  90   from 119 patients without known hiv infection were among the 23 serotypes included in the currently available polysaccharide vaccine  
class1	137	the rate of pneumococcal bacteremia is approximately 100 fold greater in aids patients in san francisco than rates reported before the aids epidemic  but more than half the episodes of pneumococcal bacteremia in hiv infected patients occurred in patients without aids  
class1	137	data on pneumococcal serotypes causing invasive disease in hiv infected patients suggest that the current pneumococcal vaccine  if effective in this population  could provide significant protection against pneumococcal disease  
class1	138	monoclonal antibody to mouse lipopolysaccharide receptor protects mice against the lethal effects of endotoxin  
class1	138	specific endotoxic lipopolysaccharide  lps  binding sites on the cell membranes of murine lymphocytes and macrophages that may serve as functional receptors for lps have recently been identified using photoactivatable cross linking lps derivatives  
class1	138	a monoclonal antibody  mab 5d3  with specificity for this 80 kda protein has also been generated and characterized  
class1	138	the capacity of mab 5d3 to protect mice against the lethal effects of endotoxin was investigated  
class1	138	pretreatment of cf1 mice with as little as 15 micrograms of mab 5d3 provided virtually complete protection against a dose of endotoxin 10 fold greater than that required to kill all mice in an untreated control group using the galactosamine sensitization model  
class1	138	significant protection was also afforded normal mice given mab 5d3 relative to saline  
class1	138	several lines of evidence suggest that mab 5d3 mediated protection is due to the agonist properties of this antibody rather than a receptor blockade mechanism  
class1	139	properties of strains of escherichia coli o26 h11 in relation to their enteropathogenic or enterohemorrhagic classification  
class1	139	thirty seven strains of escherichia coli o26 h11 from infants and calves with diarrhea were examined for properties associated with enteropathogenic  epec  or enterohemorrhagic e  
class1	139	coli  ehec   
class1	139	strains were heterogeneous with respect to vero cytotoxin  vt  production and hybridization with the ehec plasmid specific  cvd419  probe  26 strains produced vt1  1 produced vt2  
class1	139	twenty four of 27 vt  strains and 5 of 10 vt  strains hybridized with the cvd419 probe and produced enterohemolysin  these properties are characteristic of ehec  
class1	139	the strains did not hybridize with the epec adherence factor probe  a property characteristic of some epec  
class1	139	nevertheless  36 strains adhered to hep 2 cells in a localized manner and were positive by the fluorescence actin staining  fas  test that is considered to correlate with the ability to cause attaching and effacing lesions in vivo  
class1	139	epec and ehec cause these lesions  
class1	139	although the fas test appeared to be the most general pathogenicity test for the o26 h11 strains  it could not be used to assign strains specifically to epec or ehec groups  
class1	140	fucosylated oligosaccharides of human milk protect suckling mice from heat stabile enterotoxin of escherichia coli  
class1	140	human milk protects suckling mice from the diarrheagenic effects of heat stabile enterotoxin of escherichia coli  st   
class1	140	to identify the human milk fraction responsible for this protection  pooled skimmed  deproteinated milk was passed through charcoal  whereupon lactose was separated from the oligosaccharides  
class1	140	the oligosaccharides contained st protective activity  the lactose did not  
class1	140	the neutral  but not the acidic  fraction exhibited protective activity against st  22  vs  
class1	140	57  mortality  respectively  p less than  001   
class1	140	the fucosylated  but not the nonfucosylated  subfractions of the neutral fraction contained the factor protective against st  35  vs  
class1	140	50  mortality  respectively  p less than  05   
class1	140	an oligosaccharide isolation scheme based on different principles produced confirmatory results  
class1	140	the commercially available neutral fucosylated oligosaccharides of human milk did not significantly protect the mice from the effects of st  
class1	140	thus  the protective factor against st seems to be a minor neutral fucosyloligosaccharide of human milk  
class1	141	platelet activating factor or a platelet activating factor antagonist decreases tumor necrosis factor alpha in the plasma of mice treated with endotoxin  
class1	141	when l platelet activating factor  paf  or alprazolam  a paf antagonist  was administered to lipopolysaccharide  lps  treated mice  the level of plasma tumor necrosis factor  tnf alpha  determined by either elisa or a cytotoxic assay using wehi cells was significantly lowered  
class1	141	the inactive stereoisomer  d paf  was not effective in lowering plasma tnf alpha levels in lps treated mice  
class1	141	the decrease in plasma tnf alpha induced by l paf or alprazolam was partly reversed by indomethacin  
class1	141	despite a decrease in plasma tnf alpha  l paf or alprazolam caused an increase in the amount of tnf alpha mrna present in the kidneys and the livers of lps treated mice  suggesting that a posttranscriptional event leading to the synthesis or release of tnf alpha was inhibited by these agents  
class1	142	protective effects of polyclonal sera and of monoclonal antibodies active to salmonella minnesota re595 lipopolysaccharide during experimental endotoxemia  
class1	142	mice were passively immunized with sera from blood donors active for rough lipopolysaccharides  lps   the j5  rc chemotype  mutant of escherichia coli o111 b4  and the re595  re chemotype  mutant of salmonella minnesota  
class1	142	all protected the mice against lethal challenge with smooth e  
class1	142	coli wf96 lps  e  
class1	142	coli and salmonella rough mutant lps  or free lipid a  
class1	142	epitopes recognized by monoclonal antibodies  mabs  reacting with the lps of s  
class1	142	minnesota re595 or lipid a were localized in the 2 keto 3 deoxy d manno octulosonic acid  kdo  region and on lipid a  
class1	142	core reactive mabs reacted with their homologous re lps and with free lipid a  
class1	142	one  gl11  cross reacted with the kdo alone  
class1	142	mabs gl6  gl11  l 4  l 6  and l 8 protected the actinomycin d sensitized mice against the lethal effects of lps from e  
class1	142	coli wf96  salmonella enteritidis  e  
class1	142	coli j5  s  
class1	142	minnesota re595  and free lipid a  
class1	142	the gl11 antibody was also protective when injected after lps challenge  
class1	142	these results indicate that antibodies directed against the core glycolipid of s  
class1	142	minnesota re595 lps may be useful as an additive form of therapy that may enable decreased mortality during gram negative bacterial sepsis  
class1	143	antimicrobial resistance of shigella isolates in the usa  the importance of international travelers  
class1	143	a nationwide sample of shigella isolates was collected and tested for resistance to 12 antimicrobial agents to assess the prevalence and epidemiologic correlates of antimicrobial resistance in shigella  
class1	143	of the isolates  32  were resistant to ampicillin  7  to trimethoprim sulfamethoxazole  and 0 4  to nalidixic acid  
class1	143	fifty  20   of 252 isolates were associated with foreign travel  
class1	143	the best predictor of clinically important resistance was a history of foreign travel  20  of isolates from foreign travelers showed trimethoprim sulfamethoxazole resistance  compared with only 4  of isolates from those without such a history  
class1	143	quinolone resistance was not identified in travel related isolates  and quinolones may be more appropriate for initial therapy of travel related shigellosis than is trimethoprim sulfamethoxazole  
class1	144	cefuroxime treatment failure of nontypable haemophilus influenzae meningitis associated with alteration of penicillin binding proteins  
class1	144	a 10 year old boy presented with nuchal rigidity and cerebrospinal fluid  csf  leukocytosis initially and again on day 6 of intravenous cefuroxime therapy  200 mg kg day   
class1	144	both csf specimens yielded nontypable beta lactamase negative haemophilus influenzae that were susceptible by disk tests but relatively resistant to cefuroxime  mic  8  to 16 fold greater than that of control isolates   
class1	144	to define the mechanism of resistance  the cefuroxime resistance marker was transformed to a susceptible h  
class1	144	influenzae recipient  inactivation and permeability of beta lactam substrate were tested and the penicillin binding protein  pbp  profiles were examined  
class1	144	inactivation of beta lactam substrate was not detected and reduced permeability was not found  
class1	144	however  reduced beta lactam binding to pbps 4 and 5 was observed  18  to 27 fold more penicillin and 2 5 to 4 fold more cefuroxime was required to saturate or block 50  of the binding sites of these pbps  respectively  
class1	144	thus  reduced affinity of pbps 4 and 5 for beta lactam substrate appears to be the mechanism of cefuroxime resistance in this strain  
class1	144	the reduced affinity of these targets appears to have contributed to the bacteriologic and clinical failure in this patient  
class1	145	prevention of catheter associated urinary tract infection with a silver oxide coated urinary catheter  clinical and microbiologic correlates  
class1	145	in a prospective clinical trial involving 482 acutely hospitalized patients  the overall incidence of catheter associated urinary tract infection  uti  10   was similar in recipients of a silver oxide coated urinary catheter  silver catheter  or a control silicone catheter  
class1	145	however  female sex and absence of antimicrobial use were independently associated with an increased risk of uti  
class1	145	after stratification for these variables  the silver catheter reduced the incidence of uti among women not receiving antimicrobial agents  19  for control catheter vs  
class1	145	0 for silver catheter  p    04  confidence interval for the difference in incidence  0 4  38   but not in the other subgroups  
class1	145	gram positive uti was associated with absence of antimicrobial use  the control catheter  and catheter care violations  
class1	145	gram negative and candidal utis were more common after 7 days of catheterization  and candidal uti was associated with being female and antimicrobial use  
class1	145	these findings demonstrate that several clinical variables influenced the incidence and microbiology of catheter associated uti and that the silver catheter appeared to prevent uti among women not receiving antimicrobials  
class1	146	restriction endonuclease analysis of total cellular dna of aspergillus fumigatus isolates of geographically and epidemiologically diverse origin  
class1	146	no typing system exists for aspergillus fumigatus  though isolates are distinguishable by phenotypic characteristics  
class1	146	dna was prepared by lysis of protoplasts  followed by deproteination  phenolchloroform extraction  and dialysis  
class1	146	dna prepared was of uniform size and exceeded 60 kb  
class1	146	after digestion with sali and xhoi endonucleases  dna was electrophoresed  stained  and photographed  
class1	146	differences in the mobilities of 10  to 50 kb bands distinguished isolates  
class1	146	reproducibility was shown by repeated preparations and animal passage  
class1	146	by use of a proposed notation system for describing restriction fragment length polymorphism patterns  31 epidemiologically characterized isolates from three continents revealed 24 patterns  dna types   
class1	146	three dna types were represented by 3 isolates each and 1 dna type by 2 isolates  20 types were unique  
class1	146	two groups of 3 isolates of the same dna type were from stanford university hospital  
class1	146	one patient isolate from stanford was the same dna type as a sewage isolate from new jersey  
class1	146	another stanford isolate was the same as a german isolate  
class1	146	these observations indicate widespread dispersal of some clones and restricted locales for others  
class1	146	paired isolates from airway fluids of three patients had two dna types in each  
class1	146	restriction endonuclease typing shows promise for investigating the epidemiology and ecology of a  
class1	146	fumigatus  
class1	147	coccidioidomycosis in human immunodeficiency virus infected patients  
class1	147	coccidioidomycosis is at best a complicated fungal infection  often it is life threatening  
class1	147	coccidioidomycosis is confined epidemiologically to the southwestern region of the usa  and most cases have occurred in that area  particularly in arizona  
class1	147	however  we have seen several cases in san francisco in patients with only a history of travel to endemic areas  
class1	147	in part because of its regional distribution  information about the clinical presentation  diagnosis  and treatment of patients with coccidioidomycosis has lagged behind information about other  more commonly encountered aids associated opportunistic infections  
class1	147	drs  
class1	147	galgiani and ampel have probably had the largest single experience with coccidioidomycosis in individuals infected with the human immunodeficiency virus  
class1	147	these specialists share their experience and make recommendations as to how these complicated conditions should be approached  
class1	148	detection of interleukin 3 in the serum of mice infected with mycobacterium lepraemurium  
class1	148	infection of mice by mycobacterium lepraemurium is accompanied by ablation of erythropoiesis in the bone marrow and gross enlargement of the spleen  
class1	148	this  together with increased monocytopoiesis and the earlier demonstration of macrophage colony stimulating factor in the serum of infected mice  suggested the activity of additional cytokines  
class1	148	eight weeks after infection of mice by m  
class1	148	lepraemurium  interleukin 3  il 3  activity was demonstrated in the serum  titer  1 3200   
class1	148	the serum titer of il 3 activity was maximal after 13 weeks  greater than 1 6400  and was slightly reduced after 18 weeks  1 6400   
class1	148	that the il 3 activity detected in the serum of the m  
class1	148	lepraemurium infected mice reflected the presence of il 3 itself was confirmed by a neutralization assay using anti murine il 3 antibodies  il 3 activity in the serum of mice 13 weeks after infection was completely abolished by the anti il 3 antibodies  
class1	148	finally  a 1 kb signal of il 3 rna was detected in the spleens of m  
class1	148	lepraemurium infected mice 13 weeks after infection  
class1	149	partial characterization of chlamydia trachomatis isolates resistant to multiple antibiotics  
class1	149	in vitro susceptibility testing was done on urogenital isolates of chlamydia trachomatis from five patients  four of whom were suspected treatment failures  
class1	149	at least one isolate from each patient was resistant to tetracycline at concentrations greater than or equal to micrograms ml  although less than 1  of a population of organisms showed high level resistance  
class1	149	fully resistant populations selected by passage through 8 micrograms ml tetracycline either died or lost their resistance on further passage in antibiotic free medium  
class1	149	relatively large inocula were required to demonstrate resistance  and morphology of inclusions was altered at high tetracycline concentrations  
class1	149	the observed resistance may be a new characteristic of the organism or merely newly recognized  
class1	149	isolates resistant to tetracycline were resistant to doxycycline  erythromycin  sulfamethoxazole  and clindamycin but sensitive to rifampin  ciprofloxacin  and ofloxacin  
class1	149	thus  resistance to tetracycline  erythromycin  and clindamycin occurs in c  
class1	149	trachomatis and may be a factor in some treatment failures  
class1	150	bacterial meningitis in the united states  1986  report of a multistate surveillance study  the bacterial meningitis study group  
class1	150	a prospective  laboratory based surveillance project obtained accurate data on meningitis in a population of 34 million people during 1986  
class1	150	haemophilus influenzae was the most common cause of bacterial meningitis  45    followed by streptococcus pneumoniae  18    and neisseria meningitidis  14    
class1	150	rates of h  
class1	150	influenzae meningitis varied significantly by region  from 1 9 100 000 in new jersey to 4 0 100 000 in washington state  
class1	150	the overall case fatality rates for meningitis were lower than those reported in several studies from the early 1970s  suggesting that improvements in early detection and antibiotic treatment may have occurred since that time  
class1	150	concurrent surveillance was also performed for all invasive disease due to the five most common causes of bacterial meningitis  
class1	150	serotypes of group b streptococcus other than type iii caused more than half of neonatal group b streptococcal disease and mortality  suggesting that an optimal vaccine preparation must be multivalent  
class1	150	of the organisms evaluated  group b streptococcus was the second most common cause of invasive disease in persons greater than 5 years old  
class1	151	a large outbreak of antibiotic resistant shigellosis at a mass gathering  
class1	151	in july 1987  a large outbreak of shigellosis occurred among attendees at a mass gathering in a national forest  the annual rainbow family gathering  
class1	151	sanitation in the campsite was poor  allowing widespread transmission of disease  probably by food  water  and person to person spread  
class1	151	the attack rate may have been greater than 50  among the estimated 12 700 attendees  
class1	151	the outbreak was caused by shigella sonnei  resistant to ampicillin  tetracycline  and trimethoprim sulfamethoxazole  the organism was of colicin type 9 and contained a 90 kilobase plasmid not found in non outbreak related strains  
class1	151	the dispersal of the group resulted in nationwide dissemination of the organism  and outbreaks in three states were linked to transmission from attendees at the gathering  
class1	151	this outbreak demonstrates the potential for rapid dissemination of disease in such a setting and the necessity for careful planning of mass gatherings  
class1	152	quantitation of tamm horsfall protein binding to uropathogenic escherichia coli and lectins  
class1	152	in quantitative experiments using elisa  binding of tamm horsfall protein  thp  to uropathogenic escherichia coli was studied with monoclonal antibody to thp  
class1	152	adherence to e  
class1	152	coli bearing type 1 fimbriae was proportional to thp concentration and size of the bacterial inoculum  
class1	152	type 1 fimbriae bearing e  
class1	152	coli bound 50 times more thp than did non type 1 fimbriated or p fimbriated strains  
class1	152	concanavalin a and wheat germ agglutinin bound thp in a dose dependent fashion  whereas pokeweed mitogen and vicia villosa b4 isolectin did not  
class1	152	addition of mannose and n acetylglucosamine reduced adherence of thp to concanavalin a and wheat germ agglutinin by 50  80   
class1	152	sugar inhibition studies suggested that the fimbrial receptor site for thp has lectin like properties and that thp binds to fimbriae via its mannose side chains  
class1	152	this quantitative assay is useful for studying the interaction between thp  uroepithelial cells  and bacteria in vitro  
class1	153	prevalence and diagnosis of legionella pneumonia  a 3 year prospective study with emphasis on application of urinary antigen detection  
class1	153	during a 3 year period the frequency of legionellosis in hospitalized patients with community acquired and nosocomial pneumonias was 3 4   23 684 cases  and 5 9   33 559   respectively  
class1	153	of the diagnostic tests evaluated  detection of legionella pneumophila serogroup 1 antigen in urine had the highest sensitivity  with 86  of culture proven cases being positive  
class1	153	sensitivities of serologic tests and examination of respiratory secretions  culture and direct immunofluorescence  were 36  and 26   respectively  
class1	153	the diagnostic value of serology and of examination of respiratory secretions can be low when specimens are obtained and processed under the typical conditions of hospitalization  
class1	153	urinary antigen detection represents an important diagnostic addition  and examination of postmortem lung tissue from fatal cases with pneumonia is an important adjunct for estimating the prevalence of legionellosis and for assessing the effectiveness of premortem diagnostic tests  
class1	154	tumor necrosis factor alpha plays a role in host defense against histoplasma capsulatum  
class1	154	tumor necrosis factor alpha was detected in supernatants collected from balb c mouse peritoneal macrophages incubated continuously with histoplasma capsulatum  
class1	154	the levels of tnf alpha measured by actinomycin d bioassay peaked within hours after exposure and then greatly declined by 24 h  
class1	154	tnf alpha was also measured in bronchoalveolar lavage fluid from balb c mice challenged intranasally with h  
class1	154	capsulatum  
class1	154	lavage fluid tnf alpha levels exhibited the same pattern as the in vitro supernatants  they peaked within hours after challenge and lower levels were detected at 24 h  
class1	154	treatment of mice with anti tnf alpha antibody accelerated mortality in response to systemic infection and significantly increased tissue colony counts in the liver and spleen  
class1	154	in the murine model  tnf alpha is produced in response to h  
class1	154	capsulatum and appears to play some role in host defense to infection  
class1	155	bacterial infections in patients with visceral leishmaniasis  
class1	155	bacterial infections are often seen in patients with visceral leishmaniasis  
class1	155	to determine the incidence of such infection and the more common infectious agents  30 consecutive patients with visceral leishmaniasis were followed throughout hospitalization  
class1	155	there were 24 episodes of bacterial infection in 18 patients  60    
class1	155	the incidence of bacterial infections in these patients was 22 2 1000 days of admission  
class1	155	the proportion of patients becoming infected by time was significantly greater in the visceral leishmaniasis group than in controls  p less than  01   
class1	155	the skin  respiratory tract  and middle ear were the most common sites of infection  and pseudomonas aeruginosa and staphylococcus aureus were the most common agents  
class1	155	low grade virulence bacteria  e g   serratia and providencia species  were also isolated from some cases  
class1	155	bacterial infections  mainly nosocomial  in patients with visceral leishmaniasis tend to be severe and can cause death  
class1	155	when bacterial infection is suspected in these patients  empiric antibiotic therapy should be started immediately  including coverage for p  
class1	155	aeruginosa and s  
class1	155	aureus  after appropriate diagnostic procedures are taken  
class1	156	confocal microscopic detection of human immunodeficiency virus rna producing cells  
class1	156	a central anomaly in the pathogenesis of aids is that few actively infected cd4  cells  1 in 10 4  10 5  have been detected in the peripheral blood  even though dramatic depletion  often greater than 90   of cd4  cells is the hallmark of disease progression  
class1	156	a sensitive  35s based human immunodeficiency virus  hiv  rna in situ hybridization technique was coupled with a new detection method  confocal laser scanning microscopy  to examine transcriptionally active hiv infected cells from individuals at different disease stages  
class1	156	in 35 symptomatic hiv infected individuals  aids and aids related complex   an average of 1 in 350 mononuclear cells produced hiv rna  
class1	156	in contrast  in an asymptomatic group of 30 individuals  an average of 1 in 2000 mononuclear cells produced hiv rna  
class1	156	these data  obtained using this improved detection method  suggest there are more hiv rna producing cells in hiv infected individuals than previously reported  
class1	156	in addition  increased numbers of hiv transcribing cells were found to correlate with declining clinical condition as assessed by karnofsky performance score  
class1	156	these data suggest that viremia per se may account for the pathologic consequences in hiv infection  
class1	157	transmission of chlamydia pneumoniae in young children in a japanese family  
class1	157	chlamydia pneumoniae strain twar was isolated from the respiratory tract of a 5 year old girl suffering from pneumonia  
class1	157	the igm and igg antibody titers to twar were 1 32 and 1 128  respectively  
class1	157	cultures and serology for other common bacterial and viral respiratory pathogens were negative  
class1	157	although she was treated with 35 mg kg day rokitamycin  twar was repeatedly isolated after treatment  
class1	157	her 3 year old sister developed acute bronchitis  and twar was isolated from her nasopharynx  
class1	157	she was treated with 43 mg kg day erythromycin with prompt improvement  and twar was not isolated after treatment  
class1	157	although her mother  grandmother  and 8 month old sister suffered from respiratory illness during these periods  twar was not isolated from them  
class1	157	the repeated isolations from the index patient suggest that infection was transmitted from sister to sister  
class1	157	this case represents the first reported isolation of twar from young children in the same household and the first from japan  
class1	158	pilot trial of selective decontamination for prevention of bacterial infection in an intensive care unit  
class1	158	selective decontamination of the oropharynx and gastrointestinal tract with nonabsorbable antimicrobials and sucralfate  a stress ulcer prophylactic that maintains the normal gastric acid bacterial barrier  were compared for prevention of pneumonia in a cardiac surgery intensive care unit  
class1	158	over 8 months  51 patients received selective decontamination and 56 received sucralfate  
class1	158	the selective decontamination regimen included polymyxin  gentamicin  and nystatin given as an oral paste and as a solution  patients also received standard antacid or histamine2 blocker stress ulcer prophylaxis  
class1	158	patients in the selective decontamination group had significantly less colonization of the oropharynx and stomach by gram negative bacilli  12  vs  
class1	158	55   p less than  001   significantly fewer infections due to gram negative bacilli  6  vs  
class1	158	20   p    02   and fewer infections overall  12  vs  
class1	158	27   p    04   
class1	158	there was one episode of pneumonia in the selective decontamination group and five in the sucralfate group  
class1	158	mortality and length of stay did not differ between the groups  but those receiving selective decontamination had less than one third as many days of systemic antibiotic therapy with no increase in colonization or infection with resistant gram negative bacilli  
class1	158	thus  selective decontamination appeared to reduce both extrapulmonary and pulmonary infections  
class1	159	occurrence of secondary attenuating mutations in avirulent salmonella typhimurium vaccine strains  
class1	159	the attenuating delta aroa554 mutation in salmonella typhimurium strain sl3261 was complemented in vitro by selecting for aroa  recombinant dna clones  
class1	159	sl3261 containing cloned aroa  genes did not require exogenous phenylalanine  tryptophan  tryosine  p aminobenzoic acid  or dihydroxybenzoic acid for growth in defined media  
class1	159	cloned aroa  genes did not restore wild type virulence to sl3261  however  in a murine typhoid model  
class1	159	the delta aroa554 mutation was transduced into s  
class1	159	typhimurium strain sr 11  a mouse virulent strain recently passaged in mice  
class1	159	the sr 11 delta aroa554 mutant was highly attenuated for mice challenged parenterally  
class1	159	the same cloned aroa  genes isolated in sl3261 restored the virulence of the sr 11 delta aroa554 mutant to that of wild type sr 11  
class1	159	these results suggest that while the delta aroa554 allele remains effective in reducing s  
class1	159	typhimurium virulence  laboratory passage of attenuated vaccine strains may lead to the accumulation of additional attenuating defects  
class1	160	nasal carriage of staphylococcus aureus  correlation with hormonal status in women  
class1	160	in view of recent observations on hormone microorganism interactions  a study of staphylococcus aureus nasal carriage in relation to sex hormone status was undertaken  
class1	160	prospectively in 479 women attending a colpocytologic clinic  hormonal status was assessed by determining the karyopyknotic index  ki  on smears stained by the papanicolaou method  
class1	160	rates of s  
class1	160	aureus nasal carriage were 29 3  in premenopausal women and 21 9  in postmenopausal women  p not significant   
class1	160	carriage rates were significantly higher  p    026  chi 2 7 32  for women with high kis  40 7   than for those with intermediate and low kis  27 03  and 25 1   respectively   
class1	160	s  
class1	160	aureus nasal carriage also correlated independently and significantly with previous antibiotic use and the presence of insulin treated diabetes mellitus  
class1	160	this preliminary observation confirms an association between levels of sex hormones as reflected by the ki and s  
class1	160	aureus nasal carriage rates  
class1	161	treatment evaluation of experimental staphylococcal infections  comparison of beta lactam  lipopeptide  and glycopeptide antimicrobial therapy  
class1	161	ly 146032  teicoplanin  vancomycin  oxacillin  cephalothin  cefamandole  ampicillin plus sulbactam  and cefoperazone plus sulbactam were studied against six isolates of staphylococci  including both staphylococcus aureus and coagulase negative staphylococci  using in vivo and in vitro methods  
class1	161	in vitro susceptibility measurements demonstrated that all six isolates were sensitive to ly 146032 and vancomycin and that five of six isolates were sensitive to tiecoplanin  cefamandole  ampicillin plus sulbactam  and cefoperazone plus sulbactam  
class1	161	comparison of antimicrobial therapy in an in vivo rabbit model demonstrated that cefoperazone plus sulbactam was active against the greatest number of isolates  five of six  based on a reduction of greater than or equal to 5 0 log10 colony forming units per milliliter  cfu ml  from growth control at the end of the animal treatment study  
class1	161	vancomycin and oxacillin were equal in achieving reductions of greater than or equal to 5 0 log10 cfu ml in four of the six isolates  
class1	161	comparing each isolate s in vivo outcome to in vitro data shows that in vitro susceptibility tests overpredict the sensitivity of these six isolates to ly 146032 and vancomycin  are variable for teicoplanin  cefamandole  ampicillin plus sulbactam  and cefoperazone plus sulbactam  and underpredict for oxacillin  
class1	162	a  silent  intracranial complication of frontal sinusitis  
class1	162	intracranial complications of frontal sinusitis  although rare today  do still develop despite widespread use of antibiotics  
class1	162	we report a case which demonstrates how silently a frontal lobe abscess may present with subtle changes in mood and behaviour  with no focal neurological signs  
class1	162	diagnosis and management are discussed and a brief review of the incidence of intracranial complications of frontal sinusitis  mode of spread  clinical presentation  investigations  treatment and bacteriology is presented  
class1	163	rhinosporidiosis associated with squamous cell carcinoma in the tongue  
class1	163	the peritumoural region of a squamous cell carcinoma of the tongue when examined with light and electron microscope showed nodular bodies in the submucosa with all the distinctive features of  sporangium and  spores  of rhinosporidiosis  
class1	163	the occurrence of rhinosporidiosis in the tongue along with malignancy has not been reported hitherto  
class1	163	some interesting observations and causal relationships are discussed  
class1	164	another hazard of ear syringing  malignant external otitis  
class1	164	a case of malignant external otitis is presented  
class1	164	this occurred in a healthy 72 year old non diabetic  non immuno compromised man after ear syringing  
class1	164	the infection was treated with oral ciprofloxacin for eight weeks with complete resolution  
class1	165	adult immunization in a network of family practice residency programs  
class1	165	a substantial proportion of morbidity and mortality associated with vaccine preventable diseases occurs among adults  
class1	165	teaching residents about disease prevention is mandated in the curriculum guidelines for family practice programs  
class1	165	a cooperative study among the kansas city family practice residency programs was begun to look at immunization behaviors in these teaching programs  
class1	165	a retrospective audit of medical records and a prospective survey of residents and faculty were performed  
class1	165	from the medical records of 400 patients seen for health maintenance examinations  the frequency of tetanus diphtheria immunizations recorded was 4 75   
class1	165	the pooled immunization rate recorded for pneumococcal vaccine was 25   and for influenza vaccine  24   
class1	165	although 93  of respondents knew patients need tetanus diphtheria immunization every 10 years  on a written questionnaire giving clinical examples  they were less likely to elect to immunize older patients eligible for tetanus diphtheria vaccine  
class1	165	the following immunization criteria were listed by respondents  for pneumococcal vaccine  age over 65 years  86    for influenza vaccine  age over 65 years  85    chronic diseases  69    residence in a chronic care facility  7    and being a health care worker  28    
class1	165	educational interventions stressing the appropriate criteria and involvement of the patient are planned at the separate programs  
class1	166	causes of death in hospitalized intravenous drug abusers  
class1	166	the authors reviewed at autopsy the causes of death of 274 patients with evidence of intravenous drug abuse who had been admitted to a large public hospital  
class1	166	there were 127 who died from diseases unrelated to intravenous drug abuse  and in 41  of these  chronic alcoholism was implicated  
class1	166	deaths from overdose syndromes and drug related organ pathology comprised only 11  of all cases  
class1	166	the mean age at death was 39 years  
class1	166	there was a male female ratio of 3 6 1  
class1	166	half of all patients died from infection  72 from acquired immunodeficiency syndrome  aids  alone  
class1	166	these findings indicate that persons hospitalized with a history of intravenous drug abuse usually die from causes other than overdose and that aids and chronic alcoholism are significant problems  
class1	166	emphasis should be placed upon detecting  hidden  intravenous drug deaths to provide more accurate statistical information  
class1	167	early hospital discharge of children with cancer treated for fever and neutropenia  identification and management of the low risk patient  
class1	167	children with leukemia and solid tumors are often hospitalized for empiric broad spectrum antibiotic therapy because of fever during periods of chemotherapy induced neutropenia  
class1	167	conventional practice dictates that parenteral antibiotics be continued until the patient is afebrile and has recovered from neutropenia  ie  until the absolute neutrophil count  anc  exceeds 500 cells per cubic millimeter  
class1	167	however  the practice in our center has been to discontinue parenteral antibiotic therapy and discharge many such patients before resolution of neutropenia  
class1	167	since the feasibility and safety of this approach has not been studied  we reviewed the records of 114 consecutive hospitalizations for fever and neutropenia in 61 patients during a 13 month period  
class1	167	seventy seven children  68   were discharged to their homes while still neutropenic after they had been afebrile for 1 to 2 days on parenteral antibiotics  had negative blood cultures  appeared well  and usually had some evidence of bone marrow recovery  
class1	167	five patients  4 4   developed recurrent fever and required rehospitalization within 7 days of discharge  
class1	167	only three of the 77 patients  3 9   who were sent home with neutropenia had recurrent fever  
class1	167	each had a brief and uneventful second hospitalization  
class1	167	two of the 37 children discharged with an anc over 500 cells per cubic millimeter required rehospitalization  
class1	167	a declining anc and advanced malignancy were risk factors in predicting recurrence of fever following discharge  
class1	167	a rising monocyte count was a predictor of imminent recovery from neutropenia  
class1	167	these results suggest that  early  discharge of an afebrile yet still neutropenic patient is safe when the patient is in remission  has no evidence of serious infection  appears clinically stable  and has indications of bone marrow recovery  
class1	167	the conventional approach of routinely continuing the hospitalization until resolution of neutropenia may be unnecessary in such low risk patients  
class1	168	subarachnoid hemorrhage caused by a fungal aneurysm of the vertebral artery as a complication of intracranial aneurysm clipping  case report  
class1	168	intracranial aneurysms are an uncommon manifestation of fungal infection  
class1	168	a case is described in which the formation of an aneurysm followed an intracranial intraoperative aspergillus infection attributable to a long period of preoperative antibiotic medication and immunosuppressive therapy with steroids  
class1	169	adult immunizations  are they worth the trouble  
class1	169	there are good data to recommend routine use of vaccines against measles  rubella  tetanus  influenza  and pneumococcal infections in adults  
class1	169	an adolescent or an adult born after 1956 is considered to be susceptible to measles unless he or she has received two doses of live measles vaccine or has suffered a physician diagnosed case of measles  
class1	169	tetanus is largely a disease of the elderly  and there is a universal need for immunizations with tetanus toxoid  
class1	169	influenza continues to be a major public health problem  and influenza vaccine should be given annually to the elderly and to those at high risk  
class1	169	the efficacy of pneumococcal vaccine in american adults is still being debated  
class1	169	results from case control studies show that the vaccine is about 60  effective in reducing the incidence of disease due to vaccine related strains  
class1	169	its use in the elderly and in those at higher risk for pneumococcal infection is recommended  
class1	170	gunshot injuries to the hip and abdomen  the association of joint and intra abdominal visceral injuries  
class1	170	a retrospective review of all gunshot injuries to the hip at our medical center over a 24 year period was performed  
class1	170	adequate information and radiographs were available for 49 patients  
class1	170	of these  five patients  10 2   had associated abdominal visceral injuries  
class1	170	these five patients were examined at an average of 5 9 years after their injury  and compared by utilizing the harris hip score rating  
class1	170	radiographs were also obtained  
class1	170	four of these five patients  80   had initially developed infections in their hip joints  with all four having poor functional outcomes  with an average harris hip score of 48 5 from their hip injury  
class1	170	careful initial evaluation and aggressive surgical and antibiotic treatment are recommended to prevent these poor results  
class1	171	clinical course and pharmacokinetics following a massive overdose of amphotericin b in a neonate  
class1	171	amphotericin is the drug of choice for the treatment of fungal infections in infants and children  
class1	171	when used in the recommended doses  amphotericin therapy is associated with high rates of adverse effects  including nephrotoxicity  hepatotoxicity  decrease in white blood cells  platelets and hemoglobin  chills  fever and even death  1   
class1	171	we report a case involving a neonate who was exposed to a 50 fold overdose of amphotericin over a three day period  
class1	172	fatal sepsis following intravesical bacillus calmette guerin administration for bladder cancer  
class1	172	intravesical administration of bacillus calmette guerin has been shown to be highly effective treatment of superficial bladder cancer  
class1	172	complications from bacillus calmette guerin therapy are usually minor but serious and even fatal reactions can occur  
class1	172	five recent cases illustrate the gravity of bacillus calmette guerin sepsis  
class1	172	one man with severe debility and the organic brain syndrome died acutely with a fever of 40 c  
class1	172	two men had frank sepsis that progressed to multiorgan failure and death  
class1	172	sepsis progressed despite the use of isoniazid  rifampin and streptomycin  
class1	172	two men who had equally progressive sepsis with intravesical bacillus calmette guerin survived with the use of cycloserine for the first 72 hours of treatment  
class1	172	triple antituberculous antibiotics  including cycloserine  may be lifesaving  
class1	172	sepsis resulted from intravenous absorption through inflamed or disrupted urothelium  
class1	172	bacillus calmette guerin treatment should not be administered in the presence of severe cystitis or after grossly traumatic catheterization  
class1	173	fatal disseminated mycobacterial infection following intravesical bacillus calmette guerin  
class1	173	we describe a fatal case of disseminated mycobacteriosis after intravesical bacillus calmette guerin immunotherapy  
class1	173	we summarize the prior safety record of this therapeutic modality  discuss local and systemic pathophysiological mechanisms by which dissemination might have occurred  and review the reported clinical experience with antituberculous chemotherapy for significant bacillus calmette guerin infection  
class1	173	finally  we offer suggestions for prophylaxis of certain patients with a history of exposure to intravesical bacillus calmette guerin  
class1	174	disseminated histoplasmosis with embolic endovascular complications  a case report  
class1	174	a 57 year old man had subacute embolic ischemia of his right foot and subsequent acute embolic ischemia of his left foot after angiography  
class1	174	thrombus removed at the time of the left femoral thromboembolectomy grew histoplasma capsulatum confirming the diagnosis of disseminated histoplasmosis  
class1	174	surgical revascularization of the right leg and parenteral amphotericin b was followed by chronic ketoconazole therapy for 16 months  
class1	174	the patient has remained asymptomatic at 30 months after operation  
class1	174	effective treatment of endovascular infection with ischemic complications of histoplasmosis requires surgical revascularization and intensive chemotherapeutic intervention  
class1	174	histoplasmosis is a ubiquitous infection in endemic areas that often has an asymptomatic subclinical course  
class1	174	involvement of the cardiovascular system is rarely reported  
class1	174	previous case reports have described infected cardiac valves and aortic aneurysms  
class1	174	this report describes the uncommon presentation of disseminated histoplasma capsulatum infection as a peripheral embolic event and the successful management with revascularization combined with systemic amphotericin b followed by ketoconazole therapy  
class1	175	association of group c beta hemolytic streptococci with endemic pharyngitis among college students 
class1	175	throat cultures were performed throughout 2 school years to determine whether non group a beta hemolytic streptococci  nga bhs  could be isolated more frequently in 232 college students who had symptomatic pharyngitis than from 198 age matched controls with noninfectious problems  
class1	175	duplicate throat swabs were inoculated onto plates that contained sheep blood agar  one plate being incubated in a 5  co2 atmosphere and the other in an anaerobic environment  
class1	175	the bhs were grouped using latex agglutination  
class1	175	among the nga bhs  only those from group c were isolated significantly more often among the patients compared with the controls  26  vs 11    
class1	175	quantitative colony counts of isolates of group c bhs were generally higher among patients than controls  
class1	175	patients with group c bhs had fever  exudative tonsillitis  and anterior cervical adenopathy significantly more frequently than did patients who had throat cultures that were negative for group c bhs  
class1	175	group c bhs were epidemiologically associated with endemic pharyngitis in this college student population  
class1	176	positive lyme serology in subacute bacterial endocarditis  a study of four patients  
class1	176	lyme borreliosis is a multisystem inflammatory disorder caused by the tick borne spirochete borrelia burgdorferi  
class1	176	clinical manifestations are protean  involving the skin  joints  peripheral and central nervous systems  and the heart  
class1	176	however  the presentation of lyme disease often overlaps with that of other conditions  
class1	176	we describe four patients from a region endemic for lyme disease who had elevated levels of antibodies reactive to b burgdorferi and whose signs and symptoms were initially attributed to lyme borreliosis but whose subsequent blood cultures established a diagnosis of nonspirochetal subacute bacterial endocarditis  
class1	176	although immunoblots on serum samples from three of the four patients were consistent with prior infection from b burgdorferi  a positive immunoblot does not establish active infection  
class1	176	similarly  seropositivity to b burgdorferi only indicates possible exposure to this organism  
class1	176	the occurrence of positive serologies to b burgdorferi in the presence of other diseases can lead to diagnostic confusion  
class1	177	effect of short term intermittent antibiotic treatment on growth of burmese  myanmar  village children  
class1	177	to test the hypothesis that subclinical enteric infection  such as bacterial overgrowth   rice malabsorption  and growth faltering are causally linked  a field trial of low dose  short term  intermittent antibiotic treatment was carried out in 142 hydrogen producing  by lactulose breath hydrogen test  burmese village children aged 6 59 months  
class1	177	the children were randomly allocated treatment with metronidazole  20 mg kg or 5 mg kg daily   amoxycillin  25 mg kg daily   or placebo given 1 week per month for 6 months  
class1	177	a cooked rice meal breath hydrogen test was done to classify the children as rice absorbers  ra  or rice malabsorbers  rm  before treatment and monthly on the day before each cycle of treatment  
class1	177	there were no differences between the treatment groups  so they were considered together  
class1	177	factorial analysis showed that antibiotic treatment did not significantly affect the proportion of rm children  
class1	177	the only significant difference between antibiotic treated and placebo treated children s growth was in the subgroup of rm children aged 36 47 months  the antibiotic treated children had significantly greater linear growth  
class1	177	in other age groups antibiotic treatment had no effect on growth  
class1	178	person to person transmission of pseudomonas cepacia between patients with cystic fibrosis  
class1	178	ribotyping  a method of strain identification based on analysis of bacterial genomic restriction fragment length polymorphisms  was used to investigate the acquisition of pseudomonas cepacia by a patient with cystic fibrosis  
class1	178	analysis of isolates recovered from the index patient and his contacts showed person to person transmission of this opportunist organism  
class1	178	this documentation of the transmission of p cepacia from one cystic fibrosis patient to another suggests that measures to limit the acquisition of the pathogen by patients with cystic fibrosis may be worth while  
class1	179	buruli ulcer in benin 
class1	179	in a study of 28 patients with mycobacterium ulcerans infection  buruli ulcer  in oinhi  benin  it became clear that the disease can regress as well as progress  and that patients can have lesions of different stages simultaneously  
class1	179	a system of disease staging was introduced  i   subcutaneous nodule  ii   cellulitis  iii   ulceration  iv   scar formation   
class1	179	research to find an effective treatment for this crippling disease is urgently needed  
class1	180	impact of active immunisation against enteritis necroticans in papua new guinea  
class1	180	enteritis necroticans  known locally as pigbel  has been a major cause of illness and death among children in the highlands of papua new guinea  
class1	180	after a successful trial of active immunisation against the beta toxin of the causative organism  clostridium perfringens type c  immunisation of children was begun in 1980  
class1	180	the effects of the immunisation programme on pigbel admissions in 3 of the 5 major highland hospitals were assessed  
class1	180	in each of the centres studied the proportion of admissions due to enteritis necroticans dropped significantly after immunisation was introduced  p less than 0 001  and hospital admissions for pigbel in 1984 86  when immunisation was well established  were less than one fifth of previous figures  
class1	181	changing epidemiology of group a streptococcal infection in the usa  
class1	181	to see whether changes in the epidemiology of group a streptococcal disease in the usa have been accompanied by a corresponding change in serotype distribution  epidemiological and m typing and t typing data for 5193 strains sent to the centers for disease control  atlanta  between 1972 and 1988 were analysed  
class1	181	the proportions of m types 1  3  and 18 increased significantly during the study period  
class1	181	these m types were more likely to be invasive  to cause fatal infection  and to occur in a cluster of infections than were other types  
class1	181	by contrast  the proportions of m types 4 and 12 decreased  they were less invasive and were less likely to be found in clusters than were other types  
class1	181	these data suggest that changes in the epidemiology of group a streptococcal disease may be related to changes in the distribution of m types causing infection  
class1	182	value of antigen detection in predicting invasive pulmonary aspergillosis 
class1	182	two elisas were used to detect serum and urinary aspergillus antigen in 121 patients who were profoundly neutropenic after leukaemia therapy or bone marrow transplantation  
class1	182	the presence of antigen correctly predicted development of invasive pulmonary aspergillosis  ipa  in 16 patients  
class1	182	in 2 other cases antigen appeared after the clinical diagnosis had been made  while in only 1 case was antigen not detected  
class1	182	in 11 of 13 episodes of clinically suspected fungal infection antigen was detected before clinical diagnosis was made  
class1	182	by contrast  antigen was detected in only 1 of 90 patients who had no evidence of ipa  
class1	182	both elisas gave positive and negative predictive values for ipa of greater than 95   demonstrating the value of antigen detection in early diagnosis of aspergillus infection and the assay s ability to predict subsequent development of ipa  
class1	182	we conclude that neutropenic patients should be screened for aspergillus antigen  and propose that initial detection of fungal antigen justifies commencement of empirical antifungal therapy  
class1	182	such an approach should improve the survival of patients who are at risk of developing this usually fatal infection  
class1	183	infective dermatitis of jamaican children  a marker for htlv i infection 
class1	183	in jamaican children infective dermatitis is a chronic eczema associated with refractory nonvirulent staphylococcus aureus or beta haemolytic streptococcus infection of the skin and nasal vestibule  
class1	183	14 children between the ages of 2 and 17 years with typical infective dermatitis  attending the dermatology clinic at the university hospital of the west indies in jamaica  were tested for antibody to human t lymphotropic virus type 1  htlv 1   
class1	183	all were seropositive  whereas 11 children of similar age with atopic eczema were all negative  
class1	183	in 2 of 2 cases of infective dermatitis  the biological mother was htlv 1 seropositive  
class1	183	none of the 14 patients showed signs of adult t cell leukaemia lymphoma  though experience with previous cases of infective dermatitis indicates the possibility of such progression  
class1	184	disseminated histoplasmosis in the acquired immune deficiency syndrome  clinical findings  diagnosis and treatment  and review of the literature  
class1	184	histoplasmosis is a serious opportunistic infection in patients with aids  often representing the first manifestation of the syndrome  
class1	184	most infections occurring within the endemic region are caused by exogenous exposure  while those occurring in nonendemic areas may represent endogenous reactivation of latent foci of infection or exogenous exposure to microfoci located within those nonendemic regions  
class1	184	however  prospective investigations are needed to prove the mode of acquisition  
class1	184	the infection usually begins in the lungs even though the chest roentgenogram may be normal  
class1	184	clinical findings are nonspecific  most patients present with symptoms of fever and weight loss of at least 1 month s duration  
class1	184	when untreated  many cases eventually develop severe clinical manifestations resembling septicemia  
class1	184	chest roentgenograms  when abnormal  show interstitial or reticulonodular infiltrates  
class1	184	many cases have been initially misdiagnosed as disseminated mycobacterial infection or pneumocystis carinii pneumonia  
class1	184	patients are often concurrently infected with other opportunistic pathogens  supporting the need for a careful search for co infections  
class1	184	useful diagnostic tests include serologic tests for anti h  
class1	184	capsulatum antibodies and hpa  silver stains of tissue sections or body fluids  and cultures using fungal media from blood  bone marrow  bronchoalveolar lavage fluid  and other tissues or body fluids suspected to be infected on clinical grounds  
class1	184	treatment with amphotericin b is highly effective  reversing the clinical manifestations of infection in at least 80  of cases  
class1	184	however  nearly all patients relapse within 1 year after completing courses of amphotericin b of 35 mg kg or more  supporting the use of maintenance treatment to prevent recurrence  
class1	184	relapse rates are lower  9 to 19   in patients receiving maintenance therapy with amphotericin b given at doses of about 50 mg weekly or biweekly than with ketoconazole  50 60    but controlled trials comparing different maintenance regimens have not been conducted  
class1	184	until results of such trials become available  our current approach is to administer an induction phase of 15 mg kg of amphotericin b given over 4 to 6 weeks  followed by maintenance therapy with 50 to 100 mg of amphotericin b given once or twice weekly  or biweekly  
class1	184	if results of a prospective national institutes of allergy and infectious disease study of itraconazole maintenance therapy document its effectiveness  alternatives to amphotericin b may be reasonable  
class1	185	coccidioidomycosis during human immunodeficiency virus infection  a review of 77 patients  
class1	185	through a retrospective review  we identified 77 previously unreported cases of coccidioidomycosis during hiv infection  
class1	185	patients were classified into 1 of 6 categories based on their primary clinical presentation  20 had focal pulmonary disease  group 1   31 had diffuse pulmonary disease  group 2   4 had cutaneous coccidioidomycosis  group 3   9 had meningitis  group 4   7 had extrathoracic lymph node or liver involvement  group 5   and 6 has positive coccidioidal serology without a clinical focus of infection  group 6   
class1	185	coccidioidal serologies were positive on initial testing in 83  of the patients in whom such serologic testing was performed  
class1	185	sera from 39  of patients were positive for tp antibodies while 74  had cf antibodies  
class1	185	eleven of 12 seronegative patients had pulmonary disease  group 1 or 2   
class1	185	serologic results of other patients sent to a single reference laboratory were similar  with 26  positive for immunodiffusion tp antibodies and 79  positive for immunodiffusion cf antibodies  
class1	185	for the 77 patients in this study  the cd4 lymphocyte count was below 0 250 x 10 9  cells l in 46 of the 55 patients who had this test performed  and a low cd4 count was significantly associated with mortality  p less than 0 01   
class1	185	at the time of follow up  32 of the 77 patients  42   had died  
class1	185	there were significantly more deaths in those with diffuse pulmonary disease  group 2  than in other groups  p less than 0 001   
class1	185	amphotericin b  ketoconazole  fluconazole  and itraconazole were all used as antifungal therapies  
class1	185	outcome could not be related to the therapy used  
class1	185	of note  3 patients developed coccidioidomycosis while receiving ketoconazole for other conditions  
class1	186	extrapulmonary pneumocystosis  clinical features in human immunodeficiency virus infection  
class1	186	pneumocystis carinii infection is reported with increasing frequency as a cause of disease outside of the respiratory tract in patients with human immunodeficiency virus  hiv  infection  
class1	186	extrapulmonary pneumocystosis is not limited to patients in any discrete risk group for hiv infection  
class1	186	patients with hiv infection who develop extrapulmonary pneumocystosis frequently do not have concurrent p  
class1	186	carinii pneumonia  
class1	186	signs and symptoms of extrapulmonary pneumocystosis are nonspecific but when present are frequently referable to the tissues or organs involved  
class1	186	extrapulmonary pneumocystosis can be diagnosed by examination of tissue biopsies from affected sites using standard histologic techniques  
class1	186	therapy with antimicrobial agents used to treat p  
class1	186	carinii pneumonia has been effective in some patients  
class1	186	an association between use of aerosolized pentamidine for prevention of p  
class1	186	carinii pneumonia and development of extrapulmonary pneumocystosis has been suggested but remains unconfirmed  
class1	186	other factors such as the use of zidovudine and duration of immunodeficiency may also be important to the pathogenesis of extrapulmonary pneumocystosis  
class1	186	further studies are needed to better identify risk factors that may predispose patients to the development of extrapulmonary pneumocystosis  
class1	187	soleus specific myopathy induced by passive stretching under local tetanus  
class1	187	twenty four adult albino rats were injected with tetanus toxin into the right gastrocnemius muscle and then subjected to sustained dorsiflexion of the right ankle joint for 2 to 14 days  
class1	187	histologic examinations of the soleus after this procedure showed myopathic changes  characterized by variations in fiber diameters  myonecrosis with opaque fibers  interstitial fibrosis  and small groups of regenerated fibers  
class1	187	electron microscopy revealed derangement of t tubules immediately adjacent to the sarcolemma in the early degenerative stage  
class1	187	the size and wet weight of soleus increased compared to that of the control side between 2 and 5 days post tetanus  
class1	187	serum got  ldh  and creatine kinase  ck  levels were elevated especially in the early degenerative stages  
class1	187	peri  and endomysial fibrosis developed gradually from about 3 days post tetanus  
class1	187	pathomechanisms inducing these changes were discussed  
class1	188	a randomized  prospective field trial of a conjugate vaccine in the protection of infants and young children against invasive haemophilus influenzae type b disease 
class1	188	background  
class1	188	haemophilus influenzae type b is the leading cause of invasive bacterial disease in young children  
class1	188	the capsular polysaccharide vaccine does not protect children at greatest risk  those under the age of 18 months   but a polysaccharide protein conjugate vaccine has proved to be more immunogenic in this age group  
class1	188	methods  
class1	188	we enrolled 114 000 infants in finland in an open  prospective  randomized trial of a h  
class1	188	influenzae type b capsular polysaccharide diphtheria toxoid conjugate vaccine  polyribosylribitol phosphate diphtheria toxoid  prp d    
class1	188	children born on odd numbered days were vaccinated at the ages of 3  4  6  and 14 to 18 months  those born on even numbered days formed the control group and received the same vaccine at the age of 24 months  
class1	188	results  
class1	188	after three doses of the vaccine there were 4 cases of verified bacteremic h  
class1	188	influenzae type b disease in the group receiving early vaccination  as compared with 64 cases in the control group  between the ages of approximately 7 and 24 months  
class1	188	the protective efficacy of the vaccine was thus 94 percent  95 percent confidence interval  83 to 98   
class1	188	no serious adverse effects were reported  
class1	188	the immune response to the conjugate vaccine was characteristic of a t cell dependent response when studied in a cohort of 120 infants  
class1	188	the primary immunization series resulted in a geometric mean concentration of anticapsular antibody of 0 53 micrograms per milliliter at the age of seven months  and the fourth dose evoked an anamnestic response  with a mean antibody concentration of 45 22 micrograms per milliliter  
class1	188	conclusions  
class1	188	a new conjugate vaccine consisting of the capsular polysaccharide of h  
class1	188	influenzae type b covalently linked to a protein carrier  prp d   administered to infants beginning at the age of 3 months  is highly effective in protecting young finnish children  7 to 24 months old  against invasive h  
class1	188	influenzae type b infections  
class1	189	limited efficacy of a haemophilus influenzae type b conjugate vaccine in alaska native infants  the alaska h  influenzae vaccine study group 
class1	189	background  
class1	189	the prevention of invasive haemophilus influenzae type b disease requires a vaccine that is effective when administered during the first six months of life  
class1	189	the infants of alaska natives are at particularly high risk of invasive h  
class1	189	influenzae type b disease  
class1	189	methods  
class1	189	to evaluate the protective efficacy of a h  
class1	189	influenzae type b polysaccharide diphtheria toxoid conjugate vaccine  polyribosylribitol phosphate diphtheria toxoid  prp d    we enrolled 2102 alaska native infants in a randomized  double blind  placebo controlled trial in which either the vaccine or a saline placebo was administered at approximately two  four  and six months of age  
class1	189	results  
class1	189	after 3969 subject years of follow up and 32 episodes of h  
class1	189	influenzae type b disease  the overall incidence of invasive disease was not reduced significantly in the vaccinated subjects  6 0 cases per 1000 patient years   as compared with the placebo controls  9 6  or with other alaska native infants  6 0   
class1	189	after one  two  or three doses there was no significant protective efficacy with the vaccine  after three doses the efficacy was only 35 percent  95 percent confidence interval   57 to 73   
class1	189	the lack of efficacy was not related to the age at onset of disease  age at immunization  type of disease  degree of alaska native heritage  time after immunization  or year of the study  
class1	189	levels of h  
class1	189	influenzae type b anticapsular antibody in recipients of the vaccine became significantly higher than levels in those who received placebo only after the second and third doses  
class1	189	even after the third dose  only 48 percent of the vaccinated infants had antibody levels of more than 0 1 microgram per milliliter  geometric mean titer  0 18   
class1	189	antibody responses did not vary with the level of maternally acquired antibody  degree of alaska native ancestry  or age at time of the first or second immunizations  but they increased with increasing age at time of the third dose  p less than 0 001   
class1	189	conclusions  
class1	189	we found no evidence that the prp d vaccine provides significant protection  at least for alaska native infants  against invasive diseases caused by h  
class1	189	influenzae type b  
class1	189	the ineffectiveness of the vaccine paralleled its limited immunogenicity  
class1	190	the agent of bacillary angiomatosis  an approach to the identification of uncultured pathogens 
class1	190	background  
class1	190	bacillary angiomatosis is an infectious disease causing proliferation of small blood vessels in the skin and visceral organs of patients with human immunodeficiency virus infection and other immunocompromised hosts  
class1	190	the agent is often visualized in tissue sections of lesions with warthin starry staining  but the bacillus has not been successfully cultured or identified  
class1	190	this bacillus may also cause cat scratch disease  
class1	190	methods  
class1	190	in attempting to identify this organism  we used the polymerase chain reaction  
class1	190	we used oligonucleotide primers complementary to the 16s ribosomal rna genes of eubacteria to amplify 16s ribosomal gene fragments directly from tissue samples of bacillary angiomatosis  
class1	190	the dna sequence of these fragments was determined and analyzed for phylogenetic relatedness to other known organisms  
class1	190	normal tissues were studied in parallel  
class1	190	results  
class1	190	tissue from three unrelated patients with bacillary angiomatosis yielded a unique 16s gene sequence  
class1	190	a sequence obtained from a fourth patient with bacillary angiomatosis differed from the sequence found in the other three patients at only 4 of 241 base positions  
class1	190	no related 16s gene fragment was detected in the normal tissues  
class1	190	these 16s sequences associated with bacillary angiomatosis belong to a previously uncharacterized microorganism  most closely related to rochalimaea quintana  
class1	190	conclusions  
class1	190	the cause of bacillary angiomatosis is a previously uncharacterized rickettsia like organism  closely related to r  
class1	190	quintana  
class1	190	this method for the identification of an uncultured pathogen may be applicable to other infectious diseases of unknown cause  
class1	191	clinical and pathological features of bacillary peliosis hepatis in association with human immunodeficiency virus infection 
class1	191	background  
class1	191	peliosis hepatis is characterized by cystic  blood filled spaces in the liver and is seen in patients with chronic infections or advanced cancer and as a consequence of therapy with anabolic steroids  
class1	191	cutaneous bacillary angiomatosis is a bacterial infection that occurs in patients with human immunodeficiency virus  hiv  infection  its histologic appearance is that of a pseudoneoplastic vascular proliferation  
class1	191	methods  
class1	191	we studied liver tissue from eight hiv infected patients with peliosis hepatis  two of whom also had cutaneous bacillary angiomatosis  
class1	191	for comparison we examined tissue from four patients who had peliosis hepatis without hiv infection  
class1	191	tissues were examined histologically on routine sections and with special stains and electron microscopy  
class1	191	results  
class1	191	the histologic features seen in peliosis hepatis associated with hiv infection  but not in the four cases unrelated to hiv infection  were myxoid stroma and clumps of a granular purple material that on warthin starry staining and electron microscopy proved to be bacilli  
class1	191	the bacilli  which could not be cultured  were morphologically identical to those found in the skin lesions of cutaneous bacillary angiomatosis  
class1	191	the clinical courses of two of the patients with this  bacillary peliosis hepatis  indicate that it responds to antibiotic treatment  
class1	191	conclusions  
class1	191	hiv associated bacillary peliosis hepatis is an unusual  treatable opportunistic infection  probably caused by the same organism that causes cutaneous bacillary angiomatosis  
class1	191	our failure to find bacilli in non hiv associated cases implies that other pathogenetic mechanisms may also be responsible for peliosis hepatis  
class1	192	a newly recognized fastidious gram negative pathogen as a cause of fever and bacteremia 
class1	192	background  
class1	192	we identified a motile  curved  gram negative bacillus as the cause of persistent fever and bacteremia in two patients with symptomatic human immunodeficiency virus infection  
class1	192	the same organism was subsequently recovered from a bone marrow transplant recipient with septicemia and from two immunocompetent persons with week long febrile illnesses  
class1	192	all the patients recovered after antimicrobial therapy  
class1	192	methods and results  
class1	192	primary cultures of blood processed by centrifugation after blood cell lysis yielded adherent  white  iridescent  morphologically heterogeneous colonies in 5 to 15 days  
class1	192	subcultures grew in four days on chocolate  charcoal yeast extract  or blood agar  
class1	192	the organisms stained weakly with safranin and were not acid fast  
class1	192	fluorescent antibody tests for legionella and francisella were negative  
class1	192	biochemical reactivity was minimal and difficult to ascertain  
class1	192	agar dilution testing revealed in vitro susceptibility to most antimicrobial agents tested  
class1	192	the cellular fatty acid composition of the isolates was similar  resembling that of rochalimaea quintana or brucella species  but not helicobacter pylori or species of campylobacter or legionella  
class1	192	as resolved by gel electrophoresis  cell membrane preparations of all isolates contained similar proteins  with patterns that differed from that of r  
class1	192	quintana  
class1	192	patterns of digestion of dna from all isolates by ecorv restriction endonuclease were virtually identical and also differed from that of r  
class1	192	quintana  
class1	192	on immunodiffusion  serum from one convalescent patient produced a line of identity with sonicates of all five isolates  
class1	192	conclusions  
class1	192	this pathogen may have been unidentified until now because of its slow growth  broad susceptibility to antimicrobial agents  and possible requirement of blood cell lysis for recovery in culture  
class1	192	it should be sought as a cause of unexplained fever  especially in persons with defective cell mediated immunity  
class1	193	seizures and other neurologic sequelae of bacterial meningitis in children  
class1	193	background  
class1	193	although the mortality rate among children with bacterial meningitis has decreased dramatically in recent decades  some patients are left with neurologic sequelae  
class1	193	it has not been clearly established which features of the acute illness predict the chronic neurologic sequelae  including late seizures or epilepsy  
class1	193	methods  
class1	193	we followed 185 infants and children prospectively during and after acute bacterial meningitis  
class1	193	the mean duration of follow up was 8 9 years  range  0 1 to 15 5   
class1	193	during the first six years standard neurologic examinations were performed  telephone interviews were conducted thereafter  
class1	193	results  
class1	193	one month after meningitis  69 children  37 percent  had neurologic abnormalities  
class1	193	many of these signs resolved within a year  leaving only 26 children  14 percent  with persistent deficits  18  10 percent  had only sensorineural hearing loss  and 8  4 percent  had multiple neurologic deficits  
class1	193	thirteen children  7 percent  had one or more late seizures not associated with fever  
class1	193	the presence of persistent neurologic deficits indicative of cerebral injury was the only independent predictor of late afebrile seizures  p less than 0 001   
class1	193	conclusions  
class1	193	after bacterial meningitis only children with permanent neurologic deficits are at high risk for epilepsy  
class1	193	those with normal examinations after the acute illness have an excellent change of escaping serious neurologic sequelae  including epilepsy  
class1	194	the sequelae of haemophilus influenzae meningitis in school age children  
class1	194	background  
class1	194	previous data on the consequences of haemophilus influenzae type b meningitis for school age children have been inconsistent  and much of the information on risk factors has been inconclusive  
class1	194	the present study was designed to evaluate the sequelae of this disease with a protocol for the comprehensive assessment of neuropsychological function  
class1	194	methods  
class1	194	ninety seven school age children  mean age  9 6 years   each of whom had a school age sibling  were recruited from a survey of the medical records of 519 children treated for h  
class1	194	influenzae type b meningitis between 1972 and 1984  at a mean age of 17 months  at the children s hospitals of toronto  ottawa  and montreal  
class1	194	of the 97 children  41 had had an acute neurologic complication  
class1	194	sequelae were assessed by comparing the index children with their nearest siblings on the basis of standardized measures of cognitive  academic  and behavioral status  
class1	194	results  
class1	194	only 14 children  14 percent  had persisting neurologic sequelae  sensorineural hearing loss in 11  unilateral in 6 and bilateral in 5   seizure disorder in 2  and hemiplegia and mental retardation in 1  
class1	194	although the total sample of index children scored slightly below the siblings in reading ability  the 56 children without acute phase neurologic complications  58 percent  were indistinguishable from their siblings on all measures  
class1	194	the differences between the groups were small even for the 41 pairs in which the index child had had an acute neurologic complication  mean full scale iq  102 for the index children vs  
class1	194	109 for the siblings   
class1	194	sequelae were also associated with lower socioeconomic status and a lower ratio of glucose in cerebrospinal fluid to that in blood at the time of the meningitis  
class1	194	behavioral problems were more prominent in index boys than index girls and in those who were older at the time of testing  but sex and age were not related to cognitive or academic sequelae  
class1	194	conclusions  
class1	194	we find a favorable prognosis for the majority of children who are treated for meningitis caused by h  
class1	194	influenzae type b  
class1	195	whither short course chemotherapy for tuberculous meningitis  
class1	195	short course chemotherapy is well established for the treatment of pulmonary tuberculosis but not for extrapulmonary disease  
class1	195	we present a series of 35 cases in which chemotherapy for tuberculous meningitis was given for a period of less than 2 years  
class1	195	short term therapy was associated with recrudescence of tuberculous meningitis and  in some cases  with the development of deep cerebral infarcts and permanent neurological deficits  
class1	195	we think short term chemotherapy for tuberculosis of the central nervous system is inadequate  
class1	196	chronic lyme disease with an expansive granulomatous lesion in the cerebellopontine angle  
class1	196	expansive granulomatous lesions in the posterior cranial fossa are rare and have not been reported in conjunction with lyme disease  
class1	196	we report a patient with verified borrelia burgdorferi infection who developed a tumor in the cerebellopontine angle  
class1	196	rapid growth of the tumor led to signs of cerebral compression and to hydrocephalus  
class1	196	surgical intervention was required despite florid meningitis  
class1	196	the histological examination showed inflammatory  nonspecific granulation tissue  
class1	196	the origin of this tissue is almost certainly causally related to the b  
class1	196	burgdorferi infection  
class1	196	signs of inflammation resolved rapidly after subtotal resection  
class1	196	the clinical  radiological  and biochemical course is documented  
class1	196	this is the first report of an expansive cerebral lesion in the chronic phase of lyme disease  
class1	197	infectious intracranial aneurysms  comparison of groups with and without endocarditis  
class1	197	a series of 12 patients with infectious intracranial aneurysms is presented  and a number of unusual features of the disorder are emphasized  
class1	197	a comparison of characteristics of the aneurysms and clinical course is made between patients with and without infective endocarditis  
class1	197	most of the unusual characteristics of infectious aneurysms  including rare locations  causative organisms  and predisposing medical conditions  occurred in the group without endocarditis  
class1	197	the relationship of atypical features of infectious aneurysms to the etiology of aneurysm formation is discussed  and an approach to treatment is presented  
class1	198	streptococcus bovis meningitis  report of 2 cases  
class1	198	we describe 2 cases of streptococcus bovis meningitis and review the 9 cases previously reported  
class1	198	this microorganism is a rare cause of meningitis in which there are no distinctive clinical or laboratory features  
class1	198	the gram stain of the csf is usually negative  
class1	198	ten of the 11 cases had some underlying disease or comorbid condition that predisposed to s bovis infection  gastrointestinal disorder  endocarditis  csf leak  polymyalgia rheumatica  and mandibular block  
class1	198	treatment with high dose penicillin is usually adequate  
class1	199	pelvic pain and infections  
class1	199	infectious etiologies of both acute and chronic pelvic pain are common and may involve multiple organ systems  
class1	199	in the evaluation of the acute pain  it is important to remember that rapidity of diagnosis is important because of the possibility of significant morbidity and even death if a condition is not attended to rapidly  
class1	199	in recent years  laparoscopic evaluation of the pelvis has provided a better understanding of the pathophysiology of some of these infections  as well as possible therapeutic maneuvers  
class1	199	the evaluation of chronic pelvic pain requires a thorough attempt at careful diagnosis with minds open to the possibility that other organ systems besides the genital tract may be involved  
class1	199	laparoscopy also may be an important diagnostic and therapeutic tool in the evaluation of the sequelae of pelvic inflammation leading to chronic pelvic pain  
class1	199	all therapeutic modalities that are instituted on the basis of the diagnostic evaluation must take into consideration that a strong emotional component is generally associated with chronic pelvic pain  
class1	199	such components must be addressed in order to achieve the best possible results for the patient  
class1	200	the prevalence of cardiac valvular pathosis in patients with systemic lupus erythematosus  
class1	200	the purpose of this study was to determine the prevalence of valvular pathosis in a population of patients with sle  to assess the candidacy of such patients for antibiotic prophylaxis before dental treatment  
class1	200	the hospital records of 112 patients with sle were reviewed and screened for endocarditis  heart murmurs  and other valvular pathosis  
class1	200	two of the 112 patients had confirmed cases of bacterial endocarditis  
class1	200	this prevalence is comparable to endocarditis prevalence rates in patients with prosthetic valves and is also three times that in patients with rheumatic heart disease  
class1	200	the high prevalence of endocarditis in this population of patients with sle suggests that according to present perspectives on patient management  patients with sle should be considered for antibiotic prophylaxis before dental therapies associated with formation of a bacteremia  
class1	201	oral histoplasmosis as a presenting disease in acquired immunodeficiency syndrome  published erratum appears in oral surg oral med oral pathol 1991 jan 71 1  76  
class1	201	a 43 year old homosexual man visited his dentist with painful  nodular  ulcerated lesions on the soft palate  right buccal mucosa  and right posterior maxillary gingiva  
class1	201	serologic studies for exposure to human immunodeficiency virus  performed before biopsy  were positive  
class1	201	biopsy of the maxillary gingiva demonstrated sheets of histiocytes containing small intracellular yeasts  which on culture were identified as histoplasma capsulatum  
class1	201	bilateral leukoplakic lesions with some vertical furrowing involving the lateral borders of the tongue were also noted  
class1	201	histologically  hyperkeratosis and fungal hyphae were identified  
class1	201	the patient was treated for histoplasmosis with amphotericin b  which resulted in significant improvement of the oral lesions  
class1	201	he was subsequently hospitalized for fatigue and dyspnea and was found to have pneumocystis carinii pneumonia  
class1	201	pulmonary status deteriorated within a 3 week period  and the patient died  
class1	201	autopsy findings were negative for histoplasmosis but positive for necrotizing and cavitary p  
class1	201	carinii pneumonia  pulmonary and hepatic herpes simplex infections  and pulmonary and intestinal cytomegalovirus infection  
class1	202	apical closure of mature molar roots with the use of calcium hydroxide  
class1	202	calcium hydroxide may induce apical root closure in affected mature teeth as well as in immature teeth  
class1	202	once an apical hard tissue barrier is formed  a permanent root canal filling can be safely condensed  
class1	202	two cases are described in which calcium hydroxide induced apical root closure in mature molar teeth where the apical constriction was lost because of chronic inflammatory process  
class1	203	nosocomial bacteremias in measles  
class1	203	the purpose of this study was to determine whether nosocomial bacteremias occurred more frequently in patients admitted with severe measles compared with general pediatric admissions  
class1	203	in a retrospective survey of 977 blood culture reports during a 4 year period  1985 to 1988  the incidence of nosocomial bacteremias in patients with measles was found to be on the average of 3 37 100 admissions year  approximately 6 times that of general pediatric patients  0 57   
class1	203	gram negative organisms  predominantly klebsiella and salmonella species  accounted for 86 5  of all isolates from measles patients  with 23  of these being multiply antibiotic resistant  
class1	203	all the isolates from the general patients were fully susceptible to antibiotics  
class1	203	the duration of hospitalization was more than doubled in both groups of affected patients  
class1	203	the onset of hospital acquired bacteremias occurred on an average of 11 2 days after admission in the patients with measles and 20 5 days in the general patients  
class1	203	our findings revealed that nosocomial bacteremias occurred with greater frequency in patients with measles and contributed to the morbidity of these patients  
class1	204	thrombocytosis after pneumonia with empyema and other bacterial infections in children  
class1	204	thrombocytosis is seen in association with many conditions  including infectious diseases  
class1	204	we studied thrombocytosis after severe bacterial infections  particularly pneumonia with empyema in children  
class1	204	a systematic survey of the phenomenon was conducted  
class1	204	twenty seven children admitted for pneumonia with empyema were studied  
class1	204	thrombocytosis  platelet counts greater than 500 x 10 3  microliters  was present in 92 5   
class1	204	platelet counts reached their maximum at 15 1     3 7 days  range  7 to 25  and declined to normal after 3 weeks of illness  
class1	204	compared with a healthy control group  significant thrombocytosis  but of lower incidence  was also noted in children with lobar pneumonia without pleural effusion  bacterial meningitis and osteomyelitis  
class1	204	platelet functions were examined in seven of the children but no abnormalities were observed  
class1	204	bone marrow aspiration of three children with pneumonia and empyema showed megakaryocytic hyperplasia  
class1	204	we found no correlation between thrombocytosis  neutrophilia  fever  the clinical course  complications  prognosis or treatment  
class1	204	neither thromboembolic nor hemorrhagic phenomena were observed  
class1	205	central nervous system tuberculosis in children  a review of 30 cases  
class1	205	the medical records of 30 children with central nervous system tuberculosis  cns tuberculosis  who were treated between march  1976  and february  1989  were reviewed  
class1	205	all had cranial computerized tomography scans at presentation  
class1	205	the mean cerebrospinal fluid leukocyte count was 200 mm3  protein 239 mg dl  glucose 25 mg dl and csf serum glucose ratio 21   
class1	205	mantoux skin tests with 5 tuberculin units were greater than or equal to 10 mm induration in 50   and chest radiographs were positive in 40  of patients  
class1	205	hydrocephalus was demonstrated by cranial computerized tomography in all 30 patients  100    
class1	205	cranial computerized tomography scan demonstrating hydrocephalus is a sensitive radiographic nervous system tuberculosis and should be part of the early evaluation of children with suspected central nervous system tuberculosis  
class1	206	the use of prophylactic furazolidone to control a nosocomial epidemic of multiply resistant salmonella typhimurium in pediatric wards  
class1	206	the nosocomial spread of enteric pathogens is often difficult to control in overcrowded pediatric wards  
class1	206	during 1983 and 1984  despite cohorting of patients and enforced hand washing  more than 200 cases of nosocomial multiply resistant salmonella typhimurium phage type r 9 were observed on two adjacent pediatric wards  
class1	206	most cases occurred during the summer months  
class1	206	after 19 new cases were detected early in the summer of 1985  oral administration of furazolidone throughout their entire hospital stay  2 5 mg kg twice daily  was recommended for all subsequently hospitalized infants  
class1	206	among the 114  65   infants who were appropriately treated  only one additional case  1   was detected  
class1	206	in contrast 11  19   cases occurred among the 59 infants who were inappropriately treated  5 of 35  14   of those who were not treated and 6 of 24  25   in whom treatment with furazolidone was delayed greater than 24 hours  p less than 0 001 between the appropriately and inappropriately treated groups   
class1	206	in pediatric wards where infection control measures cannot be optimally applied  prophylactic furazolidone administration may be helpful in preventing the spread of enteric pathogens  
class1	207	safety evaluation of prp d haemophilus influenzae type b conjugate vaccine in children immunized at 18 months of age and older  follow up study of 30 000 children  
class1	207	we evaluated the safety of the prp d conjugate hib vaccine  prohibit  connaught  in 29 309 children vaccinated at 18 60 months of age in the southern california kaiser permanente medical clinics during the period april 1  1988  to july 31  1989  
class1	207	surveillance for potential reactions involved postcard questionnaires  telephone surveys  reports of kaiser staff and review of hospitalizations and covered two periods following immunization   1  the first 48 hours and  2  days 2 through 30  
class1	207	surveillance for invasive hib disease involved the above methods in addition to systematic reviews of laboratory and hospital records through january 31  1990  
class1	207	rates of local and systemic reactions within 48 hours of vaccination with prp d alone were low  less than or equal to 2  for fever greater than 102 degrees f  local redness or swelling  and similar to those previously reported after vaccination with prp  
class1	207	hospitalization and seizures  0 15  and 0 09  of vaccinated children  respectively  occurring within 1 month of immunization appeared to be unrelated to vaccination  
class1	207	one 29 month old child had onset of a fatal episode of hib sepsis meningitis within 48 hours of vaccination  
class1	207	also  a 30 month old child developed hib meningitis 10 months after prp d vaccination  
class1	207	we conclude that prp d is safe when given alone or in combination with other childhood vaccines between 18 and 60 months of age  
class1	208	case control study of cryptosporidium parvum infection in peruvian children hospitalized for diarrhea  possible association with malnutrition and nosocomial infection  
class1	208	a retrospective  hospital based case control study was used to investigate whether there were any clinical characteristics that could distinguish cryptosporidium parvum infected children with diarrhea from other non c  
class1	208	parvum infected children with diarrhea  
class1	208	ten percent  24 of 248  of children admitted to a rehydration ward at cayetano heredia university hospital  lima  peru  were infected with c  
class1	208	parvum  
class1	208	the 24 patients infected with c  
class1	208	parvum  cases  were matched to an equal number of noninfected patients  controls   
class1	208	c  
class1	208	parvum infected patients were more likely to be malnourished than were children without this infection  p less than 0 05   
class1	208	also nosocomial infection caused by c  
class1	208	parvum occurred in three severely malnourished patients  two of whom died  
class1	208	no other clinical or laboratory characteristics were found that would distinguish children with diarrhea caused by c  
class1	208	parvum from other children with diarrhea  
class1	208	in children hospitalized for diarrhea c  
class1	208	parvum infection occurs most frequently in malnourished children  
class1	209	immunogenicity of haemophilus b conjugate vaccine  meningococcal protein conjugate  in children with prior invasive haemophilus influenzae type b disease  
class1	209	children younger than 2 years of age with previous invasive haemophilus influenzae  hib  type b disease may not develop protective antibodies to antigens of hib and may be at risk of developing a second episode of hib disease  
class1	209	twenty three children with prior hib disease were immunized with haemophilus b conjugate vaccine  meningococcal protein conjugate   
class1	209	children 12 to 24 months of age were given one dose of vaccine and children younger than 12 months of age were given 2 doses 2 months apart  
class1	209	antibody to the polysaccharide capsule of hib  prp  was measured by radioimmunoassay  
class1	209	eighteen children had preimmunization serum antibody concentrations less than 0 150 micrograms ml  
class1	209	all 18 children responded with greater than 0 150 micrograms ml of antibody after a single dose of vaccine  
class1	209	only 1 of the 23 children had a preimmunization serum antibody concentration greater than 1 000 micrograms ml  
class1	209	seventeen children ultimately responded with greater than 1 000 micrograms ml of antibody  p less than 0 0001   concentrations of antibody thought to correlate with protection  
class1	209	haemophilus b conjugate vaccine  meningococcal protein conjugate  is immunogenic in children with invasive hib disease  
class1	209	children younger than 2 years of age with invasive hib disease should be subsequently immunized with a hib conjugate vaccine  
class1	210	clinical features of adenovirus enteritis  a review of 127 cases  
class1	210	we retrospectively analyzed the clinical features of 127 hospitalized pediatric patients whose fecal samples were positive for adenovirus  ad  by electron microscopy during an 18 month period  
class1	210	serotyping results obtained by microneutralization tests and restriction endonuclease analysis were available for 105 of 127 cases  
class1	210	there were 69 males and 58 females and 94  of patients were less than 4 years of age  
class1	210	the average body temperature was 38 degrees c rectal  range  36 2 40 8 degrees c  with an average duration of fever of 1 6 days  
class1	210	the average duration of clinical illness was 8 8 days  range  1 to 32 days   
class1	210	although ad 40 and ad 41 were isolated in the majority of cases  59 of 105  56    ad 31 was associated with 18 of 105 cases  17    
class1	210	of the 18 cases associated with ad 31  14 were nosocomial and associated with diarrhea  
class1	210	our survey confirms the importance of fastidious enteric ad in infantile diarrhea  ad 40  ad 41  and suggests that ad 31 produces a clinical syndrome indistinguishable from that caused by ad 40 and ad 41  
class1	210	the occurrence of ad enteritis in patients admitted for unrelated illnesses well after initial hospitalization suggests that ad is also an important cause of nosocomial enteritis in our hospital  
class1	211	dexamethasone effects on the hospital course of infants with bronchopulmonary dysplasia who are dependent on artificial ventilation  
class1	211	a randomized double blind placebo controlled trial was conducted to evaluate the effects of enterally administered dexamethasone on the hospital course of infants with bronchopulmonary dysplasia  
class1	211	a total of 23 infants with a birth weight less than 1500 g who were dependent on artificial ventilation 3 to 4 weeks of age received dexamethasone  n   12  or saline placebo  n   11   
class1	211	dexamethasone  0 5 mg kg per day  was given in tapering doses for 7 days followed by hydrocortisone  8 mg kg per day  which was progressively reduced for a total of 17 days of therapy  
class1	211	infants who received dexamethasone required less oxygen on days 8 and 17  p less than  05  and were more likely to extubate 8 days after therapy than infants in the control group  respectively 8 12 vs 3 11 infants  p less than  05  p    12 after yates correction   
class1	211	the use of dexamethasone significantly shortened median duration of mechanical ventilation  4 vs 22 days  p less than  05  but had no effect on length of oxygen therapy  hospitalization  home oxygen therapy  occurrence and severity of retinopathy of prematurity  rate of growth  and mortality  
class1	211	no significant complications resulted from dexamethasone therapy  
class1	211	measurements of plasma dexamethasone levels confirmed the absorption of drug from the gastrointestinal tract  23 7 ng ml in dexamethasone vs 4 6 ng ml in the control group  p less than  05   
class1	211	dexamethasone administration resulted in short term improvements in pulmonary function but did not ameliorate the hospital course of infants with bronchopulmonary dysplasia  
class1	212	health assessment of the early adolescent  challenges and clinical issues  
class1	212	although early adolescence spans only 4 years  it is a critical time in the life of a young person in forming opinions and selecting options  
class1	212	specific attention to the growing and changing needs of this population is imperative if their health status is to improve  
class1	213	mycoplasmal pneumonia  are you thinking of atypical presentations  
class1	213	the presentations of mycoplasmal pneumonia can be varied and sometimes complicated  
class1	213	the atypical nature of this illness  as opposed to the clear pattern of findings in classic bacterial pneumonias  leads the physician to the diagnosis  
class1	213	appropriate therapy then allows quick improvement as a rule  with few sequelae  
class1	214	a rhesus monkey model for sexual transmission of a papillomavirus isolated from a squamous cell carcinoma  
class1	214	recently we molecularly cloned and characterized a papillomavirus from a lymph node metastasis of a primary penile carcinoma found in a rhesus monkey  this virus species  rhesus papillomavirus type 1  rhpv 1   is similar to oncogenic human papillomaviruses  hpvs   such as hpv 16 or hpv 18  in that the rhpv 1 dna was found to be integrated in the tumor cell dna  
class1	214	to compare the sexual transmission and oncogenic nature of rhpv 1 with these hpvs  we undertook an extensive retrospective study of a group of rhesus monkeys whose sexual mating and offspring histories were known  
class1	214	these animals had mated directly with the index male mentioned above or were secondarily exposed to this virus through intermediate sexual partners  
class1	214	this study combines cytological  histopathological  and several complementary hybridization and dna amplification techniques on multiple tissue samples to demonstrate the sexually transmitted nature of rhpv 1  
class1	214	the oncogenic potential of rhpv 1 is suggested in several of the infected animals by the presence of various degrees of neoplasia including squamous cell cancer of the cervix  
class1	215	antibiotic therapy for common infections  
class1	215	several important points regarding the treatment of urinary tract infections should be made  
class1	215	single dose and short course antibiotic therapy is appropriate only for women with acute bacterial cystitis due to e  
class1	215	coli  
class1	215	studies comparing single dose to full course therapy have not been sufficiently designed to draw valid statistical conclusions  and only tmp smx is recommended at this time  
class1	215	recurrent uti in women is almost always due to reinfection  which is best managed by prophylactic antibiotics  
class1	215	acute bronchitis and acute exacerbations of chronic bronchitis are often due to viral infections  and therefore antibiotic therapy is not always needed  
class1	215	in acute exacerbations of chronic bronchitis  the clearest success rates for antibiotic therapy have been in patients  who have all three of the following symptoms  increased dyspnea  increased sputum production  and sputum purulence  
class1	215	mupirocin is an important addition to the agents used to treat bacterial skin infections due to streptococcal and staphylococcal strains  
class1	215	in impetigo  mupirocin has been demonstrated to be as effective or superior to oral erythromycin  
class1	215	in prostatitis  data on the fluoroquinolones appears impressive  but further comparative trials are needed  
class1	215	they may become first line  empiric therapy  
class1	215	the newer oral antibiotics are not recommended as initial  empiric therapy in the outpatient management of common infections  with the possible exception of the treatment of prostatitis  
class1	215	these newer agents may be more important in the treatment of recurrent or resistant infections  
class1	216	early postoperative care of the cardiac transplantation patient  routine considerations and immunosuppressive therapy  
class1	216	the authors have attempted to outline the current state of the art with respect to the early postoperative management of the cardiac transplant recipient with special attention to immunosuppressive therapies  
class1	216	the commonly used agents  as well as the most successful combination regimens  have been described along with the current levels of expectation regarding rates of rejection and infection  
class1	216	much has been learned regarding the management of these problems  
class1	216	much remains to be learned to further decrease the incidence of postoperative infection and rejection and  equally if not more importantly  studies to investigate the etiology of transplant coronary artery disease need to be undertaken such that measures to delay or prevent its occurrence and or arrest its progression can be instituted  
class1	217	bacterial tracheitis  report of eight new cases and review  
class1	217	bacterial tracheitis  previously referred to as nondiphtheritic laryngitis with marked exudate  was commonly discussed in pediatric textbooks before 1940  
class1	217	it seemed to disappear as a clinical entity after that time  but it has been recorded with increasing frequency in the pediatric literature since 1979  
class1	217	we describe eight new cases and review 110 previously described cases  
class1	217	the clinical course consists of a prodromal upper respiratory illness with stridor  fever  and a variable degree of respiratory distress  
class1	217	unlike patients with croup  patients with bacterial tracheitis do not respond to aerosolized racemic epinephrine  
class1	217	most patients require endotracheal intubation  some require tracheostomy  
class1	217	reported complications include pneumonia  pneumothorax  formation of pseudomembranes  toxic shock syndrome  and cardiopulmonary arrest  
class1	217	bacterial tracheitis is a secondary bacterial infection following a primary viral respiratory infection  
class1	217	the most common preceding viral infection is parainfluenza  
class1	217	staphylococcus aureus and haemophilus influenzae are the predominant causes of bacterial tracheitis  
class1	217	secondary bacterial infection may occur as a result of tracheal mucosal injury or impairment of normal phagocytic function due to viral infection  
class1	218	hypercalcitoninemia  hypocalcemia  and toxic shock syndrome  
class1	218	toxic shock syndrome is a multisystem illness frequently complicated by hypocalcemia  
class1	218	the etiology of the hypocalcemia  which may be severe  is not well understood  
class1	218	we report two cases of fatal toxic shock syndrome accompanied by severe hypocalcemia  each patient also had an inappropriately elevated serum calcitonin level  which in one case was as high as 179 000 pg ml  
class1	218	hypercalcitoninemia may be a cause of the low serum calcium levels as well as of certain clinical manifestations of toxic shock syndrome  
class1	219	brucella endocarditis  the role of combined medical and surgical treatment  
class1	219	brucella endocarditis  although a rare complication of brucellosis  is the main cause of death related to this disease  
class1	219	this report describes a case of aortic endocarditis due to brucella abortus in an elderly farmer with known aortic stenosis  
class1	219	urgent valve replacement was performed because of progressive heart failure despite appropriate antimicrobial treatment  
class1	219	the infection was cured with trimethoprim sulfamethoxazole and rifampin given for 3 months after surgery  
class1	219	a review of the literature reports on the 38 other cases of cured brucella endocarditis made clear the need for combined antimicrobial treatment and surgical valve replacement  
class1	220	tuberculous psoas muscle abscess following chemoprophylaxis with isoniazid in a patient with human immunodeficiency virus infection  
class1	220	a 34 year old man with human immunodeficiency virus infection and disseminated mycobacterium avium and mycobacterium intracellulare infection developed a right psoas muscle abscess due to mycobacterium tuberculosis  
class1	220	the abscess occurred 18 months after completion of a 12 month course of chemoprophylaxis with isoniazid that was given because of a positive reaction with purified protein derivative of tuberculin  
class1	220	the adjacent vertebrae did not appear to be involved  
class1	220	the abscess was drained with a percutaneously inserted catheter  and he received standard antituberculous chemotherapy  
class1	220	three weeks into therapy  a second drainage with a catheter was required  
class1	220	the isolation of two mycobacteria in this patient and the apparent failure of chemoprophylaxis with isoniazid are noted  
class1	221	resolution of lung abscess due to pseudomonas aeruginosa with oral ciprofloxacin  case report  
class1	221	a case of lung abscess due to pseudomonas aeruginosa is presented that did not resolve with the use of conventional antipseudomonal antibiotics  including tobramycin with ticarcillin clavulanate and ceftazidime with gentamicin and ticarcillin clavulanate  
class1	221	oral ciprofloxacin was administered for 12 weeks  and the infection was resolved  
class1	221	no resistance occurred  and there was no recurrence of abscess within 18 months following therapy  
class1	222	pulmonary and disseminated infection due to mycobacterium kansasii  a decade of experience  
class1	222	fifty five patients with mycobacterium kansasii isolates  47 pulmonary and eight disseminated  were identified at a large texas hospital from 1975 to 1985  
class1	222	the mean age of patients was 60 years  and there was a slight male predominance  
class1	222	isolation of m  
class1	222	kansasii usually represented disease  
class1	222	the great majority of patients with pulmonary infection due to m  
class1	222	kansasii had underlying pulmonary diseases  and 70  had nonpulmonary predisposing factors  
class1	222	m  
class1	222	kansasii pulmonary disease clinically and radiographically resembled pulmonary tuberculosis  
class1	222	disseminated m  
class1	222	kansasii infection occurred in severely immunocompromised patients  who frequently had pulmonary predispositions as well  
class1	222	disseminated infection most of ten involved the lung  reticuloendothelial system  bone  joint  and skin and presented with signs and symptoms related to these organs  
class1	222	despite only moderate in vitro susceptibility of m  
class1	222	kansasii to routine antituberculous drugs  most patients responded to rifampin containing regimens  
class1	222	the prognosis of patients with m  
class1	222	kansasii disease was determined primarily by their underlying diseases  
class1	223	spectrum of cryptococcus neoformans infection in 68 patients infected with human immunodeficiency virus  
class1	223	sixty eight patients infected with human immunodeficiency virus  hiv  and cryptococcus neoformans who presented to three major medical centers in new orleans  louisiana  were studied retrospectively  
class1	223	in patients with meningitis the most common presenting symptoms were fever and headache  
class1	223	those without central nervous system involvement generally had an isolated pulmonary infection due to c  
class1	223	neoformans and presented with cough and dyspnea  
class1	223	csf parameters were abnormal in 41  of patients  and the india ink preparation was positive in 88  of patients with cultures of csf positive for c  
class1	223	neoformans  
class1	223	the overall median survival time for the 47 patients who died was 5 months  with a range of 0 22 months  
class1	223	of the 27 patients who received maintenance therapy with amphotericin b  two  7   relapsed  
class1	223	the only factors found to be associated with a poor prognosis were abnormal computed tomography of the head and altered mental status on presentation  
class1	223	c  
class1	223	neoformans infections in hiv infected patients remain difficult to treat and have a poor prognosis  
class1	224	comparison of species distribution and antimicrobial susceptibility of aerobic actinomycetes from clinical specimens  
class1	224	to compare the species distribution and antimicrobial susceptibility of aerobic actinomycetes  we evaluated 366 isolates referred to the centers for disease control from october 1985 through february 1988  
class1	224	we used conventional biochemical tests to identify the various species  
class1	224	four species accounted for 191  52   of aerobic actinomycete isolates  nocardia asteroides  98 isolates   actinomadura madurae  42 isolates   streptomyces griseus  28 isolates   and nocardia brasiliensis  23 isolates   
class1	224	sputum and wounds were the most common sources  
class1	224	no isolate was resistant to amikacin  no n  
class1	224	brasiliensis isolate was resistant to sulfamethoxazole or trimethoprim sulfamethoxazole  and no a  
class1	224	madurae isolate was resistant to ceftriaxone or imipenem  
class1	224	in summary  our findings show that unusual species of aerobic actinomycetes can cause infection  colonization  or both and that antimicrobial resistance varies markedly by species  
class1	225	a case of group b streptococcal pyomyositis 
class1	225	the group b streptococcus is an opportunistic pathogen that causes a variety of serious infections including bacteremias  puerperal sepsis  and neonatal meningitis  
class1	225	group b streptococcal infections of muscle are rare  
class1	225	we report here an unusual case of group b streptococcal pyomyositis  
class1	225	pyomyositis arises predominantly from infections caused by staphylococcus aureus and  occasionally  streptococcus pyogenes  
class1	225	because of the rarity of pyomyositis in temperate climates  the common lack of localizing signs or symptoms  and the frequently negative blood cultures  considerable delay often precedes the diagnosis of pyomyositis  in fact  the infection has been initially misdiagnosed as muscle hematoma  cellulitis  thrombophlebitis  osteomyelitis  or neoplasm  
class1	225	diagnosis may be greatly aided by radiologic techniques that can demonstrate the sites of muscle enlargement and the presence of fluid collections  
class1	225	the response to antibiotics is usually rapid  but resolution of the infection may require aspiration of deeply situated muscle abscesses  
class1	225	this report describes a diabetic patient with an unusual presentation of pyomyositis that mimicked an acute abdomen  
class1	226	pneumococcal endometritis and neonatal sepsis  
class1	226	a recent case of postpartum maternal endometritis and neonatal sepsis due to streptococcus pneumoniae prompted this report and a review of previous citations  
class1	226	although this rare presentation of pneumococcal infection is potentially fatal to both mother and child  early empiric antibiotic coverage for the most frequent etiologic agents of this syndrome  group b streptococci  was and is adequate for systemic pneumococcal infections  
class1	227	visceral protothecosis mimicking sclerosing cholangitis in an immunocompetent host  successful antifungal therapy  
class1	227	a healthy 39 year old man who had clinical findings consistent with sclerosing cholangitis was found to have systemic protothecosis at surgery  
class1	227	severe granulomatous inflammation and palpable nodules were found in the gallbladder  on the surface of the liver  and in the duodenum  
class1	227	prototheca wickerhamii was detected in biopsied specimens and stool  the titer of indirect fluorescent antibody to this organism was 1 2 000  
class1	227	the patient recovered after a short course of treatment with amphotericin b and 3 months of oral therapy with ketoconazole  
class1	227	he had no other concurrent illness and had no abnormality in his immune system  
class1	227	this is the second reported human case of systemic protothecosis  
class1	227	an elevated igg level  an elevated erythrocyte sedimentation rate  eosinophilia  and abnormal levels of enzymes in the liver were found in both cases  
class1	227	protothecosis should be considered in the differential diagnosis of hepatic and biliary inflammatory diseases of uncertain etiology  
class1	228	enterobacter bacteremia in pediatric patients  
class1	228	enterobacter has emerged as an important human pathogen  particularly in sick  hospitalized patients  
class1	228	previous reports of nonepidemic enterobacter bacteremia have focused on adult patients  
class1	228	in this report  the epidemiologic factors  clinical characteristics  treatment  and outcome for 33 patients with enterobacter bacteremia in a large children s hospital during a 5 year period are reviewed  
class1	228	the ratio of males to females was 1 2 1  
class1	228	the patients  ages ranged from 2 days to 24 years  and 18 patients were less than 18 months old  
class1	228	twenty two cases were nosocomially acquired  six were polymicrobial in nature  
class1	228	significantly underlying conditions were present in 32 patients  
class1	228	the biliary tract and central venous catheters were the most common sources of bacteremia  
class1	228	two thirds of patients had preceding antibiotic therapy  
class1	228	the overall mortality was 24   mortality attributable to enterobacter bacteremia was 18   
class1	228	statistically significant differences in mortality were associated with an age less than 18 months  p    031  or thrombocytopenia  p    017   presence of fever was of borderline significance  p    098   
class1	228	enterobacter bacteremia is an important cause of morbidity and mortality in pediatric patients  
class1	229	endocarditis due to ampicillin resistant nontyphoid salmonella  cure with a third generation cephalosporin  
class1	229	a case of ampicillin resistant salmonella bacteremia complicated by endocarditis in a 78 year old man is presented  
class1	229	previous rheumatic valvular heart disease and the lack of response to initial treatment with chloramphenicol prompted us to consider this diagnosis  
class1	229	there was a good clinical response after treatment with ceftriaxone alone and corresponding improvement on the echocardiogram  
class1	229	this case demonstrates the possible endovascular complications of salmonella bacteremia in elderly people and that endocarditis should be included among the invasive infections due to ampicillin resistant salmonella that could potentially be treated with the newer cephalosporins  
class1	230	listerial myocarditis in cardiac transplantation  
class1	230	clinical signs of heart failure developed in two cardiac transplant recipients and were interpreted initially as graft rejection  
class1	230	morphologic examination of explanted hearts revealed myocarditis with abscess formation and necrosis consistent with a bacterial process  listeria monocytogenes was isolated from myocardial tissue in the first case and from blood in both  
class1	230	the first patient also developed signs of meningoencephalitis  but the second had no signs of infection outside the heart  
class1	230	antimicrobial therapy and retransplantation were successful in eradicating listeriosis  
class1	230	the differential diagnosis of heart failure in cardiac transplant recipients includes infectious myocarditis due to l  
class1	230	monocytogenes  
class1	231	group c streptococcal arthritis  case report and review  
class1	231	streptococci account for approximately 15  20  of cases of nongonococcal septic arthritis  
class1	231	the majority of these are due to group a streptococci  but group b and group g streptococci are being isolated more frequently  
class1	231	we present a case of group c streptococcal arthritis and summarize nine additional cases reported in the literature  
class1	231	the group c streptococci include the large colony of voges proskauer negative bacteria  streptococcus equi  streptococcus equisimilis  streptococcus zooepidemicus  and streptococcus dysgalactiae  as well as as the minute colony of voges proskauer positive streptococcus anginosus   streptococcus milleri   group c organisms  
class1	231	any joint may become infected  but joints affected by preexisting rheumatologic abnormalities are more frequently involved  
class1	231	bacteremia was documented in five of the 10 patients  
class1	231	one patient had an associated pneumonia  and another patient had an associated acute aortic valve endocarditis  
class1	231	none of the infections involved a prosthetic joint or an overlying cellulitis  associations reported for group g streptococcal arthritis  
class1	231	surgical drainage of the infected joint was required in six of the 10 patients  
class1	231	we concluded that the presence of two groups of organisms sharing the same lancefield group antigen necessitates the careful identification of isolates to determine potential clinical differences  
class1	232	primary meningococcal conjunctivitis  report of 21 patients and review  
class1	232	neisseria meningitidis is an uncommon cause of acute bacterial conjunctivitis  
class1	232	twenty one cases of primary meningococcal conjunctivitis  pmc  are reported herein and 63 cases published in the literature since 1899 are reviewed  
class1	232	in the 84 cases of pmc available for analysis  the male to female ratio was 1 76 1  nine of the patients were neonates  55 were children  and 20 were adults  
class1	232	conjunctivitis was unilateral in 66 3  of the patients  
class1	232	gram stain of conjunctival exudate disclosed gram negative diplococci in all cases in which it was done  
class1	232	culture of the conjunctival exudate yielded n  
class1	232	meningitidis in all cases  and 44  of the isolated meningococci belonged to serogroup b  
class1	232	ocular complications  which occurred in 15 5  of the patients  most frequently were corneal ulcers  
class1	232	systemic meningococcal disease developed in 17 8  of the patients  the overall mortality was 13 3  for patients with pmc complicated by systemic disease  
class1	232	development of systemic disease was significantly more frequent in patients receiving only topical therapy than in those treated with systemic therapy  31 71  vs  
class1	232	2 38   p    001   
class1	232	gram negative diplococci observed in conjunctival exudate are an indication for systemic antibiotic therapy because of the risk of systemic complications associated with the use of topical therapy alone  
class1	232	when properly treated  patients with pmc have a favorable prognosis  
class1	233	quinolone antibiotics in the treatment of salmonella infections 
class1	233	the 4 fluoroquinolones are a new class of antimicrobial agents that possess broad in vitro antibacterial activity  including efficacy against enteric pathogens such as salmonella  shigella  campylobacter  yersinia  and vibrio species  
class1	233	these drugs are clinically effective against both drug sensitive and multiresistant strains of salmonella typhi and salmonella paratyphi that cause enteric fever  
class1	233	in salmonella enterocolitis  the quinolones  unlike older antimicrobial agents that may have little impact on the duration of symptomatic illness and can in fact prolong fecal carriage of salmonellae  actually shorten the course of clinical disease and terminate excretion of these organisms in the stool  
class1	233	similarly  for chronic carriers of both typhoidal and nontyphoidal salmonella strains  the quinolones are effective in eradicating biliary and fecal reservoirs of infection  
class1	233	immunosuppressed persons with salmonellosis  such as those with aids  may benefit from both short term treatment and prolonged prophylaxis with a quinolone antibiotic  
class1	233	the optimal agent  dose  and duration of quinolone therapy for all salmonella syndromes remain to be determined by larger controlled trials  
class1	234	infectious diseases as a canadian subspecialty  with projections to the year 2000  
class1	234	infectious diseases is a relatively new subspecialty in canada  
class1	234	during the past decade  however  important advances have been made  
class1	234	these include the formation of the canadian infectious diseases society and the development of the first royal college of physicians and surgeons examinations in the subspecialty of infectious diseases  
class1	234	the majority of canadians training for practice in the field of infectious diseases are now enrolled in programs in canada  
class1	234	despite predictions in the united states of an excess of physicians who specialize in infectious diseases  such a situation has not occurred in canada  
class1	234	more physicians with training in infectious diseases will be required in canada in the next decade to fill positions in patient care  microbiology  for individuals with both clinical and laboratory training   research  epidemiology and infection control  programs related to human immunodeficiency virus infections  geographic and international medicine  the pharmaceutical industry  and education and administration  
class1	234	in canada  the extent to which infectious diseases physicians are involved in these areas varies from that in the united states  
class1	234	this review suggests a continued need for physicians with appropriate training in infectious diseases  
class1	235	protection of mice against the lyme disease agent by immunizing with recombinant ospa  
class1	235	lyme borreliosis is a tick borne illness caused by borrelia burgdorferi  
class1	235	the gene for outer surface protein a  ospa  from b  
class1	235	burgdorferi strain n40 was cloned into an expression vector and expressed in escherichia coli  
class1	235	c3h hej mice actively immunized with live transformed e  
class1	235	coli or purified recombinant ospa protein produced antibodies to ospa and were protected from challenge with several strains of b  
class1	235	burgdorferi  
class1	235	recombinant ospa is a candidate for a vaccine for lyme borreliosis  
class1	236	syphilis  human immunodeficiency virus infection  and targeting prevention  
class1	236	to examine the interaction between syphilis and human immunodeficiency virus type 1  hiv 1  infection in oklahoma  we conducted an unlinked hiv seroprevalence survey using serum specimens submitted to the oklahoma state department of health for serologic test for syphilis  
class1	236	of specimens with positive results from fluorescent treponemal antibody absorption test  fta abs   6 3  were hiv 1 seropositive compared to 0 8  of those that had negative results from fta abs  
class1	236	among specimens positive for syphilis  hiv 1 seropositivity was found almost exclusively among those from persons 20 to 39 years of age and more often among those from men than those from women  9 9  vs 1 3    
class1	236	of syphilis positive specimens from 20  to 39 year old men  17 6  were hiv 1 seropositive  
class1	236	in oklahoma  an area with a relatively low overall prevalence of hiv 1 infection  targeting prevention efforts to young adults who test positive for syphilis should be an efficient way to reach some persons at high risk for hiv 1 infection  
class1	237	neurologic abnormalities in a patient with human ehrlichiosis  
class1	237	human ehrlichiosis is a tick borne rickettsial disease characterized by fever  headache  myalgias  anorexia  and occasionally rash  
class1	237	in our patient  changes in mental status  upper motor neuron signs  cerebrospinal fluid pleocytosis  and increased serum protein levels were found in association with serologically confirmed ehrlichiosis and were most likely due to vasculitis involving the central nervous system  
class1	237	intraleukocytic inclusions  although observed in our case  have been infrequently found in other reported cases of ehrlichiosis  
class1	238	left ventricular pseudoaneurysm complicating mitral valve replacement in a 4 year old child with acute bacterial endocarditis  
class1	238	a 4 year old child with acute bacterial endocarditis required mitral valve replacement  
class1	238	a left ventricular pseudoaneurysm developed following surgery  
class1	238	the etiology and diagnosis of this complication are discussed  
class1	239	pleuropulmonary tularemia  successful treatment with erythromycin  
class1	239	a 64 year old man had community acquired pneumonia that was retrospectively diagnosed as pleuropulmonary tularemia  
class1	239	he was successfully treated with erythromycin  
class1	239	we review the case and briefly discuss the literature on this point  
class1	240	antibodies in human tears during and after infection  
class1	240	the tear content of antibodies specific for various infectious agents has recently begun to be investigated  
class1	240	important parameters of tear analysis with respect to antibody content are the method of tear collection and the laboratory techniques used to detect specific antibodies in the lacrimal fluid  
class1	240	normal tears contain antibodies directed against both bacteria and viruses  and the antibody response in lacrimal fluid during immunization of animals and humans has been studied to some extent  
class1	240	this response has also been analyzed in humans during and after natural infection with certain viral and bacterial pathogens  
class1	240	it has become clear that local antibody synthesis takes place in the lacrimal gland  but at least some of these antibodies appear in tears because of lymphocyte sensitization in the common mucosal immune system  
class1	240	a certain degree of transudation of serum antibodies to tears is also often encountered  especially in severely inflamed eyes  
class1	240	much of the data currently available needs to be confirmed  and more extensive studies need to be carried out for many pathogens  
class1	240	potential benefits of such studies include development of new diagnostic techniques as well as a better understanding of when and how antibodies confer protection or may be potentially damaging  
class1	241	hyperbaric oxygen therapy for necrotizing fasciitis reduces mortality and the need for debridements  
class1	241	twenty nine patients with necrotizing fasciitis were treated from 1980 to 1988  
class1	241	this study evaluates how the addition of hyperbaric oxygen  hbo  therapy to surgical treatment has affected mortality and the number of debridements required to achieve wound control in these patients  
class1	241	two groups of patients were viewed  group 1  n   12  received surgical debridement and antibiotics only  group 2  n   17  received hbo  90 minutes at 2 5 atm  average 7 4 treatments  in addition to surgery and antibiotics  
class1	241	both groups were similar in age  race  sex  wound bacteriology  and antimicrobial therapy  
class1	241	body surface area affected was similar  however  perineal involvement was more common in group 2  53   than in group 1  12    
class1	241	the admitting conditions of patients in group 1  non hbo  were diabetic  33   white blood cell count more than 12 000  50   and shock  8   
class1	241	the admitting conditions of patients in group 2  hbo  were diabetic  47   white blood cell count more than 12 000  59   and shock  29   
class1	241	although group 2 patients receiving hbo were more seriously ill on admission  mortality was significantly lower  23   compared to group 1  66    p less than 0 02   
class1	241	in addition  only 1 2 debridements per group 2 patient were required to achieve wound control versus 3 3 debridements per group 1 patient  p less than 0 03   
class1	241	the addition of hbo therapy to the surgical and antimicrobial treatment of necrotizing fasciitis significantly reduced mortality and wound morbidity  number of debridements  in this study  especially among nonclostridial infections  
class1	241	we conclude that hbo should be used routinely in the treatment of necrotizing fasciitis  
class1	242	giant basilar aneurysm in the course of subacute bacterial endocarditis  
class1	242	we describe a man aged 42 years with mitral valve regurgitation who suffered from subacute bacterial endocarditis caused by streptococcus morbillorum  
class1	242	the clinical picture began with a toxic syndrome  
class1	242	five months later  the patient had an embolic episode and a right rostral pontine stroke  which was followed a few days later by an adversive focal seizure on the right  
class1	242	despite antibiotic treatment  he suffered complete third nerve palsy  
class1	242	arteriography  magnetic resonance imaging  and computed tomography of the brain showed a giant aneurysm in the rostral end of the basilar artery  the aneurysm was clipped  
class1	242	we discuss the clinical features  radiology  and characteristics of this aneurysm as a unique case of a giant bacterial aneurysm in the vertebrobasilar system  
class1	243	management of peyronie disease by implantation of inflatable penile prosthesis  
class1	243	sixty seven patients with advanced peyronie disease were treated by implantation of an inflatable penile prosthesis  ipp   
class1	243	twenty eight of the 67 patients had documented total erectile failure  
class1	243	the remaining 39 patients had significant penile curvature causing  mechanical impotence  due to inability to achieve adequate vaginal penetration and chose implantation of an inflatable penile prosthesis  in some cases  combined with a straightening procedure  rather than one of the standard penile straightening procedures  
class1	243	currently  63 of the 67 patients have functioning prosthetic devices  in 3 other patients the device was removed because of infection  and 1 patient was dissatisfied and had the device removed  
class1	243	for impotent patients with severe peyronie disease for whom other medical or surgical treatment is neither desirable nor suitable  we recommend implantation of an inflatable penile prosthesis combined with a possible straightening procedure  
class1	244	diagnosis and treatment of prostatic infections  
class1	244	the diagnosis and management of prostatitis and pelviperineal pain is a challenge to the clinician  
class1	244	careful examination of the prostatic fluid and bacteriologic cultures to differentiate bacterial from nonbacterial prostatitis are essential  
class1	244	antimicrobial therapy is effective in the majority of men with acute or chronic bacterial prostatitis  
class1	244	nonbacterial prostatitis is the most common type of prostatitis  
class1	244	the etiology is unknown and treatment with repeated antimicrobial therapy is ineffective  
class1	244	alpha blocking agents may relieve symptomatology  
class1	244	pelviperineal pain may be of prostatic origin but other nonprostatic causes should be sought  
class1	245	hiv disease  a review for the family physician  part ii  secondary infections  malignancy and experimental therapy  
class1	245	the first part of this two part article included recommendations for the initial evaluation of patients suspected of having hiv infection  the centers for disease control s classification scheme for hiv disease and current recommendations for the use of zidovudine  
class1	245	in this second part  secondary infections and malignancy are reviewed  and various experimental therapies are briefly discussed  
class1	246	effects of common illnesses on infants  energy intakes from breast milk and other foods during longitudinal community based studies in huascar  lima   peru  
class1	246	to assess the effects of common infections on dietary intake  131 peruvian infants were observed longitudinally  
class1	246	home surveillance for illness symptoms was completed thrice weekly  and food and breast milk consumption was measured during 1615 full day observations  
class1	246	mean      sd  energy intakes on symptom free days were 557     128 kcal d  92 4     26 5 kcal kg 1 d 1  for infants aged less than 181 d and 638     193 kcal d  77 7     25 7 kcal kg 1 d 1  for infants aged greater than 180 d  
class1	246	statistical models controlling for infant age  season of the year  and individual showed significant 5 6  decreases in total energy intake during diarrhea or fever  
class1	246	there were no changes with illness in the frequency of breast feeding  total suckling time  or amount of breast milk energy consumed  
class1	246	by contrast  energy intake from non breast milk sources decreased by 20 30  during diarrhea and fever  and the small decrements in total energy consumption during illness were explained entirely by reduced consumption of non breast milk foods  
class1	247	bacteremia in an ambulatory setting  improved outcome in children treated with antibiotics  
class1	247	we undertook a study of 414 bacteremic patients  167 with haemophilus influenzae and 247 with streptococcus pneumoniae bacteremia  to evaluate their clinical presentation  laboratory and clinical results  and subsequent outcomes  
class1	247	patients with h influenzae bacteremia were more likely to have soft tissue foci  poorer clinical appearance at presentation  and be at higher risk for subsequent serious focal infections  persistent bacteremia  and subsequent hospital admissions than patients with s pneumoniae  
class1	247	patients with h influenzae bacteremia had a 21 1 fold increase in risk of meningitis  95  confidence interval  ci  of 3 8 to 78 0  compared with those with s pneumoniae  
class1	247	the odds ratio for initial lumbar puncture was 5 25  95  ci  1 1 23 6    
class1	247	ambulatory patients treated with antibiotics at presentation were less likely to develop new serious soft tissue infections  persistent bacteremia  or to require subsequent hospital admissions than untreated patients  
class1	247	the effect of treatment was greater for patients with s pneumoniae than those with h influenzae  
class1	247	careful follow up and reevaluation of patients with presumptive bacteremia is essential because treated and untreated patients can still develop serious soft tissue infections  
class1	248	percutaneous central venous catheterization  three years  experience in a neonatal intensive care unit  
class1	248	prolonged venous access is desirable in very low birth weight infants and infants for whom feedings are contraindicated  
class1	248	we prospectively evaluated 481 small diameter venous catheters placed percutaneously in 317 patients over 3 years  
class1	248	of 478 catheters  241  50   were placed in infants weighing 1 kg or less  
class1	248	mean catheter stay was 13 days  range  less than 1 to 77 days   
class1	248	almost half  49   of the central and thoracic catheters  91  of placements  were removed nonelectively  43  due to problems such as leaking or clotting and 6  to suspicion of sepsis or venous occlusion  
class1	248	of the 23 episodes of possible sepsis in the 478 catheter stays  six  1 3   were confirmed catheter related sepsis  12  2 5   were confirmed alternate locus sepsis  
class1	248	three factors specific to percutaneous central venous catheter related sepsis were prolonged catheter stay  3 to 5 weeks   staphylococcus epidermidis  and weight less than or equal to 1 kg  
class1	248	four factors specific to alternate locus sepsis were presence of an alternate infection site  earlier infection  1 to 2 weeks   extremely low birth weight  and prolonged clinical instability  
class1	248	percutaneous central venous catheterizations reduced the need for the stress of repeated venipuncture  resulting in lower complication rates than those reported with surgically placed central venous catheters  and leading to identification of risk factors specific to catheter sepsis and alternate locus sepsis  
class1	249	 spontaneous sump syndrome   successful treatment by duodenoscopic sphincterotomy  
class1	249	 sump syndrome  is a rare complication of side to side choledochoenterostomy operations which develops in the distal  nonfunctioning limb of the common bile duct where lithogenic bile  gastrointestinal contents  and debris accumulate  
class1	249	we report here a patient who developed spontaneous sump syndrome as a result of the formation of choledochoduodenal fistula  and who presented with multiple pyogenic liver abscesses  
class1	249	the patient s symptoms and liver abscesses resolved completely after treatment by endoscopic sphincterotomy and antibiotics  
class1	249	this case demonstrates that sump syndrome may occur spontaneously  that it can be a cause for pyogenic liver abscess formation  and that it may be treated effectively by endoscopic sphincterotomy  
class1	250	adult and pediatric peritonitis rates in a home dialysis program  comparison of continuous ambulatory and continuous cycling peritoneal dialysis  
class1	250	we reviewed our 115 month experience with continuous ambulatory peritoneal dialysis  capd  and continuous cycling peritoneal dialysis  ccpd  in adult and pediatric patients to determine whether there is a difference in the incidence of peritonitis between patients performing capd or ccpd  
class1	250	peritonitis rates were similar in patients performing capd or ccpd in both the adult and pediatric age groups  
class1	250	the overall capd peritonitis rate was significantly lower in adult patients when compared with pediatric patients  
class1	250	there was no difference in peritonitis rates for ccpd between adult and pediatric patients  
class1	250	when the data are divided into 3 year subgroups  the incidence of peritonitis is significantly lower in adult patients undergoing either capd or ccpd when compared with pediatric patients during the years 1986 to 1988  
class1	250	there is significant improvement over time in the incidence of peritonitis in both adult and pediatric patients performing ccpd  similarly  there is a trend toward improvement in patients performing capd  
class1	250	staphylococcus species organisms remain the most common bacterial cause of peritonitis  except in pediatric patients under the age of 2 years or with nephrostomies  where gram negative rod infections were more common  
class1	250	peritonitis resulted in discontinuation of peritoneal dialysis in a greater number of adult patients  
class1	250	these results suggest that the number of catheter manipulations is not important in determining the incidence of peritonitis  
class1	250	pediatric patients are more likely than adult patients to develop peritonitis with either capd or ccpd  
class1	250	adult patients are more likely than pediatric patients to discontinue peritoneal dialysis secondary to peritonitis  
class1	251	epidemiology of lyme disease in virginia  
class1	251	prior to january 1986  only one case of lyme disease was reported from virginia  
class1	251	in 1986 87  however  the virginia department of health observed an increase in reports of suspected lyme disease by physicians  despite the fact that ixodes dammini is not highly prevalent in the virginia tick population  
class1	251	twenty eight cases of lyme disease were identified in virginia  of which eight cases occurred in 1986 and 20 in 1987  
class1	251	lyme disease appears to be increasing in frequency in virginia and moving southward along the eastern atlantic seaboard  
class1	252	use of intrapleural streptokinase in the treatment of thoracic empyema  
class1	252	the incidence of pleural effusions in bacterial pneumonia may exceed 40   a factor that may be related to increased morbidity and mortality  
class1	252	options in the treatment of complicated pleural effusions or empyema  when unresponsive to closed tube drainage  include repositioning of the indwelling tube thoracostomy or insertion of additional chest tubes  instillation of intrapleural streptokinase  and surgical intervention  
class1	252	the authors describe the course of three patients wherein the use of intrapleural streptokinase was efficacious in effecting prompt drainage of previously inadequately evacuated empyema  thus eliminating the necessity for further invasive intervention  
class1	253	antenatal microbiologic and maternal risk factors associated with prematurity  
class1	253	in a prospective study of 202 women  gestational age 24     4 weeks   we evaluated possible influences of lower genital tract infection or bacterial conditions on obstetric outcomes  including preterm labor  preterm premature rupture of membranes  and preterm birth  
class1	253	the presence of bacterial vaginosis  18 7   was associated with an increased risk of preterm labor  relative risk  2 6  95  confidence interval  1 08 to 6 46   
class1	253	for women with bacterial vaginosis who also had mobiluncus species morphotypes identified on gram stain  the relative risk of preterm labor was 3 8  95  confidence interval  1 32 to 11 5   
class1	253	presence of vaginal mycoplasma hominis  10 8  of patients  was associated with both preterm labor  relative risk  1 8  95  confidence interval  0 77 to 4 4  and preterm birth  relative risk  5 1  95  confidence interval  1 45 to 17 9   
class1	253	recovery of staphylococcus aureus  3 0   was associated with preterm labor  relative risk  3 1  95  confidence interval 1 12 to 8 7   
class1	253	identification of two or more bacterial linked abnormalities was also associated with preterm labor  relative risk  3 3  95  confidence interval  1 44 to 7 58   
class1	253	an increased level of vaginal wash protease  greater than or equal to 10 trypsin units   16   was associated with preterm labor and was noted in 50  of women with preterm premature rupture of membranes  
class1	253	a history of prior preterm birth was the single best historical predictor of both preterm labor  relative risk  3 6  95  confidence interval  1 92 to 6 83  and preterm birth  relative risk  6 7  95  confidence interval  2 2 to 20 4   
class1	253	history of three or more abortions  antenatal urinary tract infection  and occurrence of medical complications during pregnancy also correlated with increased risk of preterm labor  
class1	253	these findings affirm and refine associations of various maternal reproductive tract infections with preterm labor  premature rupture of membranes  and birth  allowing for controlled treatment trials aimed at prevention of preterm birth  
class1	254	cervicovaginal microflora and pregnancy outcome  results of a double blind  placebo controlled trial of erythromycin treatment  
class1	254	available information suggests that some instances of preterm birth or premature rupture of membranes are associated with clinically unrecognized infection and inflammation of the lower uterine segment  decidua  and fetal membranes  
class1	254	various cervicovaginal microorganisms have been recovered from these sites  
class1	254	many of these microorganisms produce factors that may lead to weakening of the fetal membranes  release of prostaglandins  or both  
class1	254	this study evaluated the presence of various lower genital tract microflora and bacterial conditions in 229 women enrolled in a double blind  placebo controlled trial of short course erythromycin treatment at 26 to 30 weeks  gestation to prevent preterm birth  
class1	254	demographic  obstetric  and microbiologic parameters were prospectively evaluated  
class1	254	premature rupture of membranes occurred less frequently  p less than 0 01  among women who received erythromycin  6   versus placebo  16    
class1	254	preterm premature rupture of membranes also occurred less frequently  although not significantly  p   0 3  in patients who received erythromycin  2   versus placebo  5    
class1	254	erythromycin treatment significantly decreased the occurrence of premature rupture of membranes among women who were initially positive for chlamydia trachomatis infection  
class1	254	logistic regression analysis demonstrated that c  
class1	254	trachomatis  p   0 05  odds ratio  9   vaginal wash phospholipase c  p   0 08  odds ratio  6  and prior preterm birth  p   0 007  odds ratio 17  were associated with increased risk of preterm birth  
class1	254	bacterial vaginosis  mycoplasma hominis  ureaplasma urealyticum were not significantly associated with increased risk of preterm birth or preterm rupture of membranes  
class1	254	these findings support a role for selected lower genital tract microflora in preterm birth and premature rupture  
class1	254	large controlled treatment trials of specific infections or conditions associated with preterm birth and premature rupture of membranes are required to confirm the value of antimicrobial treatments in prevention of microbial associated preterm birth  
class1	255	pregnancy outcomes among mothers infected with human immunodeficiency virus and uninfected control subjects  
class1	255	between june 26  1985  and feb  
class1	255	24  1989  101 seropositive pregnant women and 129 seronegative pregnant women from the same prenatal clinics in brooklyn and the bronx were recruited into a prospective study of human immunodeficiency virus infection in pregnant women and their offspring  
class1	255	this report details the course of pregnancy and short term neonatal outcomes of 91 seropositive women and 126 seronegative women who gave birth during the study period  
class1	255	seropositive mothers were significantly more likely to have sexually transmitted diseases  17 6  vs 7 1   p   0 017  and medical complications  43 0  vs 25   p   0 006  during pregnancy  
class1	255	no other obstetric complications  e  
class1	255	g   chorioamnionitis  endometritis  toxemia  or placental problems  were associated with serologic status  
class1	255	after controlling for confounding variables  drug use  tobacco use  age of mother  and clinic   we found that the mother s serologic status was not significantly associated with birth weight  gestational age  head circumference  or apgar scores among live infants  
class1	255	for example  after adjustment on confounders we found that children born to seropositive mothers weighed about 7 gm more than children of seronegative mothers  95  confidence interval   180 to 194 gm   
class1	255	we conclude that in this population human immunodeficiency virus infection has little demonstrable impact on the status at birth of live neonates  
class1	256	perinatal mortality in victoria  australia  role of group b streptococcus  
class1	256	group b beta hemolytic streptococcus is the most common infective cause of neonatal morbidity and mortality  
class1	256	it is therefore surprising that no agreement exists for an approach to its prevention  
class1	256	there is also increasing evidence that occult infection may play an etiologic role in premature rupture of the membranes and preterm labor  
class1	256	in this report we review the role of group b beta hemolytic streptococcal sepsis as a cause of perinatal wastage in the state of victoria  australia during the period 1982 to 1987  
class1	256	group b beta hemolytic streptococcus accounted for 1 7  of overall perinatal deaths  and for 30 3   77 of 254  perinatal deaths directly attributable to infection  
class1	256	by comparison  over the same 6 year period  erythroblastosis accounted for 0 5  of perinatal wastage and there were only two deaths as a result of congenital syphilis  
class1	256	the true incidence of lethal group b beta hemolytic streptococcal infection is probably greater because of the absence of histologic and bacteriologic studies in many perinatal deaths  
class1	256	we believe that intrapartum chemoprophylaxis with penicillin of all group b beta hemolytic streptococcus positive carrier mothers would significantly reduce neonatal morbidity and mortality from this cause  
class1	257	epidemiologic differences between chlamydia and gonorrhea  
class1	257	to assess the prevalence  demographics  and transmission patterns of genital chlamydia infection  we screened 3 078 patients  and compared identified cases  n   511  to gonorrhea cases  n   291  diagnosed in the same setting  
class1	257	chlamydia cases were younger and more likely to be white than their gonorrhea counterparts  
class1	257	chlamydia cases were distributed diffusely  geographic overlap between the two diseases was only about 40 percent  
class1	257	gonococcal coinfection was noted in less than 10 percent of patients with chlamydia  
class1	257	nearly half of men with chlamydia and four fifths of women were asymptomatic and most cases were identified through screening or contact tracing  
class1	257	populations at high risk for chlamydia are seemingly different from those for gonorrhea  
class1	257	differences may be due to control interventions  active for gonorrhea  passive for chlamydia   
class1	257	chlamydia case reporting and control initiatives are recommended  
class1	258	garlic in oil associated botulism  episode leads to product modification  
class1	258	in february 1989  three cases of botulism occurred in persons who consumed garlic bread made from a garlic in oil product  
class1	258	testing of leftover garlic in oil showed it to have a ph of 5 7 and to contain high concentrations of clostridium botulinum organisms and toxin  
class1	258	this was the second episode of botulism associated with a low acid garlic in oil product which needs constant refrigeration  
class1	258	in response  the food and drug administration has taken steps to prevent a recurrence by requiring that microbial inhibitors or acidifying agents be added to such products  
class1	259	day care characteristics associated with haemophilus influenzae disease  haemophilus influenzae study group  
class1	259	to identify characteristics of day care facilities associated with h  
class1	259	influenzae disease  we compared 92 licensed facilities in which a case of h  
class1	259	influenzae disease had occurred with randomly selected facilities at which no cases occurred  
class1	259	matched univariate analysis showed that personnel at facilities where h  
class1	259	influenzae disease occurred were more likely than those at control facilities to use towels or handkerchiefs to wipe children s noses  admit children who were not toilet trained or had diarrhea   liberal fecal policy    had a narrower age range  were more likely than control facilities to be for profit and less likely to use volunteers  
class1	259	in a multivariate model that adjusted for age range  profit status and liberal fecal policy  towel or handkerchief use  or 5 5  95  ci  1 1  30  was the only variable independently associated with case facilities  
class1	259	this is the first association of a specific day care practice with h  
class1	259	influenzae disease  
class1	260	evidence for gonococcal transmission within a correctional system  
class1	260	in a study to examine sexually transmissible disease occurring within a large correctional system where sexual activity is prohibited  27 male inmates acquired culture proven gonorrhea from in jail sexual activity during a three month period  
class1	260	these results provide evidence to encourage inmate education about the acquired immunodeficiency syndrome  aids  and to support condom distribution programs in correctional facilities  
class1	261	hiv seroprevalence among male ivdus in houston  texas  
class1	261	hiv seroprevalence was 8 4 percent in a sample of 921 heterosexual male intravenous drug users in houston  texas who were not in drug treatment at the time of the study  
class1	261	males who were black  injected drugs daily  or had a history of syphilis had greater odds of being hiv positive than participants without those characteristics  
class1	262	south american blastomycosis  ophthalmic and oculomotor nerve lesions  
class1	262	a case of south american blastomycosis began with an oropharyngeal lesion which was followed by a granulomatous uveitis  
class1	262	the patient was treated with amphotericin b and showed a clinical regression  
class1	262	four months later  he developed a right 3rd cranial nerve palsy  aggravating the clinical aspect with a severe generalized involvement of the central nervous system and death  
class1	262	necropsy showed blastomycotic meningoencephalitis  
class1	263	recombinant capsular antigen  fraction 1  from yersinia pestis induces a protective antibody response in balb c mice  
class1	263	yersinia pestis produces a glycoprotein capsule  the biosynthesis of which appears to be temperature dependent  
class1	263	the fraction i  f1  component of this capsule is specific to y  
class1	263	pestis and the detection of f1 antibodies is the basis for several serological tests  
class1	263	we report the cloning of the f1 gene and its expression in escherichia coli using the phagemid vector lambda zapii and a f1 specific monoclonal antibody  
class1	263	the recombinant f1 antigen had a molecular weight of 17 kda  which proved to be identical to that of the f1 antigen produced by y  
class1	263	pestis  
class1	263	the recombinant cells produced f1 antigen at 37 degrees c but only minimal amounts at 27 degrees c  suggesting that the genetic features affected by temperature in y  
class1	263	pestis may be operating in the e  
class1	263	coli clone  
class1	263	it is not known if their similar molecular weights reflect the glycosylated nature of both proteins  
class1	263	f1 antigen purified from the e  
class1	263	coli recombinant induced a protective immune response in balb c mice challenged with up to 10 5  virulent y  
class1	263	pestis  
class1	263	the resistance of immunized mice to plague infection correlated with high titers of f1 antibody  
class1	263	the cloned gene expresses an immunogenically competent f1 antigen suitable for use in plague serodiagnostics and vaccine development  
class1	264	role of surgery in antibiotic induced pseudomembranous enterocolitis  
class1	264	with the increased use of prophylactic and broad spectrum antibiotics  pseudomembranous colitis has emerged as a significant clinical problem  
class1	264	management with specific anti clostridium difficile therapy  vancomycin or metronidazole  has reduced mortality to less than 2   
class1	264	nevertheless  the disease may progress to a fulminant toxic colitis or colonic perforation  
class1	264	additionally  another subset of patients will present with a dramatic clinical picture  suggesting acute peritonitis  eventuating in unnecessary laparotomy  
class1	264	this report reviews both the medical and surgical literature during the past 15 years of patients treated for pseudomembranous colitis  
class1	264	analysis of this clinical data has provided us with the opportunity to both define the role of surgery in this disorder and illustrate the necessity for a combined medical and surgical cooperative approach in the early management of this iatrogenic disease  
class1	265	blood contamination of anaesthetic and related staff 
class1	265	the incidence of skin contamination of anaesthetic and related staff by patient s blood and saliva was studied during 270 anaesthetics in cardiff hospitals over seven continuous days in october 1989  
class1	265	a survey was also made of current hepatitis b immunisation status and glove wearing habits of 75 anaesthetists  
class1	265	blood from 35  14   patients caused skin contamination of 65 staff during 46 incidents  
class1	265	twenty eight  61   of the contamination incidents occurred during vessel cannulation  
class1	265	five  8   of the 65 staff contaminated by blood already had cuts on their hands  
class1	265	there were nine incidents  4   of skin contamination by saliva  
class1	265	fifty three  71   anaesthetists were immunised against hepatitis b  
class1	265	only seven  9   anaesthetists wear gloves for oral or nasal intubation  six  8   for insertion of peripheral venous cannulae  47  63   for insertion of arterial lines and 67  89   for insertion of central lines  
class1	265	all anaesthetic and associated staff should wear gloves on a routine basis  
class1	266	infection during chronic epidural catheterization  diagnosis and treatment  
class1	266	a potentially serious complication of long term epidural catheterization in cancer patients is infection  
class1	266	the early signs of infection were studied in 350 patients in whom long term epidural catheters were inserted  
class1	266	three areas of the catheter track were found to be involved  exit site and superficial catheter track infection  and epidural space infection  
class1	266	the authors identified the early signs of infection in each area and the progress of the infection from the deep track to include the epidural space in four of these patients  
class1	266	all 19 patients who developed deep track or epidural infections were successfully treated with antibiotics and catheter removal  
class1	266	none of the patients required surgery for spinal cord decompression  
class1	266	catheters were replaced in 15 of the 19 treated patients who requested them after treatment with no recurrent infections  
class1	266	it was concluded that use of long term epidural catheterization is associated with a definable epidural infection rate  
class1	266	the use of epidural opioid analgesia is an effective and safe means of obtaining pain relief for terminally ill patients when patients are monitored for possible infection and receive prompt treatment when the diagnosis is established  
class1	267	toxic streptococcal syndrome  
class1	267	the streptococcal toxic shocklike syndrome is a recently recognized  multisystem disorder that shares many of the features of staphylococcal toxic shock syndrome  but is caused by toxins elaborated by group a beta hemolytic streptococcus  
class1	267	we describe a patient who fulfilled the major criteria for the clinical diagnosis of toxic shock syndrome  fever  hypotension  multisystem dysfunction  and diffuse macular erythroderma followed by desquamation  and who demonstrated serologic evidence suggesting streptococcal infection  
class1	267	in patients presenting with clinical findings consistent with a toxic shocklike syndrome  the emergency physician should consider streptococcal infection as a potential etiology  
class1	268	tetanus immunization status and immunologic response to a booster in an emergency department geriatric population  
class1	268	study objectives  although effective procedures for the prevention of tetanus have long been available  serosurveys done since 1977 demonstrate that 49  to 66  of the elderly population lacks a protective antitoxin level  more than 0 01 iu ml   
class1	268	this study was undertaken to assess the tetanus immunization status of patients presenting to an emergency department and to evaluate their immunologic response to a tetanus booster  
class1	268	setting  the study was conducted in a tertiary care ed  
class1	268	type of participants  the patients enrolled were 65 or more years old and had breaks in their skin barriers  
class1	268	design  at each patient s initial presentation  pertinent demographic data and tetanus immunization history were recorded  
class1	268	the patient was then followed for 21 days  
class1	268	interventions  each patient s antitoxin titer was determined on a serum sample by elisa  and  if required by the advisory committee on immunization practices criteria  a booster was administered at the first visit  
class1	268	measurements and main results  serum antitoxin assays were repeated on days 7  14  and 21 after the initial visit until seroconversion  titer more than 0 01 iu ml   
class1	268	forty four patients  55   had protective levels at initial presentation  and in 36  45   the levels were not protective  
class1	268	age and sex were not predictive of protection  
class1	268	past military service and a definite history of three or more previous immunizations were good predictors of protection  
class1	268	of 34 patients who were followed serially for inadequate initial titers  only 19  56   seroconverted by day 14  
class1	268	patients who did not seroconvert were more likely to be older  p less than  05   
class1	268	conclusions  this study demonstrated that a significant number of elderly patients lacked an initial protective level of tetanus antitoxin  
class1	268	of these  44  failed to seroconvert within 14 days and carried a potential risk of developing tetanus  
class1	269	erythromycin failure with subsequent pasteurella multocida meningitis and septic arthritis in a cat bite victim  
class1	269	we report the case of a 75 year old woman who developed pasteurella multocida meningitis and septic arthritis while being treated for a cat bite wound infection with erythromycin  
class1	269	review of the literature revealed that erythromycin has poor in vitro activity against this bacterium and has been associated with serious clinical failures  
class1	269	we recommend that erythromycin not be prescribed for empiric therapy of established animal bite infections  
class1	269	suggestions for optimal empiric therapy of animal bite infections and the differential diagnosis of severe cat bite associated sepsis are discussed  
class1	270	the role of mucous glycoproteins in the rheologic properties of cystic fibrosis sputum  
class1	270	cystic fibrosis  cf  is characterized by excessive amounts of thick and tenacious mucous secretions that obstruct organ ducts and passages  
class1	270	in the respiratory tract this is associated with chronic infection resulting in the hypersecretion of purulent sputum  which the patient finds difficult to clear  
class1	270	we have studied the rheologic properties of purulent sputum from six patients with cf and five patients with chronic bronchitis to assess whether cf is associated with increased sputum viscoelasticity  
class1	270	in addition  we have isolated the major rheologic determinants  mucous glycoproteins  from cf and chronic bronchitis sputa and  using a magnetic microrheometer  investigated the possibility that the altered properties of mucus in cf are associated with abnormalities in these glycoproteins  
class1	270	creep compliance analysis indicated that the cf sputa possessed raised levels of both elasticity  p less than 0 01  and viscosity  p less than 0 01   
class1	270	these increases in both rheologic parameters were found to be associated with increases in the dna content  p less than 0 01  and dry weight  p less than 0 05   
class1	270	mucous glycoproteins were isolated from cf and chronic bronchitis sputum samples by gel filtration on sepharose cl4b  followed by concentration to form 8  wt wt gels  
class1	270	in the absence of other sputum components  no abnormality in the rheologic properties of cf mucin gels could be detected  
class1	270	however  when dna was added  the cf gels responded with increases in both elasticity and viscosity of as much as 30   p less than 0 05   an effect not observed in the chronic bronchitis gels  
class1	270	these results suggest that a subtle abnormality may exist in cf mucous glycoproteins and that this could have a role in the altered physical properties of mucous secretions in cf  
class1	271	human intestinal tissue antibiotic concentrations  clindamycin  gentamicin  and mezlocillin  
class1	271	an antibiotic  to be effective for prophylaxis in abdominal trauma  should quickly achieve high concentrations in the intestinal wall and at enough inhibitory levels to kill most aerobic and anaerobic bacteria that are potential contaminants at the site of surgical incision  
class1	271	therefore  we studied the intestinal tissue levels of clindamycin  gentamicin  and mezlocillin to see whether the tissue levels achieved by these antibiotics in the intestinal tissue were adequate  
class1	271	a single dose of mezlocillin  4 grams  clindamycin  600 mg and gentamicin  80 mg  quickly reached the desired concentrations  i e   52 3  9 69 and 6 1 micrograms gram of intestinal tissue respectively  
class1	271	these levels were high enough to inhibit the growth of most isolates of e  
class1	271	coli and b  
class1	271	fragilis  common pathogens involved in intra abdominal abscess  
class1	272	the inactivation of antithrombin iii by serum elastase in patients with surgical infections  
class1	272	the relationship between serum elastase and antithrombin iii was determined in septic surgical patients as a possible mechanism for intravascular thrombosis and hypercoagulability during sepsis  
class1	272	eighteen patients with surgical infections and elevated white blood cell counts had their blood assayed daily for white blood cell count  serum elastase  and antithrombin iii  until the patient s white blood cell count returned to normal  
class1	272	antithrombin iii was significantly lower  0 87   when elastase was above the normal range  greater than 14 2 micrograms ml   
class1	272	elastase was significantly higher  30 6 micrograms ml   when antithrombin iii was less than normal  
class1	272	these data indicate that elevated serum elastase is associated with a significant reduction in circulating antithrombin iii  
class1	272	stimuli that increase serum elastase  i e  
class1	272	surgery  trauma  or sepsis may promote intravascular thrombosis by the inhibition of antithrombin iii at the blood endothelial cell interface  
class1	273	effect of human immunodeficiency virus  hiv  infection on the course of syphilis and on the response to treatment  
class1	273	purpose  to evaluate evidence that concurrent infection with human immunodeficiency virus  hiv  alters both the natural history of syphilis  by increasing the frequency of early neurosyphilis  and the response to penicillin  
class1	273	data identification  review of major works on syphilis in the english language and files maintained since 1971  supplemented by a systematic search using index medicus and medlars  
class1	273	data extraction  the works mentioned above were critically reviewed for information on early neurosyphilis and  where relevant  hiv infection  
class1	273	results of data analysis  the central nervous system is regularly involved in early syphilis  
class1	273	standard recommended doses of benzathine penicillin provide cerebrospinal fluid levels that are probably at the borderline of efficacy  and cure relies on treatment and an adequate host immune response  
class1	273	early neurosyphilis  appearing within 2 years of onset of infection with treponema pallidum  was uncommon in the prepenicillin era and usually occurred after inadequate therapy  
class1	273	this complication was exceedingly rare in the first three decades of penicillin use  
class1	273	in contrast  in the past decade  40 patients with hiv infection have been reported to have asymptomatic neurosyphilis  or syphilitic meningitis  cranial nerve abnormalities  predominantly in cranial nerves ii and viii   or cerebrovascular accidents  singly or together  
class1	273	in 40  of cases  hiv infection was first diagnosed when neurologic symptoms appeared  
class1	273	of the 38 patients for whom information was available  18 had the acquired immunodeficiency syndrome  aids   7 had aids related complex  and 13 had antibody to hiv  
class1	273	sixteen had previously been treated for syphilis  of whom 5  31   had received benzathine penicillin within the previous 6 months  
class1	273	preliminary data also suggest that skin lesions and vdrl  venereal disease research laboratory  antibody in hiv infected patients with secondary syphilis respond more slowly to conventional penicillin therapy  
class1	273	conclusion  intensive therapy and follow up observation is indicated for early syphilis in hiv infected subjects  
class1	273	novel approaches to treatment deserve systematic evaluation  
class1	274	recurrent seizures in children with shigella associated convulsions  
class1	274	fifty five children with shigella associated convulsions were followed prospectively to investigate their risk of subsequent febrile or nonfebrile seizures  
class1	274	the duration of the follow up period was between 6 9 and 14 1 years  9 7     3 1 years   
class1	274	no case of nonfebrile seizures and only 2 cases  3   of subsequent febrile seizures were observed during this period  
class1	274	we conclude that although febrile and shigella associated convulsions share many clinical features  the natural history of these two conditions seems to be distinctly different  
class1	274	shigella related convulsions are not associated with an increased incidence of subsequent febrile or nonfebrile convulsions  
class1	275	iatrogenic contamination of multidose vials in simulated use  a reassessment of current patient injection technique  
class1	275	an investigation of the potential spread of iatrogenic infections through contaminated multidose vials was performed  
class1	275	contamination of a multidose vial was hypothesized to occur after a single syringe is used to inject an infected patient with medication  and the same syringe subsequently is used to withdraw additional medication from the multidose vial  
class1	275	if the contaminated multidose vial is used for another patient  an iatrogenic infection may be spread  
class1	275	laboratory study of this injection technique found that viral plaque forming units could be transmitted to a multidose vial in this manner  
class1	275	a survey of 100 fellows of the american academy of dermatology from the united states found that 24  of the respondents used this potentially unsafe procedure  
class1	275	the potential for iatrogenic spread of the human immunodeficiency virus and hepatitis b virus is described  
class1	275	recommendations to avoid patient infection are made  
class1	276	outcome after acute osteomyelitis in preterm infants  
class1	276	eight cases of skeletal infection in preterm infants were studied  
class1	276	all the infants were systemically unwell  with polymorpholeucocytosis  
class1	276	diagnosis was by blood culture  and any radiographic changes were apparent at the time of presentation  
class1	276	infection was often multifocal  with sites around the knee being most commonly affected  
class1	276	staphylococcus aureus was the pathogen isolated in six of the eight cases  in these treatment with fusidic acid was effective and well tolerated  even at doses that were less than the recommended therapeutic minimum  
class1	276	even with prompt diagnosis and aggressive treatment orthopaedic sequelae are common  
class1	277	thoracoplasty  current application to the infected pleural space 
class1	277	thoracoplasty  once commonly used in the management of cavitary pulmonary disease  continues to find application in the obliteration of infected pleural spaces  
class1	277	this study reports a series of 13 patients receiving thoracoplasty between 1976 and 1989  
class1	277	five patients had chronic apical empyema spaces without prior resection of lung tissue  
class1	277	two of the empyemas were due to tuberculosis  two were due to atypical mycobacteria  and one was due to postpneumonic empyema  
class1	277	all patients had extensive destruction of upper lobe tissue  
class1	277	eight patients had undergone prior pulmonary resection  3 had persistent infected spaces in the early postoperative period  3 had development of empyemas and bronchopleural fistulas late  5 to 19 years  after pulmonary resection  and 2 had postpneumonectomy empyema  
class1	277	all patients had rigid cavity walls preventing space obliteration by rib removal alone and required concomitant resection of the thickened pleura and intercostal muscle tissues  
class1	277	bronchopleural fistulas were present in 11 patients and were closed with adjacent nonintercostal muscle  
class1	277	all patients survived and had successful obliteration of the infected spaces with acceptable physiological and cosmetic results  
class1	277	we conclude that thoracoplasty remains a useful procedure in the management of the infected pleural space in select patients  
class1	278	air contamination in open heart surgery with disposable coveralls  gowns  and drapes  
class1	278	the effect of a polypropylene coverall  replacing shirt and trousers  combined with sterile laminated gowns and drapes compared with an all cotton system was studied in regard to the dispersion of bacteria and particles in a conventionally ventilated operating theater  
class1	278	the operations carried out were open heart procedures in 30 adult patients  
class1	278	blood agar sedimentation plates were placed in the operative  anesthesia  and perfusion areas  
class1	278	the mean sedimentation values during 1 hour after the start of operation were as follows in the laminate group  63 colony forming units  cfu  m2 in the operative area  77 cfu m2 in the anesthesia area  and 143 cfu m2 in the perfusion area  
class1	278	the corresponding figures in the cotton group were 350 cfu m2  364 cfu m2  and 437 cfu m2  respectively  p less than 0 0002   
class1	278	at the beginning of the operation  the mean values noted for colony forming units in the air at the operative site were 8 0 cfu m3 in the laminate group and 31 cfu m3 in the cotton group  
class1	278	one hour later  the values were 10 cfu m3 and 22 cfu m3  respectively  p less than 0 0002   
class1	278	at the end of the operation  the number of particles 5 microns or larger in the air at the operative site was 278 m3 in the laminate group and 592 m3 in the cotton group  
class1	278	it is concluded that the use of a polypropylene coverall and laminated gowns and drapes significantly reduces the particle and bacterial contamination of the air and the bacterial sedimentation during cardiac operations  
class1	279	myocardial preservation using lidocaine blood cardioplegia  
class1	279	prevention of ventricular fibrillation after aortic unclamping using lidocaine hydrochloride as an additive to cold potassium blood cardioplegia was studied prospectively in 46 patients undergoing elective myocardial revascularization  
class1	279	patients were similar with respect to age  ventricular function  severity of coronary artery disease  cross clamp time  completeness of revascularization  frequency of internal thoracic artery grafting  systemic temperature at the time of cross clamp removal  and mean infusate volume and temperature  
class1	279	patients receiving lidocaine blood cardioplegia  group 1  23 patients  had a significant reduction in the incidence of ventricular fibrillation  22  versus 74   p less than 0 0005  and in the mean number of cardioversion attempts required to defibrillate the heart  0 5     1 3 versus 1 9     0 97  p less than 0 0005  after cross clamp removal compared with controls  group 2  23 patients   
class1	279	there were no differences between the two groups postoperatively with regard to cardiac enzyme release  hemodynamic measurements  or clinical outcome  
class1	279	patients receiving lidocaine blood cardioplegia tended to have a lower incidence of new postoperative atrial fibrillation  9  versus 26    
class1	279	ventricular function was preserved equally in both groups  
class1	279	we conclude that lidocaine is a safe additive to potassium blood cardioplegia and significantly reduces the incidence of ventricular fibrillation after aortic unclamping  
class1	280	antimicrobial prophylaxis for open heart operations  
class1	280	between 1986 and 1988  450 adults undergoing coronary artery bypass  cardiac valve replacement  or both were enrolled into a prospective  randomized  comparative trial of cephalothin versus cefamandole as perioperative prophylaxis  
class1	280	they were assessed during their hospitalization and at 6 weeks and 6 months after discharge for postoperative infectious complications  
class1	280	eleven patients had major postoperative infections including 5 with sternal wound infections  three bacteremic   6 with bacteremia  1 with prosthetic valve endocarditis  and 3 with severe venous donor graft site infections  
class1	280	eight major infections occurred in patients receiving cephalothin prophylaxis and three in patients receiving cefamandole  with all five sternal wound infections occurring in the cephalothin group  
class1	280	postoperative pathogens responsible for the major infections included gram negative aerobes in 5 patients  staphylococcus aureus in 4  and staphylococcus epidermidis in 2  
class1	280	preoperative colonizing staphylococcal isolates were not predictive of postoperative staphylococcal pathogens  
class1	280	although there was no statistically significant difference in rate of major postoperative infectious complications using either cephalothin or cefamandole prophylaxis  there was a trend in favor of cefamandole  
class1	280	gram negative aerobes are becoming increasingly important pathogens in this setting  
class1	281	treatment of postoperative infection of ascending aorta and transverse aortic arch  including use of viable omentum and muscle flaps  
class1	281	postoperative infection of the ascending aorta and aortic arch in 40 patients was treated by antibiotic therapy alone  4 patients  or by operation and lifelong suppressive antibiotic therapy  36 patients   
class1	281	complications of infection included antibiotic resistant infection  infected false aneurysm  rupture of suture line  aortocutaneous fistulas  aortic right ventricular fistulas  arterial embolus  aortic valve insufficiency  aortobronchial fistula  mediastinal abscess  and chest wall problems  
class1	281	these were treated by a variety of operations including composite valve graft replacement  graft replacement  patch graft closure of false aneurysm  simple suture of disrupted suture lines and false aneurysm  and debridement of mediastinum and chest wall  
class1	281	the area of reconstruction was covered  and mediastinal dead space was reduced by mobilization of viable tissue  including local tissue and distant structures such as flaps of muscle and omentum  
class1	281	thirty three patients  83   were early survivors  and 28 patients  70   were alive and well at last follow up 4 months to 6 5 years after operation  
class1	282	management of mycotic rupture of the ascending aorta after heart lung transplantation  
class1	282	a 19 year old woman underwent heart lung transplantation for obstructive bronchiolitis  
class1	282	eleven days later mycotic rupture of the ascending aorta occurred  
class1	282	emergency cardiopulmonary bypass was instituted via the femoral vessels and the chest was reopened under cardiac massage  
class1	282	perforation of the aorta at the site of insertion of the cardioplegic cannula in the donor aorta was seen  
class1	282	under circulatory arrest the infected area was excised  a pericardial patch plasty was performed  and the region was covered with a muscle flap  
class1	282	postoperatively  candida albicans was found in the excised specimen of the aorta  in drainage fluid  and in the bronchoalveolar lavage  
class1	282	high doses of antimycotics were administered intravenously and for irrigation of the mediastinum  which resulted in an eradication of fungi in all cultures 7 days later  
class1	282	six weeks after reoperation the patient was discharged home  and she remains well 9 months postoperatively  
class1	283	left recurrent laryngeal nerve paralysis  an unusual presentation of histoplasmosis  
class1	283	a case of histoplasmosis seen as left recurrent laryngeal nerve paralysis in a 49 year old man is described  
class1	283	the patient had roentgenographic findings of a solitary  noncalcified left upper lobe mass and mediastinal adenopathy  
class1	283	tissue diagnosis of histoplasmosis was obtained using a thoracotomy  allowing institution of appropriate treatment  
class1	284	job s syndrome  a rare cause of recurrent lung abscess in childhood  
class1	284	a clinical syndrome characterized by recurrent staphylococcal infection of the skin and respiratory tract from birth was described in 1966 and referred to as job s syndrome  
class1	284	marked hyperimmunoglobulinemia e was later found to be associated with this syndrome  
class1	284	this article describes a case of job s syndrome as a cause of recurrent lung abscess during childhood necessitating lung resection  
class1	285	empiric treatment of fungal infections in the neutropenic host  review of the literature and guidelines for use  
class1	285	persistent fever that is refractory to broad spectrum antibacterials is common in neutropenic patients undergoing induction chemotherapy of acute leukemia  
class1	285	clinical experience suggests that many of these patients are infected with fungi  
class1	285	until recently  data supporting the role of empiric antifungal therapy in this setting were limited to small groups of patients or postmortem reports  
class1	285	evolving evidence in larger patient populations supports data from smaller series  febrile neutropenic patients who have failed to respond to a 4  to 7 day course of broad spectrum antibacterials may benefit from the early initiation of antifungal therapy  
class1	285	patients with fungal colonization or pulmonary infiltrates and adult patients who have not received previous fungal prophylaxis may especially benefit from the early use of antifungal drugs  
class1	285	amphotericin b has been the  gold standard  for empiric antifungal therapy  although the newer azoles may be useful in certain situations  
class1	286	seroprevalence of helicobacter pylori in seventh day adventists and other groups in maryland  lack of association with diet  
class1	286	to evaluate the possible role of diet in the transmission of helicobacter pylori  we compared h pylori seroprevalence among seventh day adventists  who are vegetarian and abstain from alcohol  caffeine  and meat  n   94  and two non seventh day adventist control groups  n   168   
class1	286	with the use of an enzyme linked immunosorbent assay h pylori antigen prepared in a french pressure cell  we found no difference in seroprevalence among these groups  however  seropositivity strongly correlated with age and black race  
class1	287	recurrent meningitis in a patient with congenital deficiency of the c9 component of complement  first case of c9 deficiency in europe  
class1	287	we describe the first cases  to our knowledge  of c9 deficiency in europe that were detected in a swiss family  of which two members  one with a complete deficiency and the other with approximately half normal c9 levels  experienced bacterial meningitis  
class1	287	the index patient  a 56 year old white man with a history of purulent meningitis at the age of 23 years  presented with an acute meningococcal meningitis  
class1	287	no impairment of cellular immunity or immunoglobulin deficiency could be found  
class1	287	complement assays showed a complete deficiency of the c9 component  while the other individual component levels were normal and the hemolytic activity  measured using the ch50 assay  was only slightly reduced  
class1	287	a family study revealed complete c9 deficiency in the patient s healthy brother and half normal c9 concentrations in his sister  his son  who also had experienced an episode of bacterial meningitis   and his niece  consistent with an inherited c9 deficiency  
class1	287	this first case of recurrent meningitis in a white patient with complete c9 deficiency suggests that this complement defect may also be a risk factor for bacterial  especially neisserial  infections  
class1	288	aerobic and anaerobic bacteriology of wounds and cutaneous abscesses  
class1	288	the aerobic and anaerobic microbiologic characteristics of 584 wounds and 676 skin or soft tissue abscesses were studied and correlated with the infection site  
class1	288	in wounds  aerobic or facultative bacteria only were present in 223 specimens  38    anaerobes only in 177 specimens  30    and mixed flora in 184 specimens  32    
class1	288	in total there were 1470 isolates  558 aerobic and 912 anaerobic  an average of 2 5 isolates per wound  1 6 anaerobic and 0 9 aerobic isolates   
class1	288	in abscesses  aerobic or facultative bacteria were recovered in 177 specimens  26    anaerobes only in 243 specimens  36    and mixed flora in 256 specimens  38    
class1	288	in total there were 1702 isolates  602 aerobic and 1100 anaerobic  an average of 2 5 isolates per abscess  
class1	288	the highest rates of anaerobes in wounds were in the inguinal  buttocks  and trunk areas and in abscesses in the perirectal  external genitalia  neck  and inguinal areas  
class1	288	the predominant aerobic organisms were staphylococcus aureus  363 isolates   group a streptococci  98 isolates   and escherichia coli  97 isolates   
class1	288	the predominant anaerobic organisms were bacteroides species  986 isolates   peptostreptococcus species  559 isolates   clostridium species  153 isolates   and fusobacterium species  109 isolates   
class1	288	the predominance of certain isolates in certain anatomical sites was correlated with their distribution in the normal flora adjacent to the infected site  
class1	288	these data highlight the polymicrobial nature of wounds and cutaneous abscesses  
class1	289	does survival depend on the amount of autotransplanted splenic tissue  
class1	289	susceptibility to streptococcus pneumoniae infection was studied in 11 groups of rats allocated to sham operation  splenectomy  or splenic autotransplantation of 10   20   30   40   50   60   70   80   or 90  of the removed spleen  
class1	289	three months later  all rats were exposed intravenously to type 1 streptococcus pneumoniae  median lethal dose  ld50  for control group   
class1	289	survivors were killed 13 days after the bacterial challenge  
class1	289	autopsy showed that more splenic tissue was recovered in rats that received less than 50  splenic tissue compared with those that received 50  or more  
class1	289	more survivors were found among sham operated rats  47 5   95  confidence intervals  32 to 68  and rats that had 40  splenic tissue implanted  35   confidence interval  20 to 54  or those that were found to have regenerated 40  splenic tissue  
class1	289	we conclude that 40  of the spleen should be autotransplanted to protect the rat optimally against infection after splenectomy  
class1	290	antibiotic pharmacokinetics in surgery 
class1	290	pharmacokinetics is the study of variables that affect drug concentrations at the effector site  
class1	290	the descriptive terms peak concentration  elimination half life  volume of distribution  and bioavailability are commonly used to express pharmacokinetic variability among drugs used in patient care  
class1	290	the pharmacokinetic characteristics of drugs are important for surgeons to understand because they represent differences that may assume clinical significance when selecting antibiotics for preoperative preventive indications  
class1	290	in addition  the changing hemodynamic pattern of the stressed and septic patient may result in changing pharmacokinetic patterns for an antibiotic  which  in turn  may require changes in the dosing regimen during the course of treatment  
class1	291	nontropical pyomyositis as a cause of subacute  multifocal myalgia in the acquired immunodeficiency syndrome  
class1	291	we report a case of nontropical pyomyositis in a patient with acquired immunodeficiency syndrome and disseminated mycobacterium avium infection  in which severe myalgia was the presenting symptom over several weeks  
class1	291	multifocal muscle lesions were identified by gallium scanning and magnetic resonance imaging techniques  
class1	291	the epidemiology  possible pathogenesis  clinical features  diagnostic imaging  and therapy are reviewed  
class1	291	early suspicion of nontropical pyomyositis in severely immunocompromised patients with  cryptic  myalgia is recommended  
class1	292	outbreak of spontaneous staphylococcal arthritis and osteitis in mice  
class1	292	staphylococcus aureus is the most common bacterial species found in association with nongonococcal bacterial arthritis in humans  
class1	292	we present here the first description of spontaneous bacterial arthritis and osteitis in mice  
class1	292	clinically  the most obvious findings were swelling and or ankylosis of hindpaws and nodose changes of the tail  
class1	292	the prevalence of arthritis and osteitis ranged from 0  to greater than 50  of the mice studied  depending on the mouse strain  
class1	292	the most prominent histopathologic feature of the arthritis was hypertrophy of the synovial tissue and destruction of cartilage and underlying bone  
class1	292	most of the s aureus infected mice displayed an identical phage type  which was also the only s aureus phage type found in skin isolates from clinically healthy mice  
class1	292	however  a few s aureus isolates were not typeable  indicating that an additional strain s  might cause bacterial arthritis in mice  
class1	293	levels of serum granulocyte colony stimulating factor in patients with infections  
class1	293	to clarify the physiologic roles of granulocyte colony stimulating factor  g csf  in infectious states in vivo  we examined the serum levels of g csf in patients with infection  
class1	293	serum samples from 24 patients in the acute stage of infection  14 men and 10 women  age 65 to 101  without hematologic disorders   as well as samples from 32 age matched normal elderly volunteers were investigated  
class1	293	sixteen of the initial 24 patients were reexamined after the recovery phase  
class1	293	g csf levels were examined by quantitative enzyme immunoassay  
class1	293	the g csf level in normal elderly controls  25 3     19 7 pg ml  was not different from that reported in other findings  
class1	293	there was no statistically significant relationship between their g csf level and peripheral white blood cell count or neutrophilic granulocyte count  
class1	293	the g csf level in the acute stage of infection was 731 8     895 0 pg ml  with a range of 30 to 3 199 pg ml  
class1	293	there was no significant difference in g csf levels between patients with respiratory tract infection and those with urinary tract infection  
class1	293	in all 16 cases examined  the serum g csf level in the acute stage of infection was significantly higher than that after recovery phase  the latter being the same as the level in normal elderly controls  
class1	293	g csf must therefore play a significant role in human infectious states in vivo  
class1	294	acute and chronic bacterial prostatitis  a review of treatment approaches  
class1	294	some authors describe acute bacterial prostatitis as a self limiting disease  and as with any other acute septic condition  parenteral broad spectrum antibiotic therapy is indicated  
class1	294	chronic bacterial prostatitis  however  is associated with a causative organism persisting unaltered in prostatic fluid and leading to relapsing urinary tract infections  
class1	294	in the 1970s  several workers produced a classification system and bacteriologic localization cultures for establishing the diagnosis of prostatitis  
class1	294	krieger and crawford point to an important factor that is omitted in many clinical trials with episodes of chronic bacterial prostatitis in men  
class1	294	if localization studies of the prostate infection are attempted in the presence of bacteriuria  the urine must be sterilized with nitrofurantoin or penicillin g  
class1	294	urine cultures obtained from first voided urine  bladder urine  and urine voided after prostatic massage should show no growth  and the expressed prostatic secretion can then be examined for evidence of prostatic infection  
class1	294	this procedure reduces the contamination of the expressed prostatic secretion by the organism from the urinary tract infection  
class1	294	this is important  because antibiotic treatment is determined by the sensitivity of the organism isolated from the prostate as well as by the ability of the antibiotics to penetrate the prostate  
class1	294	meares outlines the pharmacokinetic features needed for drug diffusion into prostatic fluid and provides detailed information on the physical characteristics of the prostate during acute and chronic bacterial prostatitis  
class1	294	unfortunately  the choice of an ideal drug cannot be extrapolated from this information because pharmacodynamic principles cannot predict clinical efficacy  
class1	294	some authors find that sulfamethoxazole trimethoprim has the best cure rate in the treatment of chronic bacterial prostatitis  
class1	295	sexually transmitted diseases of the colon  rectum  and anus  the challenge of the nineties  
class1	295	during the past two decades  an explosive growth in both the prevalence and types of sexually transmitted diseases has occurred  
class1	295	up to 55 percent of homosexual men with anorectal complaints have gonorrhea  80 percent of the patients with syphilis are homosexuals  
class1	295	chlamydia is found in 15 percent of asymptomatic homosexual men  and up to one third of homosexuals have active anorectal herpes simplex virus  
class1	295	in addition  a host of parasites  bacterial  viral  and protozoan are all rampant in the homosexual population  
class1	295	furthermore  the global epidemic of aids has produced a plethora of colorectal manifestations  
class1	295	acute cytomegalovirus ileocolitis is the most common indication for emergency abdominal surgery in the homosexual aids population  
class1	295	along with cryptosporidia and isospora  the patient may present to the colorectal surgeon with bloody diarrhea and weight loss before the diagnosis of human immunodeficiency virus  hiv  disease  
class1	295	other patients may present with colorectal kaposi s sarcoma or anorectal lymphoma  and consequently will be found to have seropositivity for hiv  
class1	295	however  in addition to these protean manifestations  one third of patients with aids consult the colorectal surgeon with either condylomata acuminata  anorectal sepsis  or proctitis before the diagnosis of hiv disease  
class1	295	although aggressive anorectal surgery is associated with reasonable surgical results in some asymptomatic hiv positive patients  the same procedures in aids  symptomatic hiv positive  patients will often be met with disastrous results  
class1	295	it is incumbent upon the surgeon  therefore  to recognize the manifestations of hiv disease and diagnose these conditions accordingly  
class1	296	immunogenicity in animals of a polysaccharide protein conjugate vaccine against type iii group b streptococcus  
class1	296	the native capsular polysaccharide of type iii group b streptococcus elicits a specific antibody response in only 60  of nonimmune human subjects  
class1	296	to enhance the immunogenicity of this polysaccharide  we coupled the type iii polysaccharide to tetanus toxoid  
class1	296	prior to coupling  aldehyde groups were introduced on the polysaccharide by controlled periodate oxidation  resulting in the conversion of 25  of the sialic acid residues of the polysaccharide to residues of the 8 carbon analogue of sialic acid  5 acetamido 3 5 dideoxy d galactosyloctulosonic acid  
class1	296	tetanus toxoid was conjugated to the polysaccharide by reductive amination  via the free aldehyde groups present on the partially oxidized sialic acid residues  
class1	296	rabbits vaccinated with the conjugate vaccine produced igg antibodies that reacted with the native type iii group b streptococcal polysaccharide  3 3 rabbits   while rabbits immunized with the unconjugated type iii polysaccharide failed to respond  0 3 rabbits   
class1	296	sera from animals receiving conjugate vaccine opsonized type iii group b streptococci for phagocytic killing by human peripheral blood leukocytes  and protected mice against lethal challenge with live type iii group b streptococci  
class1	296	the results suggest that this method of conjugation to a carrier protein may be a useful strategy to improve the immunogenicity of the type iii group b streptococcus polysaccharide in human subjects  
class1	297	isolation of hiv 1 from the blood of seropositive adults  patient stage of illness and sample inoculum size are major determinants of a positive culture  the walter reed retroviral research group  
class1	297	results of hiv 1 blood cultures from 609 seropositive adults across all stages of illness at the walter reed army medical center were reviewed  
class1	297	hiv 1 was isolated by coculturing of patient peripheral blood mononuclear leukocytes  pbmcs  with normal blood donor target pbmcs that had been stimulated with phytohemagglutinin and interleukin 2  
class1	297	the hiv 1 isolation success rate at walter reed increased progressively each year from 1986 to 1989  
class1	297	in 1989  hiv 1 was isolated from a single blood specimen from patients in walter reed stages 1 2  3 4  and 5 6 in 75   49 65   90   37 41   and 97   30 31  of cases  respectively  
class1	297	none of 22 blinded negative control specimens was positive  
class1	297	pbmc cultures from late stage patients regularly became positive within 7 days  92    compared to only 46  of positive cultures from early stage patients  
class1	297	for most patients  the lowest number of serially diluted pbmcs that resulted in a positive culture was 30 000 patient pbmcs  but the range was 300 to 3 million cells  
class1	297	hiv 1 was isolated less frequently from plasma  5 18  28    
class1	297	plasma viremia was detected only in patients with relatively high titers of infected pbmcs  
class1	297	forty six blood specimens from  at risk  seronegative adults were also cocultured  none was positive  
class1	298	ocular syphilis  
class1	298	the ability of syphilis to mimic different ocular disorders can lead to misdiagnosis and delay in appropriate antimicrobial therapy  
class1	298	the authors describe their experience over the past 5 years with the ocular manifestations of syphilis in 25 patients who comprised 2 45  of 1020 new patients  
class1	298	uveitis was the most common ocular manifestation seen  
class1	298	all patients had positive results from fta abs tests  whereas only 68  had reactive serum vdrls  
class1	298	two of five patients tested for human immunodeficiency virus  hiv  antibody were reactive  
class1	298	the authors recommend routine fta abs and vdrl screening in patients with uveitis or unexplained ocular inflammation  
class1	298	they also recommend testing for hiv antibody in luetics and aggressive treatment with high dose aqueous penicillin for syphilis  
class1	299	acute syphilitic posterior placoid chorioretinitis  
class1	299	six patients with evidence of secondary syphilis presented with visual loss in both eyes caused by large  placoid  yellowish lesions with faded centers at the level of the pigment epithelium in the macula and juxtapapillary areas  
class1	299	all eyes had vitreitis  
class1	299	all of the lesions showed a similar fluorescein angiographic pattern of early hypofluorescence and late staining  
class1	299	five patients had mucocutaneous lesions typical of secondary syphilis  
class1	299	all five patients treated with antibiotics had prompt improvement in visual function and resolution of the fundus lesions  
class1	299	the ophthalmoscopic and angiographic appearance of these posterior fundus lesions was sufficiently characteristic to suggest a diagnosis of secondary syphilis  
class1	299	modification of the host response to syphilis by human immune deficiency virus  hiv  infection may be partly responsible for this peculiar fundus picture  
class1	299	three of the four patients tested positive for hiv  
class1	300	the national immunization program of the netherlands  
class1	300	after a brief explanation of the immunization policy in the netherlands  the national immunization program is described  with special attention given to coupling of the municipal population records with a computerized database of individual immunization records at the provincial level  
class1	300	the dutch program achieves coverage rates greater than 90  for all routine immunizations  
class1	300	participation in the program is free of charge to every child living in the country up to the age of 13 years  but there is no obligation or requirement to be immunized  
class1	300	financing of the program is also discussed  
class1	301	postneonatal infectious disease mortality  the french situation  
class1	301	mortality caused by infectious and parasitic diseases represents a limited part of all postneonatal deaths in france  which have been stable for the past decade  
class1	301	this component is worthy of careful analysis because it is at least partially preventable  
class1	301	statistics are presented and interpreted  with discussion on which disorders should be included in assessing the impact of infection on morbidity and mortality  
class1	301	figures and international rankings change according to the inclusiveness of the definition chosen  
class1	301	there is need for epidemiologic and statistical research to make comparisons of mortality more clear  
class1	301	morbidity is also important because of high incidence  frequent hospitalization  and a heavy social cost  
class1	301	policy and services in france that relate to control and treatment of infection are described  as are shortcomings that call for further efforts  
class1	302	postneonatal mortality in norway  a study of recent trends and comparison with other mortality rates in norwegian children  
class1	302	postneonatal mortality in norway decreased rapidly from 1956 to 1980 but subsequently remained stable  
class1	302	in recent years the postneonatal death rate appears to be increasing  primarily due to greater numbers of deaths attributed to the sudden infant death syndrome  
class1	302	during the same period  mortality among older children has also decreased  with the decline evident in all leading causes  
class1	302	only among people aged 15 to 19 years have recent trends been less than encouraging  with the number of fatal traffic accidents in particular remaining stable or increasing  
class1	302	although there is room for continued improvement  the widely held belief that the health status of norwegian children is good is supported by the trends in mortality  
class1	303	treating systemic fungal infections in aids patients  prolonging life against the odds  
class1	303	fungal infections have become one of the major causes of death among immunocompromised patients  particularly patients with aids  
class1	303	accurate and quick diagnosis is difficult  therefore  empirical therapy is often necessary  
class1	303	this scenario is complicated by the fact that most antifungal agents are toxic at the doses used or relatively ineffective against deep seated mycoses  
class1	303	because the population of aids patients is increasing  physicians will be faced more often with the management of systemic fungal infections  
class1	303	despite the current bleak prognosis for these patients  several new antigen detection tests are being developed and triazole agents are proving to be effective and less toxic than their predecessors  
class1	303	many cases of systemic mycoses do result in mortality  but appropriate treatment can both prolong life and improve its quality  
class1	304	a randomized prospective study of topical antimicrobial agents on skin grafts after thermal injury  
class1	304	we prospectively studied 52 consecutive patients who were treated by early tangential excision and grafting following thermal injury  
class1	304	the usefulness of two topical antimicrobial agents  0 5  silver nitrate  ag  and neomycin  1 gm liter  plus bacitracin  50 000 units liter   nb   was compared with the effectiveness of ringer s lactate  rl  for prevention of autogenous skin graft loss due to infection  
class1	304	graft loss of 10 percent or more occurred in 17 patients  33 percent   due to infection in 16  
class1	304	skin graft loss was a minor problem in patients with less than 20 percent total body surface area  tbsa  burn  ag  0 of 6  nb  1 of 6  rl  1 of 5   
class1	304	the use of either antimicrobial  ag or nb  resulted in less graft loss  1 of 14  than rl  4 of 6  p less than 0 05  in the 20 to 40 percent tbsa burn group  
class1	304	large burns  greater than 40 percent  had a very high incidence of at least 10 percent graft loss  67 percent  regardless of treatment  
class1	304	infection in the area of graft loss was caused by antibiotic resistant organisms or yeast in 50 percent of the ringer s lactate group and the entire neomycin plus bacitracin group  
class1	304	no graft infections were caused by resistant organisms or yeast in the silver nitrate group  
class1	304	this study demonstrates that topical antimicrobial agents reduce infection related skin graft loss in patients with medium sized  20 to 40 percent tbsa  burns and that neomycin plus bacitracin is associated with rapid emergence of drug resistant organisms whereas silver nitrate is not  
class1	305	how and why aztreonam works  
class1	305	aztreonam is the first monocyclic beta lactam antibiotic  monobactam  to be tested clinically  
class1	305	its synthetic structure determines specific areas of activity  including enhanced activity against pseudomonas species  exceptional activity against gram negative bacteria  stability to beta lactamases and lack of activity against gram positive bacteria  all of which can be directly related to its chemical composition  
class1	305	aztreonam has a high affinity for the protein binding protein 3  pbp 3  of aerobic gram negative bacteria  
class1	305	most of these organisms are inhibited and killed at low concentrations of the drug  
class1	305	aztreonam binds poorly to pbp sites of the aerobic gram positive and anaerobic bacteria and consequently has relatively poor inhibitory effects against these bacteria  
class1	305	in vitro  minimum inhibition concentration  mic  values against almost all of the enterobacteriaceae and against neisseria and haemophilus strains are typically below 1 microgram per milliliter  
class1	305	mic values against pseudomonas aeruginosa of 8 micrograms per milliliter are comparable with those of other antipseudomonal beta lactams and the acylureidopenicillins  
class1	305	as combination therapy with amino glycosides  aztreonam acts in synergy against p  
class1	305	aeruginosa  acinetobacter and gentamicin resistant gram negative rods  
class1	305	aztreonam is widely distributed in the body tissues and fluids  and the average elimination half life is 1 7 hours  
class1	305	intramuscular dosing results in peak serum levels in approximately one hour  while intravenous dosing results in peak levels within five minutes  
class1	305	after a 2 gram dose given intravenously  mic90 values for most of the enterobacteriaceae are exceeded for eight hours  and those for p  
class1	305	aeruginosa  for almost six hours  
class1	305	the steady state volume of distribution is approximately 0 18 liter per kilogram  
class1	305	concentrations above the mic90 for most gram negative bacteria are also present within bone  prostate and cerebrospinal fluid  
class1	305	between 60 and 70 per cent of the drug is excreted unchanged in the urine  resulting in concentrations approximating 3 000 micrograms per milliliter two hours after a 1 gram dose given intravenously  
class1	305	serum clearance of aztreonam is directly proportional to creatinine clearance  
class1	305	dosage adjustment must  therefore  be made in the presence of reduced clearance  
class1	305	dosing varies between 0 5 and 2 0 grams every six to 12 hours  depending on the severity of the infection  
class1	305	the characteristics of aztreonam suggest that it is a useful nonnephrotoxic drug for treatment of aerobic gram negative infection  
class1	306	antifungal therapy and its use in surgical treatment  
class1	306	modern surgery continues to make significant therapeutic advances  and a major component in the adjunctive care allowing these improved procedures is the successful use of broad spectrum antibacterials  
class1	306	however  the widespread administration of potent antibacterials and the frequent use of a variety of catheters  along with an increase in the number of immune compromised patients requiring invasive procedures  have allowed deep seated mycoses to become more common  
class1	306	nosocomial fungal infections are frequent  particularly in the urinary tract and in the blood  
class1	306	this rise in identified fungal infections  along with frequent empiric treatment of suspected infection  has significantly increased amphotericin b therapy in surgical services in the last five years  
class1	306	while amphotericin b remains the standard for treatment of nosocomial mycoses  other antifungal agents are available  flucytosine  miconazole  ketoconazole and fluconazole   
class1	306	despite experience with the older agents and the development of new agents  many questions remain concerning the use of currently available antifungal treatments in postsurgical patients  
class1	306	the following discussion attempts to summarize the magnitude of the problem  the difficulties with diagnosis and laboratory evaluations  the characteristics of the antifungal agents and particular problems with antifungal treatment in surgery  
class1	307	vancomycin pharmacokinetics in hydrocephalic shunt prophylaxis and relationship to ventricular volume  
class1	307	vancomycin pharmacokinetics were determined in 25 patients receiving ventriculoperitoneal shunts for hydrocephalus  
class1	307	computed tomography scan derived ventricular brain ratio as an expression of hydrocephalus varied between 9 3  and 15 4   12 9      1 7    
class1	307	one hour prior to surgery each patient received 1 g of vancomycin infused intravenously over 60 minutes  
class1	307	samples of cerebrospinal fluid and venous blood were obtained 1 hour later and vancomycin levels assayed by fluorescence polarization immunoassay  
class1	307	there were 11 females and 14 males  with a mean age of 44 5     10 3 years and a mean weight of 72 0     11 4 kg  
class1	307	all had normal renal function  
class1	307	levels of vancomycin in the cerebrospinal fluid at 1 hour ranged from 0 1 to 1 5 micrograms ml  0 9     0 3   
class1	307	weight did not affect these values  p greater than 0 1   
class1	307	simultaneous blood vancomycin levels varied between 9 1 and 38 7 micrograms ml  22 3     8 3   
class1	307	ventricular volume  expressed as the ventricular brain ratio  did not correlate with cerebrospinal fluid vancomycin levels  p greater than 0 5   
class1	307	there was no significant increase in concentrations of vancomycin in csf as cerebrospinal fluid protein concentration increased  nor when blood vancomycin concentration was greater than 20 mg dl  therapeutic range   p greater than 0 1   
class1	307	no patient had evidence of infection at 6 months follow up  
class1	307	these results indicate minimal cerebrospinal fluid penetrance of vancomycin when administered systemically 1 hour prior to shunt surgery  
class1	307	in addition concentrations of vancomycin in cerebrospinal fluid bear no relationship to weight  ventricular volume  meningeal inflammation  or blood levels in the therapeutic range  
class1	307	the minimum inhibitory concentration of vancomycin for staphylococci is 1 5 to 3 1  and as bactericidal levels of 5 to 8 minimum inhibitory concentration are needed to kill organisms  a combination of both systemic and intraventricular vancomycin may be needed to ensure adequate cerebrospinal fluid and tissue concentration of antibiotic during shunt prophylaxis  
class1	308	brain stem tuberculoma in adult patients  diagnosis and treatment  
class1	308	a consecutive series of six adult patients ranging in age from 29 to 53 years is presented  
class1	308	the clinical and radiological features in each patient are described  
class1	308	attention is drawn to the features demonstrated on computed axial tomography  
class1	308	in only one patient  the first encountered  was surgical excision undertaken and histological verification obtained  
class1	308	one patient died before any form of treatment could be instituted  
class1	308	the remaining four patients were treated with antituberculous chemotherapy alone and their progress monitored by sequential computed tomography  
class1	308	the excellent response and good outcome in this conservatively treated group are documented  
class1	309	brain abscess associated with congenital pulmonary arteriovenous fistula  
class1	309	a case of brain abscess associated with congenital pulmonary arteriovenous fistula was presented and 52 reported cases were reviewed  
class1	309	the brain abscess was successfully treated with repeated aspiration and drainage  and the pulmonary arteriovenous fistula  located in the right lower lobe  was resected  
class1	309	the arteriovenous fistula occurs as a common pulmonary manifestation of hereditary hemorrhagic telangiectasia  however  no symptoms suggesting these two were noted in this case  
class1	309	brain abscesses can be an initial clinical manifestation in asymptomatic pulmonary arteriovenous fistula  
class1	309	this possible association should be borne in mind in cases of brain abscesses of unexplained etiology  
class1	310	botulism among alaska natives  the role of changing food preparation and consumption practices  
class1	310	alaska natives have one of the highest rates of food borne botulism worldwide  
class1	310	all outbreaks have been associated with the consumption of native foods  but in recent years outbreaks have occurred in previously unaffected areas and have involved new food items  
class1	310	five botulism outbreaks occurred between 1975 and 1985 in an area of southwestern alaska without previous confirmed outbreaks and among one ethnic group  the yupik eskimo  
class1	310	of the 5 outbreaks  3 were associated with fermented beaver tail  a nontraditional native food recently introduced into the region  
class1	310	preparation techniques vary widely within villages and among ethnic groups  
class1	310	traditional fermentation techniques have changed over the past 50 years  current preparation methods used by some families and ethnic groups may be more favorable for clostridium botulinum growth  
class1	310	prevention efforts should be targeted at high risk subgroups of alaska natives who appear to have modified traditional practices and increased their risk of food borne botulism  
class1	311	high dose phenylephrine infusion in the hemodynamic support of septic shock  
class1	311	a 75 year old man with hyperdynamic septic shock and vasodilation was successfully supported hemodynamically for 88 5 hours through the use of a continuous infusion of phenylephrine at dosages up to 360 micrograms min  
class1	311	the only other vasoactive compound administered was dopamine at a dosage of 3 4 micrograms kg min  
class1	311	hemodynamic evaluation indicated improvements in mean arterial pressure  cardiac output  and oxygen transport parameters during the period of hemodynamic support  which did not indicate a detrimental effect on perfusion of vital organs and tissues despite the use of this vasoconstrictor  
class1	311	phenylephrine s pharmacologic properties may represent an advantage for its use as a vasoconstrictor over catecholamines such as norepinephrine and dopamine  particularly in patients who develop tachyarrhythmias with these agents  
class1	311	the pharmacology  dosage  and appropriate monitoring of therapy with phenylephrine in patients with septic shock are discussed  
class1	312	controversies in the treatment of streptococcal pharyngitis 
class1	312	an increasing number of cases of sore throat caused by group a beta hemolytic streptococci occur with concomitant colonization by organisms that may  protect  the streptococci through beta lactamase inactivation of penicillin at the site of infection  
class1	312	the failure of penicillin to eradicate many of these bacteria  which include staphylococcus aureus  haemophilus influenzae  moraxella  branhamella  catarrhalis and a multitude of pharyngeal anaerobes  may help to explain why penicillin is sometimes ineffective for acute and recurrent group a streptococcal infections  
class1	312	therapeutic alternatives currently include cephalosporins  erythromycin  rifampin combined with penicillin  amoxicillin clavulanate potassium and others  
class1	313	concomitant neurocysticercosis and brucellosis  
class1	313	a young mexican woman had headache and left arm weakness develop shortly after immigrating to the united states  
class1	313	a solitary cerebral cysticercus was found at surgery  but  instead of the expected finding of clear fluid  the cyst contained pus from which brucella melitensis was cultured  
class1	313	although the patient had no signs or symptoms suggestive of brucellosis  agglutination studies revealed igm and igg antibodies consistent with active brucellosis  
class1	313	clinicians should be alert to the possibility of multiple infections in immigrants from countries where parasites and bacteria that are uncommon in the united states are endemic  
class1	314	impetigo  current etiology and comparison of penicillin  erythromycin  and cephalexin therapies  
class1	314	we attempted to determine the causative bacterial pathogens of impetigo in children in our area  to compare the effectiveness of three frequently used oral antimicrobial treatment regimens  and to correlate the antimicrobial sensitivity of the bacterial isolates with clinical responses to treatment  
class1	314	seventy three children with impetigo were randomly assigned to receive penicillin v potassium or cephalexin monohydrate  both administered in dosages of 40 to 50 mg kg per day  or erythromycin estolate administered in a dosage of 30 to 40 mg kg per day  
class1	314	all drugs were given in three divided doses for 10 days  
class1	314	treatment failure was defined as persistence of lesions 8 to 10 days after initiation of drug therapy as determined by examiners blinded to the treatment therapies  
class1	314	forty five  62   cultures showed staphylococcus aureus only  14  19   showed s aureus and group a beta hemolytic streptococci  six  8   showed group a beta hemolytic streptococci only  and eight  11   showed no growth or other organisms  
class1	314	treatment failure occurred in six  24   of 25 patients treated with penicillin v  one  4   of 25 patients treated with erythromycin estolate  and no patients treated with cephalexin  
class1	314	we conclude that s aureus is the most common cause of impetigo in children in our study population  that cephalexin is the most effective treatment  that erythromycin estolate is nearly equally effective and may be preferred on a cost effectiveness basis  and that penicillin v is inadequate for treatment of this infection  
class1	315	lung function in children following empyema  
class1	315	spirometry was performed and response to exercise was measured in 15 children following recovery from empyema to evaluate the impact of pleural infection on subsequent lung function  
class1	315	seven children underwent chest tube drainage  eight did not  
class1	315	the two groups were similar in age  mean     sd  6     5 years   sex distribution  bacterial pathogen producing empyema  and age at follow up evaluation  12     5 years   
class1	315	only one child reported recurrent respiratory symptoms  
class1	315	no child had restrictive spirometric changes  total lung capacity  less than 80   vital capacity  less than 80  predicted  but seven of 15 had a reduced forced expiratory volume in 1 second  less than 80  predicted  or forced expiratory flow during the middle half of the vital capacity  less than 75  predicted   suggesting mild airway obstruction  
class1	315	no child demonstrated reduced exercise tolerance due to restrictive ventilatory limitations  
class1	315	mild obstructive abnormalities in lung function were identified with equal frequency in children treated with and without chest tube drainage  
class1	316	ocular atopy and mycotic keratitis  
class1	316	in a retrospective analysis  we studied the association between ocular atopy and keratomycosis  
class1	316	forty one  26 3   of 156 patients with fungal corneal ulcers were found to have preexisting allergic conjunctivitis  
class1	316	all patients had been using a combination of antibiotics and corticosteroids before developing the corneal ulcer  
class1	316	fungus isolation on sabouraud s agar medium was obtained in 74 8   31 42  ulcers  
class1	316	the most common fungi isolated were fusarium  32 3   and aspergillus  29    
class1	316	one percent silver sulfadiazine was used as an antifungal agent in these patients  
class1	316	overall efficacy of this drug was found to be 77 8   with fusarium being the most sensitive  87 5    
class1	317	endophthalmitis due to sporothrix schenckii after penetrating ocular injury  
class1	317	a 13 year old boy developed endophthalmitis from traumatic inoculation of vegetable material penetrating his right eye  
class1	317	sporothrix schenckii was morphologically identified from the intraocular fluids  
class1	317	however  repeated attempts to culture the organism proved negative  
class1	317	seventeen sporotrical endophthalmitis cases have so far been reported  and before this report  only one of them was secondary to trauma  
class1	317	this is the sole eye to our knowledge not only to have escaped enucleation after sporotrical endophthalmitis but to have achieved useful  20 50  vision  
class1	318	clindamycin vs penicillin for anaerobic lung infections  high rate of penicillin failures associated with penicillin resistant bacteroides melaninogenicus  
class1	318	thirty seven adult patients with anaerobic lung infections  27 lung abscesses and 10 necrotizing pneumonias  were submitted to transthoracic needle aspiration and or bronchoscopic specimen brush cultures before therapy and thereafter in all cases considered to be failures  
class1	318	patients were randomly assigned to receive either clindamycin  600 mg intravenously every 6 hours  or penicillin g  2 million u every 4 hours for no less than 8 days  until clinical and radiological improvement became apparent  
class1	318	treatment was continued orally with clindamycin  300 mg every 6 hours  or penicillin v  750 mg every 6 hours  until completing a minimum of 4 weeks  
class1	318	ten of the 47 anaerobes initially isolated from the lung  nine bacteroides melaninogenicus and one bacteroides capillosus  were resistant to penicillin  but none were resistant to clindamycin  
class1	318	five of the nine patients harboring these penicillin resistant bacteroides received penicillin  and all failed to respond to therapy  
class1	318	overall  eight of the 18 patients in the penicillin group and one of 19 in the clindamycin group failed to respond to therapy  
class1	318	these drugs were equally well tolerated in both groups  
class1	318	the presence of penicillin resistant bacteroides is a frequent cause of penicillin failure in patients with anaerobic lung infections  
class1	318	in this setting  clindamycin appears to be the current therapy of choice for initial treatment  
class1	319	spectrum of invasive haemophilus influenzae type b disease in adults  
class1	319	a prospective nationwide surveillance of invasive haemophilus influenzae type b disease among adults  greater than or equal to 16 years old  was conducted in finland during 1985 through 1988  
class1	319	thirty one cases were identified  annual incidence  0 22 100 000   
class1	319	of these infections  71  occurred in patients with severe underlying conditions  
class1	319	the overall case fatality rate was 26   
class1	319	septicemia  13 patients  and pneumonia  seven patients  were the most common clinical manifestations of h influenzae type b infection  the others were epiglottitis  six patients   meningitis  three patients   and arthritis  two patients   
class1	319	epiglottitis occurred in significantly younger patients  all of whom were women and four of whom were previously healthy  
class1	319	subtyping of the h influenzae type b isolates according to the major outer membrane protein subtype  biotype  and lipopolysaccharide serotype showed that patterns that were uncommon  14   among children were more common  27   in the adults  
class1	320	group b streptococcus endocarditis following second trimester abortion  
class1	320	an 18 year old woman who underwent an elective second trimester abortion developed streptococcus agalactiae  group b streptococcus  endocarditis characterized by a large  pedunculated vegetation involving a previously normal tricuspid valve  
class1	320	polyarthritic symptoms  as well as multiple pulmonary emboli  were experienced  and cure followed a course of treatment using intravenous penicillin g potassium combined with gentamicin sulfate  
class1	320	endocarditis caused by this pathogen usually occurs among individuals compromised by underlying chronic disorders and  today  is a rare sequela of pregnancy and abortion  
class1	320	when planning therapy  consideration should be given to the possibility of tolerance among clinical isolates and the need for operative intervention in selected patients  
class1	321	toxic shock syndrome associated with use of latex nasal packing  
class1	321	we treated a previously healthy young man who developed toxic shock syndrome 2 days after elective septoplasty with nonabsorbent latex packing  
class1	321	this case emphasizes that non menstrual wound associated toxic shock syndrome can occur after surgery that does not involve absorbent splinting or packing and should be considered in patients who present within a few days after surgery with fever  sunburnlike rash  hypotension  and multisystem complaints and laboratory abnormalities  
class1	322	streptococcal endocarditis temporally related to transesophageal echocardiography  
class1	322	a case of streptococcal sanguis endocarditis temporally related to a transesophageal echocardiogram is reported  and the literature on the incidence of bacteremia occurring during transesophageal echocardiography is reviewed  
class1	322	on the basis of this case and review of the literature  a reevaluation of the current guidelines for endocarditis prophylaxis during this procedure is recommended  
class1	323	eustachian valve endocarditis  
class1	323	m mode and cross sectional echocardiography showed a highly mobile globular pedunculated mass 3 0 cm long with a maximum diameter of i 5 cm  attached to the eustachian valve in a heroin addict with staphylococcal endocarditis  
class1	324	a study of immunoglobulin g in the cerebrospinal fluid of 1007 patients with suspected neurological disease using isoelectric focusing and the log igg index  a comparison and diagnostic applications  
class1	324	cerebrospinal fluid and serum immunoglobulin g from 1007 patients with suspected neurological disease were analysed by 2 methods  isoelectric focusing for the detection of oligoclonal banding  and quantitative measurement of igg and albumin for the formulation of a log igg index  
class1	324	a comparison of the 2 methods in the detection of local synthesis of igg showed that isoelectric focusing not only gave a much higher yield overall  with 282 patients showing local synthesis versus 225 for the log igg index  but also a higher specificity  with a false positive rate of 0  versus 3 5   
class1	324	in addition  of the 282 patients positive by isoelectric focusing only 163  58   were positive by the log igg index  
class1	324	of the 1007 patients studied  206 had multiple sclerosis  ms   and isoelectric focusing showed local synthesis in 95  of clinically definite cases  with a 90  detection rate overall  
class1	324	the log igg index was positive in only 67  of clinically definite cases  with an overall 59  detection rate  
class1	324	thus with the exceptions noted above  local synthesis of igg as defined by isoelectric focusing is confined to demyelinating  inflammatory  infectious and postinfectious disorders  
class1	324	our results compare very favourably with the published sensitivities of magnetic resonance imaging in the detection of abnormalities in multiple sclerosis  and better than those for evoked potentials  
class1	324	where both these investigations are readily available isoelectric focusing provides a useful adjunct  
class1	324	for the majority of physicians and neurologists who do not have ready access to magnetic resonance imaging  isoelectric focusing is an excellent alternative  
class1	324	we would also recommend that it become the standard for the measurement of igg abnormalities in the cerebrospinal fluid and that the use of quantitative data be abandoned for routine purposes  
class1	325	newer concepts in antimicrobial therapy  
class1	325	advances in the treatment of infection have continued to increase both the length and quality of life  
class1	325	unfortunately  many bacteria can readily adapt to their environment and develop a tolerance to the antimicrobial agents in widespread use  
class1	325	during the recent past  the consumption of cephalosporins has increased so dramatically as to parallel the initial acceptance of penicillin  
class1	325	organisms that are resistant to the cephalosporins will no doubt continue to thrive  especially within the susceptible host  
class1	325	it is essential for the clinician to become familiar with the newest antimicrobial agents to more effectively treat modern infections  
class1	326	simplified two stage below knee amputation for unsalvageable diabetic foot infections  
class1	326	a simplified two stage below knee amputation for unsalvageable diabetic foot infections was done on 19 limbs with 84  good results for healing  
class1	326	the first stage was the standard below knee amputation with a long posterior flap in which the fascia and skin were closed in the central portion with the medial and lateral portions of the wound left open for drainage  
class1	326	the second stage was delayed until closure of the open wounds three to seven days after the first stage  
class1	326	wagner s classification of diabetic foot lesions was used to stratify these cases  
class1	326	grades 3 and 4 foot infections had a uniformly good prognosis for healing with this surgical technique  
class1	326	grade 5 foot infections had a poor prognosis for healing  especially if associated with renal failure and dialysis  even with an initial guillotine amputation  
class1	327	initial evaluation of human monoclonal anti lipid a antibody  ha 1a  in patients with sepsis syndrome  
class1	327	ha 1a  a human monoclonal immunoglobulin m antibody that binds specifically to the lipid a domain of endotoxin  was administered to septic patients to evaluate the safety  pharmacokinetics  and immunogenicity of the antibody  
class1	327	thirty four patients received a single infusion of either 25 mg  100 mg  or 250 mg  and were followed clinically for 14 to 21 days after treatment  
class1	327	ha 1a serum levels were measured before infusion and frequently after infusion with a radiometric assay  
class1	327	a one compartment pharmacokinetic model was fit to the measured serum levels  and accurately described the changes in ha 1a level over time in each dose group  r2    99   
class1	327	the mean     sem apparent volume of distribution of ha 1a was 48 5     4 5 ml kg  and the mean serum clearance was 2 8     0 4 ml kg h  
class1	327	the mean serum half life of ha 1a was 15 9     1 5 h  
class1	327	the mean serum level one hour after a 100 mg dose was 33 2     2 4 micrograms ml  and the mean concentration 24 h later was 9 1     1 6 micrograms ml  
class1	327	the dose administered and presence of gram negative bacterial infection did not significantly influence the volume of distribution or serum clearance  
class1	327	no adverse reactions to ha 1a were observed  and no antibodies against ha 1a were detected in any patient  
class1	327	these data indicate that the pharmacokinetics of ha 1a are well described by a one compartment pharmacokinetic model  and that ha 1a is safe and nonimmunogenic in patients with sepsis  
class1	328	dependence of oxygen consumption on oxygen delivery in children with hyperdynamic septic shock and low oxygen extraction  
class1	328	we studied the effect of increasing systemic oxygen delivery  do2  by packed rbc  prbc  transfusion on oxygen consumption  vo2  in children with hyperdynamic septic shock  
class1	328	after routine resuscitation with volume loading and pharmacologic support  patients were studied if they had significant derangements of oxygen transport variables defined as  baseline vo2 less than 180 ml min m2 and oxygen extraction  o2 extr  less than 24   
class1	328	eight studies were performed  
class1	328	prbc transfusion increased do2 from 636     167 to 828     266 ml min m2  p less than  01  without increasing cardiac index  5 2     1 3 vs  
class1	328	5 0     1 4 l min m2   
class1	328	vo2 increased from 112     36 to 157     60 ml min m2  p less than  01  while o2 extr was unchanged  18     3  vs  
class1	328	19     6    
class1	328	despite initial low o2 extr  vo2 can be increased in pediatric septic shock by a further increase in do2  
class1	328	since vo2 correlates with survival  one should consider enhancing do2 further despite initial low o2 extr and high do2  
class1	328	effects on morbidity and mortality require further study  
class1	329	accuracy in early prediction of prognosis of patients with septic shock by analysis of simple indices  prospective study  
class1	329	in 26 consecutive septic shock patients  we analyzed the clinical  hemodynamic  and metabolic data before and during volume infusion to test their circulatory reserve in response to fluid repletion  
class1	329	these patients were investigated to identify early variables that could predict outcome  
class1	329	there were 15 survivors  group a  and 11 nonsurvivors  group b   
class1	329	as a mean  group a patients were hemodynamically evaluated 2 3 h after onset of the sepsis syndrome  whereas group b patients underwent cardiac catheterization after a 12 h interval  
class1	329	at the initial evaluation  both groups demonstrated similarly decreased mean arterial pressure  mean heart rate  and mean cardiac filling pressure  
class1	329	only group a patients evidenced elevated cardiac index  ci   greater than 4 l min m2  associated with low systemic vascular resistance index  less than 7400 dyne sec cm5 m2   which is generally recognized as hyperdynamic cardiac state  
class1	329	however  none of the initial cardiovascular variables could serve as a predictor for survival  
class1	329	fluid challenge increased left ventricular preload from 6 to 12 4 and from 7 8 to 12 7 mm hg in group a and group b  respectively  
class1	329	the increases were associated with significant increases in ci from 4 4 to 6 9 and from 3 to 3 8 l min m2  
class1	329	however  at the end of fluid challenge  only group a patients exhibited normal cardiac response  as evidenced by the change in left ventricular stroke work index  lvswi  for a given increase in the pulmonary capillary wedge pressure  wp  that was referred to as left cardiac preload  
class1	330	femoral artery cannulation for monitoring in critically ill children  prospective study  
class1	330	seventy seven attempted percutaneous femoral artery cannulations were prospectively evaluated in 74 children  
class1	330	artery cannulation was successfully accomplished in 73  95   cases and lasted for a mean of 6 days  
class1	330	sixty percent of the catheters were inserted on the first attempt  
class1	330	fifty two  71   patients weighed less than 10 kg and 55  75   patients were less than 12 months old  
class1	330	fifty one  70   patients received inotropic support at the time of cannulation  and 27  37   eventually died from causes unrelated to catheter insertion  
class1	330	there was one episode each of line associated infection and transient distal ischemia not resulting in tissue loss  and two episodes of catheter malfunction  
class1	330	in eight  11   patients  signs of distal vascular insufficiency developed shortly catheter placement and resolved after catheter removal  
class1	330	the development of this complication correlated significantly  p less than  05  with younger age  5 5 vs  
class1	330	22 3 months   
class1	330	we conclude that femoral artery cannulation has a high degree of success in very small  critically ill children  
class1	330	it should be considered an acceptable alternative to small vessel cannulation when the latter is not technically achievable  or in the unstable patient where rapid establishment of reliable arterial access is necessary  
class1	331	incidence of colonization  nosocomial pneumonia  and mortality in critically ill patients using a trach care closed suction system versus an open suction system  prospective  randomized study  
class1	331	eighty four intubated  mechanically ventilated patients were prospectively evaluated for incidences of colonization and nosocomial pneumonias dependent on whether they received endotracheal suctioning by an  open  suction method vs  
class1	331	 closed  suction  trach care closed suction system  method  
class1	331	results show that closed suctioning is associated with a significant  67  vs  
class1	331	39  p less than  02  increase in colonization compared with open suctioning  
class1	331	however  difference in the incidence of nosocomial pneumonia was not significantly  26  vs  
class1	331	29   different between closed and open suctioning  
class1	331	differences in severity of illness  acute physiology and chronic health evaluation ii and therapeutic intervention scoring system   age  sex  presence of ng tubes  use of h2 antagonists or antacids  use of antibiotics  and history of smoking were all nonsignificant  
class1	331	survival analysis demonstrated that the probability of survival without developing nosocomial pneumonia was greater among closed suctioning patients vs  
class1	331	open suctioned patients  p less than  03   
class1	331	this study shows that suctioning performed via the trach care closed suction system increases the incidence of colonization but not the incidence of nosocomial pneumonia  and may actually decrease mortality when compared with open suction systems  
class1	332	risks of human immunodeficiency virus infection to patients and healthcare personnel  
class1	332	the risk of nosocomial human immunodeficiency virus  hiv  infection among hospitalized patients comes almost exclusively from transfusion of fresh blood products  
class1	332	current estimates of the risk of hiv infection from the transfusion of blood or components vary from 1 40 000 to 1 250 000  0 0025  to 0 0004    with the most probable likelihood estimated to be 1 153 000  0 0007    
class1	332	the major route of transmitting such hiv infection is via blood collected during the interval between infection of the donor and development of a detectable circulating antibody level to the aids virus  i e   the  window period    
class1	332	the current risk to hemophiliacs receiving treated coagulation factor concentrates is negligible  
class1	332	the risk to healthcare personnel of acquiring hiv infection from accidental puncture wounds and from handling hiv infected blood or body fluids is 0 42  per episode  
class1	332	most reported seroconversions have resulted from penetrating injuries with sharp objects contaminated with hiv positive blood  
class1	332	the degree of risk to healthcare workers will vary with the community  the patient population served  and the frequency of penetrating injuries  
class1	333	cardiac involvement in aids  
class1	333	cardiac involvement in aids may occur at any stage of hiv disease and may manifest as congestive cardiomyopathy  potentially lethal arrhythmia  or pericardial effusion and tamponade  
class1	333	the heart may be affected by nearly all of the opportunistic infections and many of the malignancies associated with the syndrome  
class1	333	although often clinically unobtrusive  cardiac lesions may be important in the pathogenesis of significant clinical symptoms and play an often unrecognized role in the prognosis and natural history of aids  
class1	334	prostacyclin but not phentolamine increases oxygen consumption and skin microvascular blood flow in patients with sepsis and respiratory failure  
class1	334	inadequate tissue oxygenation may occur in critically ill patients with sepsis despite an apparently adequate o2 transport  qo2   and this may contribute to the development of an o2 debt and also to multiple organ failure  
class1	334	it has been shown that increasing qo2 by infusing a vasodilator may reveal this o2 debt in septic patients  
class1	334	to investigate whether the site of action of vasodilators may be of importance in unmasking such an o2 debt  we administered prostacyclin  a prostaglandin with a preferential effect on the microcirculation  and phentolamine  an arteriolar vasodilator  in 11 patients studied during the first 48 hours after the onset of sepsis  and compared their effect on whole body oxygen consumption  vo2  and skin microvascular blood flow  
class1	334	the results demonstrated that increasing qo2 by prostacyclin but not by phentolamine significantly increases vo2 in critically ill patients with sepsis  
class1	334	the site of action of vasodilators may therefore play an important role in their ability to unmask an o2 debt  
class1	335	pseudomonas aeruginosa compared with escherichia coli produces less endotoxemia but more cardiovascular dysfunction and mortality in a canine model of septic shock  
class1	335	we investigated the effects of two different gram negative bacteria and radiation induced leukopenia on endotoxemia  cardiovascular abnormalities  and mortality in a canine model of septic shock  
class1	335	serial hemodynamics were measured in conscious dogs using radionuclide heart scans and thermodilution cardiac output catheters  
class1	335	plasma endotoxin concentrations were determined with a chromogenic limulus amebocyte lysate assay  
class1	335	viable pseudomonas aeruginosa or escherichia coli implanted intraperitoneally produced concordant hemodynamic patterns of septic shock  p less than 0 01   
class1	335	endotoxin concentrations were more than tenfold lower in dogs infected with p aeruginosa compared with e coli  p less than 0 0001   
class1	335	despite lower endotoxin levels  p aeruginosa infected dogs had a higher mortality  p less than 0 01   more severe hypotension  p less than 0 05   and greater depression of the left ventricular ejection fraction  p less than 0 05  than dogs with e coli sepsis  
class1	335	a nonlethal e coli challenge combined with leukopenia  induced by a nonlethal dose of radiation  resulted in a mortality of 60 percent  p less than 0 01  without greater cardiovascular dysfunction or higher endotoxin concentrations  
class1	335	these findings suggest that bacterial products other than endotoxin and host related factors may be important contributors to the toxicity  cardiovascular instability  and mortality of gram negative septic shock  
class1	335	quantitative determinations of plasma endotoxin are unlikely to correlate with the clinical severity of septicemia in heterogeneous patient populations infected with different gram negative organisms  
class1	336	septic pulmonary embolism complicating a central venous catheter  
class1	336	bacteremia is a recognized complication in patients with indwelling central venous catheters  
class1	336	more recently pulmonary embolism in such patients has also been described  
class1	336	despite abundant clinical experience with these devices  to our knowledge  septic pulmonary embolism has not been reported in adult patients  
class1	336	this case illustrates such a complication  
class1	337	adult respiratory distress syndrome due to blastomycosis during pregnancy  
class1	337	a 23 year old healthy woman in her third trimester of pregnancy developed adult respiratory distress syndrome secondary to blastomyces dermatitides  
class1	337	pregnancy related immunosuppression was believed to be responsible for the fungal infection  
class1	337	following emergency delivery of the infant and a full course of amphotericin b therapy  the patient made an uneventful recovery  
class1	337	although the fetal and maternal sides of the placenta demonstrated fungal spores  the child remained healthy  
class1	337	to our knowledge  this is the first report of blastomycosis associated adult respiratory distress syndrome occurring during pregnancy  
class1	338	management of brucella endocarditis with aortic root abscess  
class1	338	three cases of brucella endocarditis with aortic root abscess are reported  
class1	338	two patients were successfully managed by a combination of medical therapy and surgery  
class1	338	the third patient died suddenly 36 hours after admission to hospital  
class1	339	reduction of contamination at total hip replacement by special working clothes  
class1	339	we assessed wound  air and operative field contamination at 50 total hip operations  performed in a zonal ventilation system  
class1	339	theatre staff wore either a specially designed polypropylene non woven coverall or conventional cotton shirt and trousers  
class1	339	the surgeons wore partially impermeable operating gowns  
class1	339	the polypropylene coverall was associated with significantly lower air and wound counts  
class1	339	the coverall was warmer than cotton but judged to be acceptable  
class1	339	the combined use of zonal ventilation and the coverall achieved ultra clean air conditions  
class1	340	why use drains  
class1	340	there is no firm published evidence to support the use of closed suction drains  
class1	340	over 20 years ago  large studies by the public health laboratory service and the national research council found that drains were risk factors for wound infection  
class1	340	a prospective randomised study of the use of closed suction drains after surgery for fractured neck of femur in 70 patients failed to show that drains improved wound healing  
class1	340	drained cases had more complications  
class1	341	the efficacy of pediatric blood culture sets in the determination of burn bacteremia  
class1	341	a blood culture is an essential laboratory procedure necessary to confirm a septic episode  
class1	341	however  it is important to collect the blood sample at the appropriate time with an acceptable technique  
class1	341	the standard method is to collect at least 5 to 10 ml blood per culture bottle from patients with fevers  
class1	341	however  this volume of blood is an unrealistic amount to take from the frequently febrile pediatric patient  
class1	341	alternatively  the pediatric blood culture bottle allows the collection of 1 ml blood per bottle to perform the same evaluation  
class1	341	we evaluated the two techniques of blood culture collection over a 9 month period and compared the results between adult and pediatric blood culture bottles  
class1	341	seventy six patients  from november 1988 through february 1989  had blood cultures performed with the adult culture bottles  which produced a total of 1314 samples  
class1	341	a total of 113 patients  from march through july 1989  had blood cultures performed with the pediatric culture bottles  which produced a total of 758 samples  
class1	341	percent recovery for the adult bottles versus the pediatric bottles was 13 95  versus 22 8   p less than 0 0001   
class1	341	since the amount of blood necessary to isolate an infectious agent is critical not only for laboratory identification but also for the volume of blood of pediatric patients  these data clearly establish the efficacy of pediatric blood culture bottles and the utilization of smaller amounts of blood  
class1	341	not only did this approach significantly enhance organism recovery rate  but it may well be more cost effective because fewer cultures need to be performed to isolate the infectious organism  
class1	342	lack of association between medication use and the presence or absence of bacteriuria in elderly women  
class1	342	this study was undertaken to determine if there is an association between medication use and the presence or absence of bacteriuria in elderly ambulatory women  
class1	342	of 198 women who participated in three urine culture surveys  every 6 months  during the 18 month study period  66  34 4   had bacteriuria on at least one survey  
class1	342	both univariate and multivariate analyses for the demographics  age  place of residence  and medication use  by drug class  revealed that only place of residence had a significant association with the presence or absence of bacteriuria  
class1	342	in this regard  bacteriuric subjects more commonly resided in the nursing home and less commonly lived in the apartment house complex compared with nonbacteriuric subjects  p less than  05   
class1	342	therefore  this study demonstrates that in elderly ambulatory women  medication use does not appear to be associated with the presence or absence of bacteriuria  
class1	343	absence of significant bacteremia during urinary catheter manipulation in patients with chronic indwelling catheters  
class1	343	the objective of this study was to quantify the microorganisms present in blood at urinary catheter removal and at reinsertion in patients with chronic indwelling urinary catheters  
class1	343	this was a prospective study during a 4 month period at a university affiliated geriatric medical center  
class1	343	our subjects were 33 patients with chronic indwelling urinary catheters and positive urinary cultures  the urinary catheter was usually changed once a month  
class1	343	a peripheral vein line was used for blood withdrawal and urinary cultures and quantitative blood cultures  isolator  were performed during and shortly after urinary catheter removal and insertion  
class1	343	all patients had significant bacteriuria  greater than 10 5  cfu ml  with an average of 2 3 microorganisms  
class1	343	among the 46 sequential quantitative blood cultures performed  only two patients had bacteremia from the urinary source and at a very low concentration  one patient had 0 13 cfu ml str  
class1	343	faecalis in blood 5 minutes after removal of the urinary catheter  and the other 0 1 cfu ml proteus mirabilis 5 minutes after reinsertion of a new urinary catheter  
class1	343	none of the patients had any subjective or objective clinical problem during the 36 hours after the urinary manipulation  
class1	343	clinical symptoms and bacteremia are rare events  and prophylactic antibiotics do not appear necessary during urinary catheter removal and reinsertion in elderly institutionalized patients  
class1	343	further studies are necessary to identify risk factors in the rare instances of patients with bacteremia  
class1	344	clinically inapparent  asymptomatic  bacteriuria in ambulatory elderly men  epidemiological  clinical  and microbiological findings  
class1	344	in a prospective longitudinal study  ambulatory elderly men were followed from 1 to 4 5 years to gain insight into the prevalence rates  clinical characteristics  and patterns of clinically inapparent  asymptomatic  bacteriuria  cib   
class1	344	the prevalence of cib was 12   29 238  and increases with age  
class1	344	unlike the gram negative organisms that cause overt urinary tract infection in this age group  gram positive organisms dominated the cib group  
class1	344	both the cib and abacteriuric patients have multiple chronic medical conditions and are indistinguishable on that basis  
class1	344	twenty nine elderly men with bacteriuria and 105 abacteriuric subjects were followed with serial urine cultures  
class1	344	during the study period the bacteriuric subjects exhibited spontaneous temporary or permanent resolution  76   22 29   intermittency  21   6 29   and probable bacterial persistence  38   11 29   
class1	344	no consistent pattern of bacteriuria was evident  
class1	344	therefore  antimicrobial therapy is not warranted in the treatment of asymptomatic or clinically inapparent bacteriuria in ambulatory elderly men  
class1	345	mycobacterium leprae specific t cells from a tuberculoid leprosy patient suppress hla dr3 restricted t cell responses to an immunodominant epitope on 65 kda hsp of mycobacteria  
class1	345	the polar tuberculoid type  tt  of leprosy  characterized by high t cell reactivity to mycobacterium leprae  is associated with hla dr3  
class1	345	surprisingly  dr3 restricted low t cell responsiveness to m  
class1	345	leprae was found in hla dr3 positive tt leprosy patients  
class1	345	this low responsiveness was specifically induced by m  
class1	345	leprae but not by m  
class1	345	tuberculosis and was seen only in patients and not in healthy controls  
class1	345	we studied this patient specific  m  
class1	345	leprae induced  dr3 restricted low t cell responsiveness in depth in one representative hla dr3 positive tt leprosy patient by using t cell clones  
class1	345	from this patient two types of t cell clones were obtained  one type was cross reactive with m  
class1	345	tuberculosis and recognized an immunodominant epitope  amino acids 3 to 13  on the 65 kda heat shock protein  hsp  the other type was m  
class1	345	leprae specific and reacted to a protein other than the 65 kda one  
class1	345	to examine whether these m  
class1	345	leprae specific t cell clones were responsible for the dr3 restricted low responsiveness to m  
class1	345	leprae  we tested them for the ability to suppress the proliferation of the dr3 restricted  65 kda  hsp reactive clones  
class1	345	the dr3 restricted  m  
class1	345	leprae specific t cells completely suppressed the proliferative responses of dr3 restricted  cross reactive t cell clones to the 65 kda hsp from the same patient as well as from other individuals  
class1	345	also  dr3 restricted responses to an irrelevant ag were suppressed by the m  
class1	345	leprae specific t cell clones  
class1	345	however  no suppression of non dr3 restricted t cell responses was seen  
class1	345	although the mechanism must still be elucidated  this m  
class1	345	leprae induced  dr3 restricted immunosuppression may at least partly explain the observed dr3 associated low t cell responsiveness in tt leprosy patients  
class1	346	a comparison of rapid enzyme immunoassay tests for the detection of chlamydia trachomatis cervical infections  
class1	346	two rapid enzyme immunoassay test kits were compared with culture for the detection of chlamydia trachomatis endocervical infections  
class1	346	endocervical samples for c trachomatis culture and the two enzyme immunoassay tests were evaluated from 502 county health department and planned parenthood patients  
class1	346	the prevalence of infection in this population was 12   
class1	346	sensitivity and specificity of the abbott testpack chlamydia were 51 7  and 99 5   respectively  and of the kodak surecell chlamydia were 76 7  and 98 6   respectively  
class1	346	the positive and negative predictive values for testpack were 93 9  and 93 8   and for surecell were 88 5  and 96 9   respectively  
class1	346	additionally  an in vitro investigation was used to evaluate whether typical office staff  physicians  nurses  medical technicians  receptionists  and radiology technicians  were able to perform competently the tests in each kit  
class1	346	office personnel tested 12 dilutions of a c trachomatis stock sample or negative control sample as unknowns for each kit in the in vitro investigation  
class1	346	there were no differences among office staff in performance when compared for each test kit  
class1	346	selective use of these enzyme immunoassay tests for high risk patients in a family practice population that has a high prevalence of patients with c trachomatis infection may be helpful when rapid test results are required and cultures are not feasible  
class1	346	after appropriate training  most physician office personnel were equally able to perform the enzyme immunoassay tests evaluated  
class1	347	neonatal interleukin 1 beta  interleukin 6  and tumor necrosis factor  cord blood levels and cellular production  
class1	347	in a prospective study  levels of interleukin 1 beta  il 1 beta   interleukin 6   il 6   and tumor necrosis factor  tnf  were measured in a blind fashion in cord blood plasma from 92 neonates by specific immunoassays  and were correlated with the clinical courses of the infants  including type of delivery and perinatal complications  
class1	347	plasma il 1 beta concentration was undetectable in infants born by normal vaginal delivery or elective cesarean section but was significantly increased in infants born after induced vaginal deliveries  142     68 pg ml  or urgent cesarean section  290     21 pg ml  both p less than 0 05 compared with normal deliveries   
class1	347	the il 1 beta levels were elevated in infants with severe perinatal complications  282     116 pg ml  p less than 0 001   whereas tnf and il 6 levels were not related to these complications  
class1	347	infants with isolated perinatal infectious complications had elevated levels of plasma il 6 compared with those of sick neonates without infection  p less than 0 001   
class1	347	in contrast  tnf plasma levels and il 1 beta production by cord blood leukocytes were decreased in infants with infectious complications alone  both p less than 0 05   
class1	347	these studies suggest that the levels of il 1 beta  il 6  and tnf in the cord plasma relate differentially to clinical complications in the perinatal period  
class1	348	vaginitis emphysematosa  a report of four cases  
class1	348	it has been hypothesized that vaginitis emphysematosa is a manifestation of trichomonal or gardnerella infection  
class1	348	in support of this etiologic concept  four cases of the disorder are described showing the apparent curative effect of treating the associated infection  
class1	348	the linkage of these and other reported cases with conditions of impaired immunity suggests that immunologic factors are involved in the pathogenesis  
class1	349	a general model of sexually transmitted disease epidemiology and its implications for control  
class1	349	achieving control of stds may be possible by integrating the activities discussed previously with further research to provide additional empiric data on sex behavior  to develop innovative strategies to access and communicate with those most at risk of std  i e   core group members   and to foster biologic study of std pathogens with the goal of vaccine development  
class1	349	new strategies to identify core group members aside from the currently used std repeater status would be of immense help in targeting educational efforts  laboratory screening  and vaccines  
class1	349	achieving more complete control of stds may be possible if recent advances in our understanding of their epidemiology and transmission dynamics can be translated into effective new interventional strategies  
class1	350	chlamydial infections  
class1	350	chlamydia trachomatis is a unique intracellular parasite that causes a number of common sexually transmitted disease syndromes  including nongonococcal urethritis in both men and women  epididymitis in men  and pelvic inflammatory disease in women  
class1	350	infants exposed at delivery are at risk for the development of conjunctivitis and pneumonia  
class1	350	there is strong evidence that chlamydia is a cause of obstructive infertility and ectopic pregnancy in women  
class1	350	it appears that these complications result from the chronic inflammatory response and secondary scarring that are elicited by long term asymptomatic or nearly asymptomatic fallopian tube infections  
class1	350	because treatment with tetracycline  doxycycline  or erythromycin is simple  effective  and inexpensive  major efforts should be put into identifying asymptomatic young women through screening of the subpopulations at highest risk  
class1	350	these include sexually active adolescent women and older women who are not monogamous  
class1	350	blacks are at higher risk than other ethnic groups for infection  
class1	350	the cost of diagnosing chlamydial infection has decreased with the introduction of new nonculture diagnostic tests  
class1	350	this should increase the availability of testing for screening purposes  
class1	350	it is critical to remember that male sex partners of infected women must be treated  otherwise all efforts to prevent long term complications by identifying and treating asymptomatic women are doomed to failure  
class1	351	syphilis in adults  
class1	351	this article reviews the clinical manifestations of syphilis  diagnostic tests that might help to diagnose accurately the disease  and current recommendations for therapy  
class1	351	the association of syphilis and human immunodeficiency virus infection raises additional questions related to transmission  diagnosis  and therapy of both diseases  
class1	352	chancroid and the role of genital ulcer disease in the spread of human retroviruses  
class1	352	chancroid is the most prevalent form of genital ulcer disease in developing countries and is undergoing a resurgence in industrialized countries  
class1	352	as a result of a nonspecificity of the clinical findings  the etiologic diagnosis of genital ulcer disease requires laboratory support  
class1	352	genital ulcer disease is a risk factor for the transmission of human retroviral infections  
class1	352	an understanding of this interaction is emerging and will impact on the treatment and control programs for the agents causing genital ulcer disease  
class1	353	human papillomavirus infections of the genital tract  
class1	353	infection of the genital tract by hpv is a sexually transmitted disease of increasing prevalence  
class1	353	the association of hpv infection with genital tract malignancies is of great concern  and further studies are needed to clarify this association  
class1	353	few investigators believe at this time that proof of a direct causative role exists for hpv in these cancers  but indirect evidence of such a role is abundant  
class1	353	there are many clinical forms of hpv infection of the genital tract  and few clinicians can easily recognize them all  
class1	353	treatment of condyloma acuminatum is difficult and frustrating  
class1	353	cryotherapy with liquid nitrogen is the safest and most effective therapy for most forms of condyloma acuminatum  
class1	353	recurrence of condyloma acuminatum is common with all presently used forms of therapy  probably owing to latent hpv infection in normal appearing skin  
class1	353	no form of treatment is ideal for all forms of condyloma acuminatum  but without continued efforts to find better therapeutic modalities and preventative measures  the epidemic of genital hpv infection will continue unchecked  
class1	354	the  nuisance  sexually transmitted diseases  molluscum contagiosum  scabies  and crab lice  
class1	354	although molluscum contagiosum  scabies  and infestation by crab lice do not carry the requirements of partner notification or other long term consequences  they are among the most commonly reported sexually transmitted disease  
class1	354	molluscum contagiosum is a benign viral infection of the skin epidermal layer  most often transmitted by intimate skin to skin contact  
class1	354	the lesions often resolve spontaneously over time  but patient discomfort or social reasons may require destructive removal of the lesions  
class1	354	scabies is caused by the sarcoptes scabiei mite  
class1	354	the victims continually itch  especially at night  and often seek over the counter topical remedies before seeing a clinician  
class1	354	once a correct diagnosis is made  successful resolution of this disease and its itching can be achieved  
class1	354	head and pubic lice account for most of the more than three million cases of louse infestation treated in the united states each year  
class1	354	symptoms of infestation generally include itching that leads to scratching  erythema  irritation  and inflammation  
class1	354	a careful diagnosis followed by disinfection  symptomatic treatment  and psychologic support should result in a complete cure with no long term effects  
class1	355	common nonvenereal genital lesions  
class1	355	there are a wide variety of local and systemic skin diseases that produce lesions in the genitoanal region  
class1	355	these lesions may resemble those produced by sexually transmitted microorganisms  
class1	355	the purpose of this article is to make physicians aware of the common skin diseases that produce lesions on the genitalia to avoid the inappropriate diagnosis of a sexually transmitted disease  
class1	356	approach to men with urethritis and urologic complications of sexually transmitted diseases  
class1	356	the most important causes of urethritis  and epididymitis in younger men  are c  
class1	356	trachomatis and n  
class1	356	gonorrhoeae  
class1	356	management of these syndromes requires a thorough sexual history  genital examination  evaluation for objective and laboratory evidence of infection  antimicrobial therapy directed toward the major etiologies  and evaluation and treatment of sexual partners  
class1	356	treatment of n  
class1	356	gonorrhoeae requires use of a single dose regimen active against this organism  plus a 7  to 10 day tetracycline regime active against c  
class1	356	trachomatis and nongonococcal urethritis  
class1	356	with recommended regimens  microbiologic failure is infrequent in compliant patients  
class1	356	recurrent urethritis is frequent  however  
class1	356	the management of patients with persistent or recurrent symptoms requires careful reevaluation of the patient  documentation of urethritis  and re treatment with antimicrobials if urethritis is documented by positive cultures or increased numbers of polymorphonuclear leukocytes in urethral secretions  
class1	356	additional treatment beyond this point usually is not indicated  even though a proportion of men will remain symptomatic and some of these will have increased numbers of polymorphonuclear leukocytes in urethral secretions  
class1	356	the most important causes of prostatitis  and epididymitis in older men or men with urethral structural abnormalities  are classical urinary tract pathogens rather than sexually transmitted pathogens  
class1	356	management of these infections includes documentation of the infection and treatment directed toward the specific pathogen  
class1	356	men with symptoms of  prostatitis  must be evaluated using both urine and prostatic secretions to document infection and inflammation  
class1	356	the majority of men with such symptoms do not have an infection that can be documented  
class1	356	these men respond poorly to medications  
class1	356	men with documented chronic bacterial prostatitis require long courses of antimicrobials to effect cure  
class1	356	in some cases  however  the disease is intractable  and chronic suppression with antimicrobials may be necessary  
class1	357	approach to the patient with genital ulcer disease  
class1	357	the three major diseases characterized by genital ulcers  genital herpes  syphilis  and chancroid  are common  with genital herpes being most common in industrialized countries and chancroid being most common in developing countries  
class1	357	one fourth to one half of patients with genital ulcers have no diagnosed cause for their illness despite diagnostic efforts  
class1	357	the bulk of these cases is probably constituted by one of the three diseases for which diagnostic tests are falsely negative  
class1	357	there is accumulating evidence that genital ulcers facilitate the transmission of human immunodeficiency virus  hiv   and they may also be markers of high risk behavior for acquisition of hiv  
class1	357	appropriate therapy of patients with genital ulcers  as well as their sexual partners  depends on accurate diagnosis  
class1	357	patients with genital ulcers  particularly those with syphilis or chancroid  should be encouraged to undergo testing for hiv infection  
class1	358	vaginal infections in adult women  
class1	358	often trivialized by the medical profession  vaginitis in adult women is not only extremely common but is the source of considerable distress and often results in marked suffering  
class1	358	epidemiologic studies described in this article indicate the high prevalence of vaginitis and the large number of causes  
class1	358	although the majority of infections in women are due to bacterial vaginosis  vvc  and trichomoniasis  it is clear that many other causes exist  and we have yet to discover the etiology of many clinical syndromes  
class1	358	considerable progress has been made in understanding the pathogenesis of the three common vaginitides  
class1	358	although excellent progress has been made by the pharmaceutical industry in providing new drugs for vaginitis  any further progress will require a better understanding of etiology and pathogenesis  
class1	358	vaginitis causes major symptoms and is more than a nuisance problem  
class1	358	clinicians owe it to their patients to attempt to make an accurate diagnosis and not to rely on empiric therapy  
class1	359	pelvic inflammatory disease  
class1	359	the costs of pid to both individuals and society are enormous  
class1	359	although primary prevention of pid through control of lower genital tract infections is the most effective prevention strategy  early diagnosis and treatment of acute pid may minimize some of its serious sequelae  
class1	359	although laparoscopy is helpful for establishing the diagnosis of salpingitis  other less invasive tests along with selected clinical criteria may also be useful  
class1	359	treatment of pid  which is empiric and broad spectrum  is oriented toward polymicrobial pid  
class1	359	whenever possible  women with pid should be hospitalized for parenteral therapy  
class1	359	the 1989 cdc std treatment guidelines recommend two regimens for inpatient parenteral therapy  clindamycin gentamicin and cefoxitin  or equivalent cephalosporin doxycycline  
class1	359	outpatient management of pid should be monitored closely  the cdc recommended regimen includes use of intramuscular cephalosporins and oral doxycycline  
class1	359	oral penicillins are no longer recommended  
class1	360	sexually transmitted arthritis syndromes  
class1	360	sexually transmitted infections may provoke a wide variety of rheumatic lesions  
class1	360	disseminated n  
class1	360	gonorrhoeae infection leads to septic arthritis  which may be rapidly destructive but which responds promptly to appropriate antibiotic therapy  
class1	360	in contrast  both gonococcal and nongonococcal infections may lead to aseptic  reactive  arthritis or reiter s syndrome  
class1	360	inheritance of hla b27 confers a relative risk of 30 to 50 times for the development of this condition  
class1	360	the demonstration of c  
class1	360	trachomatis antigen in joint material from a minority of patients suggests that direct interaction between microbial components and class i hla antigens in the joint may be central to the pathogenesis of this disease  
class1	360	arthralgia and arthritis occur in up to 50  of individuals in the prodrome of hepatitis b infection  
class1	360	joint symptoms may be accompanied by urticarial or cutaneous vasculitic lesions  especially on the legs  both features resolve with the onset of jaundice  
class1	360	hepatitis b infection is also a major cause of necrotizing vasculitis  which may or may not be associated with overt hepatitis  
class1	360	seronegative arthritis  including reiter s syndrome  psoriatic arthritis  and undifferentiated arthritis  a sjogren s like syndrome  vasculitis  and myopathies have been described in association with hiv infection  
class1	360	it is clear that synovitis occurs in those patients despite the fact that hiv is present in immune cells within the joint during inflammatory arthritis and that both antigen presentation and lymphocyte responsiveness within the joint are impaired  
class1	360	nevertheless  synovitis may occur in the presence of marked cd4 positive lymphocyte depletion  
class1	360	rheumatic syndromes  including arthralgia  inflammatory arthritis  and neuropathic arthritis  may occur during any stage of congenital or acquired syphilis  
class1	360	syphilitic synovitis responds well to antibiotic therapy  but neuropathic lesions cannot be treated effectively  
class1	360	septic arthritis has rarely been described as a complication of disseminated mycoplasma or urea plasma infections  and joint lesions sometimes associated with erythema nodosum have also been reported in lymphogranuloma venereum and granuloma inguinale  
class1	361	sexually transmitted causes of gastrointestinal symptoms in homosexual men  
class1	361	the possible etiologic agents that may cause gastrointestinal complaints in homosexually active men are multiple  and their diagnosis is complex  
class1	361	this article presents a logical approach to the work up and diagnosis of gastrointestinal complaints in homosexually active men and to discuss their treatment and disease intervention  
class1	362	the interrelationship between human immunodeficiency virus infection and other sexually transmitted diseases  
class1	362	the epidemiology of hiv infection in the united states is changing  with a dramatic reduction in the incidence of new hiv infection in homosexual men over the past decade because of altered sexual practices  
class1	362	in contrast  heterosexual transmission of hiv is increasing and is disproportionately occurring in inner city racial minorities in association with drug use  populations that are currently experiencing epidemics of previously controlled stds  
class1	362	sexually transmitted diseases  especially genital ulcerative diseases and perhaps c  
class1	362	trachomatis and t  
class1	362	vaginalis  facilitate sexual transmission of hiv  
class1	362	in addition  hiv infection itself appears to increase the severity of certain stds once they are acquired  
class1	362	the control of stds  particularly in those populations that are at high risk for hiv infection  should be of high priority and should be an integral component of aids control programs  
class1	363	amoxycillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis  
class1	363	72 adults with erythema migrans  early lyme borreliosis  were enrolled in a randomised prospective trial comparing amoxycillin 500 mg plus probenecid 500 mg three times a day with doxycycline 100 mg twice a day for 21 days  
class1	363	these antibiotic regimens were chosen because of the known in vitro sensitivity of borrelia burgdorferi  the antibiotic tissue penetration  the pharmacokinetics of the drugs  and because the organism can disseminate early in the course of infection  
class1	363	72 patients were evaluable  35 in the doxycycline group and 37 in the amoxycillin probenecid group   
class1	363	the two regimens were equally effective for treatment of erythema migrans  
class1	363	mild fatigue or arthralgia were the only post treatment complaints  which resolved within 6 months  
class1	363	none of the patients needed further antibiotic treatment for lyme borreliosis  
class1	364	bird attack on milk bottles  possible mode of transmission of campylobacter jejuni to man 
class1	364	a case control study was carried out to test the hypothesis that the rise in the rate of campylobacter jejuni infection in the brigend area of south wales during may was due to the consumption or handling of milk from bottles that had been attacked by birds  
class1	364	32 of 36 cases meeting the case definition were interviewed  along with 2 controls per case  matched for age  sex  and area of residence  
class1	364	there were strong associations between campylobacter infection and doorstep delivery of milk bottles  a history of milk bottle attack by birds  milk bottle attack by birds during the week before illness  and consumption of milk from attacked bottles during the week before illness  
class1	364	there was a very strong dose response relation between frequency of bird attack and illness  
class1	364	controls with a history of milk bottle attack by birds were more likely than cases to have taken preventive measures against bird attack and consumption of contaminated milk  
class1	364	although few people witnessed the attacks  the likely culprits are magpies  pica pica  and jackdaws  corvus monedula   
class1	365	a randomized  double blind trial of nystatin therapy for the candidiasis hypersensitivity syndrome 
class1	365	background  
class1	365	candida albicans infection has been proposed to cause a chronic hypersensitivity syndrome characterized by fatigue  premenstrual tension  gastrointestinal symptoms  and depression  
class1	365	long term antifungal therapy has been advocated as treatment for the syndrome  which is most often diagnosed in women with persistent or recurrent candida vaginitis  
class1	365	methods  
class1	365	to determine the efficacy of nystatin therapy for presumed candidiasis hypersensitivity syndrome  we conducted a 32 week randomized  double blind  cross over study using four different combinations of nystatin or placebo given orally or vaginally in 42 premenopausal women who met present criteria for the syndrome and had a history of candida vaginitis  
class1	365	the outcomes studied were the changes from base line in scores for vaginal  systemic  and overall symptoms and in the results of standardized psychological tests  
class1	365	results  
class1	365	the three active treatment regimens  oral and vaginal nystatin  oral nystatin and vaginal placebo  and oral placebo and vaginal nystatin  and the all placebo regimen significantly reduced both vaginal and systemic symptoms  p less than 0 001   but nystatin did not reduce the systemic symptoms significantly more than placebo  
class1	365	on average  the scores for systemic symptoms improved 25 percent with the three active treatment regimens and 23 percent with the all placebo regimen  a difference of only 2 percent  95 percent confidence interval   3 to 7 percent   
class1	365	as expected  the three active treatment regimens were more effective than placebo in relieving vaginal symptoms  p less than 0 001   
class1	365	all four regimens reduced psychological symptoms and global indexes of distress  there were no significant differences among the treatment regimens  
class1	365	conclusions  
class1	365	in women with presumed candidiasis hypersensitivity syndrome  nystatin does not reduce systemic or psychological symptoms significantly more than placebo  
class1	365	consequently  the empirical recommendation of long term nystatin therapy for such women appears to be unwarranted  
class1	366	interleukin 1 receptor antagonist reduces mortality from endotoxin shock  
class1	366	about five out of 1 000 patients admitted to hospital develop bacterial sepsis leading to shock  the mortality rate for which is high despite antibiotic therapy  
class1	366	the infection results in hypotension and poor tissue perfusion  and eventually leads to the failure of several organ systems  
class1	366	bacterial endotoxin is thought to be the direct cause of shock in gram negative sepsis  because it can cause shock in animals  and antibodies against endotoxin prevent gram negative shock in animals and in humans  
class1	366	but  the symptoms of septic shock are the result of the actions of host cytokines induced by the endotoxin  
class1	366	the cytokine interleukin 1 has been implicated as an important mediator of septic shock because it can induce tachycardia and hypotension and act synergistically with tumour necrosis factor to cause tissue damage and death  
class1	366	we now report that a specific interleukin 1 receptor antagonist reduces the lethality of endotoxin induced shock in rabbits  indicating that interleukin 1 does indeed play an important part in endotoxin shock  
class1	367	acute axonal polyneuropathy associated with anti gm1 antibodies following campylobacter enteritis  
class1	367	we report 2 patients with guillain barre syndrome  gbs  following campylobacter jejuni enteritis  
class1	367	electrophysiologic studies indicated that the predominant process was axonal degeneration of motor nerves  and clinical recovery was poor  
class1	367	serum testing by thin layer chromatography and enzyme linked immunosorbent assay revealed that the sera from both patients contained high titers of igg antibody against gm1 ganglioside  
class1	367	these cases may represent a subgroup of gbs as acute axonal polyneuropathy following c jejuni enteritis associated with anti gm1 antibodies  
class1	368	human immunodeficiency virus infection in pregnancy  
class1	368	among an estimated 1 million to 1 5 million americans infected with hiv  about 10 per cent are women  
class1	368	moreover  almost 30 per cent of hiv infection among women is acquired through heterosexual activity  
class1	368	therefore  the average obstetrician gynecologist is not sheltered from dealing with hiv  
class1	368	this article offers guidelines for caring for hiv infected pregnant women during antepartum  intepartum  and postpartum phases  
class1	369	calcitonin gene related peptide levels are elevated in patients with sepsis  
class1	369	calcitonin gene related peptide  cgrp   an endogenous vasoactive peptide encoded by the calcitonin gene in nerve cells  is distributed throughout the cardiovascular system and is a potent vasodilator  
class1	369	plasma levels of cgrp have been elevated in animal models with sepsis  
class1	369	this study was designed to determine whether plasma cgrp levels are elevated in patients with sepsis and perhaps contribute to the hyperdynamic cardiovascular state in sepsis  
class1	369	plasma cgrp levels were obtained from normal healthy volunteers and from patients with sepsis  
class1	369	volunteers were afebrile and had normal pulse and blood pressure  
class1	369	patients with sepsis were selected according to the following criteria   1  temperature higher than 38 5 degrees c   2  white blood count greater than 14 000 ml   3  positive blood culture of bacterial organisms   4  hemodynamic parameters consistent with hyperdynamic sepsis  and  5  negative history of thyroid or other endocrine abnormalities  
class1	369	cgrp was extracted and assayed by radioimmunoassay for iodine 125 labeled human cgrp  
class1	369	in patients with sepsis  the cardiac index was 5 4     0 5 l min m2  normal  3 0   systemic vascular resistance was 7 1     0 5 mm hg l min  normal  16   oxygen delivery was 1496     137 ml min  normal  1000   
class1	369	plasma cgrp levels were significantly elevated in the patients with sepsis  14 9     3 2 pg ml  compared to plasma cgrp levels in control volunteers  2 0     0 3 pg ml  p less than 0 0005   
class1	369	these elevated levels of cgrp may contribute to the decreased vascular resistance and increased cardiac output in the hyperdynamic septic state  
class1	370	perirenal candidial abscess  
class1	370	perirenal candidial abscesses are rare  with few well documented cases in the literature  
class1	370	we describe a case of a perinephric abscess treated with amphotericin b and nephrectomy  
class1	371	tetracyclines in urology  current concepts 
class1	371	tetracyclines have an unusually broad spectrum of antimicrobial activity  
class1	371	they are generally well tolerated  with relatively few side effects compared with alternative antibiotic choices  
class1	371	tetracyclines also compare favorably with newer antimicrobials  i e   oral quinolones  with respect to cost and microbial resistance  
class1	371	doxycycline s and minocycline s spectrum of antibacterial activity  pharmacokinetic profile  and safety profile make them preferred drugs when tetracyclines are indicated in urologic infections  
class1	372	antibiotic therapy for bacillus species infections  
class1	372	we reviewed 36 cases of culture proven bacillus species ocular infections occurring between september 1974 and december 1989  
class1	372	kirby bauer disk sensitivities were available in 34 of the 36 cases  95    
class1	372	all bacillus species isolates were sensitive to the aminoglycoside antibiotics  n   34  and to vancomycin hydrochloride  n   32   resistance to clindamycin was found in four of 18  22   of tested isolates  
class1	372	although b  
class1	372	cereus was uniformly sensitive to these antibiotics  resistance to clindamycin occurred in four cases in the non b  
class1	372	cereus group  
class1	372	the microbroth dilution technique confirmed the kirby bauer data  
class1	372	the aminoglycosides were uniformly effective  but the cephalosporins  first  second  and third generation drugs  were consistently ineffective against b  
class1	372	cereus and varied from sensitive to moderately sensitive for the non b  
class1	372	cereus isolates  
class1	372	our microbiologic laboratory findings suggest that vancomycin hydrochloride in combination with an aminoglycoside ensures more consistent antibiotic coverage of bacillus species ocular infections  
class1	373	helicobacter pylori and associated duodenal ulcer  
class1	373	twenty three children with coexistent duodenal ulcer and helicobacter pylori infection were treated with either two weeks of amoxycillin  25 mg kg day  in addition to six weeks of cimetidine  or cimetidine alone  
class1	373	endoscopy with antral and duodenal biopsies for urease test  microaerophilic culture  and histological studies were performed at entry  six weeks  12 weeks  and at six months  
class1	373	children with persistent h pylori infection at six weeks were given a further two weeks  course of amoxycillin  
class1	373	h pylori persisted in all children not receiving amoxycillin treatment but cleared in six of the 13 children  46   treated with amoxycillin  
class1	373	with failure of h pylori clearance at six months  only two out of six  33   ulcers had healed and 50  of patients had experienced ulcer recurrence  
class1	373	in contrast  when h pylori remained cleared all ulcers healed and no ulcer recurred  
class1	373	persistent h pylori infection was associated with persistent gastritis and duodenitis despite endoscopic evidence of ulcer healing  
class1	373	detection and eradication of h pylori deserves particular attention in the routine management of duodenal ulceration in children  
class1	374	continued need for pneumococcal prophylaxis after splenectomy 
class1	374	two children died from pneumococcal infection five and eight years after splenectomy  
class1	374	pneumococcal vaccination had not been given to either child  
class1	374	when the infection developed both children were not taking prophylactic penicillin  
class1	374	vaccination and daily penicillin reduce the incidence of this complication and therefore we strongly recommend that both of these measures are continued indefinitely  
class1	375	urinary infection following out patient flexible cystoscopy  
class1	375	of 161 flexible cystoscopies performed in an out patient endoscopy suite  the incidence of urinary tract infection was 7 5   
class1	375	infection rates were higher in patients with a history of previous urinary tract infection or where an additional procedure was also performed  
class1	375	no difference was noted between the infection rates in men and women  
class1	376	antibiotic compared with antiseptic prophylaxis for prostatic surgery  
class1	376	two different regimens of cephalosporin antibiotic prophylaxis were compared with antiseptic lubricating jelly to try to prevent infection and complications in 196 men after prostatic surgery  
class1	376	pre operative urine was cultured and prostatic chips  170 cases  were also cultured to define the source of any infection  
class1	376	the use of antibiotics was associated with a reduced risk of postoperative bacteriuria  
class1	376	no serious complications occurred  although 1 patient in the antiseptic treated group developed rigors  79 of 170 patients  46   had positive prostatic chip cultures  of whom 74 had sterile pre operative urine  
class1	376	there was no association between the result of chip culture and the presence of a pre operative catheter  
class1	376	culture positive patients had an increased risk of post operative urine infection  although the same organism was found in the prostate and urine in only 36  of cases of post operative bacteriuria and in 43  54   the organism cultured from the prostate was staphylococcus albus  
class1	376	this study provides further evidence of the benefit of true prophylactic antibiotic therapy for transurethral prostatic surgery and the prostatic chip data suggest that some of the risk is due to pre operative contamination of the prostate in the absence of per operative urinary infection or catheterisation  
class1	377	helicobacter pylori and gastric carcinoma  serum antibody prevalence in populations with contrasting cancer risks  
class1	377	this investigation examined the correlation between helicobacter pylori  hp  infection  as reflected in immunoglobulin g serum antibodies  and the risk of gastric cancer  
class1	377	serum samples were obtained from populations with contrasting gastric cancer risks  
class1	377	the highest prevalence of hp infection  93   was observed in the adult population at highest gastric cancer risk  the residents of pasto  colombia  
class1	377	in the lower risk colombian city of cali  a 63  overall prevalence rate was found  
class1	377	both children and adults were sampled in new orleans  louisiana  where gastric cancer rates are high for blacks but not for whites  
class1	377	the prevalence of hp infection was significantly higher in black than in white adults  70  versus 43   p   0 0001  
class1	377	a higher prevalence was also detected in black compared with white children  49  versus 32   p   0 01  however  an even greater disparity was noted when comparing children from two hospitals  regardless of race  which serve different socioeconomic groups  
class1	377	a prevalence rate of 54  was found at charity hospital compared with 24   p   0 0001  at children s hospital  
class1	377	our findings indicate that socioeconomic conditions  known to influence gastric cancer risk  are also important determinants of hp infection  
class1	378	metabolic regulation of renal gluconeogenesis in response to sepsis in the rat  
class1	378	1  
class1	378	the regulation of renal gluconeogenesis was studied in rats made septic by a caecal ligation and puncture technique  
class1	378	2  
class1	378	blood glucose concentrations were not markedly different in septic rats  but lactate  pyruvate and alanine concentrations were markedly increased  compared with sham operated rats  
class1	378	conversely  blood ketone body concentrations were significantly decreased in septic rats  
class1	378	both plasma insulin and glucagon concentrations were markedly elevated in response to sepsis  
class1	378	3  
class1	378	the maximal activities of glucose 6 phosphatase  ec 3 1 3 9   fructose 1 6 bisphosphatase  ec 3 1 3 11   pyruvate carboxylase  ec 6 4 1 1  and phosphoenolpyruvate carboxykinase  ec 4 1 1 49  were markedly decreased in kidneys obtained from septic rats  suggesting diminished renal gluconeogenesis  
class1	378	4  
class1	378	renal concentrations of lactate  pyruvate and other gluconeogenetic intermediates were markedly elevated in septic rats  whereas those of acetyl coa and fructose 2 6 bisphosphate were decreased and unchanged  respectively  
class1	378	5  
class1	378	the rate of gluconeogenesis from added lactate  pyruvate and glycerol was decreased in isolated incubated renal tubules from septic rats  
class1	378	6  
class1	378	sepsis decreased the arteriovenous concentration difference for glucose  lactate  and alanine  
class1	378	septic rats showed decreased net rates of glucose production and net rates of removal of lactate and alanine as compared with sham operated controls  
class1	378	7  
class1	378	it is concluded that the diminished capacity for renal gluconeogenesis in septic rats could be the result of changes in the maximal activities or regulation of key non equilibrium gluconeogenic enzymes or both  but the effect of other factors  e g  
class1	378	toxins  has not been excluded  
class1	379	thoracic empyema  causes  diagnosis  and treatment  
class1	379	thoracic empyema is a disease that has been recognized for centuries  
class1	379	the principles of management as stated by hippocrates remain more or less unchanged  
class1	379	diagnosis can be masked by the underlying cause  preemptive antibiotic treatment  or the now frequently associated debilitating diseases  
class1	379	with no other specific investigation  the main diagnostic test remains diagnostic thoracentesis  
class1	379	when an empyema is encountered  the objectives are to save life  eliminate the empyema  its complications  and chronicity  return pulmonary mechanics to normal  and reduce the duration of the hospital stay  
class1	379	the introduction of antibiotics has dramatically influenced the spectrum of the disease now encountered  
class1	379	if the original infection is adequately treated  empyema rarely occurs  
class1	379	penicillin has removed the major cause of empyema  and further developments in antibiotics now mean that the majority of empyemas occur when patients are disabled by other disease processes or malnutrition  or where there remains a delay in medical attention  
class1	379	these patients are often less able to withstand the prolongation of the infective processes that is sometimes encountered with the staged approach to treatment  
class1	379	developments in operative and postoperative care have meant that these patients can best be treated by more aggressive and definitive surgical management  
class1	380	causes  diagnosis  and treatment of pharyngitis  
class1	380	pharyngitis is a common disease of the respiratory tract that can be caused by several different viruses and bacterial organisms  
class1	380	clinically speaking  the most important causative agent is group a streptococcus  streptococcus pyogenes   
class1	380	although rare  postpharyngitis complications arise as a result of disease caused almost exclusively by group a streptococcus  
class1	380	because group a streptococcal pharyngitis usually responds well to antimicrobial treatment  it is important to diagnose it  
class1	380	penicillin  erythromycin  and peroral first generation cephalosporins have been documented to be effective  
class1	380	in addition to group a streptococcus  c  
class1	380	pneumoniae and m  
class1	380	pneumoniae have also been detected in patients with pharyngitis  
class1	380	the possibility of diagnosing these organisms is limited at the present  
class1	380	clinical surveys are still needed  moreover  to evaluate the effect of antimicrobial treatment on the disease caused by these organisms  
class1	380	although routine viral diagnostic methods do not help primary care physicians in treating patients with pharyngitis  information on bacteria and viruses in the immediate environment could prove to be of great help in daily clinical work  
class1	381	surgical wound infection and cancer among the elderly  a case control study  
class1	381	surgical wound infection occurs in fewer than 5  of operations  
class1	381	nevertheless  it represents the second most common type of hospital acquired infection and results in increased morbidity and mortality  
class1	381	as with all nosocomial infections  the rate of surgical wound infection increases with age  
class1	381	patients over 65 years of age run an approximately 15  risk of surgical wound infection  
class1	381	two thirds of patients with invasive cancer other than non melanotic skin cancer are aged 65 years and over  
class1	381	over half of them are treated surgically for their cancer  
class1	381	cancer and other chronic diseases have been cited as possible causes of the increased risk of nosocomial infection among the elderly  
class1	381	using the foothills hospital wound study data base as the sampling frame  we conducted a case control study of surgical wound infection and cancer among the elderly  
class1	381	cancer was found not to be a risk factor for surgical wound infection  
class1	381	the results are discussed in relation to the role of immunity in both disorders  
class1	382	endophthalmitis after placement of a molteno implant  
class1	382	i report a case of early postoperative endophthalmitis following placement of a molteno implant  
class1	382	excellent results were obtained by immediate removal of the implant and surgical management of the infection  followed by replacement of the implant  
class1	383	chancroid  results from an outbreak in houston  texas  
class1	383	a recent  and continuing  epidemic of chancroid in houston has included morphologic variation in the disease  including so called dwarf  classic  giant  transient  follicular  phagedenic  and pseudogranuloma inguinale types  
class1	383	most cases were clearly acquired by unprotected sexual encounters with local prostitutes  
class1	383	the strain of haemophilus ducreyi responsible for this outbreak was relatively easily cultured on routine media  unexpected sensitivity of this strain to vancomycin rendered the recommended  selective  growth medium much less optimal for isolation  
class1	383	therapeutic success uniformly followed the use of intramuscular ceftriaxone sodium  one case responded to oral ciprofloxacin hydrochloride  
class1	384	a resurgence of acute rheumatic fever in a mid south children s hospital  
class1	384	a resurgence of acute rheumatic fever  arf  has been reported in many areas of the united states in recent years  
class1	384	we retrospectively reviewed the medical records of inpatients with a new diagnosis of arf from 1982 through 1988 at a children s hospital that serves a six state referral area in the mid south  
class1	384	thirty patients were identified  21 of whom were seen in 1987  13  and 1988  8   
class1	384	the rate of new cases of arf per 1000 hospital discharges  0 7  was significantly greater for 1987 and 1988 than it was  0 15  from 1982 through 1986  
class1	384	patients with recently diagnosed arf were predominantly from nonurban areas  and polyarthritis was the most common recent major manifestation  
class1	384	reasons for the resurgence of arf in the us  including the mid south  are unclear  but our experience serves to support recently published guidelines for the diagnosis and management of streptococcal pharyngitis in light of this resurgence of arf  
class1	385	sternoclavicular septic arthritis due to haemophilus influenzae  
class1	385	we have reported a case of septic sternoclavicular arthritis illustrating a rare complication of infection with a relatively common pathogen  haemophilus influenze  
class1	385	early identification of the infecting organism and appropriate antibiotic therapy are essential to prevent further morbidity from the complications of this unusual pyoarthritis  
class1	386	drug therapy for helicobacter pylori infection  problems and pitfalls  
class1	386	antibacterial chemotherapy against helicobacter pylori is currently being assessed by open or randomized controlled clinical studies for its efficacy in eradicating this bacterium from the stomach of patients with gastritis or gastroduodenal ulcer  
class1	386	whereas there is presently no  optimal  agent and treatment scheme  the combination of some antibiotics  metronidazole  tinidazole  amoxicillin  with bismuth salts proves definitely superior in vivo to either of these agents administered alone  
class1	386	several reasons have been proposed  to explain the clinical failure after treatment  insufficient concentration of active drugs in gastric mucus  instability of some agents at an acidic ph  inappropriate formulation of drug  insufficient duration of treatment  and variable compliance of patients  
class1	386	recently  it has appeared from several clinical trials that h  
class1	386	pylori may rapidly acquire resistance to some antibiotics  and that this event might also account for clinical failure  
class1	386	a critical review of the literature on h  
class1	386	pylori treatment indicates that association of bismuth and antibiotics or of antibiotics alone both may efficiently reduce the risk of emergence of resistance and improve the therapeutic outcome  
class1	386	guidelines of treatment are suggested in order to avoid the future misuse of antibiotics that would increase selection of antibiotic resistant h  
class1	386	pylori and negatively affect the ecology of the gastric microflora  
class1	386	likewise  an accurate definition of a subset of patients with h  
class1	386	pylori who really will require treatment needs to be rapidly established  
class1	387	helicobacter pylori infection  a simplified diagnostic approach  
class1	387	we evaluated the diagnostic accuracy of endoscopic finding of nodular antritis and rapid urease test  rut  in order to simplify the approach to the diagnosis of helicobacter pylori  h  
class1	387	pylori  infection  
class1	387	forty four consecutive patients  mean age 7 9 yr  range 6 13 yr  referred because of recurrent abdominal pain as the main symptom  were prospectively investigated for the presence of h  
class1	387	pylori  
class1	387	h  
class1	387	pylori positivity or negativity was defined as the concordance of two of the following tests  rut  microbiologic culture  and histologic examination on bioptic samples  
class1	387	rut sensitivity was 100   whereas specificity was 87 5   
class1	387	the presence of nodular antritis had a sensitivity of 96 4  and specificity of 87 5  in h  
class1	387	pylori infection diagnosis  
class1	387	the predictivity value of combined rut and nodular antritis  whether positive or negative  was 100   
class1	387	only in case of discordance do we suggest the utilization of other expensive tools for diagnosis of h  
class1	387	pylori infection  
class1	388	helicobacter pylori infection in patients with acquired immune deficiency syndrome  
class1	388	a controlled study was conducted on patients with human immunodeficiency virus  hiv  infection referred for upper endoscopy to evaluate the prevalence of helicobacter pylori  h  
class1	388	pylori  infection  
class1	388	four different stains and culture for h  
class1	388	pylori were performed on biopsy specimens from the gastric antrum  
class1	388	sixteen  40   of 40 patients with acquired immune deficiency syndrome  aids  or aids related complex  arc  were diagnosed to be infected with h  
class1	388	pylori versus 14  39   of 36 age matched control patients  
class1	388	eight of 15 aids arc patients without aids related esophagogastroduodenal findings  53   were infected with h  
class1	388	pylori versus 8 25  32   with endoscopic findings typical of aids  
class1	388	no invasion of the lamina propria by h  
class1	388	pylori was noted in any patient  
class1	388	active chronic gastritis was present in 60  of aids arc patients and 61  of controls  
class1	388	fifty eight and 59   respectively  of active chronic gastritis cases were infected with h  
class1	388	pylori  
class1	388	all the h  
class1	388	pylori infections  except one  were found in patients with chronic gastritis  
class1	388	in aids arc patients  h  
class1	388	pylori infection and active chronic gastritis are as common as in other patients referred for upper endoscopy  
class1	388	they may play a pathogenic role  especially when endoscopic aids related findings are lacking  
class1	388	cell mediated immune deficiency does not appear to increase the risk of infection with h  
class1	388	pylori  
class1	389	comparison of two ascitic fluid culture methods in cirrhotic patients with spontaneous bacterial peritonitis  
class1	389	the conventional method of ascitic fluid culture detects bacteria in only 50  of cirrhotic patients with neutrocytic ascites and suspected spontaneous bacterial peritonitis  sbp   
class1	389	we have prospectively compared two ascites culture methods in cirrhotic patients with spontaneous bacterial peritonitis  1  conventional  on chocolate agar  blood agar  mac conkay agar  and thioglycolate broth   and 2  modified  inoculation of 10 ml of ascites in a tryptic soy broth  tsb  blood culture bottle at the patient s bedside   
class1	389	in a 21 month period  70 episodes of sbp were diagnosed according to our criteria in 60 cirrhotic patients  
class1	389	both culture methods were performed simultaneously  
class1	389	the conventional grew bacteria in 40 episodes  57    whereas the modified grew bacteria in 54 episodes  77    a significantly higher sensitivity  p   0 0001   
class1	389	in 16 cases  23    ascitic culture was negative by both methods  
class1	389	the mortality rate was higher among patients with culture positive sbp than those with culture negative sbp  46  vs 37    but did not reach statistical significance  
class1	389	we conclude that ascitic fluid inoculated into a tsb blood culture bottle at the patient s bedside should be used routinely for ascites culture in cirrhotic patients  
class1	390	liver abscess complicating intratumoral ethanol injection therapy for hcc  
class1	390	we report a patient who developed multiple liver abscesses and sepsis caused by lactobacilli after the percutaneous intratumoral injection of ethanol for hepatocellular carcinoma  
class1	390	we diagnosed the liver abscess at an early stage because of a the finding of gas on ultrasound and computed tomography  
class1	390	blood cultures grew gram positive rods  which were of the lactobacillus species  
class1	390	the patient responded to the administration of antibiotics  and his hepatic tumors have not recurred in the 7 months since treatment  
class1	390	this is the first report of liver abscess following percutaneous ethanol injection therapy  
class1	391	ofloxacin treatment of chlamydia pneumoniae  strain twar  lower respiratory tract infections  
class1	391	purpose  limited data suggest that tetracycline or erythromycin is the antibiotic of choice for treating chlamydia pneumoniae infection  but they are not always effective or well tolerated  
class1	391	because the fluoroquinolone ofloxacin is effective for chlamydia trachomatis infections  we investigated its role in treating c  
class1	391	pneumoniae infections  
class1	391	patients and methods  eighty seven patients were enrolled in a randomized trial of antibiotic therapy for acute lower respiratory tract infections  
class1	391	the patients were randomly assigned to oral treatment with either ofloxacin  400 mg twice a day  or erythromycin  400 mg four times a day  for 10 days  
class1	391	frozen acute and convalescent serologic specimens were tested for twar antibody by microimmunofluorescence  
class1	391	susceptibility testing of c  
class1	391	pneumoniae to ofloxacin was also performed  
class1	391	results  four patients who received ofloxacin were retrospectively identified as having c  
class1	391	pneumoniae pneumonia  two  or bronchitis  two   
class1	391	within 2 weeks of starting ofloxacin therapy  all were cured or markedly improved  
class1	391	the minimum inhibitory concentrations of ofloxacin for three previously isolated clinical strains of c  
class1	391	pneumoniae were determined to be 1 0 to 2 0 micrograms ml  well within the achievable serum levels  3 to 5 micrograms ml  with ofloxacin therapy  
class1	391	conclusion  ofloxacin may be an effective alternative antibiotic treatment for c  
class1	391	pneumoniae respiratory infections  
class1	392	determinants of condom use among french heterosexuals with multiple partners  
class1	392	in september 1988  a sample of french individuals between 18 and 49 years of age  who reported more than one sexual partner in the past six months and who considered themselves heterosexuals  n   1088   were interviewed at home about risk perception of human immunodeficiency virus  hiv  transmission  sexual behavior  and condom use  
class1	392	systematic or occasional use of condoms during the previous 12 months was reported by 46 9 percent of respondents  
class1	392	among condom users  38 7 percent declared they had never used condoms before the last 12 months  fear of acquired immunodeficiency syndrome  aids  rather than contraception being the main motivation of these recent users  
class1	392	multivariate analysis indicates that voluntary testing for hiv  average or more than average fear of sexually transmitted diseases  stds   and knowledge of hiv carrier in personal relations are associated with condom use  
class1	393	increased septic complications with three drug sequential immunosuppression for cadaver renal transplants  
class1	393	in 152 renal transplant recipients  the results of immunosuppression with three drug sequential  minnesota antilymphocyte globulin  prednisone  azathioprine  and cyclosporine  immunosuppression  n   107  were compared with those of a two drug sequential protocol  minnesota antilymphocyte globulin  prednisone  and cyclosporine  that excluded azathioprine  n   45   
class1	393	the study groups were comparable by age  sex  etiology of renal failure  incidence of diabetes  and degree of hla matching  
class1	393	patient survival at 1 year was not significantly different in the two groups  two drug  93  versus three drug  86   p   0 19   
class1	393	one year graft survival was superior in the two drug group  two drug  93  versus three drug  75   p   0 02   
class1	393	analysis of primary transplants only  n   116  yielded the same results  
class1	393	during the first year  the serum creatinine level remained stable in both groups  
class1	393	as expected  the three drug therapy group had significantly more bacterial and viral infections  
class1	393	for low risk primary cadaveric renal transplants  two drug sequential immunosuppression is superior  
class1	394	outpatient percutaneous central venous access in cancer patients  
class1	394	a 1 year experience of percutaneous subclavian catheterization in outpatients with cancer was reviewed to document reliability  safety  and cost  
class1	394	there were 763 catheter insertions attempted with prospective documentation of complications in 664 consecutive patients  
class1	394	catheter insertion was successful in 722 attempts  95    
class1	394	there were only 13 pneumothoraces  2    
class1	394	thirty catheters required repositioning  4    
class1	394	the average catheter duration was 191 days  range  0 to 892 days   
class1	394	fifty six catheters  8   were removed because of suspected infection  
class1	394	documented catheter sepsis occurred in 21 patients  3    catheter site infection occurred in 8 patients  1    
class1	394	thus  only 0 22 infections per catheter year occurred during this 382 catheter year experience  
class1	394	the estimated cost of catheter insertion was  562  which is one third the estimated cost for tunneled catheters   1 403  and for reservoir devices   1 738   
class1	394	in our experience  percutaneous subclavian catheterization is a reliable  cost effective method compared with tunneled or reservoir devices  with an equivalent incidence of catheter related infections  
class1	394	the cornerstone of our success with this program is a staff dedicated to catheter care and intensive patient education  
class1	394	in centers where a large number of patients require central venous access  percutaneous catheterization should be the technique of choice  
class1	395	severe anemia is an important negative predictor for survival with disseminated mycobacterium avium intracellulare in acquired immunodeficiency syndrome  published erratum appears in am rev respir dis 1991 feb 143 2  451  
class1	395	disseminated mycobacterium avium intracellulare  mai  in patients with the acquired immunodeficiency syndrome  aids  is usually unresponsive to antimycobacterial therapy  
class1	395	we examined clinical and laboratory characteristics of mai organisms and their relationship to the length of survival  
class1	395	we studied factors influencing survival and compared these in 76 patients with aids with and without mai  
class1	395	serum levels of p24 antigen and erythropoietin  and cd4 positive helper t lymphocytes in blood were assessed in 36 additional patients with various clinical stages of hiv infection  
class1	395	in patients with mai infection  survival was significantly related only to total lymphocyte count  hematocrit  platelet count  and sex  
class1	395	of these  hematocrit and total lymphocyte count were the only linear predictors of survival  
class1	395	anemia was significantly more profound in patients with aids and mai than in the other patients  
class1	395	this anemia in patients with mai could not be ascribed to increased peripheral destruction of red cells  deficient nutritional factors  or erythropoietin production  hiv viral or bacterial load  or a general effect on other blood elements such as neutrophils or platelets  
class1	395	the influence of mai on survival in patients with aids did depend upon whether the mai occurred as an index infection or was preceded by other opportunistic infections  
class1	395	patients with other preceding opportunistic infection lived for a much shorter duration from the time of diagnosis of mai  
class1	396	risk factors for staphylococcus aureus nosocomial pneumonia in critically ill patients  
class1	396	staphylococcus aureus nosocomial pneumonia has become an important infection not only because of an apparently increasing incidence but also because of its high mortality rate  
class1	396	a total of 50 episodes of nosocomial pneumonia in critically ill patients in which etiologic diagnosis was well established were prospectively followed in a medical surgical intensive care unit  icu   
class1	396	s  
class1	396	aureus was isolated in a total of 13 episodes  
class1	396	in the univariate analysis the variables significantly associated with s  
class1	396	aureus nosocomial pneumonia were below 25 yr of age  coma  nonuse of corticosteroids  and antecedent trauma  
class1	396	a step forward logistic regression analysis defined only coma as significantly influencing the risk of developing s  
class1	396	aureus nosocomial pneumonia  
class1	396	we suggest that antimicrobial drugs active against s  
class1	396	aureus must be included in the initial empirical antimicrobial regimen for treating nosocomial pneumonia in patients with coma  
class1	396	the identification of factors influencing the etiology and the possibility of earlier effective antimicrobial treatment may represent a further step in the control of nosocomial pneumonia in critically ill patients by improving its prognosis  
class1	397	a rat model of prolonged pulmonary infection due to nontypable haemophilus influenzae  
class1	397	pulmonary colonization and infection with nontypable  unencapsulated  haemophilus influenzae  nthi  occurs commonly in the setting of chronic lung diseases  
class1	397	because the study of nthi pulmonary infection in animal models has been limited by the rapid clearance of organisms  a model of persistent pulmonary infection was developed  
class1	397	groups of rats were inoculated by transtracheal instillation of viable nthi suspended in broth or semisolid agar  
class1	397	some rats had received hexamethylphosphoramide  hmp  in drinking water before inoculation to cause respiratory epithelial mucosal damage  
class1	397	groups of animals were sacrificed serially  
class1	397	lungs were cultured quantitatively and their gross and microscopic anatomy examined  
class1	397	nthi was recovered in small quantities from few broth inoculated rats after the first day of infection and in none after day 7  
class1	397	in contrast  nthi was recovered from the majority of animals and in greater amounts through 2 wk after agar borne inoculation  
class1	397	hmp pretreatment further enhanced recovery through 4 wk after inoculation with an agar vehicle  
class1	397	the pulmonary inflammatory reaction was brief in broth inoculated rats  
class1	397	the longer persistence of gross and histologic changes seen in agar infected lungs paralleled the enhanced recovery of nthi  
class1	397	abscess formation occurred at 7 to 14 days in some agar inoculated animals  
class1	397	thus pulmonary inoculation of nthi in a viscous vehicle resulted in perpetuation of infection and inflammatory response  and previous damage to respiratory mucosal epithelium induced by hmp further enhanced such infection  
class1	398	disseminated conidiobolus infection with endocarditis in a cocaine abuser  
class1	398	a crack cocaine abuser developed disseminated infection caused by a species of conidiobolus not known to cause disease in vertebrates  
class1	398	the fungus gained entry via skin abrasions on the lower extremities  spread through the hematogenous route  and caused endocarditis  
class1	398	there was evidence of fungal infection in the lungs  heart  kidneys  skeletal muscles  and brain  
class1	398	an additional complication was extensive rhabdomyolysis  with a marked elevation of creatine kinase of up to 1 2 million u l  
class1	399	tuberculous meningitis  short course of chemotherapy  
class1	399	in march 1986  we began a 6 month short course trial of therapy for tuberculous meningitis  in which 28 patients were analyzed  
class1	399	the diagnosis was based on the following cerebrospinal fluid test results  in 53 5  of the cases  mycobacterium tuberculosis was identified by direct smear  in 57   culture in lowenstein jensen medium was positive  in 83 3   the detection of anti bacille calmette guerin  bcg  antibodies by enzyme linked immunosorbent assay was positive  and in 74   the dosification of adenosine deaminase activity was positive  
class1	399	in addition  in 21 4  of the cases  the diagnosis was established by means of autopsy findings  
class1	399	moreover  the diagnosis was supported by bacteriological analyses from another tissue or body fluids  
class1	399	despite the administration of an antituberculous therapy  32 4  of the patients died  all of the decreased had reached the last stage of the disease by the beginning of treatment  
class1	399	sixteen percent of the patients who survived after more than 18 months of follow up after therapy had ended suffered neurological sequelae  
class1	399	with the 6 month therapeutic regimen  the morbidity mortality is similar to that found in the longer course therapies  
class1	399	the latter regimen is therefore thought to be a good and acceptable therapeutic option for the treatment of tuberculous meningitis  
class1	400	acquired childhood aphasia  outcome 1 year after onset  
class1	400	the effects of the variables age at onset  cause  severity and bilaterality of lesion  and type of aphasia on course and outcome were investigated in a group of 28 aphasic children  
class1	400	analysis of spontaneous speech and tests of auditory verbal comprehension were used to determine the presence of aphasia  
class1	400	the severity of the cerebral lesion was assessed using a rating scale for computed tomographic scans  
class1	400	most of the children had not recovered completely 1 year after onset  
class1	400	recovery was significantly different according to etiological categories  
class1	400	complete recovery was seen in the majority of traumatic cases  
class1	401	cumulative aids incidence and altered mortality from bacterial infections  
class1	401	to determine whether populations with high cumulative incidence of acquired immunodeficiency syndrome  aids  experienced increased deaths from sepsis  central nervous system abscess  or endocarditis  new jersey aids patients were grouped according to their age  sex  race  and residence specific cumulative incidence of aids since the onset of the aids epidemic  
class1	401	between 1980 and 1986  among 25 44 year olds in the highest cumulative incidence group for aids  sepsis mortality increased from 3 3 to 15 2 deaths 100 000 year  an increase of 11 9 deaths 100 000 year  95  confidence interval  6 9  17 0  deaths 100 000 year   mortality from central nervous system abscesses increased from zero to 1 7  0 1  3 2  deaths 100 000 year  and mortality from endocarditis increased from 0 8 deaths 100 000 year to 2 4 deaths 100 000 year  an increase of 1 6   0 5  3 7  deaths 100 000 year  
class1	401	age matched new jersey patient populations with low cumulative incidence of aids did not sustain a similar increase  
class1	401	the hiv disease associated increase in sepsis mortality among young populations represents a new component of the substantial increase in u s  
class1	401	sepsis mortality that occurred over the last two decades  but was previously limited to older populations  
class1	402	patterns of bacterial infection in calves implanted with artificial hearts  
class1	402	device related infection is one of the most serious potential consequences of total artificial heart  tah  implantation  
class1	402	this complication must be addressed before the full potential benefit of these devices  especially fully implantable devices  can be realized  
class1	402	a review of research reports and clinical data was conducted to ascertain if similarities existed between the patterns of infection reported in human tah recipients and those seen in the experimental animal models  
class1	402	infection was reported in approximately 57  of the human tah recipients and approximately 47  of the implanted animals  
class1	402	implant periods ranged from 1 620 days for the humans  and 32 287 days for the animals  
class1	402	the spectrum of organisms isolated from both groups were similar  with a high proportion of infections caused by pseudomonas aeruginosa and staphylococcus epidermidis  
class1	402	in addition  numerous isolates of enterobacter and enterococci were obtained from the animals  
class1	402	positive blood cultures have often been observed in animals within 2 4 weeks following implantation of the devices  
class1	402	the similarities noted in this review suggest that the calf may be an appropriate animal model in which to study the pathogenesis of tah related infection  
class1	403	peritoneal macrophage beta 2 microglobulin production and bacterial peritonitis in capd patients  
class1	403	to evaluate the role of bacterial peritonitis in peritoneal macrophage  pm  beta 2 microglobulin  b2m  production  and its relationship with pm interleukin 1  il 1  and leukotriene b4  ltb4  release  the authors studied 20 capd patients  10 with peritonitis   1  
class1	403	in vivo plasma and peritoneal dialysis effluent  pde  b2m  il 1  and ltb4 levels  2  
class1	403	in vitro b2m  il 1  and ltb4 release by pm  
class1	403	values were compared with those seen in the plasma or with peripheral blood monocytes of 30 hemodialysis  hd  patients  10 treated with cuprophan  cu   10 with polyacrylonitrile  pan   and 10 with cellulose acetate  ca    
class1	403	results showed that in capd patients with bacterial peritonitis b2m  il 1 and ltb4 concentrations in the pde were significantly higher than those seen in capd patients without peritonitis  or in the plasma of hd patients treated with pan or ca  but were similar to those seen in hd patients treated with cu  
class1	403	at the same time  in vitro pm from capd patients with bacterial peritonitis produced more b2m  il 1  and ltb4  than did pm from capd patients without peritonitis  or peripheral blood monocytes from hd patients treated with pan or ca  
class1	403	the authors conclude that in capd patients  bacterial peritonitis is able to induce pm b2m production  probably via a cytokine mediated process  which may be analogous to what occurs with peripheral blood monocytes of hd patients treated with cu  
class1	404	prevention of infection in a porous tracheal prosthesis by omental wrapping  
class1	404	the ideal tracheal prosthesis has to permit complete incorporation by epithelialization of the luminal surface  
class1	404	this is not possible with the currently available impermeable solid silicone tube  
class1	404	the authors developed a reinforced  porous polyurethane tubular prosthesis which has the potential for complete incorporation  
class1	404	however  because these prostheses are implanted in a contamined area such as the airway  they all become infected  
class1	404	in order to prevent infection  the authors evaluated the effect of omental wrapping in guinea pigs  
class1	404	the authors  tubular prosthesis was implanted subcutaneously in the abdominal area with the ends open to the air  
class1	404	ten prostheses were wrapped with omentum and 10 prostheses were not  
class1	404	in 4 weeks  all control prostheses were infected and marsupialized  
class1	404	all the wrapped prostheses remained in place and were macroscopically not infected  
class1	404	microscopically  all wrapped prostheses were well vascularized and were incorporated by granulation tissue  which did not occur in the prostheses of the control group  
class1	404	from these results the authors conclude that omental wrapping would be an effective way to prevent infection of porous tracheal prostheses in an open to the air situation  and allow rapid tissue ingrowth and incorporation in the host  
class1	405	the role of indium labelled leukocyte imaging in pyrexia of unknown origin  
class1	405	indium 111 labeled white blood cell scanning is often used in the investigation of pyrexia of unknown origin  puo  to locate an otherwise occult source of sepsis  
class1	405	from a series of 166 white blood cell studies performed for sepsis  28 cases of true puo were identified and reviewed  
class1	405	the sensitivity was 60  and specificity 70   with a positive predictive value of 38  and negative predictive value of 90   
class1	405	only 11  of studies revealed a pyogenic cause for puo  
class1	405	these results are discussed and the potential role of gallium scanning in puo is raised  
class1	406	surgical presentation of kawasaki disease  mucocutaneous lymph node syndrome   
class1	406	five patients with kawasaki disease  mucocutaneous lymph node syndrome  are reported whose varied presentations included acute abdominal pain  peripheral arterial aneurysms  digital gangrene and sterile pyuria and whose presenting pathology ranged from hydrops of the gallbladder to enteric pseudo obstruction  
class1	406	as the complications of the disease can usually be managed without resort to surgery  which is associated with a mortality rate of up to 25 per cent  the recognition of kawasaki disease will prevent hazardous and unnecessary laparotomy  
class1	407	new isotopic technique for detecting prosthetic arterial graft infection  99mtc hexametazime labelled leucocyte imaging  
class1	407	early and accurate detection of prosthetic arterial graft infection is important because this serious complication of vascular surgery carries high morbidity and mortality rates  
class1	407	this report describes the use of a new method of isotopic imaging to detect graft infection using 99mtc hexametazime labelled leucocytes  
class1	407	seventeen patients with potentially infected arterial grafts were imaged in addition to routine investigations but were managed according to our normal surgical practice  
class1	407	99mtc imaging was positive in eight patients with proven graft infection and falsely positive in one patient with a groin haematoma  89 per cent specificity   
class1	407	there were no false negatives  100 per cent sensitivity  after an average follow up of 6 months  range 3 9 months   
class1	407	this technique has proved a reliable and rapid method of confirming graft infection  
class1	408	post cannulation radial artery aneurysm  a rare complication  
class1	408	the following case report describes an expanding aneurysmal dilatation of the radial artery which developed 17 days following cannulation  
class1	408	possible causes of this complication are  abnormal state of the vessel wall  multiple attempts at cannulation  and haematoma or infection at cannulation site  
class1	408	other major and minor sequelae following arterial cannulation are reviewed  
class1	409	widespread dermatophyte infections that mimic collagen vascular disease  
class1	409	this article reports the cases of two patients in whom a widespread dermatophyte infection mimicked the cutaneous lesions of their underlying collagen vascular disease  
class1	409	griseofulvin may be associated with an increased incidence of adverse cutaneous reactions in patients with systemic lupus erythematosus  
class1	409	one patient with systemic lupus erythematosus developed erythema multiforme after taking griseofulvin  
class1	410	parents  vs physicians  utilities  values  for clinical outcomes in potentially bacteremic children  
class1	410	our previous analyses of decision strategies in children 3 24 months with acute onset fever greater than or equal to 39 degrees c and no evident bacterial focus of infection indicated that the risks of routine blood cultures  the unnecessary hospitalization and treatment of children who clear their bacteremia spontaneously  outweigh its benefits  the prevention of a few cases with major infectious sequelae   
class1	410	because those analyses were based on parents  values for beneficial and adverse clinical outcomes  we wished to examine whether those values differed in physicians and  if so  whether the differences were sufficient to change the results of the decision analysis  
class1	410	using a pre tested linear analog utility  value  scale  we evaluated eight potential clinical outcomes in potentially bacteremic children by surveying 121 parents of healthy 3 24 month old children attending a private pediatric group practice and 57 attending physicians of a tertiary care children s hospital emergency room  
class1	410	utilities were based on a 0 1 normalization  where 0 is the utility of the worst outcome  meningitis or other major bacterial infection  plus venipuncture   and 1 the utility of the best outcome  complete recovery without venipuncture or hospitalization   and were analyzed using a recently developed statistical model of utility  
class1	410	the majority of parents and physicians combined the imputed components of the outcomes  disease  pain of venipuncture  and stress of hospitalization  in a nonlinear fashion  
class1	410	parents assigned substantially lower utility  i e  
class1	410	greater disutility  to venipuncture  minor infection  and hospitalization than did physicians  and these utilities were even lower in parents with other children at home  
class1	411	low gastric acid as a risk factor for cholera transmission  application of a new non invasive gastric acid field test  
class1	411	although gastric acid is thought to be an important host defense against certain enteric infections  field studies of the role of gastric acid in preventing enteric infections have been hampered by the lack of a suitable non invasive test  
class1	411	because low gastric acid output  gao  is an established risk factor for cholera  we assessed after validation  whether a new non invasive test which estimates gao by measuring breath hydrogen excess after ingestion of magnesium and a stimulant of gastric acid secretion  could discriminate between persons at high and at low risk of developing cholera  
class1	411	fifteen age matched pairs  participants in the field trial of two oral cholera vaccines in rural bangladesh  were tested  
class1	411	in each pair the  case  was a person who had recovered from severe cholera at least 6 months before testing and the  control  was a person who resided in the home of a cholera patient but remained uninfected  
class1	411	the stimulated breath hydrogen was higher in controls  median hydrogen excess   369 mumol 80 min  than in cases  median hydrogen excess   150 mumol 80 min   p less than 0 05  and was higher in controls in 12 out of 15 pairs  
class1	411	the results  which are consistent with past invasive assessments of the association between hypochlorhydria and cholera  suggest that this non invasive test may be useful in evaluating gao in epidemiological field studies  
class1	412	tampon absorbency  composition and oxygen content and risk of toxic shock syndrome  
class1	412	tampon use has been identified as a major risk factor for toxic shock syndrome  although the etiologic role of tampons is not clearly understood  
class1	412	two epidemiologic studies conducted to date have reported an association between tampon absorbency and risk of toxic shock syndrome  
class1	412	this finding is not corroborated by laboratory studies  however  which have suggested that absorbency may be a marker for other characteristics that create an environment conductive to the elaboration of toxic shock syndrome toxin 1  
class1	412	we used data from the previously reported tri state study to estimate simultaneously the effects of tampon oxygen content  absorbency and chemical composition  
class1	412	although the data are sparse  oxygen content was more strongly associated with risk of toxic shock syndrome than either absorbency or chemical composition  
class1	412	the results suggest that it may be possible to develop a highly absorbent tampon that is not associated with a high risk of toxic shock syndrome  
class1	413	castanospermine vs  its 6 o butanoyl analog  a comparison of toxicity and antiviral activity in vitro and in vivo  
class1	413	inhibitors of glycoprotein processing  such as castanospermine  1 6 7 8 tetrahydroxyoctahydroindolizine   have been shown previously to inhibit human immunodeficiency virus type 1  hiv 1  with acceptable toxicity in cultured human cells  
class1	413	in prior experiments  we have tested the toxicity and antiviral efficacy of castanospermine in mice infected with the rauscher murine leukemia virus  rlv   
class1	413	when compared with 3  azido 3  deoxythymidine  azt  zidovudine   castanospermine was less effective and more toxic  
class1	413	since the 6 o butanoyl analog of castanospermine was previously found to have a more favorable activity profile than the parent compound against hiv 1 in cultured cells  we compared the antiviral efficacy of both compounds in parallel in vitro and in vivo in the rlv system  
class1	413	plaque formation in the xc assay was inhibited with a 50  inhibitory concentration  ic50  of 2 4 microm for the 6 o butanoyl analog of castanospermine  as compared to 9 microm for castanospermine  
class1	413	for both compounds  concentrations resulting in significant cytotoxicity were about ten times higher  
class1	413	both compounds significantly decreased hiv 1 env induced syncytium formation in a novel in vitro assay  
class1	413	in rlv exposed mice  the 6 o butanoyl analog showed no advantage over the parent compound  both curves for toxicity as well as antiviral efficacy were super imposable  
class1	413	we conclude that the 6 o butanoyl analog of castanospermine as well as castanospermine itself are active antiviral agents in mice and that prolonged oral administration is tolerable  
class1	413	however  in comparison to azt  their antiviral activity profiles are less favorable  
class1	414	prevention of a false diagnosis of sexually acquired reactive arthritis by synovial lymphocyte responses  
class1	414	three cases are reported in which a diagnosis of sexually acquired reactive arthritis might have been made erroneously from the history  but the enteric origin of the reactive arthritis was evident from synovial lymphocyte responses  
class1	414	the importance of making the correct diagnosis and the avoidance of unwarranted spousal dysharmony is stressed  
class1	415	pyogenic sacroiliitis in a rural population  
class1	415	we describe 10 cases of pyogenic sacroiliitis occurring in a rural population  
class1	415	seven were male and 3 were female with a mean age of 22 4 years  
class1	415	none was a recent intravenous drug abuser  
class1	415	five patients had a history of recent pelvic trauma  
class1	415	99mtechnetium scintiscans revealed increased sacroiliac  si  joint uptake in 8 of 8 cases  
class1	415	blood cultures were positive in 60  of patients  
class1	415	staphylococcus aureus was isolated in 7 cases from blood and or si aspirates and hemophilus influenzae type b in one case  
class1	415	nine of 10 patients recovered completely  
class1	415	one underwent arthrodesis for recurrent si pain without evidence of relapse of infection  
class1	415	median followup was 18 months  
class1	416	sternocostoclavicular hyperostosis  two cases with differing dermatologic syndromes  
class1	416	sternocostoclavicular hyperostosis is a rare rheumatic condition characterized by ossification and erosion of the clavicle and the first rib  that has been shown to be associated with pustular skin lesions  
class1	416	we present 2 cases  one of which had features of pustulosis palmaris et plantaris and the other dissecting cellulitis of the scalp  
class1	416	although the dermatologic manifestations differ  both cases have rheumatologic and roentgenographic features diagnostic of sternocostoclavicular hyperostosis  
class1	417	yersinia enterocolitica tenosynovitis  the first case  
class1	417	we describe a case of tenosynovitis of tibialis posterior due to yersinia enterocolitica occurring after injury by a plant thorn in a 55 year old man  
class1	417	the illness was chronic with 2 recurrences in spite of antibiotic treatment  
class1	417	full recovery was obtained only after surgical intervention  
class1	417	our patient s chronic course was fostered by the persistence of thorn fragments in the infected area and the exceptionally pathogenic character of the isolated colony of yersinia  
class1	418	septic streptococcus milleri spondylodiscitis  
class1	418	we describe 2 patients presenting lumbar spondylitis due to streptococcus milleri  
class1	418	in both cases origin was related to preexistent intestinal pathology  
class1	418	surgical drainage of a collection of pus was necessary in one case  
class1	418	longterm antibiotic therapy led to full recovery  
class1	418	despite confused nomenclature streptococcus milleri must be considered a serious pathogen mainly associated with purulent infection with osteoarticular affinity  
class1	419	development and potential use of antibody directed against lipopolysaccharide for the treatment of gram negative bacterial sepsis  
class1	419	gram negative bacterial sepsis remains a major cause of lethality in hospitalized patients  despite routine therapy consisting of antimicrobial agents  hemodynamic monitoring and fluid resuscitation  and metabolic support  
class1	419	because a large body of evidence supports the concept that gram negative bacterial lipopolysaccharide  endotoxin  lps  is responsible for many of the direct and host mediator induced deleterious effects  recent work has been centered on the development and use of anti lps antibody preparations in order to ameliorate lethality  
class1	419	both polyclonal and monoclonal antibody preparations directed against the common deep core lipid a region of lps are cross reactive in vitro and cross protective in vivo against a wide range of challenge organisms and lps  and preliminary clinical trials indicate that a reduction in lethality may be possible  
class1	419	the precise endotoxin epitope against which antibody should be directed in order to maximize protection  however  has not been established  
class1	419	this modality most probably will become a standard form of adjunctive therapy within the next several years for the treatment of gram negative bacterial sepsis  
class1	420	the systemic septic response  concepts of pathogenesis  
class1	420	following resuscitation from shock  the clinical phase of persistent hypermetabolism is entered from which a substantial number of patients transcend into progressive organ failure and expire  
class1	420	the available epidemiologic  physiologic  and metabolic data are consistent with the position that a persistent degree of microcirculatory hypoxia  although it may be present in amounts that are below the sensitivity of current detection systems  becomes an increasingly less important etiologic factor as the organ failure disease progresses  
class1	420	rather  aerobic metabolism appears to be the dominant mechanism of meeting the increased work loads and energy demands  
class1	420	there is an increasing body of evidence that cytokine release systemically  and increased cell cell interaction through cytokines and prostanoids locally  may alter not only parenchymal function in the proximity of these mononuclear cells  but organ function at distant sites  
class1	420	if this latter hypothesis continues to be substantiated  it implies that the underlying cell and organ dysfunction may indeed be reversible if appropriate counter regulatory mechanisms could be developed and the appropriate timing of their application understood  
class1	421	altered ca2  homeostasis and functional correlates in hepatocytes and adipocytes in endotoxemia and sepsis  
class1	421	decreased cytosolic  ca2   and impaired ca2  release in response to an ip3 challenge are among perturbations in hepatocyte ca2  homeostasis associated with endotoxemia and sepsis  
class1	421	these changes are consistent with the accompanying alterations in appropriate physiologic functions  e g   activation of glycogen phosphorylase and gluconeogenesis  mediated by  ca2  c and defective phosphorylation of relevant enzymes  
class1	421	attenuation of ip3 binding to the subcellular fractions that are imputed to be targets of ip3 and a decrease in the size of the ip3 sensitive pool of releasable ca2  are underlying components of the mechanism of the reduced ca2  release upon ip3 stimulation and its metabolic sequelae  
class1	421	et treatment leads to a significant increase in ca2  associated with the cell surface compartment of adipocytes  a reduction in 45ca2  uptake by endoplasmic reticulum and higher cytosolic  ca2   under basal conditions and upon acth stimulation than that observed in cells of control rats  
class1	421	the reduced 45ca2  uptake is also manifest in adipocytes of septic rats  
class1	421	alterations in adipocyte metabolism induced by et include increased oxidation of glucose to co2  an insulin like effect  and increased lipolysis upon ne and acth stimulation  
class1	422	aberrations in post trauma monocyte  mo  subpopulation  role in septic shock syndrome  
class1	422	appearance of increased proportions of monocytes bearing the 72kd fcri  receptor for igg correlated to aberrant monocyte  mo  functions  depressed immune functions  and poor clinical outcome  
class1	422	the trauma patients  fcri  mo subpopulation produced the majority of their elevated il 6  tnf alpha  tgf beta  and pge2  
class1	422	igg stimulation of patients  mo through fcri not only stimulated tnf alpha  il 6  and pge2 levels  but also greatly augmented the levels of these monokines produced after subsequent bacterial challenge  
class1	422	post trauma increased il 6 levels can lead to polyclonal b cell activation and high levels of circulating  nonspecific igg as seen in trauma patients  
class1	422	this nonspecific igg triggers the fcri on the increased numbers of fcri  mo leading to ever increasing monokine levels  
class1	422	il 4 was found to downregulate patients  fcri  mo production of mediators  
class1	422	the cycle of altered cytokine levels  increased fcri  mo numbers  elevated igg  and augmented triggering of fcri  mo may be broken by addition of il 4  
class2	423	abnormal differentiation of human papillomavirus induced laryngeal papillomas  
class2	423	we studied the proliferation and differentiation of human laryngeal papillomas  which are benign tumors induced by human papillomaviruses  
class2	423	immunofluorescent stains of tissues for a number of differentiation specific proteins showed abnormal differentiation  
class2	423	papilloma tissue fragments in vitro showed a slightly decreased fraction of proliferating cells that incorporated tritiated thymidine and a markedly reduced incorporation of tritiated uridine when compared with normal tissue  
class2	423	we propose that papillomavirus infection results in normal basal cell proliferation but abnormal terminal differentiation and that this abnormality significantly contributes to the hyperplasia of the papillomas  
class2	424	laser photodynamic therapy for papilloma viral lesions  
class2	424	photodynamic therapy was tested for its therapeutic efficacy in eradicating rabbit papilloma warts  
class2	424	the wild type viral warts suspension was used to induce treatable papilloma warts in the cutaneous tissue of dutch belted rabbits  
class2	424	the photosensitizing agents used intravenously were photofrin ii at 10 mg kg of body weight and chlorin e6 monoethylene diamine monohydrochloric acid  chlorin e6 med hcl  at 1 mg kg of body weight  
class2	424	the lasers used were an argon dye laser at 628 and 655 nm and a gold vapor laser at 628 nm  
class2	424	the irradiances of 25 to 180 mw cm2 were applied topically with an end on lens optical fiber with total radiant doses of 7 5 to 54 j cm2  
class2	424	photofrin ii and the argon dye laser at the highest light dosage  54 j cm2  and chlorin e6 monoethylene diamine monohydrochloride administered 2 hours before argon dye laser irradiation at 655 nm at the highest light dosage  54 j cm2  produced wart regression  
class2	424	total wart regression without recurrence was achieved with photofrin ii and the gold vapor laser at all light dosages  
class2	424	the difference observed between the argon dye laser and the gold vapor laser might be explained by the pulsed nature of the gold vapor laser  with its high peak powers  some 5000 x the average measured light dose  
class2	424	in this model  the smaller  less cornified lesions were more effectively treated with photodynamic therapy  
class2	425	influenza infection and diabetes mellitus  case for annual vaccination  
class2	425	herein  epidemiological data on influenza pneumonia and mortality  results of clinical studies  and the outcome of influenza vaccination trials are reviewed  
class2	425	all excess mortality studies that specify for underlying disease list diabetes as one of the major risk factors  
class2	425	during influenza epidemics  death rates among patients with diabetes mellitus may increase by 5 15   
class2	425	diabetes mellitus is also mentioned as a risk factor in most clinical studies  making up 3 14  of the patients studied  
class2	425	even in recent studies  diabetes mellitus is only preceded as a risk factor by cardiovascular disease and chronic pulmonary disorders  
class2	425	to what extent cardiovascular disease and old age contribute to the increased influenza mortality and morbidity in diabetic patients remains unclear  
class2	425	the influence of epidemic influenza on the incidence of diabetic acidosis in combination with an impaired immune response to both staphylococcus aureus and the influenza virus suggests that diabetes mellitus itself is the main risk factor  
class2	425	it is concluded that all patients with diabetes mellitus should receive annual vaccinations and that  in official recommendations  patients with diabetes mellitus should be mentioned as a separate risk group  
class2	425	whole virus vaccines are preferred over subunit vaccines  
class2	426	disseminated cutaneous herpes zoster following cardiac surgery  
class2	426	our case report describes disseminated cutaneous herpes zoster in the early post operative period following cardiac surgery with cardiopulmonary bypass  
class2	426	this has not been reported previously in the absence of immunosuppressive therapy  
class2	426	despite associated neurologic and respiratory impairment  our patient was treated successfully with intravenous acyclovir and subsequently discharged  
class2	427	oligoclonal t cell receptor gene rearrangements in blood lymphocytes of patients with acute epstein barr virus induced infectious mononucleosis  
class2	427	gene rearrangement studies were performed on blood lymphocytes from eight patients with acute epstein barr virus induced infectious mononucleosis  
class2	427	the diagnosis in each case was based on characteristic clinical  hematologic  and serologic findings  
class2	427	the blood lymphocytes in each patient consisted predominantly of cd8  t cells  
class2	427	ebv dna was detected in seven patients by southern blot analysis  ebv bam hi w probe  bam hi   
class2	427	a germline configuration was found for the immunoglobulin heavy and light chain genes  jh probe  bam hi and eco ri  c kappa probe  bam hi  and c lambda probe  eco ri   
class2	427	t cell receptor gene rearrangements were detected with j gamma and j beta 1   2 probes  
class2	427	using a j gamma probe with two different restriction enzymes  bgl ii and eco ri   the blood from each patient showed several bands corresponding to the polyclonal pattern previously described in the blood of normal individuals  
class2	427	using j beta 1   2 probes with two different restriction enzymes  bgl ii and bam hi   each case showed from 3 to about 12 extragermline bands of varying intensity and in different locations from case to case  
class2	427	in addition  each case showed relative deletion of the j beta 1 germline band  
class2	427	this oligoclonal pattern of t cell receptor gene rearrangements has not been previously reported in benign or malignant t cell populations  
class2	428	cutaneous lesions of disseminated histoplasmosis in human immunodeficiency virus infected patients  
class2	428	disseminated histoplasmosis is being diagnosed more frequently in persons infected with the human immunodeficiency virus and is often the initial manifestation of the acquired immunodeficiency syndrome  aids   
class2	428	disease related cutaneous features of hiv associated disseminated histoplasmosis are defined as mucocutaneous lesions from which fungal organisms were either cultured or demonstrated histopathologically  
class2	428	we report four hiv seropositive patients with disseminated histoplasmosis who had culture positive skin or oral lesions of histoplasmosis and review the specific cutaneous manifestations of hiv associated disseminated histoplasmosis  
class2	428	including our patients  disease related skin and or mucosal lesions were present in 11  of patients  26  of 239  with hiv associated disseminated histoplasmosis  
class2	428	the possibility of disseminated histoplasmosis should be considered in all hiv infected persons and in persons with aids risk factors who have fever  weight loss  hepatosplenomegaly  and new cutaneous lesions  
class2	428	an early skin or mucosal biopsy specimen for crushed tissue preparation  histologic evaluation  and fungal culture is a simple  rapid diagnostic procedure  
class2	429	itraconazole in opportunistic mycoses  cryptococcosis and aspergillosis  
class2	429	striking results were obtained with oral itraconazole therapy in two opportunistic mycoses  
class2	429	of 28 patients with cryptococcal meningitis  18 achieved complete responses  including 16 of 24 patients with acquired immunodeficiency syndrome  
class2	429	other manifestations of cryptococcosis were similarly responsive  
class2	429	in aspergillosis 12 of 15 patients responded  including 8 of 10 immunocompromised hosts  
class2	429	these patients included those with invasive pulmonary disease  4 5   skeletal disease  2 2   pleural disease  1 2   and pericardial  sinus  mastoid  hepatosplenic  or nail disease  1 1   
class2	429	these results with itraconazole compare favorably to conventional  parenteral  therapy  and toxicity was minimal  
class2	429	this suggests that comparative trials are now in order  
class2	430	itraconazole therapy in aspergillosis  study in 49 patients  
class2	430	itraconazole  200 to 400 mg once daily  was administered to 49 patients with different types of aspergillosis  pulmonary aspergilloma  14 patients   chronic necrotizing pulmonary aspergillosis  14   and invasive aspergillosis  21   
class2	430	itraconazole was prescribed alone or in combination or after treatment with amphotericin b and flucytosine  
class2	430	of 14 aspergilloma patients  2 were cured and 8 had symptomatic improvement  
class2	430	in chronic necrotizing pulmonary aspergillosis  7 of 14 patients were cured and 6 improved significantly  
class2	430	in invasive aspergillosis treatment failed in 6 patients and 15 were cured  
class2	430	itraconazole can be an alternative to amphotericin b in the treatment of invasive aspergillosis and chronic necrotizing pulmonary aspergillosis  
class2	430	in aspergilloma itraconazole may be useful in inoperable cases  
class2	431	assessing the risk of occupational acquisition of the human immunodeficiency virus  implications for hospital policy  
class2	431	in determining infection control policy  it is essential to quantitatively assess the risk of transmission of human immunodeficiency virus  hiv  to health care workers and their families  
class2	431	the risk should be placed in perspective by comparing it with other occupational hazards  
class2	431	the risk of seroconversion from a needlestick injury can be calculated from the probability of a needlestick occurrence  the probability that the source patient is infected  and the probability of seroconversion  given an exposure  
class2	431	the risk of seroconversion due to drawing 1000 blood specimens from seropositive patients is between 86 and 470 in 100 000  
class2	431	the risk to surgeons from performing 25 operations on infected patients is approximately 272 in 100 000  
class2	431	the risk of fatal injury in the course of one year s work on a louisiana oil rig is between 188 and 283 per 100 000  
class2	432	cytomegalovirus induced osteomyelitis in a patient with the acquired immunodeficiency syndrome  
class2	432	a 43 year old man with aids had a periodontal abscess  no fever  and normal findings on funduscopic examination  
class2	432	three months later  the abscess area was debrided  and histologic examination of the tissue revealed osteomyelitis of the mandible  
class2	432	within the area of osteomyelitis were numerous cells with inclusions typical of cytomegalovirus  cmv  infected cells  
class2	432	funduscopic examination at that time revealed extensive cmv retinitis  
class2	432	osteomyelitis should be added to the list of infections caused by cmv in patients with aids  
class2	433	risk factors for white matter changes detected by magnetic resonance imaging in the elderly  
class2	433	we found increased age  p   0 001  and history or evidence of stroke  p   0 016  to be significant independent multivariate predictors of the presence and severity of leukoencephalopathy on magnetic resonance imaging brain scans in a mixed population of 35 elderly psychiatric patients and 25 neurologically healthy elderly volunteers  
class2	433	these results suggest that subcortical ischemia  as well as age related changes that may not be vascular in origin  contribute to the emergence of periventricular and other deep white matter hyperintensities that are commonly seen on the magnetic resonance imaging brain scans of older adults  
class2	434	isolation of measles virus in primary rhesus monkey cells from a child with acute interstitial pneumonia who cytologically had giant cell pneumonia without a rash  
class2	434	the isolation of measles virus in primary rhesus monkey kidney cells  prmk  in patients with documented giant cell pneumonia who have presented without a rash is limited  
class2	434	the diagnosis usually is made by cytologic examination of nasal or bronchial secretions in which characteristic multinucleated giant cells with intranuclear and intracytoplasmic inclusion bodies are observed  
class2	434	the diagnosis of giant cell pneumonia has been associated with measles virus but not exclusively  
class2	434	canine distemper  herpes group viruses  and parainfluenza infections have been associated with these cells  
class2	434	in addition  vitamin a deficiency also has been cytologically associated with multinucleated giant cells  
class2	434	the authors describe the isolation of measles virus from bronchial washing and sputum in prmk cells at 4 days from an 11 year old child with acute interstitial pneumonia who was in remission for acute lymphocytic leukemia  
class2	434	classic cytopathologic effect  cpe  consisting of syncytial and hole formation on the prmk monolayer was apparent  
class2	434	in addition  a foamy appearance of the monolayer was noted in an otherwise clean lot of monkey cells  
class2	434	confirmatory testing with measles antibody of the infected areas of the monolayer by indirect immunofluorescence  ifa  was positive for measles antigen and negative for mumps  parainfluenza  types i  ii  and iii  and influenza a and b virus  
class2	434	serologic studies for measles antibody revealed an ifa igg titer of greater than 1 10 240  and an igm titer of 1 128  
class2	434	cytologic examination of the same bronchial fluid revealed the typical giant cells with characteristic inclusions associated with measles virus  
class2	434	because this disease usually is severe  and often fatal  prompt recognition of this virus is essential  not only to the patient  who can be treated with immunoglobulin and or antiviral therapy  but also to prevent the spread of the virus to other patients and medical personnel  
class2	434	these findings also support direct evidence for the etiologic role of measles virus in giant cell pneumonia that has been detected either histologically or cytologically and in tissue culture at autopsy  
class2	435	disseminated  nonmeningeal gastrointestinal cryptococcal infection in an hiv negative patient  
class2	435	gastrointestinal cryptococcosis is extremely rare  especially in patients with no involvement of the central nervous system  
class2	435	we describe a 63 yr old man undergoing prednisone therapy for chronic hepatitis and cirrhosis who presented with peritonitis  colitis  and skin lesions  
class2	435	pathological studies revealed necrosis and numerous cryptococcal organisms in the colon  omentum  and skin  and cultures yielded cryptococcus neoformans  
class2	435	the patient died of multisystem organ failure following emergency exploratory surgery performed when he had onset of symptoms of a bowel perforation after an endoscopic biopsy  
class2	435	clinicians should be aware that gastrointestinal cryptococcosis can occur in the absence of infection of the central nervous system or lungs  and that it may affect relatively healthy patients who are immunocompromised because of splenectomy  chronic liver disease  or steroid therapy  
class2	436	sexually transmitted diseases and human immunodeficiency virus infection among women with pelvic inflammatory disease  
class2	436	both human immunodeficiency virus infections and pelvic inflammatory diseases are sexually acquired illnesses of great consequence to women  
class2	436	this study was undertaken to determine if women hospitalized with pelvic inflammatory disease  in a community endemic for human immunodeficiency virus  were at high risk to be infected with human immunodeficiency virus and if human immunodeficiency virus infections altered their hospital course  
class2	436	one hundred ten women hospitalized with pelvic inflammatory disease in brooklyn  in a hospital in which 2  of parturients are human immunodeficiency virus seropositive  agreed to human immunodeficiency virus testing  15  13 6   were found to be seropositive  
class2	436	seropositive women were significantly more likely to have an admission white blood cell count less than 10 000 mm3  p   0 001   
class2	436	human immunodeficiency virus seropositivity was not associated with a higher frequency of other sexually transmitted diseases although there was a trend toward more cases of syphilis among human immunodeficiency virus infected women  
class2	436	similarly  although there was no significant difference in rates of operative intervention  26 6  among seropositive and 8 4  among seronegative  p   0 058   there was a trend toward more surgery among those who were human immunodeficiency virus infected  
class2	436	women hospitalized with pelvic inflammatory disease  in a community endemic for human immunodeficiency virus  are at high risk for human immunodeficiency virus infection  
class2	436	more research is needed to verify a trend toward more refractory infections among human immunodeficiency virus infected women  
class2	437	high infectious morbidity in pregnant women with insulin dependent diabetes  an understated complication  
class2	437	patients with insulin dependent diabetes are prone to infection  possibly related to poor metabolic control  
class2	437	relative immune deficiency exists in pregnancy  
class2	437	we hypothesized that pregnant patients with insulin dependent diabetes are at an increased risk for infection and that infection is related to poor glycemic control  
class2	437	we matched 65 pregnant women with insulin dependent diabetes to 65 nondiabetic pregnant controls  
class2	437	at least one episode of infection before delivery occurred in 83  of the women with insulin dependent diabetes  26  in control group   
class2	437	the rate of postpartum infection was five times higher in the group with insulin dependent diabetes and they were susceptible to more kinds of infections  
class2	437	although there was no overall difference among the indices of glycemic control  hemoglobin a1 obtained before the infection was higher than during infection  
class2	437	we conclude that a high rate of infection exists in pregnant women with diabetes  infection and poor glycemic control may be associated  but it is unclear whether improvement in metabolic control will reduce this high infection rate  
class2	438	the use of in situ hybridization to show human papillomavirus deoxyribonucleic acid in metastatic cancer cells within lymph nodes  
class2	438	southern blot hybridization has been used to identify human papillomavirus types in both primary tumors and lymph node metastases  
class2	438	however  this technique requires fresh frozen tissue and is incapable of localizing deoxyribonucleic acid sequences to specific cell types in the tumor sample  
class2	438	in contrast  in situ hybridization precisely locates viral sequences within tumor cells while preserving cellular architecture  
class2	438	further  in situ hybridization requires only small samples of formalin fixed  paraffin embedded tissues  
class2	438	five lymph nodes  from four patients  containing metastatic cervical squamous tumor cells  identified with hematoxylin and eosinophil staining  were analyzed with in situ hybridization techniques with human papillomavirus type 16 deoxyribonucleic acid probes labeled with sulfur 35  
class2	438	the primary cervical cancer from all four patients had been shown to contain human papillomavirus type 16 sequences by southern blot  
class2	438	three specimens from two patients clearly showed the presence of human papillomavirus type 16 sequences within the nuclei of metastatic tumor cells  whereas two specimens were nondiagnostic most likely as a result of the small volume of cancer relative to the size of the lymph node  
class2	438	this information indicates that it is the tumor cells themselves that contain viral deoxyribonucleic acid and provides additional evidence linking human papillomavirus with cervical carcinogenesis  
class2	439	rapidly progressive outer retinal necrosis in the acquired immunodeficiency syndrome 
class2	439	two patients  both seropositive for the human immunodeficiency virus  developed rapidly progressive retinal necrosis associated with a systemic herpes zoster infection  
class2	439	the retinitis in these patients was characterized by primary involvement of the outer retina  with sparing of the inner retina and retinal vasculature until late in the disease process  a rapidly progressive course  poor response to intravenous acyclovir  and development of rhegmatogenous retinal detachment  
class2	439	in one of the patients  the retinitis was initially multifocal  
class2	439	electron microscopy of a retinal biopsy specimen from one of the patients demonstrated virus particles consistent with a herpesvirus  and polymerase chain reaction disclosed herpesvirus in a retinal biopsy specimen of the other patient  
class2	439	this entity may represent a distinct form of acute retinal necrosis that is seen in immunocompromised individuals  
class2	440	perturbation of differentiated functions during viral infection in vivo  in vivo relationship of host genes and lymphocytic choriomeningitis virus to growth hormone deficiency  
class2	440	retarded growth and disordered glucose metabolism secondary to growth hormone  gh  deficiency are associated with persistent lymphocytic choriomeningitis virus  lcmv  infection of gh producing cells in the anterior lobe of the pituitary gland  
class2	440	infected c3h st mice  which are h 2k haplotype  become gh deficient  and lcmv replicates in most  more than 90   of their gh producing cells  
class2	440	in contrast  balb wehi and swr j mice  which are h 2d and h 2q  respectively  do not develop this gh deficiency  and less than 20  of their gh producing cells are infected by virus  
class2	440	yet all three strains infected at birth with lcmv strain armstrong  arm  carry equivalent amounts of virus in their blood  brain  heart  kidney  liver  spleen  and thymus throughout life  
class2	440	of five additional h 2k murine strains tested  c3h hej and cba n mice develop this gh like disorder  whereas neither akr j  b10 br  nor balb kae mice do  indicating that the h 2k haplotype does not control the gh susceptibility  
class2	440	furthermore c3h sw mice  which have the h 2b haplotype on the c3h background  develop the disease  again negating any correlation with h 2k but inferring that the c3h background is responsible  
class2	440	one half of the hybrid offspring produced by crossing the c3h st gh deficient strain with balb wehi resistant mice develop the disease  but the trait is not sex linked  
class2	440	f1 hybrid backcrosses with the susceptible c3h st parental strain or resistant balb wehi strain indicate the involvement of more than two genes  
class2	440	hence the development of a gh deficiency by lcmv infected c3h st mice is not linked to the mhc haplotype  is not sex linked  and is not due to a dominant gene  
class2	440	multiple genes are involved and these are related to c3h background  
class2	441	central airway obstruction due to cytomegalovirus induced necrotizing tracheitis in a patient with aids  
class2	441	cytomegalovirus  cmv  infection in patients with the acquired immunodeficiency syndrome  aids  can present as either disseminated disease  pneumonitis  retinitis  gastroenteritis  neuropathy  or a subclinical infection  
class2	441	we report a patient whose initial manifestation of cmv infection was severe central airways obstruction due to necrotizing tracheitis  
class2	441	at bronchoscopy  the lesion appeared deeply ulcerated  distinctly different from previously described airway lesions in patients with aids  
class2	441	mucosal biopsies showed characteristic intranuclear and intracytoplasmic inclusions and cultures yielded only cmv  
class2	441	the patient responded partially to ganciclovir  steroids  and antibiotics against suspected anaerobic superinfection but died as a result of central nervous system disease believed due to toxoplasmosis or lymphoma  
class2	441	cmv infection of the upper airway should be considered in the patient with aids presenting with atypical cough or stridor and ulcerated endobronchial lesions  
class2	442	spontaneous splenic rupture following infectious mononucleosis  
class2	442	four cases of spontaneous splenic rupture after infectious mononucleosis  im  have been treated at this institution since 1978  
class2	442	the condition is rare  occurring in 0 1 0 5 per cent of patients with proven infectious mononucleosis  
class2	442	splenectomy is considered the treatment of choice for these patients  
class2	442	however  because recent trends in the management of traumatic splenic rupture are moving towards nonoperative treatment with selected patients  a similar approach has been considered for the patient with spontaneous splenic rupture following im  
class2	442	the major reason for avoiding splenectomy is the increased incidence of sepsis in splenectomized patients  
class2	442	yet  splenic rupture is accompanied by hemorrhage and the risks associated with blood transfusion for ongoing hemorrhage are of similar magnitude as those of sepsis following splenectomy  
class2	442	in addition  the grossly abnormal spleens seen at operation tend to include large  contained hematomas that may also be prone to rupture  
class2	442	therefore  operative management still appears to be the preferred treatment for spontaneous splenic rupture following im  
class2	442	splenectomy is curative  safe  and obviates the need for transfusion  extended hospitalization  and activity restriction  
class2	443	suppression of herpes simplex virus type 1 reactivation from latency by      9    z  2  hydroxymethyl cyclohexyl methyl  guanine  l 653 180  in vitro  
class2	443	latent herpes simplex virus type 1  hsv 1  infection was induced in human embryonic lung cells in vitro by using a combination of viral replication inhibitors and elevated temperature  
class2	443	under reactivating conditions  superinfection by human cytomegalovirus or temperature manipulation   a nonantiviral thymidine kinase inhibitor  l 653 180  was found to suppress or delay reactivation of hsv 1 from latently infected human embryonic lung cells  
class2	443	l 653 180 alone or in combination with interferon was ineffective as a primary or acute viral replication inhibitor and was unable to induce latent hsv 1 infection in cell culture  
class2	443	these data suggest that initial or acute virus replication and replication resulting from reactivation from latency are separate events  
class2	444	treatment of adult chickenpox with oral acyclovir  
class2	444	thirty one late adolescents and adults with varicella were studied  
class2	444	patients identified within 72 hours of varicella exanthem were offered open treatment with acyclovir  4 g d   and those patients identified after 72 hours of exanthem were followed up but not treated  
class2	444	twenty two patients were treated with acyclovir  
class2	444	nine patients were not treated  
class2	444	no severe complications occurred in any of the 31 patients  
class2	444	minor complications  including prolonged fever  localized secondary infections  persistent cough  and prolonged fatigue were more frequent in the untreated group  
class2	444	if the acyclovir therapy was begun within the first 24 hours of varicella exanthem  then the rash and clinical illness were dramatically lessened  
class2	444	treatment with oral acyclovir should be considered for varicella in adults who are identified within the first 24 hours of exanthem  
class2	445	sensitivity and specificity of various morphological features of cervical condylomas  an in situ hybridization study  
class2	445	fifty seven cervical biopsy specimens or endocervical curettings showing condyloma  changes suggestive of condyloma  or no changes of condyloma were analyzed for presence of nuclear atypia  nuclear enlargement and irregularity in superficial epithelium   presence of multinucleated cells  and presence of perinuclear cytoplasmic clearing in superficial squamous epithelium  
class2	445	the findings were correlated with results of in situ hybridization with biotin labeled human papillomavirus dna probes  
class2	445	moderate nuclear atypia was significantly more specific than perinuclear cytoplasmic clearing and 100  sensitive for predicting cases positive for human papillomavirus  
class2	445	of the various morphological features analyzed  perinuclear cytoplasmic clearing had the lowest specificity for predicting positive results on in situ hybridization  
class2	446	no evidence for human t cell leukemia virus type i or human t cell leukemia virus type ii infection in patients with multiple sclerosis  
class2	446	the involvement of human t cell leukemia viruses  htlvs  in the pathogenesis of 18 hungarian patients with multiple sclerosis was investigated  
class2	446	no antibody to htlvs could be detected in any of the patients  
class2	446	furthermore  using polymerase chain reaction under highly sensitive conditions  neither htlv i dna nor htlv ii dna could be noted in peripheral blood lymphocytes of the patients  
class2	446	our data do not support a causal association of htlv i or htlv ii with multiple sclerosis  
class2	447	failure to detect human t cell leukemia virus related sequences in multiple sclerosis blood  
class2	447	we tested 11 patients with multiple sclerosis for the presence of human t cell leukemia virus type i  htlv i   or type ii  htlv ii  related sequences  
class2	447	dna from blood mononuclear cells was analyzed by the polymerase chain reaction utilizing three different oligonucleotide primer pairs  
class2	447	two of these primer pairs detect sequences shared between htlv i and htlv ii in either p24  gag protein  or in p21  env transmembrane protein  
class2	447	the third primer pair was synthesized based on regions in the pol gene where amino acid sequences are conserved between htlv i  htlv ii  and the related bovine leukemia virus  
class2	447	the multiple sclerosis samples were consistently negative while appropriate control samples were positive  
class2	447	we conclude that viruses related to htlv i  htlv ii  or bovine leukemia virus are not present in the blood of patients with multiple sclerosis and  therefore  that htlv bovine leukemia virus related viruses are not likely to be involved in the pathogenesis of multiple sclerosis  
class2	448	characterization of a macrophage tropic hiv strain that does not alter macrophage cytokine production yet protects macrophages from superinfection by vesicular stomatitis virus  
class2	448	macrophages  unlike cd4  t cells  can be productively infected by human immunodeficiency virus  hiv  without prior cellular activation  
class2	448	cytopathic infection ensues without the induction of tumor necrosis factor alpha  tnf alpha   interleukin 1 beta  il 1 beta   interleukin 6  il 6   or tissue factor genes  
class2	448	in detailed studies on tnf alpha  hiv infection did not affect the regulation of tnf alpha in response to bacterial lipopolysaccharide  
class2	448	in an effort to examine the interferon responsiveness of hiv infected macrophages  the cells were challenged with vesicular stomatitis virus  vsv  with or without interferon pretreatment  
class2	448	surprisingly  hiv infected macrophages were completely resistant to vsv induced lysis even in the absence of interferon  however  no interferon was detected in the supernatants of these infected cells  
class2	448	the resistance of hiv infected macrophages to superinfection with vsv indicates a previously undescribed effect of hiv upon macrophage cellular metabolism  
class2	449	role of the monocyte macrophage in influenza virus infection of lymphocytes  implications for hiv infection  
class2	449	knowledge of the pathogenesis of viruses which are less virulent than human immunodeficiency virus  hiv  may provide valuable insights into the pathogenesis of hiv infection  
class2	449	influenza virus  an enveloped rna virus  infects monocyte macrophages  although the infection is brief and abortive  
class2	449	isolated purified lymphocytes are completely resistant to infection  
class2	449	in contrast  mixtures of lymphocytes and macrophages can synthesize all virus proteins  
class2	449	infection requires physical association of monocyte macrophages and lymphocytes in  clusters   these studies with influenza virus suggest that the pathogenesis of virus infections in mixed cell cultures may be very different from that observed in purified cell populations  and they suggest that similar studies should be performed with hiv  
class2	450	hiv 1 infection of lung alveolar fibroblasts and macrophages in humans  
class2	450	we have studied the infected cell populations in the lungs of four human immunodeficiency virus type 1  hiv 1  seropositive patients suffering from lymphocytic alveolitis or lymphocytic interstitial pneumonitis  
class2	450	adherent cells were obtained by bronchoalveolar lavage  bal  and were analyzed by various technical approaches  
class2	450	the cells considered here were alveolar macrophages and fibroblasts  and could be clearly identified morphologically and by the expression of specific cell surface markers using monoclonal antibodies  
class2	450	the presence of hiv 1 in both of these cell types was established by serological  virological  and molecular procedures  
class2	450	our results show that alveolar macrophages and fibroblasts are naturally infected in the lungs of hiv  patients  
class2	450	both cell types express the cd4 receptor molecule  in contrast to skin fibroblasts which are negative  
class2	450	alveolar macrophages and fibroblasts thus may act as eventual hiv 1 reservoirs in vivo  and are probably involved in the induction of inflammatory reactions because they are targets for cd8 cytotoxic t lymphocytes  ctl   
class2	451	antibody enhanced infection of monocytes as the pathogenetic mechanism for severe dengue illness  
class2	451	antibody dependent enhancement of certain virus infections can occur in cells expressing fc receptors  
class2	451	this mechanism plays an important pathogenetic role in the development of complications associated with dengue virus infection  including dengue hemorrhagic infection and dengue shock syndrome  
class2	451	the virulence of the virus  characterized by the ability to infect fc receptor bearing monocytes also influences the development of these severe illnesses  
class2	452	chickenpox chorioretinitis  
class2	452	chickenpox infection in an adult was complicated by peripheral chorioretinitis and treated with oral acyclovir  
class2	452	similarities of this case to the recently proposed mild type of acute retinal necrosis syndrome are discussed  
class2	453	wegener s granulomatosis presenting during first trimester of pregnancy  
class2	453	we describe a case of wegener s granulomatosis in a lady who presented acutely with pulmonary haemorrhage  fever and breathlessness during her early pregnancy  
class2	453	she responded well to aggressive medical treatment  
class2	454	an anonymous seroprevalence survey of hiv infection among pregnant women in british columbia and the yukon territory 
class2	454	we performed an anonymous seroprevalence survey of human immunodeficiency virus  hiv  type 1 infection through hiv antibody testing of blood samples from 22 512 women aged 15 to 44 years receiving prenatal care in british columbia and the yukon territory from mar  
class2	454	15 to sept  
class2	454	30  1989  
class2	454	of the samples six were confirmed to be hiv positive  this yielded a crude overall seroprevalence rate of 2 7 per 10 000 pregnant women  95  confidence interval  ci  1 0 to 5 8   
class2	454	all of the positive samples were from women 20 to 29 years of age  four were from vancouver  one was from victoria  and one was from elsewhere  
class2	454	the highest seroprevalence rates were among women aged 15 to 29 years in vancouver and victoria  7 2 and 9 4 per 10 000 pregnant women respectively   
class2	454	thus  1 in 1300 pregnant women in that age group in the metropolitan areas of british columbia was hiv positive  
class2	454	application of seroprevalence rates to the total female population in british columbia and the yukon territory revealed that as many as 401 women had hiv infection in 1989  
class2	454	our estimates likely represent the minimum  
class2	454	as a subset of women of childbearing age pregnant women are likely at lowest risk of hiv infection  and so the true number of women 15 to 44 years of age with hiv infection is probably several times higher  
class2	454	our study has provided a baseline assessment and will be repeated annually to analyse trends in hiv seroprevalence among pregnant women in british columbia and the yukon territory  
class2	455	undiagnosed tuberculosis in patients with human immunodeficiency virus infection 
class2	455	we describe the clinical features of 11 patients with human immunodeficiency virus infection in whom tuberculosis was undiagnosed and untreated prior to death  
class2	455	most patients  9 of 11  had pulmonary complaints and 8 of 11 had roentgenographic findings suggestive of tuberculosis  hilar or mediastinal adenopathy  pleural effusion  apical infiltrate or miliary pattern   
class2	455	despite these findings  tuberculin skin tests were not performed in any of the patients  
class2	455	acid fast smears of sputum were obtained in three cases and bronchoscopy performed in only four  reflecting the low index of suspicion for tuberculosis  
class2	455	pneumocystis carinii pneumonia was the presumptive diagnosis in nine cases but was confirmed in only one case  
class2	455	autopsy revealed tuberculosis as the cause of death in four patients  
class2	455	of the seven patients who did not undergo autopsy  disseminated tuberculosis  manifest by mycobacteremia  was the only life threatening illness identified and probably contributed to death  
class2	455	increased awareness of the clinical and roentgenographic features of tuberculosis in hiv infected patients  combined with more intensive use of acid fast smears and tuberculin skin testing  are necessary in order to decrease mortality from this treatable complication of hiv infection  
class2	456	pulmonary manifestations of disseminated cryptococcosis in patients with aids  
class2	456	forty eight patients with disseminated cryptococcosis and aids were retrospectively studied to define the pulmonary manifestations  
class2	456	cryptococcus neoformans  cn  was first isolated from a pulmonary site in 12 patients  
class2	456	disseminated disease was subsequently documented in all these patients  
class2	456	symptoms and roentgenographic manifestations  normal  nodular circumscribed infiltrates  pleural effusions  lobar consolidation  were diverse  
class2	456	interstitial infiltrates predicted the presence of another opportunistic lung infection besides cryptococcosis in five patients  three untreated and two treated patients   
class2	456	infectious causes other than cryptococcosis were established by culture and clinical course in five of the ten patients who developed chest roentgenographic abnormalities during amphotericin b therapy  
class2	456	endobronchial abnormalities were identified in four patients at bronchoscopy  
class2	456	bronchoalveolar lavage  9 9  and pleural fluid  3 3  cultures were sensitive tests for detection of pulmonary involvement with cn  
class2	457	infection of mice with lactate dehydrogenase elevating virus destroys the subpopulation of kupffer cells involved in receptor mediated endocytosis of lactate dehydrogenase and other enzymes  
class2	457	in previous experiments in rats  we have shown that the rapid plasma clearance of a number of clinically important enzymes is due to receptor mediated endocytosis by kupffer cells and other resident macrophages  
class2	457	others have shown that infection of mice with lactate dehydrogenase elevating virus  a virus that proliferates in macrophages  leads to reduced plasma elimination of these enzymes  
class2	457	this paper integrates these two sets of experiments  
class2	457	plasma elimination of intravenously injected  radioactively labeled lactate dehydrogenase m4 and mitochondrial malate dehydrogenase in mice was shown to be caused in part by uptake in liver  spleen and bone  
class2	457	uptake of lactate dehydrogenase m4 by these tissues was  to a large extent  saturable and the two dehydrogenases competitively inhibited each other s clearance  
class2	457	these results suggest that  also in mice  these enzymes are partly cleared from plasma by endocytosis by way of a common receptor on cells  probably macrophages  from liver  spleen and bone marrow  
class2	457	morphometrical data showed that normal mouse liver contains 23 x 10 6  kupffer cells cm3  
class2	457	this number was reduced to about 30  of that of controls 24 hr after infection of mice with lactate dehydrogenase elevating virus but returned to normal within the next 9 days  
class2	457	the saturable component of uptake of lactate dehydrogenase m4 by liver  spleen and bone had disappeared 24 hr after infection with the virus  and did not return after the kupffer cell population had recovered  
class2	457	our findings suggest that lactate dehydrogenase m4 is  to a large extent  removed from the circulation by way of a receptor on a subpopulation of macrophages that is permissive for replication of lactate dehydrogenase elevating virus  
class2	458	transfusion risks  
class2	458	hepatitis remains the most serious transfusion risk  in terms of incidence and severity  
class2	458	transfusion associated aids  hemolytic reactions  trali  and anaphylaxis are severe problems that occur relatively rarely  while febrile reactions and mild allergic reactions are common but not serious  
class2	458	the key to avoiding all these complications is autotransfusion  see the article  autologous transfusion  in this issue   
class2	458	although intraoperative scavenging became available in many centers in the united states in the 1980s  it is hoped that pre deposit autotransfusion will also become widely utilized in the next decade  
class2	459	chronic encephalitis caused by leukoencephalopathy  
class2	459	as mentioned previously  both ms and pml are demyelinating conditions of the cns and pose diagnostic difficulties in their differentiation because of similarities in their clinical findings  
class2	459	however  certain features unique to each of these diseases are helpful in clinical diagnosis  
class2	459	ms  unlike pml  is a disease of unknown cause  
class2	459	polygenetic influences in combination with exposure to an environmental agent and immune mediated factors may be operative in the pathogenesis of ms  
class2	459	age of onset peaks in the third to fourth decades with a predominance in women  as contrasted with pml  which peaks in the fifth to sixth decades in most non aids associated cases with a slight predominance in men  
class2	459	ms is more prevalent in areas farther from the equator  north america  europe  australia  and new zealand  
class2	459	common initial symptoms seen in ms include bilateral limb weakness  with the legs being affected twice as often as the arms   hyperreflexia  spasticity  optic neuritis  diplopia  incoordination  and paresthesias  
class2	459	 paresthesias are typically found in the lower limbs in a symmetric pattern  but may follow no obvious anatomic distribution and often do not correspond to the distribution of sensory symptoms  
class2	459	vibration and position sense are more frequently disturbed than pain and temperature   intellectual impairment and mental deterioration are uncommon early in ms  whereas they are a more frequent initial presentation in pml  
class2	459	in addition  the presence of speech impairment and monoparesis or hemiparesis with homonymous hemianopsia is more suggestive of pml  
class2	459	brain stem involvement is infrequent  
class2	460	sensitivity of digoxigenin and biotin labelled probes for detection of human papillomavirus by in situ hybridisation  
class2	460	the sensitivity of digoxigenin and biotin labelled dna probes for the detection of human papillomavirus  hpv  by dot blotting and in situ hybridisation was compared in tissues from cervical  laryngeal  and anogenital neoplasia  
class2	460	probes were either labelled with digoxigenin by the random primer technique and detected with anti digoxigenin antibody  or labelled with biotin by nick translation and detected with streptavidin  both methods having a common final visualisation procedure using alkaline phosphatase  
class2	460	digoxigenin labelled probes proved two to 10 fold more sensitive by quantitative dot blotting and four fold more sensitive in detecting hpv 16 dna in a series of 31 anal carcinomas  compared with biotinylated probes  
class2	460	the digoxigenin method also produced less non specific background staining of tissue sections than biotin labelled probes  
class2	460	it is concluded that digoxigenin dna labelling and detection provides a simple  reliable  and efficient alternative to the use of biotin or radioactive isotopes for the detection of hpv dna by in situ hybridisation  
class2	460	digoxigenin labelled probes also offer the possibility of double labelling in situ hybridisation procedures when used with biotin labelled probes to provide simultaneous identification of different dna sequences  
class2	461	in situ hybridisation with digoxigenin labelled dna probes for detection of viral genomes  
class2	461	the applicability of a recently developed non radioactive dna labelling and detection method  which uses the digoxigenin  dig  enzyme linked immunosorbent assay  elisa  system  for the detection of viral infections in pathology specimens by in situ hybridisation  was examined  
class2	461	its efficacy was compared with that of biotin and radioisotope labelling methods  
class2	461	three cases of progressive multifocal leucoencephalopathy  two of verruca vulgaris  and seven cases of laryngeal papilloma were studied  
class2	461	the sensitivity of the dig labelled probe was almost the same as that of a 35s labelled probe in the dot blot hybridisation test  
class2	461	using in situ hybridisation with 35s labelled and dig labelled probes  the levels of the hybridised signals detected were similar  
class2	461	the biotin labelled probe was less sensitive  particularly in the cases of laryngeal papilloma  
class2	461	the dig labelling and detection method was highly sensitive and applicable to the detection of viral infection by ish  and is preferable to a radiolabelled probe  especially when in situ hybridisation is done in the pathology laboratory  
class2	462	application of 1 nm gold probes on paraffin wax sections for in situ hybridisation histochemistry  
class2	462	an in situ hybridisation technique that uses 1 nm immunogold reagents and silver enhancement was devised to detect biotinylated dna viral probes in formalin fixed  paraffin wax sections of human cervix  
class2	462	dna probes labelled with biotin 11 deoxyuridine triphosphate were detected after hybridisation to nucleic acid sequences by an antibiotin antibody  followed by a gold labelled secondary antibody  
class2	462	silver enhancement then permitted visualisation of the signal at the light microscopic level  
class2	462	the method was reliable and produced less background staining than previously described methods  
class2	462	the signal could be enhanced by epi polarisation microscopy  
class2	462	furthermore  biotinylated dna probes may be detected directly by a 1 nm gold labelled goat antibiotin antibody without loss of labelling intensity  and this may be preferable to the longer two layer technique  previously described  
class2	463	use of immunoelectron microscopy to show ebola virus during the 1989 united states epizootic  
class2	463	a filovirus  serologically related to ebola virus  was detected by  post embedment  immunoelectron microscopical examination of ma 104 cells  
class2	463	these had been infected by inoculation with serum samples obtained during the 1989 epizootic in cynomolgus monkeys  macaca fascicularis   imported from the philippines and maintained at reston  virginia  usa  a primate holding facility  
class2	463	the immunoelectron microscopy method  when used in conjunction with standard transmission electron microscopy  tem  of infected cells  provided consistent results and was simple to perform in this epizootic  
class2	463	it is concluded that immunoelectron microscopy is potentially useful in the direct immunological diagnosis of ebola and related filoviral infections  such as marburg  in clinical samples obtained from those with acute infection  
class2	464	immunocytochemical analysis of lymph node aspirates in patients with human immunodeficiency virus infection  
class2	464	thirty four patients positive for human immunodeficiency virus  hiv  who had lymphadenopathy were investigated using fine needle aspiration  
class2	464	cytological analysis included immunocytochemical investigation with the alkaline phosphatase antialkaline phosphatase  apaap  method  
class2	464	all patients had confirmation of cytological diagnosis by lymph node biopsy  
class2	464	fifteen aspirates with follicular hyperplasia were evaluated  
class2	464	eleven patients showed b cell predominance  
class2	464	the b cell population did not show light chain restriction  
class2	464	ten patients with b cell non hodgkin s lymphoma  five with burkitt s lymphoma and five with b cell immunoblastic lymphoma  were investigated  
class2	464	nine out of 10 cases were monoclonal with respect to their light chain determinants  only one case with burkitt s lymphoma with partial lymph node metastasis did not show light chain restriction  
class2	464	the cytological diagnosis included two mycobacterial infections and four cystic lesions  
class2	464	histological investigation was necessary to diagnose the extent of lymph node disease caused by kaposi s sarcoma  
class2	464	these findings indicate that the immunocytological investigation of lymph node aspirates is useful for evaluating lymphadenopathy in hiv positive patients  
class2	465	cutaneous horn of the penis  its association with squamous cell carcinoma and hpv 16 infection  
class2	465	cutaneous horns of the penis are rare  
class2	465	including this case  only 19 cases have been reported in the english language literature  
class2	465	in 37  of the reported cases a malignant tumor was found beneath the cutaneous horn  
class2	465	our case is remarkable because a stage i squamous cell carcinoma developed on the shaft of the penis of a neonatally circumcised man  
class2	465	human genital carcinoma resulting from a multifactorial process in which  promoting  papillomavirus is an integral element is being increasingly reported  
class2	465	we review the relationship of circumcision to genital human papillomavirus infection and their synergism in the development of squamous cell carcinoma  
class2	466	widespread flat warts associated with human papillomavirus type 5  a cutaneous manifestation of human immunodeficiency virus infection  
class2	466	numerous flat and tinea versicolor like warts developed on the face  trunk  and upper extremities of a 10 year old boy with human immunodeficiency virus infection  
class2	466	nucleic acid analysis of involved skin revealed human papillomavirus type 5  which has sometimes been associated with epidermodysplasia verruciformis  
class2	466	this human papillomavirus type has also been described in patients with common variable immunodeficiency and dyskeratosis congenita and in renal allograft recipients  
class2	466	human immunodeficiency virus infection should be added to the list of immune related disorders that predispose to widespread flat warts  
class2	467	pharmacokinetics of indium 111 labeled antimyosin monoclonal antibody in murine experimental viral myocarditis  
class2	467	the pharmacokinetics of indium 111 labeled antimyosin monoclonal antibody fab were investigated with use of murine experimental viral myocarditis as a model  
class2	467	the biodistribution of indium 111 labeled antimyosin antibody fab on days 3  5  7  14  21 and 28 after encephalomyocarditis virus inoculation demonstrated that myocardial uptake increased significantly on days 5  7 and 14  maximum on day 7  in infected versus uninfected mice  p less than 0 001   
class2	467	in vivo kinetics in infected mice on day 7 demonstrated that the heart to blood ratio reached a maximum 48 h after the intravenous administration of indium 111 labeled antimyosin fab  which was considered to be the optimal time for scintigraphy  
class2	467	the scintigraphic images obtained with indium 111 labeled antimyosin fab demonstrated positive uptake in the cardiac lesion in infected mice  
class2	467	the pathologic study demonstrated that myocardial uptake correlated well with pathologic grades of myocardial necrosis  
class2	467	high performance liquid chromatography revealed the presence of an antigen antibody complex in the circulation of infected mice after the injection of indium 111 labeled antimyosin fab  
class2	467	this antigen bound to indium 111 labeled antimyosin fab in the circulation might be whole myosin and this complex may decrease myocardial uptake and increase liver uptake  
class2	467	it is concluded that indium 111 labeled antimyosin monoclonal antibody fab accumulates selectively in damaged heart tissue in mice with acute myocarditis and that indium 111 labeled antimyosin fab scintigraphy may be a useful method for the visualization of acute myocarditis  
class2	468	the role of antihistamines in otitis  
class2	468	chronic and recurrent otitis media can manifest as otitis media with effusion  
class2	468	both infection and eustachian tube obstruction  eto  have been found to play an important role in its pathogenesis  
class2	468	eto can be demonstrated during both early  and late phase reactions in patients with allergic rhinitis after intranasal challenge with an allergen  
class2	468	intranasal challenge with either histamine or prostaglandin d2 also provokes eto  with the latter mediator perhaps more potent than the former  
class2	468	middle ear effusions from patients with chronic or recurrent otitis media have been found to contain dramatically increased concentrations of histamine relative to the concentrations in their plasma  
class2	468	the development of nasal and eustachian tube obstruction in allergic rhinitis patients has been prevented by pretreatment with an antihistamine plus decongestant before intranasal challenge with pollen allergen  
class2	468	investigations are currently under way to assess the effect of antihistamine pretreatment on nasal and eustachian tube obstruction in patients undergoing intranasal histamine challenge  
class2	469	immunology of aids related to psoriasis  
class2	469	the association of severe psoriasis with hiv infection  which dysregulates and destroys the human immune system  supports the hypothesis that psoriasis is an immunologically mediated disease  
class2	469	psoriasis and kaposi s sarcoma share angiogenesis as basic early findings and could both be caused by differential cytokine expression or responsiveness  
class2	469	aids and research models including transgenic mice offer new models in which to study the role of the immune system and specific gene products in the pathogenesis of psoriasis and other skin diseases  
class2	470	the role of human immunodeficiency virus infection in pneumococcal bacteremia in san francisco residents  
class2	470	human immunodeficiency virus  hiv  is an important risk factor for invasive pneumococcal disease  but information on clinical course and infecting serotypes is limited  
class2	470	to help develop strategies to reduce the morbidity due to invasive pneumococcal disease  episodes of pneumococcal bacteremia were identified by retrospective review of microbiology records  november 1983 november 1987  at 10 san francisco hospitals and  for patients 20 55 years old living in san francisco  hiv antibody status was determined by review of medical records  
class2	470	pneumococcal isolates from one hospital were serotyped  
class2	470	of 294 patients with pneumococcal bacteremia identified  32  11   had aids at the time pneumococcal bacteremia was diagnosed and another 43  15   were hiv infected but did not have aids  12 hiv infected patients developed aids after the episode of pneumococcal bacteremia  
class2	470	the rate of pneumococcal bacteremia in aids patients was estimated to be 9 4 1000 patient years  
class2	470	serotypes of 27  82   of 33 pneumococcal isolates from hiv infected patients and 107  90   from 119 patients without known hiv infection were among the 23 serotypes included in the currently available polysaccharide vaccine  
class2	470	the rate of pneumococcal bacteremia is approximately 100 fold greater in aids patients in san francisco than rates reported before the aids epidemic  but more than half the episodes of pneumococcal bacteremia in hiv infected patients occurred in patients without aids  
class2	470	data on pneumococcal serotypes causing invasive disease in hiv infected patients suggest that the current pneumococcal vaccine  if effective in this population  could provide significant protection against pneumococcal disease  
class2	471	use of polymerase chain reaction for successful identification of asymptomatic genital infection with herpes simplex virus in pregnant women at delivery  
class2	471	the polymerase chain reaction was adapted to the amplification of a herpes simplex virus  hsv  dna sequence  common to hsv types 1 and 2  hsv 1  hsv 2   
class2	471	the amplified product was detectable by ethidium bromide staining or southern hybridization of gels and by dot hybridization  
class2	471	the hsv polymerase chain reaction detected hsv dna in samples obtained from eight patients with genital lesions from which hsv 2 was isolated in tissue culture and from four patients with labial lesions from which hsv 1 was isolated  
class2	471	the hsv polymerase chain reaction identified hsv in clinical specimens obtained from 11 women who had asymptomatic genital hsv infections at delivery  
class2	471	none of 11 samples obtained at delivery from women who had antibodies to hsv 2  but whose delivery cultures were negative  were positive by polymerase chain reaction and no false positive reactions were obtained when the reaction mixture contained human cell dna or varicella zoster virus  cytomegalovirus  epstein barr virus  or human papillomavirus dna  
class2	472	measles antibody  reevaluation of protective titers  
class2	472	a school blood drive before a measles outbreak permitted correlation of preexposure measles antibody titers with clinical protection using the plaque reduction neutralization  prn  test and an eia  
class2	472	of 9 donors with detectable preexposure prn titer less than or equal to 120  8 met the clinical criteria for measles  7 seroconfirmed  compared with none of 71 with preexposure prn titers greater than 120  p less than  0001   
class2	472	seven of 11 donors with preexposure prn titers of 216 874 had a greater than or equal to 4 fold rise in antibody titer  mean  43 fold  compared with none of 7 with a preexposure prn titer greater than or equal to 1052  p less than  02   
class2	472	of 37 noncases with preexposure prn titer less than 1052  26  70   reported one or more symptoms compared with 11  31   of 35 donors with preexposure prn titers greater than or equal to 1052  p less than  002   
class2	472	by eia  no case had detectable preexposure antibody  the preexposure geometric mean titer of asymptomatic donors  220  was not significantly higher than that of symptomatic donors who did not meet the clinical criteria for measles  153   p    10   
class2	472	the study suggests that prn titers less than or equal to 120 were not protective against measles disease and illness without rash due to measles may occur in persons with prn titers above this level  
class2	473	measles incidence  vaccine efficacy  and mortality in two urban african areas with high vaccination coverage  
class2	473	measles incidence  vaccine efficacy  and mortality were examined prospectively in two districts in bissau where vaccine coverage for children aged 12 23 months was 81   bandim 1  and 61   bandim 2   
class2	473	there was little difference in cumulative measles incidence before 9 months of age  6 1  and 7 6   respectively   
class2	473	between 9 months and 2 years of age  however  6 1  contracted measles in bandim 1 and 13 7  in bandim 2  
class2	473	even adjusting for vaccination status  incidence was significantly higher in bandim 2  relative risk 1 6  p    04   
class2	473	even though 95  of the children had measles antibodies after vaccination  vaccine efficacy was not more than 68   95  confidence interval  ci  39  84   and was unrelated to age at vaccination  
class2	473	unvaccinated children had a mortality hazard ratio of 3 0 compared with vaccinated children  p    002   indicating a protective efficacy against death of 66   ci 32  83   of measles vaccination  
class2	473	these data suggest that it will be necessary to vaccinate before age 9 months to control measles in hyperendemic urban african areas  
class2	474	evaluation of wc3 rotavirus vaccine and correlates of protection in healthy infants  
class2	474	the safety  immunogenicity  and efficacy of wc3 rotavirus vaccine was evaluated in a double blind  placebo controlled trial of healthy infants 2 12 months of age  103 received one dose of vaccine and 103 received placebo  
class2	474	vaccination appeared to be safe and induced an antibody response  wc3 neutralizing antibody  in 97  of vaccinees  
class2	474	only 9  9   of these  however  produced antibody to human rotavirus serotypes  at least 7 of the 9 were naturally infected before vaccination  
class2	474	neither the number of symptomatic episodes of rotavirus diarrhea  21 vs 25  nor the number of moderate to severe rotavirus illnesses  9 vs  
class2	474	15  was significantly different in vaccine or placebo recipients  respectively  during a predominantly serotype 1 rotavirus season  
class2	474	a slight but significant decrease in mean symptom score was detected in vaccine recipients  
class2	474	despite an overall lack of efficacy  protection could be correlated to previous rotavirus infection  high levels of wc3 neutralizing antibody  and preexisting  maternal  serotype 1 neutralizing antibody with a titer greater than or equal to 30  
class2	475	coccidioidomycosis in human immunodeficiency virus infected patients  
class2	475	coccidioidomycosis is at best a complicated fungal infection  often it is life threatening  
class2	475	coccidioidomycosis is confined epidemiologically to the southwestern region of the usa  and most cases have occurred in that area  particularly in arizona  
class2	475	however  we have seen several cases in san francisco in patients with only a history of travel to endemic areas  
class2	475	in part because of its regional distribution  information about the clinical presentation  diagnosis  and treatment of patients with coccidioidomycosis has lagged behind information about other  more commonly encountered aids associated opportunistic infections  
class2	475	drs  
class2	475	galgiani and ampel have probably had the largest single experience with coccidioidomycosis in individuals infected with the human immunodeficiency virus  
class2	475	these specialists share their experience and make recommendations as to how these complicated conditions should be approached  
class2	476	quantitative detection of brain aberrations in human immunodeficiency virus type 1 infected individuals by magnetic resonance imaging  
class2	476	the brains of 65 individuals with antibodies to human immunodeficiency virus type 1  hiv 1   20 hiv 1 seronegative homosexual men  and 75 heterosexual controls were examined by a quantitative magnetic resonance imaging technique  
class2	476	a white matter aberration was detected most frequently in patients with aids related complex  arc  or aids  but also in asymptomatic hiv 1 seropositive persons and in hiv 1 seronegative homosexual men  of whom two of three tested were reactive for hiv 1 dna by polymerase chain reaction  
class2	476	the aberration was not found in the control group  
class2	476	brain atrophy was mainly confined to patients with arc or aids  
class2	476	the brain lesions correlated with the presence of hiv 1 in cerebrospinal fluid and with elevated levels of beta 2 microglobulin and neopterin  
class2	476	the most pronounced brain aberrations were in patients with aids dementia complex  
class2	476	these findings indicate that brain aberrations may occur in persons in the early stages of hiv 1 infection  although to no greater extent than in hiv 1 seronegative homosexual men  
class2	476	the occurrence of pronounced brain lesions seems to be associated with the presence of an advanced immunodeficiency  
class2	477	distribution and specific identification of papillomavirus major capsid protein epitopes by immunocytochemistry and epitope scanning of synthetic peptides  
class2	477	monoclonal  mabs  and polyclonal antibodies were produced against the major capsid protein of detergent disrupted  purified bovine papillomavirus type 1  bpv 1   
class2	477	the precise locations of the corresponding epitopes were identified by the reactivity of mabs and selected polyclonal antibodies with synthetic  overlapping  hexameric peptides corresponding with 95  of the bpv 1 major capsid protein  
class2	477	the topography of these epitopes was determined by reactivity of antibodies with intact  conformational and nonconformational surface epitopes  and disrupted  external or internal nonconformational epitopes  bpv 1 virions  
class2	477	the distribution of epitopes in various papillomaviruses of 13 different species was determined by reactivity of the mabs and polyclonal sera with productively infected  formalin fixed papillomas  fibropapillomas  and fibromas  
class2	477	epitope scanning  using mabs and polyclonal antisera  resulted in the precise location of bpv 1 hexameric epitopes that could be correlated with their topography on the capsid and distribution in papillomatous lesions of various species  
class2	478	occurrence of groups a and b of respiratory syncytial virus over 15 years  associated epidemiologic and clinical characteristics in hospitalized and ambulatory children  
class2	478	over 15 years respiratory syncytial virus  rsv  isolates from 1209 hospitalized and ambulatory children were examined for strain group and in a subset for subgroup to determine the associated epidemiologic and clinical characteristics  
class2	478	three patterns of yearly outbreaks existed   1  strong predominance of group a strains  9 years with 83  100  a strains    2  relatively equal proportions of group a and b strains  4 years   and  3  strong predominance of group b strains  78  85   in 2 years  separated by a decade  
class2	478	the first pattern of highly dominant a strains occurred in cycles of 1 or 2 consecutive years with a single intervening year in which b strains were greater than or equal to 40  of the isolates  
class2	478	subgroups a1 and a2 predominated  while b2  3  and 4 occurred almost equally  
class2	478	a greater clinical severity for group a strains was suggested by children with group a infections requiring intensive care significantly more often  15 4 vs  
class2	478	8 3   p    008   
class2	478	further  strongly dominant a strain years were associated with higher proportions of rsv admissions requiring intensive care  16 6  vs  
class2	478	5 5   p less than  01   
class2	478	strains of subgroups a2 and b4 were more frequently found in hospitalized patients and a1 in outpatients  and the 2 years with the highest rates of intensive care admissions were those in which subgroup a2 dominated  
class2	479	effect of vaccination on serotype specific antibody responses in infants administered wc3 bovine rotavirus before or after a natural rotavirus infection  
class2	479	in an evaluation of wc3 bovine rotavirus  serotype 6  vaccine in infants  some subjects experienced a natural serotype 1 rotavirus infection before vaccination and others after  
class2	479	therefore  the effects of both wc3 and natural rotavirus strains as either primary or boosting immunogens on serotype specific neutralizing antibody responses could be determined  
class2	479	after primary natural infection  symptomatic or asymptomatic   neutralizing antibody titers were highest to serotype 1 but were consistently high to serotype 3  and low titers  greater than or equal to 20  to serotypes 2 and 4 were often detected  
class2	479	previous vaccination with wc3 had little effect on the magnitude of these responses  
class2	479	in contrast  subjects infected with serotype 1 strains before vaccination experienced large  average  12 fold  rises in neutralizing antibody to human serotypes 1 4 when vaccinated with wc3  
class2	479	thus  although wc3 and the natural strains are distinct serotypes  their epitopes were sufficiently similar that reinfection with wc3 could boost neutralizing antibody titers to human serotypes in subjects primed by a previous natural infection  
class2	480	pichinde virus infection in strain 13 guniea pigs reduces intestinal protein reflection coefficient with compensation  
class2	480	pichinde virus inoculation into strain 13 guinea pigs is a model with features reputed to be similar to hemorrhagic fever in humans  
class2	480	although the infection is lethal by day 13 19  guinea pigs of approximately 600 g do not show edema or effusions  
class2	480	this raises the questions of whether capillary damage is present in such infected animals and  if it is  why edema is absent  
class2	480	the effects of pichinide virus on protein transport across jejunal capillaries were examined in 38 normal and 7 infected strain 13 guinea pigs 12 days after inoculation  
class2	480	the latter lost 20 3  body weight but maintained normal blood pressure  serum protein concentration  and jejunal lymph flow  
class2	480	however  their protein solvent drag reflection coefficient  sigma  was reduced to  52      03  mean     se  from  73      02  2p less than  001   while permeability surface area product was not changed  
class2	480	in the absence of gross edema or effusions  pichinde virus infected guinea pigs demonstrated a leaky gut capillary wall to protein compatible with an increase in pore size or large pore number less than sufficient to change permeability surface area product  
class2	480	compensatory mechanisms that prevent edema at this stage are efficient and may include reduced capillary pressure or some degree of capillary flow stasis  
class2	481	seroprevalence of human t cell leukemia viruses in selected populations of homosexual men  
class2	481	this study sought to define the seroprevalence of human t cell leukemia virus  htlv  types i and ii in selected populations of homosexual men  
class2	481	serum specimens were screened for antibodies to htlv and to human immunodeficiency virus  hiv  by enzyme immunoassay  successive testing of specimens with positive results was done by western blotting and radioimmunoprecipitation assay  ripa  and then by polymerase chain reaction  pcr  assay on available peripheral blood mononuclear cells  pbmc   
class2	481	of 1290 specimens  only 4 had antibodies against htlv confirmed by ripa  
class2	481	pcr analysis of dna from pbmc from two subjects showed one to be htlv i and the other to be htlv ii  both men also had hiv antibodies  
class2	481	these results demonstrate a lower seroprevalence rate for htlv than some previous studies and emphasize the need for specific confirmatory tests  
class2	482	confocal microscopic detection of human immunodeficiency virus rna producing cells  
class2	482	a central anomaly in the pathogenesis of aids is that few actively infected cd4  cells  1 in 10 4  10 5  have been detected in the peripheral blood  even though dramatic depletion  often greater than 90   of cd4  cells is the hallmark of disease progression  
class2	482	a sensitive  35s based human immunodeficiency virus  hiv  rna in situ hybridization technique was coupled with a new detection method  confocal laser scanning microscopy  to examine transcriptionally active hiv infected cells from individuals at different disease stages  
class2	482	in 35 symptomatic hiv infected individuals  aids and aids related complex   an average of 1 in 350 mononuclear cells produced hiv rna  
class2	482	in contrast  in an asymptomatic group of 30 individuals  an average of 1 in 2000 mononuclear cells produced hiv rna  
class2	482	these data  obtained using this improved detection method  suggest there are more hiv rna producing cells in hiv infected individuals than previously reported  
class2	482	in addition  increased numbers of hiv transcribing cells were found to correlate with declining clinical condition as assessed by karnofsky performance score  
class2	482	these data suggest that viremia per se may account for the pathologic consequences in hiv infection  
class2	483	rotavirus specific antibody response in saliva of infants with rotavirus diarrhea  
class2	483	the reliability of saliva as an indicator of rotavirus infection was assessed among 15 infants  3 12 months  with rotaviral and 15 with nonrotaviral diarrhea  
class2	483	paired salivary samples collected during acute and convalescent phases were tested for rotavirus specific iga and igm by an elisa  
class2	483	the sensitivity of iga or igm alone to predict infection was 53 3  and 46 6   respectively  used in conjunction  the sensitivity rose to 80   
class2	483	it seems that infants with rotaviral diarrhea mount mucosal antibody responses as reflected in their saliva  possibly salivary antibodies could be used to evaluate vaccine  take  in rotavirus vaccine trials  
class2	484	infectious mononucleosis complicated by lingual tonsillitis  
class2	484	although upper airway obstruction and superimposed infection are well known complications of infectious mononucleosis  lingual tonsillitis in this context has not been mentioned in the literature  
class2	484	we describe a case of acute bacterial lingual tonsillitis with airway obstruction complicating infectious mononucleosis  
class2	484	the role of the base of tongue region in the pathophysiology of infectious mononucleosis is discussed  
class2	485	adult immunization in a network of family practice residency programs  
class2	485	a substantial proportion of morbidity and mortality associated with vaccine preventable diseases occurs among adults  
class2	485	teaching residents about disease prevention is mandated in the curriculum guidelines for family practice programs  
class2	485	a cooperative study among the kansas city family practice residency programs was begun to look at immunization behaviors in these teaching programs  
class2	485	a retrospective audit of medical records and a prospective survey of residents and faculty were performed  
class2	485	from the medical records of 400 patients seen for health maintenance examinations  the frequency of tetanus diphtheria immunizations recorded was 4 75   
class2	485	the pooled immunization rate recorded for pneumococcal vaccine was 25   and for influenza vaccine  24   
class2	485	although 93  of respondents knew patients need tetanus diphtheria immunization every 10 years  on a written questionnaire giving clinical examples  they were less likely to elect to immunize older patients eligible for tetanus diphtheria vaccine  
class2	485	the following immunization criteria were listed by respondents  for pneumococcal vaccine  age over 65 years  86    for influenza vaccine  age over 65 years  85    chronic diseases  69    residence in a chronic care facility  7    and being a health care worker  28    
class2	485	educational interventions stressing the appropriate criteria and involvement of the patient are planned at the separate programs  
class2	486	psychological functioning in a cohort of gay men at risk for aids  a three year descriptive study  
class2	486	this study describes the mental health of a large cohort of gay men participating in the chicago multicenter aids cohort study coping and change study  
class2	486	six biannual questionnaires were self administered between 1984 and 1988  
class2	486	general mental health was determined by the hopkins symptom checklist  hscl   
class2	486	an abbreviated version of the center for epidemiologic study depression scale  cesd 5  and an adapted diagnostic interview schedule  dis  question also measured depression  
class2	486	suicidal ideation was assessed by one question in the hscl  
class2	486	aids specific distress was determined by three subscales specifically developed for this study  
class2	486	while mean hscl and cesd 5 scores were stable during the observational period  aids specific distress increased over time  
class2	486	the hscl scores for the cohort were somewhat elevated above general population norms but considerably below psychiatric outpatient norms  
class2	486	fewer than 12  of the men reported elevated hscl or cesd 5 scores three or more times  
class2	486	a self reported episode of depression of two weeks or more  measured by the dis screening question  was experienced by 40 1  of the sample  
class2	486	suicidal ideation was reported on three or more visits by 18 8  of the men  
class2	486	the younger members of this cohort exhibit greater general and aids specific distress  
class2	486	income was inversely associated with general distress  
class2	486	hiv seropositive participants had generally higher aids specific distress scores than those who were seronegative  but their scores were equivalent on the hscl and cesd 5  
class2	487	implementation of preventive services in an hmo practice  
class2	487	practice does not conform to guidelines unless the guidelines are specifically implemented and performance is monitored  
class2	487	several examples of implementation in one health maintenance organization  hmo  are given  
class2	487	these include immunization for influenza and follow up of positive screening tests for colorectal and cervical cancer  
class2	487	each implementation effort has required the development of systems  which in this hmo are automated  
class2	487	several issues influencing implementation are discussed  including resource constraints and priorities for the allocation of new resources  
class2	487	developers cannot expect that their guidelines will be incorporated into clinical practice  
class2	487	they must foster specific implementation plans  
class2	488	adult immunizations  are they worth the trouble  
class2	488	there are good data to recommend routine use of vaccines against measles  rubella  tetanus  influenza  and pneumococcal infections in adults  
class2	488	an adolescent or an adult born after 1956 is considered to be susceptible to measles unless he or she has received two doses of live measles vaccine or has suffered a physician diagnosed case of measles  
class2	488	tetanus is largely a disease of the elderly  and there is a universal need for immunizations with tetanus toxoid  
class2	488	influenza continues to be a major public health problem  and influenza vaccine should be given annually to the elderly and to those at high risk  
class2	488	the efficacy of pneumococcal vaccine in american adults is still being debated  
class2	488	results from case control studies show that the vaccine is about 60  effective in reducing the incidence of disease due to vaccine related strains  
class2	488	its use in the elderly and in those at higher risk for pneumococcal infection is recommended  
class2	489	early ribavirin treatment of respiratory syncytial viral infection in high risk children  
class2	489	a 3 year prospective  blinded  multicenter study was done to assess the efficacy of early ribavirin intervention in mild respiratory syncytial virus illness in children with bronchopulmonary dysplasia or with congenital heart disease  
class2	489	a cohort of 178 children younger than 36 months of age with bronchopulmonary dysplasia or congenital heart disease were followed  
class2	489	forty seven infants whose respiratory syncytial virus infection resulted in mild symptoms of less than or equal to 72 hours  duration received ribavirin  n   20  or water placebo aerosol  n   27  either in a hospital or at home  
class2	489	outcome measures included respiratory and analog score  room air oxygen  saturation  and oxygen flow needed to maintain saturation at greater than or equal to 91   
class2	489	no difference in age  gender  family size  passive smoking  baseline oxygen saturations in room air  or duration of symptoms before treatment was found between groups  
class2	489	after 3 days of therapy  ribavirin produced a greater rate of improvement of analog scores  p   less than or equal to 0 001   lower oxygen requirements  p   0 01   and higher oxygen saturation  p   0 01   
class2	489	respiratory scores and total hospital days did not differ significantly between the groups  
class2	489	treatment failure occurred in 2 of 20 children  10   in the ribavirin group versus 5 of 27 children  18   in the placebo group  a nonsignificant difference  
class2	489	no child required assisted ventilation or had an adverse reaction  
class2	489	we conclude that early ribavirin therapy may help to reduce morbidity from respiratory syncytial virus infection in high risk young children  
class2	490	urinary retention due to sacral myeloradiculitis  a clinical and neurophysiological study  
class2	490	we report 5 cases of sacral myeloradiculitis presenting with transient urinary retention  
class2	490	neurophysiological testing  including bulbocavernosus reflex  pudendal evoked response and external anal sphincter electromyography  was performed  
class2	490	parasympathetic pelvic nerves  pudendal nerves as well as the spinal cord seem to be involved to various degrees in this infrequent disorder  
class2	491	type specific antigens for serological discrimination of htlv i and htlv ii infection  
class2	491	55 htlv i  human t cell lymphotropic virus  and 45 htlv ii carriers  confirmed by htlv type specific polymerase chain reaction  pcr   were distinguished by western blot assays with recombinant htlv i or ii envelope glycoproteins  
class2	491	recombinant protein  rp  b1 contains aminoacids 166 201 from htlv i exterior glycoprotein gp46 and was reactive with htlv i samples only  
class2	491	rp iib  which contains aminoacids 96 235 from htlv ii exterior glycoprotein gp52  was reactive with all htlv ii samples  
class2	491	39 patients  86 6   had high reactivity by densitometry  
class2	491	of 55 htlv i samples  35  65 5   had antibody reactivity to rp iib  but only 1  1 8   had high reactivity by densitometry  
class2	491	rp b1 and iib western blot assays may replace the pcr test in diagnosis of htlv infection  
class2	492	cytomegalovirus and rasmussen s encephalitis 
class2	492	in situ hybridisation with a biotinylated cytomegalovirus  cmv  dna probe was done on brain biopsy specimens from 10 patients with rasmussen s encephalitis  re  and 46 age matched control patients with other neurological diseases  
class2	492	all 10 patients with re had intractable epilepsy and focal neurological deficits  and there was perivascular cuffing  microglial nodules  astrogliosis  and neuronal loss  
class2	492	cmv genomic material was demonstrated in 7 of the 10 patients with re  in neurons  astrocytes  oligodendrocytes  and endothelial cells  and in 2 of the 46 control patients  
class2	492	probes for herpes simplex virus and hepatitis b virus were negative in all patients and in fibroblast controls  
class2	492	the results suggest that cmv is a likely cause of rasmussen s encephalitis  
class2	493	primary central nervous system lymphoma in patients with and without the acquired immune deficiency syndrome  a retrospective analysis and review of the literature  
class2	493	twenty two cases of pcl were reviewed  in which 9 patients had aids and 13 did not  
class2	493	a review of the literature identified 247 cases of aids related pcl  
class2	493	differences between patients with aids and immunocompetent pcl were noted in our series  
class2	493	aids related pcl when compared to non aids pcl in our series has the following notable clinical features  1  significantly younger age at presentation  median age 34 versus 59 years  2  significantly higher incidence of b symptoms  44  versus 8   3  worse median performance status at presentation  3 versus 1  and  4  shorter median survival  3 versus 10 months  
class2	493	differences in performance status and survival  however  were not significant  
class2	493	aids related pcl is further characterized by frequent  44   ring enhancing mass lesions on head ct scan  a finding that makes it clinically difficult to distinguish from toxoplasmosis  
class2	493	median survival appears to be improved in the absence of opportunistic infection at time of diagnosis of pcl  6 versus 2 months  
class2	493	the therapeutic approach to patients with pcl  with and without aids  is variable  
class2	493	combined modality therapy may improve the survival in patients with non aids pcl  
class2	493	therapy for patients with aids related pcl is tailored to the status of the individual and it is  therefore  difficult to make comparisons to non aids pcl patients  
class2	493	aids patients are often too ill to tolerate aggressive surgery or systemic treatment and in this instance  radiotherapy alone may be an acceptable alternative  
class2	493	nonetheless  overall survival for patients with aids related and non aids pcl remains poor  
class2	494	use of single fiber emg and macro emg in study of reinnervation  
class2	494	the use of single fiber emg and macro emg in studies of reinnervation is discussed  
class2	494	sfemg gives information about changes in the topography of the motor unit and in function of transmission in terminal nerve  motor endplate and muscle fiber  
class2	494	dynamics of reinnervation may be studied with this technique  
class2	494	the amount of reinnervation is obtained from macro emg studies  
class2	494	the capacity for reinnervation is discussed for a few conditions as well as factors that limit the reinnervation process  
class2	495	the agent of bacillary angiomatosis  an approach to the identification of uncultured pathogens 
class2	495	background  
class2	495	bacillary angiomatosis is an infectious disease causing proliferation of small blood vessels in the skin and visceral organs of patients with human immunodeficiency virus infection and other immunocompromised hosts  
class2	495	the agent is often visualized in tissue sections of lesions with warthin starry staining  but the bacillus has not been successfully cultured or identified  
class2	495	this bacillus may also cause cat scratch disease  
class2	495	methods  
class2	495	in attempting to identify this organism  we used the polymerase chain reaction  
class2	495	we used oligonucleotide primers complementary to the 16s ribosomal rna genes of eubacteria to amplify 16s ribosomal gene fragments directly from tissue samples of bacillary angiomatosis  
class2	495	the dna sequence of these fragments was determined and analyzed for phylogenetic relatedness to other known organisms  
class2	495	normal tissues were studied in parallel  
class2	495	results  
class2	495	tissue from three unrelated patients with bacillary angiomatosis yielded a unique 16s gene sequence  
class2	495	a sequence obtained from a fourth patient with bacillary angiomatosis differed from the sequence found in the other three patients at only 4 of 241 base positions  
class2	495	no related 16s gene fragment was detected in the normal tissues  
class2	495	these 16s sequences associated with bacillary angiomatosis belong to a previously uncharacterized microorganism  most closely related to rochalimaea quintana  
class2	495	conclusions  
class2	495	the cause of bacillary angiomatosis is a previously uncharacterized rickettsia like organism  closely related to r  
class2	495	quintana  
class2	495	this method for the identification of an uncultured pathogen may be applicable to other infectious diseases of unknown cause  
class2	496	clinical and pathological features of bacillary peliosis hepatis in association with human immunodeficiency virus infection 
class2	496	background  
class2	496	peliosis hepatis is characterized by cystic  blood filled spaces in the liver and is seen in patients with chronic infections or advanced cancer and as a consequence of therapy with anabolic steroids  
class2	496	cutaneous bacillary angiomatosis is a bacterial infection that occurs in patients with human immunodeficiency virus  hiv  infection  its histologic appearance is that of a pseudoneoplastic vascular proliferation  
class2	496	methods  
class2	496	we studied liver tissue from eight hiv infected patients with peliosis hepatis  two of whom also had cutaneous bacillary angiomatosis  
class2	496	for comparison we examined tissue from four patients who had peliosis hepatis without hiv infection  
class2	496	tissues were examined histologically on routine sections and with special stains and electron microscopy  
class2	496	results  
class2	496	the histologic features seen in peliosis hepatis associated with hiv infection  but not in the four cases unrelated to hiv infection  were myxoid stroma and clumps of a granular purple material that on warthin starry staining and electron microscopy proved to be bacilli  
class2	496	the bacilli  which could not be cultured  were morphologically identical to those found in the skin lesions of cutaneous bacillary angiomatosis  
class2	496	the clinical courses of two of the patients with this  bacillary peliosis hepatis  indicate that it responds to antibiotic treatment  
class2	496	conclusions  
class2	496	hiv associated bacillary peliosis hepatis is an unusual  treatable opportunistic infection  probably caused by the same organism that causes cutaneous bacillary angiomatosis  
class2	496	our failure to find bacilli in non hiv associated cases implies that other pathogenetic mechanisms may also be responsible for peliosis hepatis  
class2	497	a newly recognized fastidious gram negative pathogen as a cause of fever and bacteremia 
class2	497	background  
class2	497	we identified a motile  curved  gram negative bacillus as the cause of persistent fever and bacteremia in two patients with symptomatic human immunodeficiency virus infection  
class2	497	the same organism was subsequently recovered from a bone marrow transplant recipient with septicemia and from two immunocompetent persons with week long febrile illnesses  
class2	497	all the patients recovered after antimicrobial therapy  
class2	497	methods and results  
class2	497	primary cultures of blood processed by centrifugation after blood cell lysis yielded adherent  white  iridescent  morphologically heterogeneous colonies in 5 to 15 days  
class2	497	subcultures grew in four days on chocolate  charcoal yeast extract  or blood agar  
class2	497	the organisms stained weakly with safranin and were not acid fast  
class2	497	fluorescent antibody tests for legionella and francisella were negative  
class2	497	biochemical reactivity was minimal and difficult to ascertain  
class2	497	agar dilution testing revealed in vitro susceptibility to most antimicrobial agents tested  
class2	497	the cellular fatty acid composition of the isolates was similar  resembling that of rochalimaea quintana or brucella species  but not helicobacter pylori or species of campylobacter or legionella  
class2	497	as resolved by gel electrophoresis  cell membrane preparations of all isolates contained similar proteins  with patterns that differed from that of r  
class2	497	quintana  
class2	497	patterns of digestion of dna from all isolates by ecorv restriction endonuclease were virtually identical and also differed from that of r  
class2	497	quintana  
class2	497	on immunodiffusion  serum from one convalescent patient produced a line of identity with sonicates of all five isolates  
class2	497	conclusions  
class2	497	this pathogen may have been unidentified until now because of its slow growth  broad susceptibility to antimicrobial agents  and possible requirement of blood cell lysis for recovery in culture  
class2	497	it should be sought as a cause of unexplained fever  especially in persons with defective cell mediated immunity  
class2	498	circulating cd8  cytotoxic t lymphocytes specific for htlv i px in patients with htlv i associated neurological disease  
class2	498	the human t lymphotropic virus type i  htlv i   the first human retrovirus to be characterized  is associated with adult t cell leukaemia and a chronic progressive disease of the central nervous system termed tropical spastic paraparesis  or htlv i associated myelopathy  
class2	498	only 1  of individuals infected with htlv i develop clinical disease however  
class2	498	the various manifestations of an htlv i infection may be related to differences in the genetic backgrounds of individuals  infection with variant strains of htlv i  differences in viral tropism or host immune response to the virus  
class2	498	whereas the humoral response to htlv i is well characterized  little is known about the human cellular immune response  such as the production of cytotoxic t lymphocytes  
class2	498	here we report the presence of high levels of circulating htlv i specific cytotoxic t lymphocytes in patients with htlv i associated neurological disease but not in htlv i seropositive individuals without neurological involvement  
class2	498	these cytotoxic t lymphocytes are cd8   hla class i  restricted and predominantly recognize the htlv i gene products encoded in the regulatory region px  
class2	498	these findings suggest that htlv i specific cytotoxic t lymphocytes may contribute to the pathogenesis of associated neurological disorders associated with htlv i  
class2	499	the myelodysplastic syndromes  case report and review  
class2	499	the myelodysplastic syndromes are a heterogenous group of hematologic disorders of myeloid progenitor cells  
class2	499	oral manifestations may be among the first signs and often reflect degrees of neutropenia or neutrophil dysfunction  
class2	499	a patient with persistent herpes labialis and severe oral mucosal ulceration in myelodysplastic syndrome is reported  
class2	499	the features of myelodysplasia are reviewed and their oral manifestations and significance to dental management outlined  
class2	500	diagnosis of oral hairy leukoplakia by ultrastructural examination of exfoliative cytologic specimens  
class2	500	lingual exfoliative cytologic specimens  scrapings  were obtained from 18 patients positive for human immunodeficiency virus with clinical oral hairy leukoplakia  
class2	500	buccal mucosal scrapings were obtained from 12 of these patients  
class2	500	the specimens were processed for examination by transmission electron microscopy  tem   
class2	500	sixteen  89   of the lingual specimens revealed infection of keratinocytes by herpes type virus  
class2	500	there was no evidence of virus infection in the 12 buccal mucosal scrapings  
class2	500	fungal hyphae were seen by tem in 14  78   of the lingual scrapings and two  17   of the buccal scrapings  
class2	500	one exfoliative specimen and two biopsy specimens were stained for epstein barr virus dna with a dna probe  
class2	500	the demonstration of herpes type virions by tem in keratinocytes from a lesion clinically suspected to be hairy leukoplakia provides direct  objective diagnosis  
class2	500	furthermore  use of exfoliative cytologic specimens provides a clinically simple  noninvasive technique  
class2	501	nosocomial bacteremias in measles  
class2	501	the purpose of this study was to determine whether nosocomial bacteremias occurred more frequently in patients admitted with severe measles compared with general pediatric admissions  
class2	501	in a retrospective survey of 977 blood culture reports during a 4 year period  1985 to 1988  the incidence of nosocomial bacteremias in patients with measles was found to be on the average of 3 37 100 admissions year  approximately 6 times that of general pediatric patients  0 57   
class2	501	gram negative organisms  predominantly klebsiella and salmonella species  accounted for 86 5  of all isolates from measles patients  with 23  of these being multiply antibiotic resistant  
class2	501	all the isolates from the general patients were fully susceptible to antibiotics  
class2	501	the duration of hospitalization was more than doubled in both groups of affected patients  
class2	501	the onset of hospital acquired bacteremias occurred on an average of 11 2 days after admission in the patients with measles and 20 5 days in the general patients  
class2	501	our findings revealed that nosocomial bacteremias occurred with greater frequency in patients with measles and contributed to the morbidity of these patients  
class2	502	clinical features of adenovirus enteritis  a review of 127 cases  
class2	502	we retrospectively analyzed the clinical features of 127 hospitalized pediatric patients whose fecal samples were positive for adenovirus  ad  by electron microscopy during an 18 month period  
class2	502	serotyping results obtained by microneutralization tests and restriction endonuclease analysis were available for 105 of 127 cases  
class2	502	there were 69 males and 58 females and 94  of patients were less than 4 years of age  
class2	502	the average body temperature was 38 degrees c rectal  range  36 2 40 8 degrees c  with an average duration of fever of 1 6 days  
class2	502	the average duration of clinical illness was 8 8 days  range  1 to 32 days   
class2	502	although ad 40 and ad 41 were isolated in the majority of cases  59 of 105  56    ad 31 was associated with 18 of 105 cases  17    
class2	502	of the 18 cases associated with ad 31  14 were nosocomial and associated with diarrhea  
class2	502	our survey confirms the importance of fastidious enteric ad in infantile diarrhea  ad 40  ad 41  and suggests that ad 31 produces a clinical syndrome indistinguishable from that caused by ad 40 and ad 41  
class2	502	the occurrence of ad enteritis in patients admitted for unrelated illnesses well after initial hospitalization suggests that ad is also an important cause of nosocomial enteritis in our hospital  
class2	503	study design considerations for ribavirin  efficacy studies  
class2	503	five placebo controlled double blind studies  each including approximately 30 subjects  have addressed the question of the effect of aerosolized ribavirin on the course of rsv lower respiratory infection in infancy  
class2	503	the fact that each was able to establish a beneficial effect despite the small number of subjects studied is convincing evidence that such an effect exists  
class2	503	the studies from rochester using oximetry and an analog illness severity scale indicate that this effect is both statistically significant and clinically relevant  
class2	503	these tools are reliable and easily applicable measures for multicenter studies when illness severity is selected as an outcome measure  
class2	503	characteristics that should be taken into consideration when assigning experimental groups include age  sex  a history of prematurity or underlying conditions and arterial oxygen saturation  
class2	503	future studies will address additional questions about the efficacy of ribavirin  such as its role in critically ill children  the economic benefits of its use in terms of duration of hospitalization  the usefulness of early treatment of rsv disease in high risk infants  and the impact of treatment on long term consequences of rsv infection  
class2	503	these studies may require outcome variables and subject selection strategies different from those used in earlier studies  
class2	504	transbronchial biopsies in children after heart lung transplantation  
class2	504	sixty transbronchial biopsies have been performed in eight children after heart lung transplantation  
class2	504	the selection of fiber optic bronchoscope or a small  4 mm  30 cm  rigid bronchoscope was made according to the size of endotracheal tube required at surgery  
class2	504	if the endotracheal tube was size 7 5 or greater  a fiber optic bronchoscope was used  whereas if the endotracheal tube size was below 7  a rigid bronchoscope was used  
class2	504	for the diagnosis of lung rejection  the histology of biopsies revealed a sensitivity of 91  and specificity of 69   similar to the result in adults   
class2	504	the histology also distinguished lung infection from rejection  
class2	504	complications included three pneumothoraces and two clinically significant episodes of hemorrhage  one of which led to a cardiorespiratory arrest  which may have been caused by hypoxia  
class2	504	as a result  arterial oxygen saturation is now monitored during the procedure using a pulse oximeter  
class2	505	a rhesus monkey model for sexual transmission of a papillomavirus isolated from a squamous cell carcinoma  
class2	505	recently we molecularly cloned and characterized a papillomavirus from a lymph node metastasis of a primary penile carcinoma found in a rhesus monkey  this virus species  rhesus papillomavirus type 1  rhpv 1   is similar to oncogenic human papillomaviruses  hpvs   such as hpv 16 or hpv 18  in that the rhpv 1 dna was found to be integrated in the tumor cell dna  
class2	505	to compare the sexual transmission and oncogenic nature of rhpv 1 with these hpvs  we undertook an extensive retrospective study of a group of rhesus monkeys whose sexual mating and offspring histories were known  
class2	505	these animals had mated directly with the index male mentioned above or were secondarily exposed to this virus through intermediate sexual partners  
class2	505	this study combines cytological  histopathological  and several complementary hybridization and dna amplification techniques on multiple tissue samples to demonstrate the sexually transmitted nature of rhpv 1  
class2	505	the oncogenic potential of rhpv 1 is suggested in several of the infected animals by the presence of various degrees of neoplasia including squamous cell cancer of the cervix  
class2	506	interferon system and natural killer cell activity in myasthenia gravis  
class2	506	the autoimmune response in myasthenia gravis is well characterized  but little is known about the mechanisms initiating it  
class2	506	we have studied the interferon system and natural killer cell activity in 25 patients with myasthenia gravis and compared them to 68 healthy subjects and 96 patients with acute viral infections  
class2	506	forty four per cent of patients had circulating interferon  greater than 16 mu ml   and in a similar proportion their peripheral blood mononuclear cells were in an antiviral state  i e   showed low levels of viral replication when infected by vesicular stomatitis virus  
class2	506	spontaneous in vitro interferon production by patients  peripheral blood mononuclear cells was also common  greater than 10 mu ml  32 per cent   while the response to the alpha interferon inducer poly i c was lower than expected  possibly reflecting the already high state of activation of the interferon system  
class2	506	these results were essentially similar to those obtained in patients with viral illnesses and differed significantly from healthy controls  
class2	506	in many myasthenia gravis patients  16 of 22  73 per cent   a markedly deficient natural killer cell activity was found  with a median cytotoxicity of 6 5 per cent compared to 29 per cent in healthy subjects  p less than 0 005   
class2	506	thus  many patients with myasthenia gravis have evidence of an activated interferon system and defective natural killer cell activity  suggesting an occult viral infection or reflecting nonspecific stimulation which may nevertheless contribute to the pathogenesis of the autoimmune response  
class2	507	bacterial tracheitis  report of eight new cases and review  
class2	507	bacterial tracheitis  previously referred to as nondiphtheritic laryngitis with marked exudate  was commonly discussed in pediatric textbooks before 1940  
class2	507	it seemed to disappear as a clinical entity after that time  but it has been recorded with increasing frequency in the pediatric literature since 1979  
class2	507	we describe eight new cases and review 110 previously described cases  
class2	507	the clinical course consists of a prodromal upper respiratory illness with stridor  fever  and a variable degree of respiratory distress  
class2	507	unlike patients with croup  patients with bacterial tracheitis do not respond to aerosolized racemic epinephrine  
class2	507	most patients require endotracheal intubation  some require tracheostomy  
class2	507	reported complications include pneumonia  pneumothorax  formation of pseudomembranes  toxic shock syndrome  and cardiopulmonary arrest  
class2	507	bacterial tracheitis is a secondary bacterial infection following a primary viral respiratory infection  
class2	507	the most common preceding viral infection is parainfluenza  
class2	507	staphylococcus aureus and haemophilus influenzae are the predominant causes of bacterial tracheitis  
class2	507	secondary bacterial infection may occur as a result of tracheal mucosal injury or impairment of normal phagocytic function due to viral infection  
class2	508	early treatment with acyclovir for varicella pneumonia in otherwise healthy adults  retrospective controlled study and review  
class2	508	the effect of early acyclovir therapy on the course of varicella pneumonia in previously healthy adults was assessed  
class2	508	medical records from five university affiliated medical centers were retrospectively reviewed  included were all immunocompetent adults with a clinical diagnosis of primary varicella  a chest radiograph consistent with varicella pneumonia  and an arterial blood gas measurement indicating significant hypoxia  
class2	508	of the 38 patients who met the study criteria  11 had had a course of intravenous acyclovir initiated within the first 36 hours of hospitalization  the mean time from admission to initiation of therapy in this early treatment group was 9 6 hours  
class2	508	the group that received early acyclovir treatment had a lower mean temperature beginning on the fifth day of hospitalization  37 0 degrees c vs  
class2	508	37 7 degrees c  p    011  and a lower mean respiratory rate beginning on the sixth day of hospitalization  21 vs  
class2	508	28 respirations per minute  p    004   
class2	508	early acyclovir therapy also resulted in a significant improvement in oxygenation beginning on the sixth day of hospitalization in patients with follow up arterial blood gas measurements  p    035   
class2	508	thus  early institution of acyclovir therapy is associated with reduction in fever and tachypnea and improvement in oxygenation in otherwise healthy adults with varicella pneumonia  
class2	509	tropical neuromyelopathies and retroviruses  a review  
class2	509	debilitating disorders of the nervous system have a relatively high prevalence in the tropics  a geographic region that is often deficient in specialists in the fields of neurology and epidemiology  
class2	509	during world war ii  attention was called to a possible nutritional origin for most of these diseases  
class2	509	recently  however  human t lymphotropic virus type i  htlv i   formerly linked only to a rare form of leukemia  adult t cell leukemia   has been associated with a spastic paraplegia observed mostly in tropical areas and referred to as tropical spastic paraparesis  
class2	509	this entity is also observed in nontropical areas endemic for htlv i  including japan  south america  and the southern united states  
class2	509	viruses of the htlv family are being associated increasingly with pathology in humans  
class2	509	the pathogenesis of htlv i associated tropical spastic paraparesis remains to be understood  
class2	509	however  future research is expected to favor a multidisciplinary approach  with exciting potential insights derived from the fields of neurology  immunology  and infectious diseases  
class2	509	the aim of this review is to summarize contemporary research related to the viral etiology of this clinical entity  
class2	510	measles in israel  the west bank  and gaza  continuing incidence and the case for a new eradication strategy  
class2	510	measles continues to occur in epidemic waves in israel  gaza  and the west bank  causing morbidity and mortality  
class2	510	in israel  immunization of infants against measles began in 1967  and 90  had been immunized by the mid 1980s  
class2	510	in gaza and the west bank  where immunization of infants against measles began in 1973 and 1976  respectively  the immunization rate reached 75  in the late 1970s and increased to greater than 90  in the 1980s  
class2	510	measles epidemics  which previously had occurred in 5  to 7 year cycles  occurred every 2 4 years in the 1980s and affected individuals who were older than those affected in previous years  
class2	510	israel s commitment to eradicating measles by 1992 will require a substantially expanded immunization program in comparison with the traditional program that requires immunization of infants alone  
class2	510	the benefits of several alternative immunization strategies considerably exceed their costs  
class2	510	a new  two dose immunization will be needed as a minimal strategy  and a campaign for administering booster doses to school aged children may be required as well to achieve control and eradication of measles  
class2	510	measles is a serious but preventable public health problem  appropriate strategies must be devised by national and international public health officials to control the disease in developing and developed countries  
class2	511	impact of cytomegalovirus infection on organ transplant recipients  
class2	511	cytomegalovirus  cmv  is the single most important infectious agent affecting recipients of organ transplants  with at least two thirds of these patients having cmv infection 1 4 months after transplantation  
class2	511	latently infected allografts are the major exogenous source of cmv infection in transplant recipients  although leukocyte containing blood products can also transmit the virus  
class2	511	three patterns of cmv infection are recognized  primary infection  reactivation infection  and superinfection  
class2	511	primary infection has the greatest clinical impact  
class2	511	the clinical effects of cmv infection include infectious disease syndromes such as pneumonia and chorioretinitis  an immunosuppressed state that predisposes to potentially lethal opportunistic infection  and the initiation of a process that can result in allograft injury  
class2	511	progress has been made in controlling cmv infection  hyperimmune anti cmv globulin and certain antiviral drugs appear promising for prophylaxis  and the combination of hyperimmunoglobulin and ganciclovir appears promising for therapy  
class2	512	syphilis  human immunodeficiency virus infection  and targeting prevention  
class2	512	to examine the interaction between syphilis and human immunodeficiency virus type 1  hiv 1  infection in oklahoma  we conducted an unlinked hiv seroprevalence survey using serum specimens submitted to the oklahoma state department of health for serologic test for syphilis  
class2	512	of specimens with positive results from fluorescent treponemal antibody absorption test  fta abs   6 3  were hiv 1 seropositive compared to 0 8  of those that had negative results from fta abs  
class2	512	among specimens positive for syphilis  hiv 1 seropositivity was found almost exclusively among those from persons 20 to 39 years of age and more often among those from men than those from women  9 9  vs 1 3    
class2	512	of syphilis positive specimens from 20  to 39 year old men  17 6  were hiv 1 seropositive  
class2	512	in oklahoma  an area with a relatively low overall prevalence of hiv 1 infection  targeting prevention efforts to young adults who test positive for syphilis should be an efficient way to reach some persons at high risk for hiv 1 infection  
class2	513	ocular disease associated with epstein barr virus infection  
class2	513	epstein barr virus  ebv  is a ubiquitous dna virus of the herpesvirus genus with a high prevalence rate for antibody  about 90   in the adult population  
class2	513	it is the most common causative agent of infectious mononucleosis syndrome  
class2	513	during recent years an increasing number of ocular disease entities have been reported to be linked to ebv infection  
class2	513	these entities include oculoglandular syndrome  conjunctivitis  dry eye  keratitis  uveitis  choroiditis  retinitis  papillitis and ophthalmoplegia  
class2	513	while ebv specific serologic tests can now document recent and past primary infection with ebv and also identify patients manifesting atypical immunologic reactions to ebv  the lack of an animal model  the absence of clear cut response to therapy and the paucity of documentation by culture render the pathogenesis uncertain or the association questionable in many of these cases  
class2	514	american blood donors seropositive for human t lymphotropic virus types i ii exhibit normal lymphocyte subsets  
class2	514	recent reports have demonstrated that some lymphocyte subsets are abnormal in japanese blood donors who are seropositive for human t lymphotropic virus type i  htlv i   
class2	514	to determine if similar changes characterize american blood donors who are seropositive for htlv i ii  lymphocyte subsets were measured in 42 htlv seropositive and 42 htlv seronegative blood donors  
class2	514	the seronegative individuals were matched by age  race  and gender to the seropositive individuals  
class2	514	peripheral blood mononuclear cells were treated with a panel of 12 monoclonal antibody pairs and then analyzed by two color flow cytometry  
class2	514	no significant differences were observed between the seropositive and seronegative groups with respect to the absolute number of circulating lymphocytes or the percentages of lymphocytes belonging to the subsets assessed  
class2	514	these subsets included b  t  cd4  and cd8 cells and subpopulations of cd4 and cd8 cells defined by the coexpression of markers that appear  cd25  hla dr  cd38  or disappear  leu 8  cd45ra  after activation  
class2	514	these findings indicate that htlv seropositive persons in the american blood donor pool do not exhibit the lymphocyte subset alterations reported for htlv i seropositive blood donors in japan  
class2	515	efficiency of white cell filtration and a freeze thaw procedure for removal of hiv infected cells from blood  
class2	515	strategies for diminishing the risk of blood transfusion associated transmission of hiv 1 were evaluated  
class2	515	hiv 1 infected peripheral blood mononuclear cells were added to blood that was subsequently filtered by using different white cell  wbc  filters  cellulose acetate and polyester   
class2	515	the average log reduction of infected cells with polyester filters was at least 2 5 as measured by id50 titration and polymerase chain reaction  
class2	515	in two wbc filtration experiments with blood from seropositive donors diluted 1 4 with seronegative blood  log reductions of 2 4 and greater than 2 5 were observed  
class2	515	no cell free virus was retained by the filter used  
class2	515	a freeze thaw procedure applied to hiv 1 contaminated blood resulted in a minimal log reduction  
class2	515	these results indicate that the reduction of hiv 1 infectivity as a result of filtration is mainly due to the removal of hiv 1 infected wbcs  and that complete removal of infected wbcs cannot be achieved by the current filtration or freeze thaw procedures  
class2	515	however  the development of filters with enhanced ability to remove  possibly infected  wbcs may have the added benefit of improving the safety of donor blood  especially in multiply transfused patients  
class2	516	measles update  
class2	516	the incidence of measles in the united states dramatically increased in the 1980s  from a low of 1 497 cases in 1983 to over 17 000 cases in 1989  
class2	516	family physicians can help reverse this trend by following the revised immunization schedule  which includes a measles mumps rubella  mmr  booster for preschool age children  
class2	516	new guidelines also recommend that either the two dose mmr schedule or serologic evidence of immunity be required for all persons entering college or employed in the medical field  
class2	516	immunization policies for physician s offices should ensure that all office staff have acquired measles immunity and that a triage policy separating patients with rash from those with other illnesses is utilized  
class2	516	mild upper respiratory illness  a history of seizures  nonanaphylactic egg allergy and asymptomatic human immunodeficiency virus infection are not contraindications to measles vaccine  
class2	516	all cases of measles should be reported to the local health department  
class2	517	hiv disease  a review for the family physician  part ii  secondary infections  malignancy and experimental therapy  
class2	517	the first part of this two part article included recommendations for the initial evaluation of patients suspected of having hiv infection  the centers for disease control s classification scheme for hiv disease and current recommendations for the use of zidovudine  
class2	517	in this second part  secondary infections and malignancy are reviewed  and various experimental therapies are briefly discussed  
class2	518	comparison of southern transfer hybridization and dot filter hybridization for detection of cervical human papillomavirus infection with types 6  11  16  18  31  33  and 35  
class2	518	a commercial dot filter hybridization kit  virapap kit  was compared with southern transfer hybridization for the detection of seven types of human papillomavirus  hpv  in cervical specimens from 450 consecutive females attending a sexually transmitted diseases clinic  
class2	518	in comparison with southern transfer hybridization  performed with the same probes used in the dot filter kit  the sensitivity  specificity  and positive and negative predictive values of dot filter hybridization were 90   94   74   and 98   respectively  
class2	518	among patients with cervical cytologic dysplasia  hpv dna was detected in 44  by dot filter hybridization and in 35  by southern transfer hybridization  
class2	518	although 26  of specimens positive by dot filter hybridization were not confirmed by southern transfer hybridization  cervical dysplasia was detected in 5  25   of 20 with hpv dna detected by dot filter hybridization alone  compared with 25  8   of those with no definitive evidence of hpv by either method  p   0 009  and with 16  30   of 53 with hpv dna detected by both methods  p   0 7   
class2	518	the kappa statistic for interobserver and intraobserver reproducibility for interpretation of blots was similar for the two methods  
class2	518	the dot filter hybridization method evaluated appears to be a satisfactory alternative to southern transfer hybridization for detection of hpv dna  
class2	519	pregnancy outcomes among mothers infected with human immunodeficiency virus and uninfected control subjects  
class2	519	between june 26  1985  and feb  
class2	519	24  1989  101 seropositive pregnant women and 129 seronegative pregnant women from the same prenatal clinics in brooklyn and the bronx were recruited into a prospective study of human immunodeficiency virus infection in pregnant women and their offspring  
class2	519	this report details the course of pregnancy and short term neonatal outcomes of 91 seropositive women and 126 seronegative women who gave birth during the study period  
class2	519	seropositive mothers were significantly more likely to have sexually transmitted diseases  17 6  vs 7 1   p   0 017  and medical complications  43 0  vs 25   p   0 006  during pregnancy  
class2	519	no other obstetric complications  e  
class2	519	g   chorioamnionitis  endometritis  toxemia  or placental problems  were associated with serologic status  
class2	519	after controlling for confounding variables  drug use  tobacco use  age of mother  and clinic   we found that the mother s serologic status was not significantly associated with birth weight  gestational age  head circumference  or apgar scores among live infants  
class2	519	for example  after adjustment on confounders we found that children born to seropositive mothers weighed about 7 gm more than children of seronegative mothers  95  confidence interval   180 to 194 gm   
class2	519	we conclude that in this population human immunodeficiency virus infection has little demonstrable impact on the status at birth of live neonates  
class2	520	extensive vulvar and vaginal varicella necessitating abdominal delivery  
class2	520	maternal varicella occurs in fewer than five per 10 000 pregnancies in the united states  
class2	520	a case is reported in which markedly painful  extensive vulvar and vaginal ulcers prevented cervical examination  and cesarean section was performed with the patient under general anesthesia  
class2	521	modeling the impact of breast feeding by hiv infected women on child survival  published erratum appears in am j public health 1991 may 81 5  658 9  
class2	521	this study models the survival outcomes of children born to hiv infected  human immunodeficiency virus  women who are breast fed  bottle fed  and wet nursed  
class2	521	it is estimated that  given the relative risk of alternatives to maternal milk in developing countries  the probability of hiv transmission via breast milk would need to be at least  12 in a community with an under five child mortality rate from non hiv causes of 100 1000 live births and at least  27 in a community with a rate of 200 1000 before alternative feeding practices should be recommended even to the known hiv infected mother who has an available feeding alternative with a relative risk of 2 1  
class2	521	while such a low relative risk may be achievable with wet nursing  most studies report a relative risk of at least 3 1 for bottle feeding  
class2	521	a sensitivity analysis is conducted around the relative risk of child mortality from non hiv causes associated with different feeding practices  
class2	521	while the critical transmission rate does not vary significantly with a rate of false positives as high as 20 percent on the hiv screening test  the critical transmission rate is very sensitive to the availability of hiv screening  
class2	521	in communities where the hiv prevalence rate among mothers reaches 40 percent  breast feeding should still be recommended in the absence of hiv screening unless hiv transmission via breast milk surpasses 30 percent  
class2	522	hiv seroconversion in two homosexual men after receptive oral intercourse with ejaculation  implications for counseling concerning safe sexual practices  
class2	522	seroconversion for hiv antibody occurred in two homosexual men who reported no anal intercourse for greater than or equal to 5 years and multiple episodes of receptive oral intercourse with ejaculation  
class2	522	neither man reported intravenous drug use or receipt of blood products  
class2	522	the last antibody negative specimen was also negative by the polymerase chain reaction and p24 antigen assays  
class2	522	all sexually active persons should be clearly counselled that receptive oral intercourse with ejaculation carries a potential risk of hiv transmission  
class2	523	human t cell lymphotropic virus infection in guaymi indians from panama  
class2	523	preliminary studies found that 9  of guaymi indians from bocas del toro province have antibody to human t cell lymphotropic virus  htlv i ii   
class2	523	the present study enrolled 317  21  of the population  guaymi indians from changuinola  the capital of bocas del toro province and 333  70  of the population  from canquintu  an isolated rural village  
class2	523	demographic information and family relationships were ascertained and subjects were screened for neurologic diseases  
class2	523	serum specimens were screened by an enzyme linked immunosorbent assay for htlv i ii antibody and positives were confirmed according to u s  
class2	523	public health service criteria  
class2	523	twenty five  8   guaymi residing in changuinola and 7  2 1   from canquintu were confirmed seropositive  
class2	523	in changuinola  antibody was virtually limited to residents greater than or equal to 15 years of age  24  16   of 153  and rates were slightly higher in males than in females  in canquintu  antibody rates did not increase significantly with age and appeared higher in females than in males  
class2	523	in changuinola  there was no evidence for household clustering of infection  
class2	523	in contrast  htlv antibody among canquintu residents clustered significantly by household  
class2	523	htlv associated neurologic disease was not detected in either population  
class2	523	the atypical seroepidemiology observed in both locations might be explained if the virus endemic to the guaymi differed from htlv i previously described in the caribbean basin and japan  
class2	524	high incidence of viral hepatitis among american missionaries in africa  
class2	524	protestant missionaries  n   360  serving in sub saharan africa between 1967 1984 were studied to determine the risk of hepatitis a virus  hav  and hepatitis b virus  hbv  infection  
class2	524	personnel were serologically screened for antibody to both the hepatitis a virus  anti hav  and the surface antigen to the hepatitis b virus  anti hbs  prior to departure  periodically during service abroad  and upon completion of their african tour  
class2	524	rates of seroconversion were used as measures of the incidence of infection  
class2	524	prior to service  16  of the staff had anti hav and 3  had anti hbs  post service rates were 42  and 26   respectively  
class2	524	over 90  of the staff with greater than 20 years of service were seropositive for anti hav  
class2	524	for both viruses  the infection rate was highest during the first 1 2 years of service  when 28  of those susceptible to hav and 11  of those susceptible to hbv became infected  
class2	524	over the next decade  the median annual attack rate was 5 4  for hav and 4 2  for hbv  
class2	524	differences in the missionary hbv infection rate among the various african nations served tended to reflect differences in the magnitude of chronic hbv carriage among indigenous population groups  
class2	524	we conclude that missionaries to sub saharan africa are at enhanced risk of both hav and hbv infection  and that all should receive passive immunization with immune globulin and active immunization with hepatitis b vaccine  
class2	525	association of acute colonic pseudo obstruction  ogilvie s syndrome  with herpes zoster  
class2	525	ogilvie s syndrome  or acute pseudo obstruction of the colon is characterized by massive distension of the colon in the absence of organic distal obstruction  
class2	525	the syndrome is associated with various unrelated and  most often  extra abdominal causes  
class2	525	an association between ogilvie s syndrome and herpes zoster has been reported only once  by ceccese et al  
class2	525	in 1985  
class2	525	we present a second such case  
class2	525	this patient did not show evidence of any active illness other than the involvement of the t10 dermatome by herpes zoster  
class2	525	the patient s symptoms of colonic obstruction subsided with resolution of the zosteriform rash  
class2	526	infection with human immunodeficiency virus type 1  hiv 1  among recipients of antibody positive blood donations 
class2	526	objective  to assess the incidence of human immunodeficiency virus type 1 hiv 1  transmission by antibody  anti hiv 1  positive blood components  and to determine the immunologic and clinical course in hiv 1 infected recipients  
class2	526	design and subjects  we retrospectively tested approximately 200 000 donor blood component specimens stored in late 1984 and 1985 for anti hiv 1  and we contacted recipients of positive specimens to determine their serologic status  
class2	526	they were compared with both recipients of hiv 1 negative transfusions and healthy  untransfused  controls  
class2	526	subjects were seen at 3  to 6 month intervals for up to 4 years for clinical and immunologic evaluations  
class2	526	measurements and main results  of 133 recipients  9 had other possible exposures  
class2	526	excluding these cases  111 of 124  89 5   were anti hiv 1 positive  95  ci  84 1  to 94 5    
class2	526	the recipient s sex  age  underlying condition  and type of component did not influence infection rates  
class2	526	the cumulative risk for developing the acquired immunodeficiency syndrome  aids  within 38 months after transfusion was 13   ci  7 5  to 21 6    
class2	526	at 36     3 months after the index transfusion  seropositive recipients had lower counts of cd2 cdw26   cd4   cd4 cd29   and cd4 cd45ra subsets and more cd8 i2  lymphocytes than did recipients of anti hiv 1 negative transfusions  
class2	526	the cd4  and cd2 cdw26 subsets changed the most rapidly  
class2	526	the absolute cd8  count remained normal  
class2	526	conclusions  transfusion of anti hiv 1 positive blood infected 90  of recipients  
class2	526	the rate of progression to aids within the first 38 months after infection was similar to that reported for homosexual men and hemophiliacs  
class2	526	although most lymphocyte subset counts changed over time  cd8  counts were constant  
class2	527	delayed endolymphatic hydrops and its relationship to meniere s disease  
class2	527	delayed endolymphatic hydrops  eh  can be characterized as having ipsilateral and contralateral types  
class2	527	they are similar in that both have early and late phases of otologic symptoms and that the early phase is a profound hearing loss in one ear  
class2	527	the late phases differ  however  in that the ipsilateral type develops the symptoms of eh  episodic vertigo  in the deaf ear and the contralateral type develops the symptoms of eh  fluctuating hearing loss and or episodic vertigo  in the hearing ear  
class2	527	in more than half the cases of both types of delayed eh  the profound hearing losses in the early phase are simply discovered to be present in early childhood without a known time of onset  
class2	527	the temporal bones of two patients with contralateral delayed eh show pathologic changes in the deaf ears that are similar to those known to occur in mumps and measles labyrinthitis  whereas the pathologic changes in the hearing ears are similar to those known to occur in meniere s disease  
class2	527	these observations support the proposition that meniere s disease may occur as a delayed sequela of inner ear damage sustained during an attack of subclinical viral labyrinthitis occurring in childhood  
class2	528	characterization of the dermal infiltrate in human immunodeficiency virus infected patients with psoriasis  
class2	528	we investigated the dermal inflammatory cell infiltrates of psoriatic lesions from nine human immunodeficiency virus infected patients and nine age   sex   and site matched control specimens  
class2	528	the study was retrospective and observer blinded  
class2	528	t lymphocytes were quantitated using uchl 1  a pan t cell monoclonal antibody  and plasma cell number was estimated in hematoxylin eosin stained sections  
class2	528	differences in both variables reached statistical significance  
class2	528	there were fewer t cells and the number of plasma cells was significantly higher in specimens from the human immunodeficiency virus positive individuals in comparison with control specimens  
class2	528	as plasma cells are readily identified on hematoxylin eosin stained sections  their presence in skin biopsy specimens from psoriatic leisons should arouse suspicion of human immunodeficiency virus infection  
class2	528	the depletion of helper inducer t lymphocytes by the human immunodeficiency virus may promote the presence of plasma cells in cutaneous inflammatory infiltrates  
class2	529	sulfadiazine crystalluria revisited  the treatment of toxoplasma encephalitis in patients with acquired immunodeficiency syndrome  
class2	529	toxoplasma gondii encephalitis is an important opportunistic infection in the acquired immunodeficiency syndrome  estimated to occur in 20 000 to 40 000 patients with acquired immunodeficiency syndrome in the united states by 1991  
class2	529	the combination of sulfadiazine and pyrimethamine is regarded as the treatment of choice  
class2	529	acute renal failure due to crystal deposition in the urinary tract was well described 30 to 40 years ago and is likely to resurface as a clinical entity if appropriate prophylactic measures are not taken  
class2	529	we describe two cases of sulfadiazine induced crystalluria and renal failure in patients with acquired immunodeficiency syndrome  review the pertinent literature  and discuss the pathogenesis  
class2	529	recommendations are made for the prophylaxis and treatment of sulfadiazine related renal toxic reaction  
class2	529	physicians using this  new  drug must be aware of the potential danger of sulfonamide induced injury to the urinary tract  
class2	530	retrovirus from human t cell leukemia virus type i associated myelopathy is the same strain as a prototype human t cell leukemia virus type i  
class2	530	a retrovirus was isolated from a t cell line that was established from lymphocytes in the cerebrospinal fluid of a patient with human t cell leukemia virus type i associated myelopathy  ham   and its genome was sequenced  
class2	530	the nucleotide sequence of the 3  half of the total genome was identical in 99 5  of the nucleotides to that of the prototype human t cell leukemia virus type i that was derived from a patient with adult t cell leukemia  
class2	530	these results indicate that the same retrovirus human t cell leukemia virus type i is associated with both a neurological disease  ham  and a lymphoproliferative disease  adult t cell leukemia  
class2	531	silent infections with human immunodeficiency virus type 1 are highly unlikely in multitransfused seronegative hemophiliacs  
class2	531	we used the polymerase chain reaction  pcr  to determine the frequency of silent human immunodeficiency virus type 1  hiv 1  infections in seronegative high risk individuals with hemophilia who had been exposed to contaminated blood products more than 3 years previously  
class2	531	in a cross sectional study of a cohort of 57 prospectively followed seronegative hemophiliacs who received multiple transfusions before 1986  hiv 1 proviral dna was found transiently in only one patient  
class2	531	these data suggest that the rate of hiv infection among high risk antibody negative individuals with hemophilia is very low to absent  in the range of 0  to 2   
class2	531	these findings should provide considerable reassurance to seronegative persons with hemophilia and their sexual partners  
class2	532	predominance of polymorphonuclear leukocytes in cerebrospinal fluid of aids patients with cytomegalovirus polyradiculomyelitis  
class2	532	cytomegalovirus  cmv  polyradiculomyelitis was diagnosed in 4 of 241 consecutive neurologically assessed human immunodeficiency virus type  hiv 1  seropositive patients  
class2	532	cmv related neurologic disease was suspected on clinical grounds and was subsequently confirmed by cmv culture from cerebrospinal fluid  csf  and or cmv in situ hybridization on specific specimens  
class2	532	all four patients showed csf pleocytosis with predominance of polymorphonuclear leukocytes  pmns   
class2	532	retrospective analysis of the results of csf examination  performed in 143 of 241 patients with neurologic symptoms  showed pleocytosis in 58 of 143 patients  
class2	532	predominance of pmns was found in seven patients  including the four with cmv polyradiculomyelitis  
class2	532	it is concluded that in hiv 1 seropositive patients with a clinical diagnosis of polyradiculomyelitis  a predominance of pmns in csf could be an indication that the condition is cmv related  
class2	532	this should lead to early diagnosis and institution of specific antiviral therapy  
class2	533	acute syphilitic posterior placoid chorioretinitis  
class2	533	six patients with evidence of secondary syphilis presented with visual loss in both eyes caused by large  placoid  yellowish lesions with faded centers at the level of the pigment epithelium in the macula and juxtapapillary areas  
class2	533	all eyes had vitreitis  
class2	533	all of the lesions showed a similar fluorescein angiographic pattern of early hypofluorescence and late staining  
class2	533	five patients had mucocutaneous lesions typical of secondary syphilis  
class2	533	all five patients treated with antibiotics had prompt improvement in visual function and resolution of the fundus lesions  
class2	533	the ophthalmoscopic and angiographic appearance of these posterior fundus lesions was sufficiently characteristic to suggest a diagnosis of secondary syphilis  
class2	533	modification of the host response to syphilis by human immune deficiency virus  hiv  infection may be partly responsible for this peculiar fundus picture  
class2	533	three of the four patients tested positive for hiv  
class2	534	mapping of herpes simplex virus 1 neurovirulence to gamma 134 5  a gene nonessential for growth in culture  
class2	534	the gene designated gamma 134 5 maps in the inverted repeats flanking the long unique sequence of herpes simplex virus 1  hsv 1  dna  and therefore it is present in two copies per genome  
class2	534	this gene is not essential for viral growth in cell culture  
class2	534	four recombinant viruses were genetically engineered to test the function of this gene  
class2	534	these were  i  a virus from which both copies of the gene were deleted   ii  a virus containing a stop codon in both copies of the gene   iii  a virus containing after the first codon an insert encoding a 16 amino acid epitope known to react with a specific monoclonal antibody  and  iv  a virus in which the deleted sequences were restored  
class2	534	the viruses from which the gene was deleted or which carried stop codons were avirulent on intracerebral inoculation of mice  
class2	534	the virus with the gene tagged by the sequence encoding the epitope was moderately virulent  whereas the restored virus reacquired the phenotype of the parent virus  
class2	534	significant amounts of virus were recovered only from brains of animals inoculated with virulent viruses  
class2	534	inasmuch as the product of the gamma 134 5 gene extended the host range of the virus by enabling it to replicate and destroy brain cells  it is a viral neurovirulence factor  
class2	535	infectious mononucleosis in older adults  
class2	535	infectious mononucleosis as a manifestation of primary epstein barr virus infection occurs uncommonly in adults over age 40  
class2	535	while fever is almost universal  older patients with the disease often present without lymphadenopathy  pharyngitis  splenomegaly  lymphocytosis or atypical lymphocytes  
class2	535	jaundice and hepatomegaly occur more commonly in older patients than in adolescents and create diagnostic confusion  
class2	535	often  infectious mononucleosis in this age group is confused with lymphoma  leukemia or biliary obstruction  or is classified as  fever of unknown origin    
class2	536	primary lymphoma of the central nervous system in two children with acquired immune deficiency syndrome  
class2	536	postmortem examination disclosed central nervous system non hodgkin s lymphoma in two children who died of acquired immune deficiency syndrome  aids  at 6 and 14 months of age  respectively  
class2	536	systemic signs of lymphoma were not present  
class2	536	the b cell origin and clonality of the neoplastic cells were established by immunohistochemistry in one case and by molecular analysis of immunoglobulin gene rearrangement in the other  
class2	536	moreover  in the latter case the neoplastic cells were characterized by the presence of a single episomal ebv genome  
class2	536	according to these data  the monoclonal b cell proliferation occurred after ebv infection  thus suggesting a possible pathogenetic role of ebv in the early stages of lymphomagenesis  
class2	537	idiopathic sudden sensorineural hearing loss and postnatal viral labyrinthitis  a statistical comparison of temporal bone findings  
class2	537	although the cause of idiopathic sudden sensorineural hearing loss remains uncertain  a viral origin has been suggested in many cases on the basis of anamnestic microbiologic and pathologic data  
class2	537	twenty two temporal bone specimens from 18 patients who during life suffered a sudden partial or complete sensorineural hearing loss were studied  
class2	537	on the basis of clinical data  these cases were assigned to one of three diagnostic categories  and the temporal bones were studied by light microscopy and serial section analysis  
class2	537	the implications of the histopathologic findings for the pathogenesis of idiopathic sudden sensorineural hearing loss are discussed  
class2	538	lymphomatoid granulomatosis presenting as ulcerodestructive gastrointestinal tract lesions in patients with human immunodeficiency virus infection  a new association  
class2	538	we describe cases of severe odynophagia  extensive oral ulcerations  and bowel perforation in patients with human immunodeficiency virus infection that were caused by lymphomatoid granulomatosis  
class2	538	such presentations in human immunodeficiency virus infected individuals are usually ascribed to other causes and may be incorrectly treated on an empiric basis  
class2	538	in addition  deep tissue specimens obtained at the margin of ulcerative lesions are often necessary for definitive diagnosis  
class2	538	we review our limited treatment experience with zidovudine  interferon alfa  and h2 blockers in our patients  
class2	538	based on the markedly increased frequency in which lymphomatoid granulomatosis is being diagnosed at our institution in the post human immunodeficiency virus era  we postulated an association between these two entities  
class2	539	disseminated strongyloidiasis with central nervous system involvement diagnosed antemortem in a patient with acquired immunodeficiency syndrome and burkitts lymphoma  
class2	539	a 45 year old man presented with central nervous system involvement as the initial manifestation of disseminated infection with strongyloides stercoralis  
class2	539	several concurrent clinical factors contributed to this event  all related to the patient s immunosuppression  including high grade lymphoma  corticosteroid therapy  and acquired immunodeficiency syndrome  
class2	539	this is only the third case of cns involvement in disseminated strongyloidiasis diagnosed antemortem  
class2	540	does prematurity alter the course of respiratory syncytial virus infection  
class2	540	we compared previously healthy prematurely born infants with full term infants hospitalized with respiratory syncytial virus  rsv  infection to evaluate the role of prematurity on the clinical course of the illness  
class2	540	during a 5 yr period  1984 to 1989   484 previously healthy patients were admitted to the hospital with rsv infection  
class2	540	no differences were found in the presenting symptoms of respiratory distress  cough  fever or shock  although the premature group was more likely to present with apnea  p less than  001   
class2	540	chest roentgenograms revealed that premature infants had a higher incidence of atelectasis infiltrate and hyperinflation  p less than  05   
class2	540	premature infants had longer hospital stays as well as a higher physiologic stability index and therapeutic intervention score  p less than  001   
class2	540	they were also more likely to receive supplemental oxygen  icu admission  mechanical ventilation  and nothing by mouth status  p less than  001   
class2	540	we conclude that premature birth increases the risk of more severe and prolonged rsv disease  
class2	541	tracheal stenosis and failure to wean from mechanical ventilation due to herpetic tracheitis  
class2	541	a 64 year old man with chronic obstructive pulmonary disease presented with pneumococcal pneumonia that progressed to respiratory failure within one week  requiring mechanical ventilation  
class2	541	despite a low minute ventilation and clear chest roentgenogram  multiple weaning attempts failed  
class2	541	bronchoscopy revealed significant narrowing of the distal trachea with erythema  edema  and ulceration of the mucosa  
class2	541	cytology of tracheal washings was consistent with herpes simplex virus  and the patient was successfully extubated following treatment with intravenous acyclovir  
class2	541	bronchoscopy following acyclovir therapy demonstrated resolution of the inflammation and narrowing  
class2	541	herpetic tracheitis is a rarely recognized reversible cause of tracheal stenosis  especially in a nonimmunocompromised patient  
class2	541	it should be suspected in patients without an obvious cause of failure to wean from mechanical ventilation  and can be successfully treated with acyclovir  
class2	542	herpes simplex virus hepatitis in pregnancy  two patients successfully treated with acyclovir  
class2	542	two cases of herpes simplex virus hepatitis in pregnancy are presented  
class2	542	each case was characterized by extremely high serum aminotransferase levels with minimal bilirubin elevation  
class2	542	in both cases  liver biopsy was instrumental in arriving at the diagnosis  
class2	542	in addition  computed tomography showed a radiographic appearance of the liver not characteristically seen in other hepatic disorders of pregnancy  
class2	542	a high index of suspicion in the second case led to early recognition and treatment  
class2	542	despite the presence of fulminant liver failure and evidence of herpes encephalitis in the other case  institution of therapy with acyclovir was associated with complete recovery in both patients  
class2	542	the present cases are compared and contrasted with the literature  
class2	542	the incidence of two cases within a 6 month period suggests that herpes simplex virus hepatitis in pregnancy may occur more frequently than previously reported  
class2	543	gastrointestinal motor dysfunction in acquired selective cholinergic dysautonomia associated with infectious mononucleosis  
class2	543	this report documents the disturbance in gastrointestinal motor function in a patient with selective cholinergic dysautonomia that occurred following acute infectious mononucleosis  
class2	543	apart from the gut  other organs affected included the pupils  sweat glands  lacrimal and salivary glands  and urinary bladder  
class2	543	autonomic function tests showed the preservation of sympathetic adrenergic functions in contrast to the generalized involvement of postganglionic parasympathetic and sympathetic cholinergic nerves  including denervation hypersensitivity of the pupil and urinary bladder to exogenous cholinergic agonists  
class2	543	cardiac and abdominal vagal responses were abnormal  
class2	543	colon myenteric plexus ganglion cells were normal by morphological and immunohistochemical studies  suggesting that the selective cholinergic dysautonomia was the most likely pathophysiologic process responsible for the observed motility disorder  
class2	543	this study documents the occurrence of selective cholinergic dysautonomia following a viral illness  the importance of the extrinsic neural control on the motor function of the gastrointestinal tract  and the usefulness of combined motility and autonomic function testing in the evaluation of patients with symptoms suggestive of gut dysmotility  
class2	544	hepatic fibrin ring granulomas in a patient with hepatitis a  
class2	544	hepatic fibrin ring granulomas were found in a 30 year old patient with serologically confirmed hepatitis a  
class2	544	other causes associated with the presence of fibrin ring granulomas in the liver  such as hodgkin s and non hodgkin s lymphoma  cytomegalovirus infection  visceral leishmaniasis  and consumption of allopurinol  were ruled out  
class2	544	it is suggested that hepatitis a must be included in the differential diagnosis of a patient with hepatic fibrin ring granulomas  
class2	545	are stressful life events risk factors for herpes zoster  
class2	545	to determine if psychologically stressful life events are risk factors for herpes zoster  we conducted a case control study of zoster and self reported recent negative life events and major changes in spousal relationships  
class2	545	the subjects were 101 healthy community dwelling cases of zoster and 101 healthy controls matched for age  sex  and race and generated by random digit dialing  
class2	545	the geriatric scale of recent life events was administered to case and control subjects  and additional questions were asked regarding the perception of the life event  
class2	545	the results showed that case subjects experienced negative life events significantly more often than subjects in the control groups in the 2 months before zoster onset by analysis of discordant pairs  26 versus 10  odds ratio 2 60  95  confidence interval  ci  1 13  6 27  p    012   3 months before  29 versus 11  odds ratio 2 64  95  ci 1 20  6 04  p    007   or 6 months before  35 versus 16  odds ratio 2 00  95  ci 1 04  3 93  p    012   
class2	545	the mean number of total life events was significantly higher in cases at 6 months before zoster  case means   2 64  control means   1 82  p    008   but there were no significant differences at 2  3  or 12 months before  
class2	545	there were no significant differences between case subjects and control subjects for spousal events  or any given single life event  
class2	545	in conclusion  we found that whereas patients with herpes zoster experienced the same kinds of life events in the year preceding the illness as did control subjects  recent events perceived as stressful were significantly more common among patients with zoster  
class2	546	human immunodeficiency virus and the primary care physician  
class2	546	as the scope and size of the human immunodeficiency virus  hiv  epidemic grows  the primary care physician will need to assume a greater role  
class2	546	a knowledge of hiv risk factors and the ability to perform pretest and posttest counseling for hiv testing is essential  
class2	546	counseling patients on hiv risk reduction should be part of the hiv risk interview  
class2	546	an understanding of the benefits and contraindications of testing  as well as a respect for the impact of testing  is important  
class2	546	all hiv seropositive individuals should undergo a complete history and review of symptoms as soon as test results are known  
class2	546	judicious use of laboratory testing  including monitoring of cd4 cell counts  is recommended  
class2	546	pneumocystis carinii prophylaxis and zidovudine therapy should be offered to patients with appropriately low cd4 counts  
class2	547	immunopathology and viral reactivation  a general theory of schizophrenia  
class2	547	a theory is proposed that explains a broad range of clinical manifestations in schizophrenia  
class2	547	it is a heuristic device for organizing research in the neuroimmunology and virology of schizophrenia  
class2	547	this approach is different from other immune and viral theories of schizophrenia and defines testable hypotheses for further theory refinement or rejection  
class2	547	defective alpha interferon  aifn  regulation resulting in excessive effect is postulated to cause schizophrenia  
class2	547	the role of aifn in the regulation of development and its induction within the brain by the reactivation of viruses that are commonly present in the normal central nervous system  cns  are the primary pathophysiological mechanisms  
class2	547	biological properties of aifn include neural excitation  opiate and adrenocorticotropic hormone activity  and inhibition of cellular proliferation and differentiation  
class2	547	psychosis results from in situ viral stimulation of aifn production in the cns of a vulnerable host having defective regulation of either sensitivity or production  
class2	547	negative symptoms result from aifn effects on cns development and the behavioral toxicity of aifn  
class2	547	biological developmental abnormalities  gender differences in severity  and decline in psychotic symptoms with age are discussed in the context of the theory  
class2	547	research strategies and specific testable hypotheses are presented  
class2	548	chancroid and the role of genital ulcer disease in the spread of human retroviruses  
class2	548	chancroid is the most prevalent form of genital ulcer disease in developing countries and is undergoing a resurgence in industrialized countries  
class2	548	as a result of a nonspecificity of the clinical findings  the etiologic diagnosis of genital ulcer disease requires laboratory support  
class2	548	genital ulcer disease is a risk factor for the transmission of human retroviral infections  
class2	548	an understanding of this interaction is emerging and will impact on the treatment and control programs for the agents causing genital ulcer disease  
class2	549	human papillomavirus infections of the genital tract  
class2	549	infection of the genital tract by hpv is a sexually transmitted disease of increasing prevalence  
class2	549	the association of hpv infection with genital tract malignancies is of great concern  and further studies are needed to clarify this association  
class2	549	few investigators believe at this time that proof of a direct causative role exists for hpv in these cancers  but indirect evidence of such a role is abundant  
class2	549	there are many clinical forms of hpv infection of the genital tract  and few clinicians can easily recognize them all  
class2	549	treatment of condyloma acuminatum is difficult and frustrating  
class2	549	cryotherapy with liquid nitrogen is the safest and most effective therapy for most forms of condyloma acuminatum  
class2	549	recurrence of condyloma acuminatum is common with all presently used forms of therapy  probably owing to latent hpv infection in normal appearing skin  
class2	549	no form of treatment is ideal for all forms of condyloma acuminatum  but without continued efforts to find better therapeutic modalities and preventative measures  the epidemic of genital hpv infection will continue unchecked  
class2	550	the emergence of hepatitis b as a sexually transmitted disease  
class2	550	in the united states  approximately 300 000 cases of hepatitis b virus infection occur annually  and heterosexual activity is one of the most commonly reported risk factors for acquiring disease  
class2	550	until the number of infections transmitted through heterosexual contact can be reduced through hepatitis b vaccination  there is little chance of controlling this infection  
class2	551	epidemiology of human immunodeficiency virus infection in women in the united states  
class2	551	from 1981 to 1989  the number of women with hiv infection and acquired immunodeficiency syndrome  aids  increased rapidly  
class2	551	most women were infected through intravenous drug use or sexual contact with an infected man  
class2	551	most children were infected through mother to infant transmission during pregnancy or delivery  
class2	551	available data suggest that the rapid increase in the number of women with aids will continue for at least the next few years  
class2	552	primary care of women infected with the human immunodeficiency virus  
class2	552	aids is the leading cause of death among women aged 25 to 34 years in new york city  
class2	552	gynecologic care should be directed toward early identification and aggressive treatment of infectious and neoplastic processes that may take a more fulminant course in immunosuppressed women  
class2	552	dealing with women s contraceptive needs highlights the problem of preventing sexually transmitted diseases through contraceptive technology  
class2	552	public health policies and recommendations will be of no avail without an educated and supportive medical community  
class2	553	isolation of human t cell lymphotropic virus type 2 from guaymi indians in panama  
class2	553	human t lymphotropic virus type i  htlv i  is associated with adult t cell leukemia lymphoma and with a chronic degenerative myelopathy  
class2	553	however  another major type of htlv  htlv ii  has been isolated only sporadically  and little is known of disease associations  transmission routes  and risk factors for htlv ii infection  
class2	553	recent studies indicate that a high percentage of certain groups of i v  
class2	553	drug users and blood donors are infected with htlv ii  
class2	553	seroepidemiologic studies have found an elevated rate of seroreactivity to htlv among guaymi indians from bocas del toro province  panama  
class2	553	to identify the cause of seroreactivity among this unique population we used htlv ii specific polymerase chain reaction techniques to detect htlv genetic sequences from blood leukocytes of three seropositive guaymi indians  
class2	553	the htlv ii primer amplified polymerase chain reaction products from two of these subjects were partially sequenced and matched published htlv ii nucleotide sequences in both p24 gag  94  of 107 bases  and pol  98  of 112 bases  regions  
class2	553	a cd4  t lymphocyte line established from one of these same subjects produced htlv ii specific proteins when tested in antigen capture and immunoblot assays  as well as mature htlv particles  
class2	553	the demonstration of htlv ii infection in this geographically and culturally isolated central american indian population without typical risk factors for htlv infection suggests that htlv ii infection is endemic in this population and provides an important clue to potential natural reservoir for this virus  
class2	554	immunological studies of the basis for the apathogenicity of simian immunodeficiency virus from african green monkeys  
class2	554	potential reasons for the lack of pathogenicity of the simian immunodeficiency virus sivagm in its natural host  the african green monkey  agm  cercopithecus aethiops   were investigated with respect to immunological mechanisms  
class2	554	the functional immune response of monkeys to infection was similar  though not identical  to that of humans to infection with human immunodeficiency virus type 1  hiv 1   
class2	554	in the sera of infected animals  neutralizing antibodies were found to be low or absent  and in particular there was no neutralization of the various isolates by homologous sera  
class2	554	there was no detectable antibody complement cytotoxicity  though agm sera were able to initiate antibody dependent cellular cytolysis of infected cells in the presence of healthy effector peripheral blood lymphocytes  
class2	554	as in the human hiv system  macrophages from agms are readily infected by sivagm  
class2	554	two possibly important differences between the agm sivagm system and the human hiv system are  i  the low immune response of the agms to the core protein of sivagm and  ii  the significantly lower inhibitory effect of sivagm proteins on the proliferation of agm lymphocytes  
class2	555	granulomatous pneumocystis carinii pneumonia in a patient with the acquired immunodeficiency syndrome  
class2	555	a patient with an unusual granulomatous response to infection with pneumocystis carinii is described  
class2	555	the diagnosis was made by open lung biopsy after two negative bronchoalveolar lavages  
class2	556	bronchoalveolar lavage via a modified stomach tube in intubated patients with the acquired immunodeficiency syndrome and diffuse pneumonia  
class2	556	a simple non bronchoscopic bronchoalveolar lavage method was used in 30 patients with the acquired immunodeficiency syndrome undergoing assisted ventilation for respiratory failure  
class2	556	a modified argyle levin stomach tube was passed via the endotracheal tube and lavage performed  
class2	556	the lavage was well tolerated and performed quickly and easily  required little training  and had a high degree of sensitivity  73   a diagnosis in 22 of the 30 cases   
class2	557	current report  hiv  aids at the crossroads  a report from the 1990 international conference on aids  san francisco  
class2	557	major scientific and clinical breakthroughs in hiv disease are rarely saved for the international conference on aids  
class2	557	nevertheless  this conference provides an opportunity for experts  providers  and patients to gain new information  exchange ideas  and assess progress  
class2	557	the conference is also a public forum for political and social discussion and serves as a barometer of scientific and social trends as well  
class2	557	this year s conference featured refinements in clinical care  a deeper understanding of the epidemiologic trends  and a public awareness of the many political aspects of the aids epidemic  
class2	557	contributions from family physicians and other primary care providers about problems they face and the family aspects of hiv need still greater prominence and exposure  
class2	557	hopefully family physicians will use their expertise and report at future international conferences  
class2	558	the incidence of myocarditis in endomyocardial biopsy samples from patients with congestive heart failure  
class2	558	we present the combined experience of three yugoslavian cardiovascular centers in the application of endomyocardial biopsy for the diagnosis of myocarditis in patients who present clinically with congestive heart failure  
class2	558	the study group comprised 107 patients  mean age  40 8 years  range  19 to 61 years   
class2	558	on the basis of patient history and diagnostic tests  the following clinical diagnoses were established  dilated cardiomyopathy  85   myocarditis  16   and alcohol induced heart disease  6   
class2	558	emb samples were taken from the left ventricle  95  or both ventricles  12  by use of a king s college bioptome  with a mean of 3 2 samples per patient  
class2	558	histologic evidence of myocarditis was noted in 10 of 85 patients  12   with a clinical diagnosis of dilated cardiomyopathy  in 2 of 6 patients  33   with alcohol induced heart disease  and in 12 of 16 patients  75   with a clinical diagnosis of myocarditis  
class2	558	there was confirmation of the clinically suspected diagnosis in 63  of cases  a change of diagnosis based on histology in 15  of cases  and nonspecific findings in 22   
class2	558	however  useful information was obtained in 78  of the cases  and there was a 22  incidence of histologically proven myocarditis for the entire group  
class2	558	our results indicate that endomyocardial biopsy is beneficial in determining the true incidence of myocarditis in patients with a clinical presentation of dilated cardiomyopathy  
class2	559	effect of delayed captopril therapy on left ventricular mass and myonecrosis during acute coxsackievirus murine myocarditis  
class2	559	the effect of captopril on coxsackievirus b3 murine myocarditis was investigated  
class2	559	thirty two  3 week old mice were infected with coxsackievirus b3 on day 0 of the study  then randomized into a placebo group or a captopril group starting on day 3 of infection  
class2	559	on day 9 of infection  the mice were put to death  
class2	559	hearts were weighed and processed for light microscopic examination  
class2	559	heart weight was 125     19 mg in the control group versus 102     14 mg in the captopril group  p less than 0 0003   
class2	559	amount of necrosis as a percentage of left ventricular section was 3 5   2 0  to 7 5   in the placebo group versus 2 0   0 0  to 5 0   in the captopril group  p less than 0 01   
class2	559	the amount of dystrophic calcification was 5 0   0 0  to 27 5   in the placebo group versus 1 3   0 0  to 20 0   in the captopril group  p less than 0 01   
class2	559	the extent of the histopathologic involvement by planimetry was 10 2  in the placebo group versus 5 4  in the captopril group  p   0 052   
class2	559	we conclude that captopril is beneficial in decreasing left ventricular mass and the amount of myocardial necrosis and calcification in the short term in the murine myocarditis model  
class2	560	central retinal artery obstruction in herpes zoster ophthalmicus and cerebral vasculopathy  
class2	560	we present a case of acute central retinal artery obstruction in association with herpes zoster ophthalmicus and delayed cerebral vasculopathy  
class2	560	retinal vascular obstruction is rare in zoster  and its occurrence during postherpetic cerebral vasculopathy has not been reported previously to our knowledge  
class2	560	the syndrome of delayed cerebral vasculopathy is discussed as is its possible relationship to central retinal artery obstruction  
class2	561	central nervous system vasculitis after chickenpox  cause or coincidence  
class2	561	a 7 5 year old boy  known to have a seizure disorder  presented with an infarct in the left middle cerebral artery territory  10 weeks after severe chickenpox  
class2	561	immunofluorescent antibody titre to the varicella zoster virus in the cerebrospinal fluid was 1 32  
class2	561	cerebral angiography showed evidence of focal vasculitis  
class2	561	he presented again seven months later with an acute exacerbation of seizures  
class2	561	magnetic resonance imaging of the brain showed an old posterior extension of the infarct  but a repeated angiography demonstrated an improvement in the vasculitic process  
class2	561	cerebrospinal fluid antibody titre was again 1 32  
class2	561	although this may have been an unfortunate coincidence  a possible association between chickenpox and vasculitis  similar to that reported with herpes zoster  and with potentially significant clinical implications  should be considered  
class2	561	as a definite proof can be obtained only by a brain biopsy  however  which is generally not indicated in such cases  only additional clinical reports can lead to delineation of this association as a definite entity  
class2	562	continued need for pneumococcal prophylaxis after splenectomy 
class2	562	two children died from pneumococcal infection five and eight years after splenectomy  
class2	562	pneumococcal vaccination had not been given to either child  
class2	562	when the infection developed both children were not taking prophylactic penicillin  
class2	562	vaccination and daily penicillin reduce the incidence of this complication and therefore we strongly recommend that both of these measures are continued indefinitely  
class2	563	five year prospective study of hiv infection in the edinburgh haemophiliac cohort 
class2	563	objective  to identify measures of immune state that reflect the course of hiv related disease in order to predict deterioration of symptoms and assess response to treatment  
class2	563	design  five year longitudinal clinical and laboratory study  
class2	563	setting  regional haemophilia centre  university virology laboratory  and medical research council laboratory  
class2	563	patients  32 patients with haemophilia a exposed to a single batch of hiv contaminated factor viii concentrate from the scottish national blood transfusion service in 1984 who were followed up regularly in edinburgh  31  or abroad  one   
class2	563	main outcome measures  counts of circulating t cell subsets  cd4 and cd8   plasma beta 2 microglobulin  neopterin  and iga concentrations  and delayed type hypersensitivity to multiple skin test antigens  
class2	563	results  18 patients who seroconverted after exposure had received significantly more contaminated factor viii than the 14 who did not  mean 43  range 9 109  v 15  3 30  phials  p less than 0 01   
class2	563	the two groups were not distinguishable by other criteria before exposure  
class2	563	the group that seroconverted subsequently showed a progressive fall in mean circulating cd4 lymphocytes and an increase in plasma beta 2 microglobulin and neopterin concentrations  
class2	563	from 1987 patients in this group also showed an increase in mean circulating cd8 lymphocytes and in plasma iga concentration  neither of which was seen in patients who did not seroconvert  
class2	563	patients with hiv antibody who developed centers for disease control category iv symptoms within five years after infection showed more extreme changes in all measures  except cd8 lymphocyte count  than those whose symptoms remained in categories ii and iii  
class2	563	skin test reactivity declined to barely detectable levels in all patients positive for hiv antibody  
class2	563	conclusions  serial estimates of circulating cd4 lymphocytes and of plasma beta 2 microglobulin concentration are the most reliable measures of disease progression  of these  beta 2 microglobulin concentration seems to be the better predictor of impending serious symptoms  
class2	563	high iga concentrations reflect rather than predict disease state  
class2	563	individual variation in most measures is such that a wide range of measurements should be used in assessing the effects of trial treatment in hiv infected patients without symptoms  
class2	564	causes  diagnosis  and treatment of pharyngitis  
class2	564	pharyngitis is a common disease of the respiratory tract that can be caused by several different viruses and bacterial organisms  
class2	564	clinically speaking  the most important causative agent is group a streptococcus  streptococcus pyogenes   
class2	564	although rare  postpharyngitis complications arise as a result of disease caused almost exclusively by group a streptococcus  
class2	564	because group a streptococcal pharyngitis usually responds well to antimicrobial treatment  it is important to diagnose it  
class2	564	penicillin  erythromycin  and peroral first generation cephalosporins have been documented to be effective  
class2	564	in addition to group a streptococcus  c  
class2	564	pneumoniae and m  
class2	564	pneumoniae have also been detected in patients with pharyngitis  
class2	564	the possibility of diagnosing these organisms is limited at the present  
class2	564	clinical surveys are still needed  moreover  to evaluate the effect of antimicrobial treatment on the disease caused by these organisms  
class2	564	although routine viral diagnostic methods do not help primary care physicians in treating patients with pharyngitis  information on bacteria and viruses in the immediate environment could prove to be of great help in daily clinical work  
class2	565	increasing incidence of varicella hospitalizations in united states army and navy personnel  are today s teenagers more susceptible  should recruits be vaccinated  
class2	565	hospital records for 10 687 united states army and navy adult varicella  chickenpox  admissions were reviewed  
class2	565	annual hospital admission rates for varicella increased more than fourfold in the active duty army during 1980 to 1988 and more than 18 fold among active duty navy enlisted personnel during 1975 to 1988  
class2	565	fifty seven percent of varicella admissions occurred in the most junior military members  aged 17 to 20  
class2	565	more than half of the total varicella admissions occurred in personnel with less than a year of military service  
class2	565	multivariate analysis of the navy data confirmed increasing time related trends of risk  suggesting a national temporal trend of increased varicella susceptibility in us teenagers and young adults  
class2	565	administering a safe and effective varicella vaccine to army and navy recruits could prevent more than 7260 hospital bed days during the first year of use  
class2	566	a routine tool for detection and assessment of epidemics of influenza like syndromes in france  
class2	566	a regression model for the nonepidemic level of influenza like syndrome has been estimated from the 55 200 cases collected between october 1984 and august 1988 using the french communicable diseases computer network  
class2	566	the start of a major epidemic in 1988 89 was detected early  
class2	566	the size of the epidemic  for the entire country  was estimated at approximately 4 3 million cases  
class2	566	the excess cost of sick leave  among those of working age  was estimated at  86 million  
class2	567	increased septic complications with three drug sequential immunosuppression for cadaver renal transplants  
class2	567	in 152 renal transplant recipients  the results of immunosuppression with three drug sequential  minnesota antilymphocyte globulin  prednisone  azathioprine  and cyclosporine  immunosuppression  n   107  were compared with those of a two drug sequential protocol  minnesota antilymphocyte globulin  prednisone  and cyclosporine  that excluded azathioprine  n   45   
class2	567	the study groups were comparable by age  sex  etiology of renal failure  incidence of diabetes  and degree of hla matching  
class2	567	patient survival at 1 year was not significantly different in the two groups  two drug  93  versus three drug  86   p   0 19   
class2	567	one year graft survival was superior in the two drug group  two drug  93  versus three drug  75   p   0 02   
class2	567	analysis of primary transplants only  n   116  yielded the same results  
class2	567	during the first year  the serum creatinine level remained stable in both groups  
class2	567	as expected  the three drug therapy group had significantly more bacterial and viral infections  
class2	567	for low risk primary cadaveric renal transplants  two drug sequential immunosuppression is superior  
class2	568	cerebrospinal fluid neopterin in human immunodeficiency virus type 1 infection  
class2	568	we evaluated cerebrospinal fluid  csf  concentrations of neopterin  a putative marker of activated macrophages  in 97 subjects infected with human immunodeficiency virus type 1 who had a spectrum of neurological complications  
class2	568	the highest csf neopterin concentrations occurred in those with neurological opportunistic infections  primary central nervous systems lymphoma  and acquired immunodeficiency syndrome  aids  dementia complex  
class2	568	in general  the csf concentration of neopterin was independent of csf cell count and blood brain barrier disruption to albumin  
class2	568	in the patients with aids dementia complex  csf neopterin concentrations correlated with severity of disease and decreased in conjunction with clinical improvement following treatment with zidovudine  
class2	568	these results suggest that csf neopterin  although not disease specific  may be useful as a surrogate marker for the presence of aids dementia complex and its response to antiviral therapy  
class2	569	an hiv 1 and hiv 2 cross reactive cytotoxic t cell epitope  
class2	569	the hla b27 restricted hiv gag cytotoxic t lymphocyte  ctl  epitope  265 279  is highly conserved amongst hiv 1 isolates  only one  hiv 1eli  having a single amino acid substitution  
class2	569	over the same region hiv 2 differs by five amino acids  
class2	569	as a broadly cross protective aids vaccine should protect against infection from all isolates of hiv 1 and hiv 2  we tested ctl specific for the hiv 1 265 279 epitope with peptide analogues from hiv 1eli  hiv 2 and two simian immunodeficiency virus  siv  isolates  and with recombinant vaccinia viruses expressing the respective gag genes  to determine whether there was any cross reactivity for this ctl epitope  
class2	569	ctl from the hiv 1 infected donor could recognize the hiv 1eli peptide  the hiv 2 peptide and recombinant vaccinia virus infected target and one of the two siv peptide treated targets  
class2	569	epitopes that exhibit such cross reactivity may be valuable in vaccine design  
class2	570	response of mononuclear cells from hiv infected patients to b cell mitogens  correlation with immunological and clinical features of disease progression  
class2	570	proliferation of mononuclear cells from hiv seropositive patients to b cell mitogens was studied in the absence and presence of mixed lymphocyte culture supernatants  mlc sup   
class2	570	the results show   1  patients  responses to b cell mitogens overlap with normal responses but are  on average  consistently lower than normal   2  the addition of mlc sup increases the proliferative responses to t cell independent mitogens  but does not bring patient s responses up to control levels   3  hiv positive patients in all clinical categories have decreased responses to b cell mitogens  
class2	570	although some patients with aids centers for disease control  cdc  group ivc and ivd have the lowest responses  asymptomatic  cdc group ii  and aids related complex  arc  cdc groups iii iva and ivb  patients also show significant defects  
class2	570	 4  the same patients were recategorized using an immunological staging system  
class2	570	those patients with more normal immunohematological parameters have significantly greater responses to mitogens compared with patients with more abnormal immunological parameters  
class2	570	the data suggest that immunological staging could provide more information than clinical classification with respect to the underlying immunopathogenic events occurring in hiv infection  
class2	571	aids following mother to child transmission of hiv 2  
class2	571	mother to child infection with hiv 2 is thought to be rare  and there have been few previous reports of transmission by this route  
class2	571	reports of morbidity associated with hiv 2 infection in children are also rare  
class2	571	we describe eight children born to mothers who were infected with hiv 2  five developed aids  and three were still seropositive at 17 49 months of age  
class2	571	the only apparent route of hiv 2 transmission was from mother to child  except for one child who had been transfused  
class2	571	three of the children with aids died  all having decreased cd4  lymphocytes and mitogen responses  
class2	571	further studies are needed to determine the prevalence and natural history of mother to child transmission of hiv 2  
class2	572	an analysis of the economic impact of hiv infection among patients at mama yemo hospital  kinshasa  zaire  
class2	572	in a prospective study of adult admissions to the department of internal medicine at mama yemo hospital  kinshasa  zaire in late 1988  129 women and 122 men were screened for hiv infection  
class2	572	fifty per cent were found to be seropositive  with half of the seropositives meeting the world health organization  who  clinical aids definition  
class2	572	the hiv seropositives had a mortality rate of 50   which was significantly higher  p   0 004  than the 30  mortality rate seen in the seronegative group  
class2	572	direct costs during hospitalization did not differ   60 30 for hiv seropositives   56 50 for hiv seronegatives   but pre hospitalization expenses were significantly higher in the hiv seropositive group   170 for hiv seropositives   110 for hiv seronegatives   
class2	572	years of productive life lost due to death were also significantly higher for hiv seropositives versus hiv seronegatives  30 6 versus 21 3 years  p   0 0007   and 73  of the premature mortality in the study population was attributable to hiv infection  
class2	573	a semiquantitative microassay for measurement of relative number of blood mononuclear cells infected with human immunodeficiency virus  
class2	573	a simple semiquantitative microassay was developed for the measurement of relative number of infected peripheral blood mononuclear cells  pbmc  from individuals infected with human immunodeficiency virus  hiv   
class2	573	the assay is based on cocultivation of serially diluted pbmc of a seropositive person with phytohemagglutinin stimulated normal pbmc  
class2	573	the microassay has comparable sensitivity with the standard virus culture method in detecting positive hiv cultures  
class2	573	since the microassay uses only 2 3 x 10 5  patients  pbmc  the assay is also most suitable for hiv isolation from hiv infected infants or from aids patients with extremely low t cell counts  
class2	573	the microassay can also be used to measure antiviral effects of a drug on persistent hiv infection in vitro  
class2	573	because the microassay measures the relative number of infected pbmc  it can be readily used for following the quantitative antiviral effect of a drug in a clinical trial  
class2	574	cumulative aids incidence and altered mortality from bacterial infections  
class2	574	to determine whether populations with high cumulative incidence of acquired immunodeficiency syndrome  aids  experienced increased deaths from sepsis  central nervous system abscess  or endocarditis  new jersey aids patients were grouped according to their age  sex  race  and residence specific cumulative incidence of aids since the onset of the aids epidemic  
class2	574	between 1980 and 1986  among 25 44 year olds in the highest cumulative incidence group for aids  sepsis mortality increased from 3 3 to 15 2 deaths 100 000 year  an increase of 11 9 deaths 100 000 year  95  confidence interval  6 9  17 0  deaths 100 000 year   mortality from central nervous system abscesses increased from zero to 1 7  0 1  3 2  deaths 100 000 year  and mortality from endocarditis increased from 0 8 deaths 100 000 year to 2 4 deaths 100 000 year  an increase of 1 6   0 5  3 7  deaths 100 000 year  
class2	574	age matched new jersey patient populations with low cumulative incidence of aids did not sustain a similar increase  
class2	574	the hiv disease associated increase in sepsis mortality among young populations represents a new component of the substantial increase in u s  
class2	574	sepsis mortality that occurred over the last two decades  but was previously limited to older populations  
class2	575	complications of tenckhoff catheters post removal  
class2	575	complications due to tenckhoff catheters can occur at prolonged intervals after their removal  
class2	575	from january 1979 to october 1989  431 patients at our center began continuous ambulatory peritoneal dialysis  capd   278 of whom subsequently transferred to another form of renal replacement therapy  
class2	575	we identified 12 patients  4 3  or 12 278  with post removal catheter complications  
class2	575	there were 14 post removal complications  two each in two patients  and one in each of 12 others  
class2	575	the mean time to complication was 541     143 days  27 2 040   
class2	575	in 71   10 14  of the complications  an abscess was found at the site of the previously removed tenckhoff catheter  
class2	575	in 29   4 14  of the complications  foreign body material consistent with a retained cuff was recovered  
class2	575	documentation at the time of tenckhoff catheter removal should include a statement regarding the presence of the tenckhoff catheter cuffs  and patients with retained cuffs should be monitored closely for the development of abscesses or other complications  
class2	575	immunocompromised patients are at high risk for these complications  
class2	576	cerebrospinal norepinephrine concentrations and the duration of epidural analgesia 
class2	576	this study was performed to determine whether the addition of norepinephrine to local anaesthetics prolongs epidural analgesia in man  
class2	576	in addition  cerebrospinal fluid norepinephrine  ne  concentrations were measured  
class2	576	in the first part of the study  epidural catheters were inserted in 14 patients before herniotomy  
class2	576	mepivacaine  1 5 per cent  0 35 ml kg 1   was administered and norepinephrine  5 micrograms ml 1  was added in seven patients  
class2	576	the duration of anaesthesia was prolonged from 54     11 min to 83     12 min  p less than 0 05  and csf ne concentrations increased from 68     12 pg ml 1 to 336     85 pg ml 1 in the ne group  p less than 0 01   
class2	576	in the second part  eight patients with herpetic neuralgia received epidural analgesia at the fourth to eighth thoracic interspace  using bupivacaine 0 25 per cent  with and without ne  
class2	576	the csf ne concentrations in this group were greater than in the surgical patients before operation and increased from 254     58 to 406     58 pg ml 1 30 min after administration of bupivacaine with ne  
class2	576	the duration of pain relief was prolonged with ne  
class2	576	these results suggest that adding ne to local anaesthetics prolongs epidural analgesia  
class2	576	moreover  ne concentrations in surgical patients increased to levels similar to those found in patients suffering from herpetic analgesia  
class2	576	this suggests that the increase of csf ne in chronic pain states has an antinociceptive effect  
class2	577	a phase i study of recombinant human interferon alpha 2a or human lymphoblastoid interferon alpha n1 and concomitant zidovudine in patients with aids related kaposi s sarcoma  
class2	577	to determine the safety  maximum tolerated dose  and preliminary efficacy of concomitant interferon alpha and zidovudine therapy in aids related kaposi s sarcoma  ks   56 patients with biopsy proven ks and documented human immunodeficiency virus type 1  hiv  infection were enrolled into a phase i study  
class2	577	interferon alpha was given intramuscularly at a dose of 9  18  or 27 mu once a day and zidovudine was administered as 100 or 200 mg every 4 h for 8 weeks followed by a 48 week maintenance period  
class2	577	the major toxicities were anemia  neutropenia  and hepatotoxicity  
class2	577	neutropenia was dose limiting with 1 200 mg of zidovudine day and the lowest dose of interferon alpha  9 mu day   
class2	577	hepatotoxicity was dose limiting with 27 mu of interferon and 600 mg of zidovudine day  
class2	577	cumulative dose related anemia or neutropenia was not seen during long term follow up  
class2	577	the maximum tolerated doses for the combination were defined as 18 mu daily for interferon alpha and 600 mg daily for zidovudine  
class2	577	variable changes in cd4 lymphocytes occurred during the first 8 weeks of therapy  
class2	577	at higher doses of the combination  sustained increases in median cd4 lymphocyte numbers were noted  p less than 0 001   
class2	577	in hiv antigenemic patients  progressive antigen suppression was seen with increasing doses of the combination  p less than 0 005   
class2	577	the overall antitumor response rate was 47   
class2	577	tumor regression was associated with better survival benefits  p less than 0 001  and a pretreatment cd4 cell count greater than or equal to 200 cells mm3  p   0 01   
class2	577	in conclusion  intermediate doses of interferon alpha and lower doses of zidovudine appear to be relatively well tolerated and associated with disease improvement  including survival benefits  
class2	578	cd4  monocyte counts in persons with hiv 1 infection  an early increase is followed by a progressive decline  
class2	578	in this study  we asked whether there is a difference in the number of cd4  and cd4  peripheral blood monocytes as cd4  t cells decrease during hiv mediated immunodeficiency  
class2	578	monocytes and t cells from 90 hiv positive and 43 hiv negative persons were analyzed by flow cytometry  
class2	578	the 90 hiv positive patients represented the entire spectrum of cd4  t cell counts  
class2	578	we report that as cd4  t cells decrease  the number of cd4  monocytes decrease in parallel  
class2	578	moreover  significantly higher cd4  monocyte counts were observed in persons with early stage hiv disease  i e   greater than 800 cd4  t cells mm3  than in hiv negative persons with greater than 800 cd4  t cells mm3  
class2	578	potential implications of these findings are discussed  
class2	579	cigarette smoking  a modifier of human immunodeficiency virus type 1 infection  
class2	579	two hundred and two homosexual men enrolled in a prospective cohort study of aids risk were assessed for differences in the occurrence and progression of human immunodeficiency virus type 1  hiv 1  infection with respect to cigarette smoking  
class2	579	among subjects who were initially seronegative  smokers were more likely than nonsmokers to become hiv 1 seropositive  p   0 03   
class2	579	after seroconversion  serum beta 2 microglobulin and cd4  lymphocyte levels were elevated in cigarette smokers relative to nonsmokers  p   0 02 for both comparisons   but both of these differences disappeared within 2 years  
class2	579	there was no detectable difference in the risk of aids or pneumocystis carinii pneumonia with respect to smoking  
class2	579	our data suggest that cigarette smoking may alter the immune response to hiv 1 infection  but it appears to have no marked effect on clinical outcome  
class2	579	they also suggest that cigarette smoking may be a surrogate marker for continued high risk sexual behavior in homosexual men  
class2	580	rectourethral fistula caused by kaposi s sarcoma  
class2	580	a 35 year old man with the acquired immunodeficiency syndrome related complex was evaluated for a persistent urethral discharge  pneumaturia and watery diarrhea  
class2	580	radiographic and endoscopic procedures established the diagnosis of a rectourethral fistula  
class2	580	perineal exploration and excision of the fistula revealed the pathological diagnosis of kaposi s sarcoma  
class2	580	the differential diagnosis of an acquired rectourethral fistula and the significance of kaposi s sarcoma are discussed  
class3	581	endoscopic cholangiopancreatography in hepatic clonorchiasis  a follow up study  
class3	581	cholangiographic changes of the biliary system in 16 patients with proven hepatic clonorchiasis  diagnosed by positive stool or bile ova isolates  were studied  
class3	581	all patients presented with epigastric pain  
class3	581	other symptoms included jaundice in 31   5 of 16  and fever in 12 5   2 of 16   
class3	581	praziquantel given at 25 mg kg for three doses in 1 day were administered  
class3	581	three consecutive stool tests were performed 3 months after treatment and were negative in 87 5   14 of 16   
class3	581	ercp studies were repeated at a mean interval of 31 6 months  range  8 to 69 months   
class3	581	measurements of the bile ducts on retrograde cholangiograms before and after treatment were compared using the paired student s t test  
class3	581	filling defects and blunting of the terminal bile ducts seen on the initial cholangiogram  interpreted as the presence of adult worms  disappeared after treatment  
class3	581	however  there was no significant change between pre  and post treatment measurement of bile duct caliber  
class3	581	bile duct dilation  irregularities  and ductal proliferation persisted despite eradication of the parasite  
class3	582	cardiac echinococcosis  the diagnostic value of computed tomography scanning  
class3	582	the diagnosis of cardiac hydatid disease is a difficult one  
class3	582	conventional and specific cardiac investigations are not pathognomonic of this disease  
class3	582	in this report  the diagnostic value of computed tomography  ct  scanning was prospectively investigated in seven patients  
class3	582	in five patients  the diagnosis was confirmed surgically  
class3	582	the ct information obtained correlated accurately to the operative findings  
class3	582	in all the patients  ct densities of the lesions were measured and were found to coincide with values of mean ct densities of hydatid cysts elsewhere in the body  
class3	582	the capability of measuring tissue densities is unique to ct scanning and have been emphasized in this report  
class3	583	impact of mass treatment of onchocerciasis with ivermectin on the transmission of infection  
class3	583	onchocerciasis is a major blinding disease that  until recently  has been essentially untreatable  
class3	583	ivermectin is a safe and effective drug for the mass treatment of onchocerciasis and when used on an individual basis  it reduces the ability of the treated person to transmit onchocerca volvulus infection  
class3	583	in the present study  the effect of community based ivermectin treatment on the degree of transmission within the community was assessed by determining the incidence of new infection in children  
class3	583	ivermectin was distributed annually on three occasions to the eligible members of a population of approximately 14 000 people living on a rubber plantation in a forest area endemic for onchocerciasis  
class3	583	after 2 years  the prevalence of infection in 5 year old children decreased by 21   
class3	583	the annual incidence in an uninfected cohort of children decreased by 35  and  after age specific adjustment  the reduction in incidence in 7  to 12 year old children was 45   
class3	583	thus  community based distribution of ivermectin led to a significant reduction in incidence of new infection  
class3	583	these findings suggest that ivermectin can be important in reducing the transmission of onchocerciasis  
class3	584	disseminated strongyloidiasis in aids and non aids immunocompromised hosts  diagnosis by sputum and bronchoalveolar lavage  
class3	584	in conclusion  disseminated strongyloidiasis is a fatal disease that commonly affects the lungs  
class3	584	the disease should be suspected in an immunocompromised host who came from an area endemic for s stercoralis even years before the onset of symptoms or in patients with unexplained gram negative bacteremia or meningitis  
class3	584	treatment should be started promptly and should be maintained for a long time  
class3	585	cerebral cysticercosis  
class3	585	we studied 143 cases of cerebral cysticercosis over a 30 year period  
class3	585	in 46 there was hydrocephalus due to cysts obstructing the cerebrospinal fluid pathways  with signs of hydrocephalus and cerebellar dysfunction  
class3	585	in 97 there were cysts in the cerebral parenchyma  causing symptoms of intracranial hypertension alone in 22 cases  with additional neurological deficits in the remainder  
class3	585	before 1980 diagnosis was made by pneumoencephalography and ventriculography  but since then it has mostly been done by computed tomography  
class3	585	in 28 cases scanned  typical abnormalities were present in 25  
class3	585	complement fixation tests were positive in serum in 74  of cases and in cerebrospinal fluid in 73   and the enzyme linked immunosorbent assay test was positive in serum in 90  and in cerebrospinal fluid in 92   
class3	585	treatment of cases with hydrocephalus was by removal of the cysts at craniotomy  with placement of a shunt where necessary  
class3	585	intracranial hypertension caused by parenchymal cysts was treated with steroids and osmotic agents  if possible  
class3	585	in resistant cases subtemporal decompression was needed  unilateral in 55 cases and bilateral in eight  
class3	585	mortality in the acute stage was 11   with a further 20  at follow up  
class3	586	pleuropulmonary manifestations of hepatic amebiasis 
class3	586	pleuropulmonary manifestations of hepatic amebiasis occurred in 30 patients  18  60   presented with at least 1 pulmonary complaint and 10  33   had multiple pulmonary symptoms  
class3	586	in 14 patients  47    abnormalities were found on examination of the chest  
class3	586	in 16 chest roentgenograms  53    there was at least 1 abnormality  right sided pleural effusion  9 patients  and elevated right hemidiaphragm  8 patients  were the most common  
class3	586	all patients were treated with metronidazole  flagyl  and had resolution of the amebic liver abscess and pulmonary disease  
class3	586	pleuropulmonary disease is a common complication of amebic liver abscess  
class3	586	the clinical presentation and chest roentgenograms are virtually diagnostic and obviate the need for invasive procedures to confirm the diagnosis  
class3	586	pleuropulmonary disease resolves with amebicidal treatment of the hepatic abscess  
class3	587	ascariasis  
class3	587	ascaris lumbricoides is the most common helminth to infect humans  
class3	587	infection occurs when contaminated soil containing mature eggs is swallowed  
class3	587	clinically  infection ranges from the asymptomatic carrier state to life threatening pulmonary disease or intestinal obstruction  
class3	587	diagnosis is most frequently established by identification of the eggs in stool specimens  
class3	587	treatment with antiparasitic drugs is effective in preventing serious complications and eradicating the parasite from all members of the household  
class3	588	toxoplasmic chorioretinitis and hepatic granulomas  
class3	588	a 71 yr old male presented with a 2 month history of fever  malaise  and weight loss  
class3	588	physical exam revealed chorioretinitis  
class3	588	laboratory studies were notable for elevated levels of alkaline phosphatase  gamma glutamyl transpeptidase  aspartate transaminase  and alanine transaminase  
class3	588	immunoglobulin g antibody to toxoplasma gondii was positive to a dilution of 1 4096  whereas serologic studies for hepatitis a virus  hepatitis b virus  cytomegalovirus  epstein barr virus  human immunodeficiency virus  brucella  and tularemia were negative  
class3	588	a percutaneous biopsy of the liver revealed hepatic granulomas  
class3	588	culture of the biopsy specimen was negative for growth of mycobacteria or fungi  
class3	588	spontaneous improvement in clinical and laboratory parameters occurred over a 4 month period  
class3	589	high infectious morbidity in pregnant women with insulin dependent diabetes  an understated complication  
class3	589	patients with insulin dependent diabetes are prone to infection  possibly related to poor metabolic control  
class3	589	relative immune deficiency exists in pregnancy  
class3	589	we hypothesized that pregnant patients with insulin dependent diabetes are at an increased risk for infection and that infection is related to poor glycemic control  
class3	589	we matched 65 pregnant women with insulin dependent diabetes to 65 nondiabetic pregnant controls  
class3	589	at least one episode of infection before delivery occurred in 83  of the women with insulin dependent diabetes  26  in control group   
class3	589	the rate of postpartum infection was five times higher in the group with insulin dependent diabetes and they were susceptible to more kinds of infections  
class3	589	although there was no overall difference among the indices of glycemic control  hemoglobin a1 obtained before the infection was higher than during infection  
class3	589	we conclude that a high rate of infection exists in pregnant women with diabetes  infection and poor glycemic control may be associated  but it is unclear whether improvement in metabolic control will reduce this high infection rate  
class3	590	successful medical management of acanthamoeba keratitis 
class3	590	seven patients with documented acanthamoeba keratitis were treated with prolonged and intensive triple antiamoebic therapy consisting of topical neomycin polymyxin b gramicidin  propamidine isethionate 0 1   and miconazole nitrate 1   
class3	590	additionally  five patients were treated with topical corticosteroids  
class3	590	six of seven patients were cured of acanthamoeba keratitis with medical therapy alone  one patient required therapeutic penetrating keratoplasty to eradicate the infection  
class3	590	two patients underwent penetrating keratoplasty to improve their vision after medical therapy  
class3	590	our series differs from previous reports in that triple antiamoebic therapy was used in all seven patients and was successful in both early and advanced cases of acanthamoeba keratitis  
class3	590	prolonged and intensive topical therapy with these three antiamoebic drugs may be an effective mode of therapy for acanthamoeba keratitis  
class3	591	humoral and cell mediated immune responses to the plasmodium falciparum antigens pf155 resa and cs protein  seasonal variations in a population recently reexposed to endemic malaria  
class3	591	resurgence of falciparum malaria occurred in the central highlands of madagascar in the 1980s and the disease is currently hyperendemic  
class3	591	we determined the humoral and cellular responses to synthetic peptides reproducing the repeat sequences of 2 major plasmodium falciparum antigens  the pf155 resa and the circumsporozoite  cs  protein  
class3	591	blood samples from 83 subjects living in a rural community near antananarivo were obtained at the beginning and the end of the transmission season  
class3	591	at enrollment  40 subjects presenting with and 43 without blood parasites had similar t cell proliferative response and antibody level to all antigens tested  
class3	591	however  p  
class3	591	falciparum infected individuals exhibited a decrease in the absolute number of t lymphocytes  due to a diminished number of cd8  and natural killer lymphocytes  
class3	591	the number of cd4  cells was similar in both groups  
class3	591	in the overall population  45  of subjects had a t cell response to at least 1 resa peptide  29 35  responding to a given peptide  and 35  to the cs protein peptide  
class3	591	thirty two percent of the donors presented with resa antibodies and 23  had cs protein antibodies  
class3	591	after 20 weeks  at the end of the transmission season  cellular proliferative responses to all antigens markedly decreased as evidenced by a decrease of both the number of responders and mean stimulation indexes  
class3	591	humoral response to resa  as detected by erythrocyte membrane immunofluorescence  number of responders and mean antibody titers  markedly increased  
class3	591	humoral responses to the cs protein and resa peptides were similar  
class3	592	in vitro growth inhibition of plasmodium falciparum by sera from different regions of the philippines  
class3	592	sera from different malaria endemic regions of the republic of the philippines were compared for their ability to inhibit growth of plasmodium falciparum in vitro  
class3	592	dialyzed serum was added to synchronous cultures containing schizonts for either the total 48 hr test period or only the last 24 hr in order to analyze the effects on erythrocytic invasion and intraerythrocytic growth  respectively  
class3	592	reduction in 3h hypoxanthine uptake was used to determine the percent of inhibition compared to nonimmune serum  
class3	592	one hundred seventy sera from mindanao and palawan in the south  the centrally located island of mindoro  and luzon in the north  were tested against 4 p  
class3	592	falciparum strains from the philippines and 1 from africa  
class3	592	indirect fluorescent antibody titers were not predictive of inhibition  
class3	592	inhibition of merozoite invasion rather than intraerythrocytic parasite growth is suggested by this study  
class3	592	generally  sera were more inhibitory to parasite strains from the same geographical area than to those from more remote areas  
class3	593	comparison of active and passive case detection of cutaneous leishmaniasis in guatemala  
class3	593	to estimate the degree to which passive case detection underestimates the true incidence of cutaneous leishmaniasis in guatemala  we compared data from the passive surveillance system of the guatemalan ministry of health with a cross sectional population based survey of cutaneous leishmaniasis in guatemala  
class3	593	of the 2 938 persons interviewed  143  5   reported having had cutaneous leishmaniasis at some time in the past  37  1 3   reported the onset of infection in the 12 months before the survey  31  1 1   had active infections  and 16  0 5   had parasitologically confirmed infections  
class3	593	calculated on the basis of these reports and the estimated population of the endemic area  the total number of new cases in the leishmaniasis endemic area in the 12 months before the survey was approximately 2 574  during the same 12 month period  ministry of health data based on passive surveillance listed 64 cases of cutaneous leishmaniasis  
class3	593	in guatemala  incidence estimates based on passive surveillance may underestimate the occurrence of cutaneous leishmaniasis by as much as a factor of 40  
class3	594	diffuse cutaneous leishmaniasis acquired in peru  
class3	594	a case of diffuse cutaneous leishmaniasis  dcl  acquired in peru is described  
class3	594	the causative agent was leishmania mexicana amazonensis as determined by isoenzyme analysis and species specific monoclonal antibody binding characteristics  
class3	594	histological examination of biopsy material showed a large number of intracellular and extracellular amastigotes and few lymphocytes  
class3	594	treatment with meglumine antimoniate  glucantime  administered iv at a dosage of 20 mg antimony kg body weight day for 60 days resulted in visible improvement of the lesions  but not in clinical or parasitological cure  
class3	595	a comparison of host responses of the mongolian jird to infections of brugia malayi and b  pahangi  
class3	595	host responses of jirds receiving a single subcutaneous inoculation of subperiodic brugia malayi were compared with those of jirds similarly infected with b  
class3	595	pahangi  
class3	595	parasite burdens  lymphatic lesion severity  granulomatous reactivity  antibody responses to parasite antigens  and complete blood cell counts were assessed at 60 and 150 days post inoculation  
class3	595	at 60 days post inoculation  percentages of adults recovered at necropsy and lymphatic lesion severity were greater in b  
class3	595	pahangi infected jirds  
class3	595	at 150 days post inoculation  lesion severity and percentages of worms recovered were similar in both infections  
class3	595	no significant differences were noted in either infection in reactivity to homologous or heterologous parasite antigens in any parameter measured  
class3	595	similarities in the kinetics of the inflammatory reactivities of the 2 infections suggest that previous observations made in the jird b  
class3	595	pahangi model could be utilized in designing studies using b  
class3	595	malayi  
class3	595	further  the more marked lesion severity observed in b  
class3	595	pahangi infected jirds and the relative ease of maintaining b  
class3	595	pahangi in the laboratory support the continued use of this system as a conceptual model for the study of lymphatic lesion pathogenesis  
class3	596	transmission indices of loa loa in the chaillu mountains  congo  
class3	596	a longitudinal entomological survey of the vectors of loiasis was conducted in the missama area  lekoumou region  in the congo from september 1987 to august 1989  
class3	596	the principal catching site was a palm grove surrounded by forest 3 km from the village  
class3	596	landing biting densities of chrysops were measured by standardized fly catches lasting 11 hr carried out twice a month  
class3	596	vector landing densities were also assessed in the bantu and pygmy villages and in the fields  
class3	596	populations of chrysops from the palm grove were examined 6 times a month for infection with the infective stage of loa loa  
class3	596	chrysops silacea was the predominate vector except at the beginning of the rainy season  when c  
class3	596	dimidiata was the prevailing species  
class3	596	chrysops were caught throughout rainy season  from october to june  
class3	596	the host seeking activity of c  
class3	596	silacea was greatest in the middle of this season  february   but occurred sooner  october  for c  
class3	596	dimidiata  
class3	596	the following variables associated with transmission were calculated from our observations in the palm grove  the first figure corresponds to the first year of the study and the figure in parentheses corresponds to the second year   
class3	596	it was calculated that 2 658  2 185  c  
class3	596	silacea and 1 412  1 182  c  
class3	596	dimidiata could bite a person in the palm grove per year  including an average of 14 4  12 7  infective c  
class3	596	silacea and 9 8  7 2  infective c  
class3	596	dimidiata  
class3	596	the percentage of all dissected flies with third stage larvae in the head and the mean number of larvae in the head infective fly were 0 57  and 10 1     6 8 for c  
class3	596	silacea and 0 66  and 11 2     6 5 for c  
class3	596	dimidiata  respectively  
class3	596	the estimated annual transmission potentials were 171 1  102 9  for c  
class3	596	silacea and 116 1  73 8  for c  
class3	596	dimidiata  
class3	596	in the palm grove  transmission was ensured by 2 effective vectors during the rainy season  october to may   
class3	596	although the annual biting rate for both species was twice as low in the village as in the forest  our data suggest that effective transmission occurs there also  
class3	597	in vivo assessment of antimicrobial agents against toxoplasma gondii by quantification of parasites in the blood  lungs  and brain of infected mice  
class3	597	the in vivo effects of antimicrobial agents against toxoplasma gondii were evaluated in mice that were infected intraperitoneally with 10 4  tachyzoites of the rh strain by determination of survival rates and study of the kinetics of growth of t  
class3	597	gondii in infected mice  
class3	597	at various intervals after infection  subcultures of serial dilutions of blood  lung  and brain homogenates were performed in fibroblast tissue cultures for determination of parasitic loads  
class3	597	pyrimethamine  18 5 mg kg per day   sulfadiazine  375 mg kg per day   and clindamycin  300 mg kg per day  were administered for 10 days from day 1 or day 4 after infection  
class3	597	untreated control mice died within 9 days and showed early and predominant lung involvement  
class3	597	all mice treated with sulfadiazine administered from day 1 survived and were apparently healthy  parasitic loads decreased early after treatment  but a relapse was observed 5 days after the cessation of therapy  
class3	597	when pyrimethamine was administered from day 1  7 of 11 mice died within 25 days  by determination of parasitic loads  the effect of pyrimethamine was only demonstrable from day 6  and a relapse was constantly observed after the cessation of therapy  
class3	597	when pyrimethamine and sulfadiazine were administered in combination  100  of mice survived  when therapy was started at day 1  parasites remained undetectable  in mice treated from day 4  parasites were eradicated by day 8 but infection relapsed 8 days after the cessation of therapy  
class3	597	all mice treated with clindamycin from day 1 or day 4 died within 10 days  but parasitemia was always undetectable  
class3	598	intraoperative bronchial aspiration of ruptured pulmonary hydatid cysts  
class3	598	ruptured pulmonary hydatid cysts are seen clinically and radiologically as persistent cavitary lesions of the lung  
class3	598	bronchi opening into the pericyst cavity allow for discharge of fluid matter but not the escape of solid remnants of the collapsed parasite  
class3	598	operative manipulation of the involved lung in the course of surgical management of chronic ruptured pulmonary hydatids can force fragments of the laminated membrane or small daughter cysts into the bronchial tree  
class3	598	such extruded solid fragments lodge in bronchi of the same or opposite lung with resulting acute obstruction of airways  
class3	598	intraoperative bronchial aspiration of hydatid material was seen in 7 patients with ruptured hydatid cysts of the lung  either primary or secondary to transdiaphragmatic extension of liver hydatids  
class3	598	the first clinical sign can be unexplained difficulty in ventilation  
class3	598	effective management consists of prompt exposure of the stem bronchus on the operative side  with bronchotomy for suction retrieval of escaped solid fragments of the parasite  
class3	599	an immunofluorescence study of cerebral malaria  a correlation with histopathology  
class3	599	histopathologic and immunopathologic features of cerebral malaria have been defined in a study of six autopsy cases with severe plasmodium falciparum infection  
class3	599	in five cases  immunofluorescent studies demonstrated intense deposition of p falciparum antigen  igg  and fibrin in cerebral vessels associated with the histopathologic finding of hemorrhage in the white matter of cerebrum and cerebellum regardless of the presence of parasitized erythrocytes in the cerebral vessels  
class3	599	immunofluorescent study also demonstrated the extravascular deposits of p falciparum granular antigen associated with acute inflammatory lesion in cerebral tissue in one case  
class3	599	these findings suggested that the immunopathogenic mechanism may in some way play a role in the pathogenesis of cerebral malaria  
class3	600	in vitro rosetting  cytoadherence  and microagglutination properties of plasmodium falciparum infected erythrocytes from gambian and tanzanian patients  
class3	600	to understand the molecular mechanisms that lead to sequestration of red blood cells infected with mature stages of plasmodium falciparum and to examine the relevance of earlier studies on adherence properties of laboratory derived p falciparum parasites to the natural parasite population  we analyzed gambian and tanzanian isolates for in vitro cytoadherence and antibody mediated microagglutination  
class3	600	eighteen cryopreserved isolates of ring stage parasites were cultured for 20 to 30 hours in vitro  in the patients original erythrocytes  to the trophozoite and schizont stage  
class3	600	all parasites were positive in the microagglutination assay with at least one of four african hyperimmune sera  
class3	600	in a rosetting assay  only 2 of the 18 isolates were strongly positive  35  and 41  of parasitized erythrocytes with more than two uninfected cells bound   
class3	600	thirteen isolates showed either intermediate  5  to 18   or low  less than 5   rosetting while three isolates did not form rosettes  
class3	600	infected cell binding of the different isolates to immobilized cd36 or thrombospondin  or c32 melanoma cells correlated with the percentage of mature parasites in the blood samples  r    932 for cd36  r    946 for thrombospondin  and r    881 for c32 melanoma cells   
class3	600	there was a high correlation between binding to cd36 and thrombospondin  r    982   
class3	600	the extent of infected cell rosetting with uninfected cells in these blood samples was not correlated with these other receptor properties  
class3	600	we also observed coexpression of rosetting and cytoadherence receptors on the same parasitized erythrocytes  
class3	601	mefloquine kinetics in cured and recrudescent patients with acute falciparum malaria and in healthy volunteers  
class3	601	mefloquine pharmacokinetics were compared in a randomized clinical trial in thailand among patients with malaria and healthy volunteers  
class3	601	a single oral dose of 1500 mg mefloquine hydrochloride was administered to 11 patients and 5 volunteers and 750 mg was given to 16 patients and 5 volunteers  
class3	601	efficacy was 82  for 1500 mg and 63  for 750 mg  
class3	601	in cured patients taking 750 mg mefloquine  peak plasma drug concentration  cmax  and area under the plasma concentration time curve  auc  were significantly greater than in the patients for whom treatment failed  p less than 0 0005 and p less than 0 01  respectively   and plasma mefloquine levels were significantly higher from 8 hours to 18 days after treatment  
class3	601	mefloquine auc was reduced and variable in the presence of diarrhea  
class3	601	compared with noninfected volunteers  clinically ill patients displayed a delayed time to reach peak concentration  p less than 0 01  and significantly higher mefloquine plasma levels in the first 2 days after administration of either the 750 mg or the 1500 mg dose  
class3	601	mefloquine auc was similar in patients with malaria and healthy volunteers  
class3	601	because plasma levels increased in temporal relationship with clinical illness  mefloquine volume of distribution or clearance  or both  was reduced during the acute phase of illness  
class3	602	hemoptysis in a 49 year old man  an unusual presentation of a sporadic disease  
class3	602	although amebiasis is prevalent in tropical and subtropical areas  it occurs sporadically in the united states  
class3	602	pleuropulmonary involvement is seen in about 20 percent of the patients with amebic liver abscesses  
class3	602	we describe a patient with pleuropulmonary amebiasis who complained of hemoptysis but had no gastrointestinal symptoms  
class3	602	this rather unusual presentation caused a considerable delay in securing the diagnosis  
class3	603	variceal sclerosis in schistosomotic patients  a 5 year follow up study  
class3	603	to assess the therapeutic possibilities of injection sclerosis in schistosomotic portal hypertension  a 5 year prospective study was conducted in northeast brazil  where this parasitosis is endemic  
class3	603	fifty patients undergoing endoscopy for upper gastrointestinal hemorrhage from rupture of esophageal varices from july through december 1981 were chosen for the study  
class3	603	the 32 consenting patients were submitted to injection sclerotherapy paravariceally  using ethanolamine oleate  the 18 refusing to participate were assigned to the control group  
class3	603	the incidence of rebleeding was 28 1  in the former and 44 5  in the latter  a difference which was not statistically significant  fisher s test  p   0 375   
class3	603	mortality from rupture of esophageal varices was 3 1  in the sclerotherapy group and 27 7  in the control group  a statistically significant difference  fischer s test  p   0 017   
class3	603	since sclerotherapy markedly improved the long term survival rate of the patients  this procedure is advocated for the treatment of esophageal varices in cases of portal hypertension due to schistosomiasis  
class3	604	transfusion risks  
class3	604	hepatitis remains the most serious transfusion risk  in terms of incidence and severity  
class3	604	transfusion associated aids  hemolytic reactions  trali  and anaphylaxis are severe problems that occur relatively rarely  while febrile reactions and mild allergic reactions are common but not serious  
class3	604	the key to avoiding all these complications is autotransfusion  see the article  autologous transfusion  in this issue   
class3	604	although intraoperative scavenging became available in many centers in the united states in the 1980s  it is hoped that pre deposit autotransfusion will also become widely utilized in the next decade  
class3	605	circulating immune complex associated parasite antigens in human onchocerciasis  
class3	605	this study identified and characterized parasite antigens in sera from humans infected with onchocerca volvulus  
class3	605	immune complexes were precipitated from human sera with polyethylene glycol and analyzed by immunoblot with rabbit antibodies to o  
class3	605	volvulus  
class3	605	a 23 kda parasite antigen was detected in sera from 17 of 23 nigerian onchocerciasis patients and 5 of 10 endemic controls  
class3	605	other parasite antigens with apparent molecular masses of 62  66  and 70 kda were less consistently observed  
class3	605	these antigens were not present in nigerian or us nonendemic control sera  in sera from patients with various other parasitic infections  or in sera from us patients with autoimmune diseases  
class3	605	biochemical studies indicated that these antigens are nonglycosylated acidic proteins that do not contain phosphorylcholine  
class3	605	these antigens may be useful as targets for improved diagnostic tests for onchocerciasis based on parasite antigen detection  
class3	606	bacterial infections in patients with visceral leishmaniasis  
class3	606	bacterial infections are often seen in patients with visceral leishmaniasis  
class3	606	to determine the incidence of such infection and the more common infectious agents  30 consecutive patients with visceral leishmaniasis were followed throughout hospitalization  
class3	606	there were 24 episodes of bacterial infection in 18 patients  60    
class3	606	the incidence of bacterial infections in these patients was 22 2 1000 days of admission  
class3	606	the proportion of patients becoming infected by time was significantly greater in the visceral leishmaniasis group than in controls  p less than  01   
class3	606	the skin  respiratory tract  and middle ear were the most common sites of infection  and pseudomonas aeruginosa and staphylococcus aureus were the most common agents  
class3	606	low grade virulence bacteria  e g   serratia and providencia species  were also isolated from some cases  
class3	606	bacterial infections  mainly nosocomial  in patients with visceral leishmaniasis tend to be severe and can cause death  
class3	606	when bacterial infection is suspected in these patients  empiric antibiotic therapy should be started immediately  including coverage for p  
class3	606	aeruginosa and s  
class3	606	aureus  after appropriate diagnostic procedures are taken  
class3	607	diagnosis of intestinal amebiasis using salivary iga antibody detection  
class3	607	this investigation sought to determine whether detection of salivary iga antibodies to entamoeba histolytica could identify intestinal amebic infections among 223 school children  
class3	607	four groups of children were identified through coproparasitoscopic examination  e  
class3	607	histolytica as other parasites only  20    and parasite free  25    
class3	607	the diagnostic accuracy of salivary iga antibodies to an e  
class3	607	histolytica membrane extract was 91 5   sensitivity  85   specificity  98    maintaining high predictive value at different prevalences  
class3	607	also  a positive correlation  r    753  p less than  001  was observed between fecal e  
class3	607	histolytica membrane antigen levels and salivary iga antibody activity  
class3	607	measurement of iga antibodies in saliva may be useful in diagnosing intestinal infections with e  
class3	607	histolytica within a wide range of prevalences  
class3	607	moreover  sampling of saliva may be a useful non invasive test for immunoepidemiologic surveys  
class3	608	effects of albendazole on echinococcus multilocularis infection in the mongolian jird  
class3	608	albendazole chemotherapy of larval echinococcus multilocularis was studied in the mongolian jird by administration of medicated feed at various concentrations and durations  
class3	608	the effects were evaluated by comparison of treated and control groups in terms of host mortality  larval metastases to the lungs  and final weight and histologic appearance of larval tissue  
class3	608	viability of larval tissue at necropsy of each animal was tested by inoculation into two noninfected jirds  
class3	608	albendazole medicated feed  0 05  0 10   significantly inhibited larval growth  
class3	608	other effects of the drug included larval degeneration and necrosis  inhibition of protoscolex formation  decreased pulmonary metastases  and reduced mortality of hosts  
class3	608	adverse effects on the parasite correlated significantly with serum albendazole metabolite levels and duration of therapy  
class3	608	however  serum albendazole levels in jirds equal to or exceeding concentrations achieved in humans receiving daily doses of 10 mg kg of body weight did not kill the parasite  
class3	609	dexamethasone increases plasma levels of albendazole  
class3	609	therapy of neurocysticercosis with cysticidal drugs is frequently complicated by the exacerbation of symptoms that follows the inflammation triggered by the acute destruction of cysticerci  
class3	609	treatment of such adverse reactions with dexamethasone is highly effective  
class3	609	however  it has been shown that dexamethasone lowers the plasma levels of praziquantel  thus reducing its cysticidal efficacy  
class3	609	we measured plasma levels of albendazole  another strong cysticidal drug  when dexamethasone was given simultaneously  
class3	609	we found that dexamethasone increased the plasma levels of albendazole by about 50   p less than 0 002   hence  it seems that cysticercosis and the ensuing inflammation can be treated simultaneously with albendazole and dexamethasone without diminishing the efficacy of the cysticidal drug  
class3	610	toxoplasmosis of the conus medullaris in a patient with hemophilia a associated aids  case report  
class3	610	toxoplasma gondii has been reported to be the most common cause of focal brain lesions in patients with acquired immunodeficiency syndrome  aids   
class3	610	a case of intramedullary toxoplasmosis of the conus medullaris is reported in a patient with hemophilia a associated aids  
class3	610	the diagnosis is discussed  with particular emphasis on the magnetic resonance imaging appearance  
class3	611	cerebral malaria in children 
class3	611	cerebral malaria is a rapidly progressive encephalopathy with up to 50  mortality  
class3	611	a cardinal feature is the massing of red cells containing mature plasmodium falciparum within the cerebral capillaries  
class3	611	adhesion of these parasitised red cells to endothelium  an event which may initiate cerebral malaria  is being studied at the molecular level  
class3	611	however  the relevance of these studies to the pathophysiology and treatment of human cerebral malaria is uncertain  
class3	611	although chloroquine is still widely used to treat falciparum malaria  resistance has spread to most of the endemic zone  
class3	611	quinine is emerging as the only effective treatment for cerebral malaria  though resistance to this drug threatens to become a problem  
class3	611	alternative drugs are urgently needed  
class3	612	hiv disease  a review for the family physician  part ii  secondary infections  malignancy and experimental therapy  
class3	612	the first part of this two part article included recommendations for the initial evaluation of patients suspected of having hiv infection  the centers for disease control s classification scheme for hiv disease and current recommendations for the use of zidovudine  
class3	612	in this second part  secondary infections and malignancy are reviewed  and various experimental therapies are briefly discussed  
class3	613	detection of congenital toxoplasmosis by chorionic villus sampling and early amniocentesis  
class3	613	we describe a strategy used in this case to detect congenital toxoplasmosis early in pregnancy  
class3	613	combination of chorionic villus sampling and early amniocentesis with an in vitro cell culture technique makes prenatal diagnosis of congenital toxoplasmosis possible from the end of the first trimester of pregnancy  
class3	614	variations in malaria transmission rates are not related to anopheline survivorship per feeding cycle  
class3	614	anopheline survivorship  vectorial capacity  and mosquito infection probability estimates from mosquito infection rates were determined 4 times in 1 year in a papua new guinea village  
class3	614	estimates of survivorship over the length of the extrinsic incubation period differed significantly during the year  
class3	614	however  survivorship per feeding cycle  individual mosquito vectorial capacity  and mosquito infection probability did not vary significantly  
class3	614	estimates of these parameters were then compared to estimates of survivorship  individual vectorial capacity  and mosquito infection probability in mosquito populations in other villages in the study area  
class3	614	since survivorship per feeding cycle did not vary significantly among the mosquito populations in these villages  changes in malaria transmission potential can be better gauged from estimates of survivorship over the length of the extrinsic incubation period  
class3	614	however  as measurements of relative inoculation rates are easier to perform and have been related to parasite prevalences in children in this area  estimates of inoculation rates are a preferred option for estimating malaria transmission in the madang area of papua new guinea  
class3	615	geographical distribution of plasmodium falciparum erythrocyte rosetting and frequency of rosetting antibodies in human sera  
class3	615	uninfected erythrocytes bind spontaneously to those infected with certain strains of plasmodium falciparum  
class3	615	this is known as spontaneous erythrocyte rosetting  
class3	615	we have studied the occurrence and frequency of rosetting in 75 fresh patient isolates and have identified rosetting strains from africa  south america  and asia  
class3	615	rosetting was present in 49  of the isolates tested  the frequency of rosetting red blood cells  rbc  in individual isolates was 0 75  when scored during the first cycle of in vitro growth  
class3	615	rosetting antibodies were found in 15 out of 73  21   liberian sera as measured by disruption of rosettes in vitro  
class3	615	however  antibodies able to inhibit cd36 dependent cytoadherence of p  
class3	615	falciparum infected rbc were not detected in these sera  
class3	615	erythrocyte rosetting is a geographically widespread phenomenon  
class3	615	rosetting antibodies seem to be induced by natural infection and the molecular mechanism of rosette formation seems distinct from that of endothelial cytoadherence  
class3	616	studies in owl monkeys leading to the development of a synthetic vaccine against the asexual blood stages of plasmodium falciparum  
class3	616	during the development of a synthetic vaccine for human use against the asexual blood stages of plasmodium falciparum  monkey trials were performed to assess safety  immunogenicity  and protectivity  
class3	616	we determined the minimal infective dose of the p  
class3	616	falciparum fvo strain  the kinetics of the immune response induced by vaccination with the synthetic peptide mixture  s7   s12   s17  or the synthetic hybrid polymeric protein spf66  and the induction of protective immunity against the experimental challenge with 2 p  
class3	616	falciparum strains  
class3	616	a clear boosting effect was observed  determined by the increased antibody titers against synthetic peptides s7  s12  s17  and spf66  and by improvement in the protective immune response against the challenge  
class3	616	these studies suggest that either the peptide mixture or the synthetic hybrid polymeric protein are excellent choices for the development of a vaccine against p  
class3	616	falciparum  
class3	617	immunization of owl monkeys with a combination of plasmodium falciparum asexual blood stage synthetic peptide antigens  
class3	617	a mixture of 3 synthetic peptides  35 1  55 1  and 83 1  corresponding to portions of the 35 kda  55 kda  and 83 kda proteins from the asexual blood stages of plasmodium falciparum and a polymer of a syntheic peptide incorporating the 3 individual peptides  spf66  were tested as candidate malaria vaccine antigens in aotus nancymai  
class3	617	monkeys were immunized with combinations of the 3 peptides from 2 separate sources  centers for disease control  cdc   atlanta  ga or colombia  or with the synthetic polymer  
class3	617	animals immunized with a combination of the 3 peptides from cdc had higher antibody titers to the 35 1 and 55 1 peptides than to the 83 1 peptide  
class3	617	monkeys immunized with a combination of the 3 peptides produced in colombia developed higher levels of antibody to the 55 1 than to the 83 1 and 35 1 peptides  
class3	617	animals immunized with the polymer produced detectable antibodies to the 55 1 peptide alone  
class3	617	following challenge with p  
class3	617	falciparum  no differences were observed between the 3 vaccine groups and 2 control groups with respect to the number of animals with parasitemias greater than or equal to 10   
class3	617	the inconsistency of serologic response to all 3 peptides in these animals contrasted with previous trials performed in colombia where the monkeys developed high antibody titers against the 3 peptides and were protected against the experimental infection  
class3	618	ultrasonographical investigations of onchocerciasis in liberia  
class3	618	the efficiency of ultrasonography  us  for the diagnosis and clinical characterization of onchocerciasis was evaluated  
class3	618	us was performed on 120 probands in liberia  
class3	618	ninety two patients had generalized onchocerciasis  21 patients suffered from the chronic hyperreactive form of onchocerciasis  sowda   and 7 probands served as controls  
class3	618	patients were examined by us with linear  7 5 mhz and 5 mhz  and sector  3 5 mhz  scanners  
class3	618	us results were evaluated by examination of extirpated nodules  
class3	618	the us structure of nodules revealed a typical pattern consisting of a homogeneous echogenicity with small echodense particles and a lateral acoustic shadow  and differentiation from lymph nodes  lipoma  or fibroma was achieved  
class3	618	within the onchocercomata  calcifications or fluid were identified  
class3	618	regarding the estimation of the worm burden  it is important to note that in 24 patients  additional nodules not previously palpated were found by us  
class3	618	also  the number of worm centers in palpable conglomerate nodules were determined more exactly by us than by palpation  
class3	618	in 4 of 16 sowda patients  impalpable nodules were found by us  
class3	618	in 13 patients with positive microfilaria counts  no nodules could be detected  
class3	618	the highly characteristic ultrasonographical pattern of onchocercomata may serve as a basis for further us investigations in onchocerciasis  
class3	619	plasmodium falciparum infected anopheles stephensi inconsistently transmit malaria to humans  
class3	619	malaria was transmitted to only 5 of 10 volunteers bitten by 1 2 anopheles stephensi carrying sporozoites of the 3d7 clone of the nf54 strain of plasmodium falciparum in their salivary glands  
class3	619	parasites were detectable by culture in blood taken 7 10 days following exposure and by thick blood film 14 16 5 days after exposure  
class3	619	infectivity did not correlate with the numbers of sporozoites in the salivary glands  
class3	620	quantitative in vitro drug potency and drug susceptibility evaluation of leishmania ssp  from patients unresponsive to pentavalent antimony therapy  
class3	620	quantitative in vitro drug sensitivity of 32 leishmania isolates  16 from patients failing pentavalent antimony  sbv  therapy  was determined using a radiorespirometric microtechnique  ram   
class3	620	of 30 isolates with histories  22  73   ram tests agreed with patient history  the remaining 8  27   did not  
class3	620	there was no difference in ram drug sensitivity  clinical correlation between 15 isolates tested blindly and 15 with known clinical history  4 did not agree with clinical history in both   
class3	620	test sensitivity appeared to be limited only by the sensitivity of the leishmania to sbv and could be detected at 2 micrograms ml sb  about 10  of serum drug level   
class3	620	an isolate from a patient with untreated self healing cutaneous disease was drug resistant  
class3	620	using ram  parasite drug sensitivity can be quantified apart from patient physiologic and immunologic variables intrinsic to clinical data  
class3	620	potency differed a maximum of 100   weight  sb weight  sb  among drug lots and also between glucantime and pentostam  
class3	620	potency changes between drug lots were not explainable based on sb content or test to test variability  
class3	620	this microtest offers a rapid method for evaluating the drug sensitivity of patient isolates and for determining of the activity of pentavalent antimonials and other candidate anti leishmanials prior to the initiation of therapy  
class3	621	parasite antigenemia in untreated and treated lymphatic filarial infections  
class3	621	to evaluate the merit of antigen detection assays as a tool to monitor the efficacy of chemotherapy for lymphatic filariasis  we serially measured antigen levels in sera from jirds infected with brugia malayi and from humans with bancroftian filariasis  
class3	621	antigenemia was detected in all animals with parasitologically proven infection and was present in jirds with prepatent or occult filariasis  
class3	621	antigen levels correlated with worm burdens  and progressively declined in drug cured animals  
class3	621	treatment with diethylcarbamazine  dec  triggered a transient increase in serum levels of filarial antigens bearing the epitope recognized by the monoclonal antibody hc 11  
class3	621	all patients with bancroftian filariasis became amicrofilaremic within one week after dec treatment  
class3	621	antigenemia levels slowly declined over a period of several months in all but one treated individual  
class3	621	forty two months after treatment  progressively rising antigen levels are present in 10 patients  
class3	621	six of these remain amicrofilaremic  in the other 4  elevated antigenemia levels preceded or were detected at the same time as recurrent parasitemia  
class3	621	periodic monitoring of antigenemia levels after treatment of patients with lymphatic filariasis can be used to identify individuals who are likely to develop recurrent microfilaremia before the parasites become detectable in blood samples  thereby allowing timely retreatment  
class3	622	selective breeding of dogs for segregation of limb edema from microfilaremia as clinical manifestations of brugia infections  
class3	622	three generations of beagles were monitored for microfilaremia  mf  and clinical disease during repeated infection with brugia pahangi and were selectively bred for offspring manifesting limb edema and low or amicrofilaremia  
class3	622	a high microfilaremic female mated to a high microfilaremic male produced 7 pups  6 of which maintained mf greater than 1 000 ml for greater than 2 years after 5 monthly infections of 10 infective larvae each  
class3	622	an uninfected female mated to another high mf male produced 5 pups  4 of which did not exceed 1 000 mf ml 7 months after initiation of the repeating infection regimen  1 of these remained amicrofilaremic after 2 additional challenges  
class3	622	neither the parents nor the offspring from these matings manifested chronic limb edema  
class3	622	two matings were conducted with offspring from the microfilaremic female by breeding siblings with the lowest mf and breeding siblings with the highest mf  
class3	622	the high mf siblings produced 4 5 offspring manifesting chronic limb edema  greater than or equal to 7 months duration  and either no mf  in 2 dogs  or less than 100 mf ml after the repeating infection regimen  
class3	622	the lower mf siblings produced 5 offspring  all with greater than 1 000 mf ml 6 months after the initiation of the repeating infection regimen  none manifested edema  
class3	622	comparisons of igg antibody levels  specific for extracts of adult worms  showed no consistent differences between these 2 litters of dogs that could be associated with limb edema or mf when monitored for 16 months  however  the onset of lymph node enlargement was much earlier in the group of dogs manifesting limb edema than in the other litter  
class3	623	physical activity  opportunity for reinfection  and sibling history of heart disease as risk factors for chagas  cardiopathy  
class3	623	a case control study was conducted to examine whether physical activity  sibling history of heart disease  hhd   and length of residence in an area endemic for chagas  disease were associated with the risk of developing chagas  cardiopathy  
class3	623	two hundred forty seven cases of chagas  heart disease and 345 seropositive subjects with normal ecg  controls  were selected in a population survey in goiania  brazil  
class3	623	prevalence ratios for exposure variables were estimated for cases in relation to controls and for subgroups of seropositives with selected ecg abnormalities in relation to controls  
class3	623	increasing age and male sex were consistently and significantly related to an increased risk of ecg abnormalities  
class3	623	hhd was significantly associated with ecg alterations in 3 of the 5 comparison subgroups  any ecg alteration  right bundle branch block  and left anterior hemiblock   
class3	623	no association was found between length of residence in an area endemic  physical activity  and ecg abnormalities  
class3	623	a sample of 529 seronegative subjects were also examined and the interaction between exposure variables and seropositivity was tested to assess whether the associations found were specific for seropositives  
class3	623	males were at greater risk of any ecg alteration and left anterior hemiblock in relation to females if they were seropositive  
class3	623	an increasing risk of ventricular premature beats with age was clearer for seropositive than for seronegative subjects  
class3	623	subjects with hhd were at an increased risk of ecg abnormalities and this was greater in those with a positive serological test  p less than 0 05   
class3	623	the findings suggest a possible geographical clustering or a familial aggregation of cases of chagas  heart disease  
class3	624	efficacy and toxicity of sodium stibogluconate for mucosal leishmaniasis  
class3	624	objective  to determine the efficacy and toxicity of the world health organization s  who  recommended treatment for mucosal leishmaniasis  antimony  20 mg kg body weight per day for 28 days  
class3	624	design  open trial with 12 month follow up  
class3	624	setting  inpatient unit of a regional referral hospital in a developing country  
class3	624	patients  twenty nine consecutive eligible patients with culture confirmed infection of the mucosa with leishmania species who were otherwise healthy  
class3	624	eight patients  28   had mild to moderate disease  confined to the nasal mucosa   
class3	624	twenty one patients  72   had severe disease  including the oropharynx as well as the nasal mucosa   
class3	624	intervention  antimony  20 mg kg body weight intravenously every day for 28 days  
class3	624	patients received antimony in the form of sodium stibogluconate  
class3	624	measurements and main results  initial results of therapy were as follows  63 of 72 lesions  88   healed or markedly improved  all lesions were culture negative for parasites  and 18 of 29 patients  62   showed complete clinical and parasitologic cure of all lesions  
class3	624	by the 12 month follow up examinations  however  37 lesions had recurred  8 new lesions had appeared  and only 8 patients  30   showed clinical cure of all lesions  
class3	624	of the 8 patients with mild to moderate disease  6 were cured compared with only 2 of the 21 patients with severe disease  
class3	624	side effects of this treatment regimen included t wave inversion on electrocardiogram  4 patients   abnormal liver function tests  10 patients   and musculoskeletal pain  24 patients   
class3	624	no side effects occurred during week 1 of therapy  
class3	624	conclusions  the only recommended treatment for mucosal leishmaniasis is ineffective in patients with severe disease  
class3	624	the acceptable toxicity of the regimen suggests that longer courses of therapy with antimony  or that trials with other antileishmanial agents alone or combined with antimony be evaluated as initial therapy for this disease  
class3	625	acute renal failure in obstructive jaundice in cholangiocarcinoma  
class3	625	this study was aimed at defining the natural history of renal failure in obstructive jaundice due to cholangiocarcinoma  which is an important health problem in northeastern thailand  
class3	625	sixty four patients among a total of 130 patients with obstructive jaundice secondary to cholangiocarcinoma who developed acute renal failure were studied retrospectively  
class3	625	analysis was made with respect to clinical features  laboratory findings  and outcome  
class3	625	the development of renal failure before surgery was observed in all patients  
class3	625	it was nonoliguric in 80  and was associated with severe jaundice  gram negative infection  42    hypotension  31    hypoproteinemia  30    hyponatremia  56    and hypokalemia  63    
class3	625	the mean duration of renal failure was 2 weeks  
class3	625	all patients underwent surgery for the relief of jaundice  
class3	625	seventy seven percent of the patients survived and had recovery of renal function after the relief of jaundice  
class3	625	twenty three percent of the patients died of infection  
class3	625	clinical data highlight the higher serum bilirubin levels and the frequent occurrence of hyponatremia  hypokalemia  and hypotension in renal failure  
class3	625	their possible roles in contributing to the development of renal failure are discussed  
class3	626	sulfadiazine crystalluria revisited  the treatment of toxoplasma encephalitis in patients with acquired immunodeficiency syndrome  
class3	626	toxoplasma gondii encephalitis is an important opportunistic infection in the acquired immunodeficiency syndrome  estimated to occur in 20 000 to 40 000 patients with acquired immunodeficiency syndrome in the united states by 1991  
class3	626	the combination of sulfadiazine and pyrimethamine is regarded as the treatment of choice  
class3	626	acute renal failure due to crystal deposition in the urinary tract was well described 30 to 40 years ago and is likely to resurface as a clinical entity if appropriate prophylactic measures are not taken  
class3	626	we describe two cases of sulfadiazine induced crystalluria and renal failure in patients with acquired immunodeficiency syndrome  review the pertinent literature  and discuss the pathogenesis  
class3	626	recommendations are made for the prophylaxis and treatment of sulfadiazine related renal toxic reaction  
class3	626	physicians using this  new  drug must be aware of the potential danger of sulfonamide induced injury to the urinary tract  
class3	627	lindane  kwell  induced aplastic anemia  
class3	627	numerous toxic exposures have been implicated in causing aplastic anemia  
class3	627	thirteen cases of aplastic anemia and 5 cases of other blood dyscrasias  eg  red blood cell aplasia and thrombocytopenia  associated with lindane  have been reported in the literature  
class3	627	however  aplastic anemia secondary to the scabicidal product  lindane  kwell   has not been documented  to our knowledge  
class3	627	we present the case of a 21 year old man with a diagnosis of aplastic anemia  known prolonged exposure to lindane  and documented elevated serum lindane levels  
class3	627	his clinical course is described as well as various defects are explored for the aplasia  
class3	628	pathophysiological insights into the cardiomyopathy of chagas  disease  
class3	628	the evidence gained from both human and animal studies of chronic chagasic cardiomyopathy suggests that the disease occurs as a consequence of several discrete and progressive pathophysiological processes occurring after infection  the ultimate expression of which depends on a host of unidentified factors  
class3	628	collectively  the infection associated events compromise microvasculature function and result in hypoperfusion  with consequences indistinguishable from those observed in other  nonparasitological cardiomyopathic diseases secondary to hypoperfusion  
class3	628	therefore  chronic chagasic cardiomyopathy may share similar pathophysiological abnormalities with other chronic congestive cardiomyopathic states  
class3	629	longitudinal study of lesions of the posterior segment in onchocerciasis  
class3	629	onchocerciasis is a major cause of blindness  and much of the blindness due to onchocerciasis is caused by chorioretinitis  
class3	629	little is known about the progression of lesions in the posterior segment in either untreated or treated disease  
class3	629	the authors studied the progression of onchocercal chorioretinitis in 57 patients from 1 to 3 years  
class3	629	changes were documented from detailed ocular examinations  fundus photographs  and fluorescein angiograms  and included live intraretinal microfilariae  intraretinal hemorrhages  cotton wool opacities  intraretinal pigment  white and shiny intraretinal deposits  retinal pigment epithelial window defects  and atrophy  
class3	629	depigmentation at the edge of chorioretinal scarring progressed at a rate of up to 200 microns per year  
class3	629	ivermectin or mebendazole treatment did not appear to alter the progress of depigmentation at the edge of chorioretinal scars  
class3	629	these observations suggest that onchocercal chorioretinitis is associated with early changes in the retina and retinal pigment epithelium  and that disease in the posterior segment may progress rapidly  
class3	630	toxoplasma gondii retinochoroiditis and optic neuritis in acquired immune deficiency syndrome  report of a case  
class3	630	a 29 year old man with acquired immune deficiency syndrome  aids  was found to have a retinochoroiditis and optic neuritis of his left eye  
class3	630	results of fundus examination showed inflammatory and hemorrhagic retinal lesions consistent with retinitis due to cytomegalovirus infection  
class3	630	a computed tomographic  ct  scan demonstrated enlargement of the optic nerve  
class3	630	the eye was enucleated and results of histopathologic examination showed retinal necrosis with underlying choroiditis and an optic neuritis  
class3	630	numerous encysted toxoplasma gondii organisms were present in the retina and tachyzoites were present in the optic nerve  
class3	630	to the authors  knowledge this is the second histologically documented case of toxoplasma optic neuritis in a patient with aids  
class3	631	concomitant neurocysticercosis and brucellosis  
class3	631	a young mexican woman had headache and left arm weakness develop shortly after immigrating to the united states  
class3	631	a solitary cerebral cysticercus was found at surgery  but  instead of the expected finding of clear fluid  the cyst contained pus from which brucella melitensis was cultured  
class3	631	although the patient had no signs or symptoms suggestive of brucellosis  agglutination studies revealed igm and igg antibodies consistent with active brucellosis  
class3	631	clinicians should be alert to the possibility of multiple infections in immigrants from countries where parasites and bacteria that are uncommon in the united states are endemic  
class3	632	disseminated strongyloidiasis with central nervous system involvement diagnosed antemortem in a patient with acquired immunodeficiency syndrome and burkitts lymphoma  
class3	632	a 45 year old man presented with central nervous system involvement as the initial manifestation of disseminated infection with strongyloides stercoralis  
class3	632	several concurrent clinical factors contributed to this event  all related to the patient s immunosuppression  including high grade lymphoma  corticosteroid therapy  and acquired immunodeficiency syndrome  
class3	632	this is only the third case of cns involvement in disseminated strongyloidiasis diagnosed antemortem  
class3	633	echinococcus infestation of the biceps brachii  a case report  
class3	633	echinococcus is a genus of tapeworm endemic in certain parts of the world but found only rarely in the united states  
class3	633	an extremely unusual case of an intramuscular infestation involving an extremity occurred in a 41 year old man  
class3	633	since the infestation closely resembled a soft tissue tumor on clinical and roentgenographic examination  the patient was treated with an incisional biopsy of the mass  which consisted of a cystic cavity filled with clear fluid  
class3	633	the diagnosis of an echinococcus cyst was made only after permanent section analysis revealed numerous scoleces within the cyst lining  
class3	633	the patient was asymptomatic six months after cyst excision but still remains at risk for recurrence of the infestation  
class3	633	the present report serves to alert the reader to this rare but potentially fatal condition  
class3	633	preoperative diagnosis is imperative to avoid inadvertant rupture of a hydatid cyst  which releases viable scoleces into the systemic circulation and may precipitate an anaphylactic reaction  
class3	634	phrenomediastinal echinococcosis  
class3	634	a patient with the rare presentation of posterior mediastinal echinococcosis is reported  
class3	634	magnetic resonance imaging  mr  demonstrated the extension of a primary retroperitoneal cyst into the posterior mediastinum which was subsequently confirmed surgically to be of echinococcal origin  
class3	634	such a case of phrenomediastinal echinococcosis has been described only once before in literature  
class3	635	epidemiology of epilepsy in guaymi indians from bocas del toro province  republic of panama  
class3	635	this cross sectional study was conducted to describe the epidemiology of epilepsy in guaymi indians residing in changuinola  a small town on panama s caribbean coast near costa rica  
class3	635	we randomly selected households and attempted to enroll all residents aged less than or equal to 1 year  337 eligible subjects agreed to participate  93  response rate   
class3	635	we administered a standard neurologic disease screening examination to all subjects and  if any abnormality was found  we administered a standard neurologic evaluation  
class3	635	we detected 19 cases of active epilepsy  the mean age at onset was 12 years  and generalized tonic clonic seizures were the most common diagnosis  10 of 19  53    
class3	635	the prevalence of active epilepsy among caribbean coastal guaymi  57 1000  is considerably greater than that in lower class panama city populations  22 1000  or in other parts of the world  
class3	635	to identify risk factors for epilepsy  we collected epidemiologic data and serum  for cysticercus antibody  from subjects with active epilepsy and from 44 age sex matched controls  
class3	635	significantly more cases  47   than controls  6   had other family members with epilepsy  relative risk  rr   14   44  of cases and 13  of controls reported a history of febrile seizures during childhood  rr   6   
class3	636	light microscopic diagnosis of human microsporidiosis and variable response to octreotide  
class3	636	microsporida are protozoan parasites that have recently been identified as a cause of human disease in immunocompromised patients  
class3	636	because of their small size  they have been recognized primarily by electron microscopy  
class3	636	this has limited the study of their prevalence  incidence  and association with large volume diarrhea  
class3	636	the present report describes two cases of enterocytozoon bieneusi infection of the small intestine in patients with intractable diarrhea in whom the diagnosis was made by light microscopy and confirmed by electron microscopy  
class3	636	both patients were treated with octreotide  and one had a good response  
class3	637	b cell responses to paramyosin  isotypic analysis and epitope mapping of filarial paramyosin in patients with onchocerciasis  
class3	637	to examine the fine specificity of the human immune response to filarial paramyosin  the antigenicity of an expressed rcdna  2 55 kb  of dirofilaria immitis paramyosin was detailed by elisa  
class3	637	using sera from patients infected with onchocerca volvulus  we analyzed both the entire paramyosin molecule and six subcloned fragments for their igg  igg subclasses  and ige responses  
class3	637	patients from both guatemala  64  positive  and ghana  100  positive  reacted to paramyosin with specific igg levels above normal controls  
class3	637	although there was no anti paramyosin subclass restriction common to all patients  the igg3 response in the ghananians was significantly greater than that of guatemalans  p less than 0 001   
class3	637	ige anti paramyosin responses showed positive correlations with igg2  p less than 0 001   igg4  p less than 0 002   and igg1  p less than 0 04  responses  
class3	637	epitope mapping using the igg response to the six subclones demonstrated preferential recognition of the amino terminal end of the molecule  nucleotides 1 to 360   
class3	637	igg2 reactivity was clearly localized to the most amino terminal 120 amino acids  and the igg4 antibodies recognized amino acids immediately adjacent to this fragment  
class3	637	these studies examining the fine specificity of anti filarial immune reactions should provide a method for understanding how parasites either evade or induce host immune responses  
class3	638	eosinophilic meningitis  cause of a chronic pain syndrome  
class3	638	three tourists developed eosinophilic meningitis after visiting the fijian islands  
class3	638	two had a severe and long lasting illness with chronic intractable pain  
class3	638	in one patient electrophysiological studies and mri scan of the brain were abnormal and provided evidence of both radicular and cerebral parenchymal involvement by the most likely causative agent  angiostrongylus cantonensis  
class3	639	the  nuisance  sexually transmitted diseases  molluscum contagiosum  scabies  and crab lice  
class3	639	although molluscum contagiosum  scabies  and infestation by crab lice do not carry the requirements of partner notification or other long term consequences  they are among the most commonly reported sexually transmitted disease  
class3	639	molluscum contagiosum is a benign viral infection of the skin epidermal layer  most often transmitted by intimate skin to skin contact  
class3	639	the lesions often resolve spontaneously over time  but patient discomfort or social reasons may require destructive removal of the lesions  
class3	639	scabies is caused by the sarcoptes scabiei mite  
class3	639	the victims continually itch  especially at night  and often seek over the counter topical remedies before seeing a clinician  
class3	639	once a correct diagnosis is made  successful resolution of this disease and its itching can be achieved  
class3	639	head and pubic lice account for most of the more than three million cases of louse infestation treated in the united states each year  
class3	639	symptoms of infestation generally include itching that leads to scratching  erythema  irritation  and inflammation  
class3	639	a careful diagnosis followed by disinfection  symptomatic treatment  and psychologic support should result in a complete cure with no long term effects  
class3	640	identification of toxoplasma gondii in paraffin embedded sections by the polymerase chain reaction  
class3	640	we used the polymerase chain reaction to amplify dna fragments specific to toxoplasma gondii  
class3	640	the sensitivity of the technique allowed for the detection of as few as ten cultured t  
class3	640	gondii tachyzoites  
class3	640	we applied the same amplification technique to deparaffinized ocular sections from two cases of ocular toxoplasmosis  
class3	640	although toxoplasmic cysts could only be seen in one eye by optical microscopy  polymerase chain reaction allowed the identification of the parasite in both cases  
class3	640	our study indicates the feasibility of a sensitive dna based assay to complement pathologic studies of an ocular parasitic disease  
class3	641	acanthamoeba keratitis associated with disposable contact lenses  
class3	641	two patients developed acanthamoeba keratitis associated with the use of disposable extended wear hydrogel contact lenses  
class3	641	both patients removed  irrigated  and reinserted the contact lenses without disinfecting them  
class3	641	one patient wore the lenses on a daily basis  rinsed the lenses in tap water  stored them overnight  and discarded them weekly  
class3	641	both infections were treated successfully  
class3	641	in a third patient  acanthamoeba species was cultured from two pairs of disposable lenses that had been stored in cases rinsed with well water  
class3	641	potential benefits from disposable contact lens wear are negated when patients do not comply with a continuous wearing schedule  
class3	642	visceral leishmaniasis in a scottish child  
class3	642	a scottish girl acquired visceral leishmaniasis  kala azar  while on holiday in majorca  
class3	642	she presented with the infection  six months later  in scotland  
class3	642	because of inexperience with the disease and a degree of scepticism unnecessary investigations were carried out resulting in a delay in treatment  
class3	643	human cerebral malaria  association with erythrocyte rosetting and lack of anti rosetting antibodies  
class3	643	plasmodium falciparum isolates from 24 gambian children with cerebral malaria and 57 children with mild forms of the disease were assessed for their ability to form erythrocyte rosettes  
class3	643	all isolates from the children with cerebral malaria were able to form rosettes  whereas those from children with mild forms of the disease did not form rosettes  or had a significantly lower rosetting rate  
class3	643	plasma of children with cerebral malaria lacked anti rosetting activity  whereas plasma of children with mild disease could often disrupt rosettes in vitro  
class3	643	a monoclonal antibody to p falciparum histidine rich protein  pfhrp1 kp kahrp  disrupted rosettes of many of the isolates in vitro indicating that the rosetting ligand is relatively conserved compared with ligands associated with endothelial cytoadherence  
class3	643	the findings strongly support the hypothesis that erythrocyte rosetting contributes to the pathogenesis of cerebral malaria and suggest that anti rosetting antibodies protect against cerebral disease  
class3	644	pregnancy outcome after inadvertent ivermectin treatment during community based distribution  
class3	644	ivermectin is the drug of choice for community based treatment of onchocerciasis  
class3	644	since pregnancy testing during mass distribution campaigns is not feasible  the safety of ivermectin in pregnancy must be established  
class3	644	during a 3 year study  ivermectin was distributed to the population of a rubber plantation  14 000 people  in liberia  
class3	644	only 31  of women were aware of their pregnancy status during the first month  it was calculated that about half of women in the first trimester of pregnancy are likely to be treated inadvertently  
class3	644	203 children born to women inadvertently treated during pregnancy were identified  
class3	644	in this limited sample  there was no significant difference in birth defects between treated and untreated mothers in the same population or compared with a reference population  
class3	644	children of treated and untreated mothers showed no difference in developmental status or disease patterns  
class3	644	further surveillance is necessary  however  since no major effects of ivermectin on pregnancy outcome were detected  there seems no need to change existing strategies of ivermectin distribution  
class3	645	activated eosinophils increase vascular permeability and resistance in isolated perfused rat lungs 
class3	645	the effects of eosinophils activated with phorbol myristate acetate  pma  on isolated perfused rat lungs were examined  
class3	645	eosinophils were obtained from lungs of rats infected with toxocara canis by bronchoalveolar lavage  incubated with pma  and administered to an isolated perfused rat lung preparation  
class3	645	vascular endothelial permeability was assessed by measuring the capillary filtration coefficient  kf c  in the perfused lungs  
class3	645	in lungs receiving either no eosinophils  control  or nonactivated eosinophils  there were no changes in pulmonary hemodynamics or kf c  
class3	645	however  in lungs receiving 2 x 10 6  eosinophils activated with pma  there was a transient 4 8 fold increase in pulmonary vascular resistance that peaked at 30 min  primarily due to the constriction of small arteries and veins  
class3	645	after the initial pressor response  kf c was increased to 7 5 times control at 130 min and resulted in marked lung edema  increased wet dry weight ratios  and edema on histologic examination  
class3	645	pulmonary arterial pressure and kf c responses were dose related for eosinophil numbers between 1 x 10 6  and 4 x 10 6  cells  
class3	645	peak airway pressure  paw  during constant tidal volume ventilation also increased in lungs receiving activated eosinophils compared to the control and nonactivated eosinophil groups  
class3	645	these findings indicate that activated eosinophils are potent effector cells and can cause pulmonary vasoconstriction  bronchoconstriction  and vascular endothelial injury without widespread plugging of capillaries by aggregated eosinophils  
class4	646	abnormal differentiation of human papillomavirus induced laryngeal papillomas  
class4	646	we studied the proliferation and differentiation of human laryngeal papillomas  which are benign tumors induced by human papillomaviruses  
class4	646	immunofluorescent stains of tissues for a number of differentiation specific proteins showed abnormal differentiation  
class4	646	papilloma tissue fragments in vitro showed a slightly decreased fraction of proliferating cells that incorporated tritiated thymidine and a markedly reduced incorporation of tritiated uridine when compared with normal tissue  
class4	646	we propose that papillomavirus infection results in normal basal cell proliferation but abnormal terminal differentiation and that this abnormality significantly contributes to the hyperplasia of the papillomas  
class4	647	cisplatin fluorouracil interaction in a squamous cell carcinoma xenograft  
class4	647	patients with squamous cell carcinoma of the head and neck are treated with cisplatin and fluorouracil according to a schedule based on the findings of clinical studies  
class4	647	a similar schedule showed a supra additive effect in the treatment of xenografted human squamous cell carcinoma of the head and neck  
class4	647	we sought to ascertain whether this schedule was optimal  
class4	647	a single intraperitoneal injection of cisplatin  7 5 mg kg  was combined with three injections of fluorouracil given during a 24 hour period  total dose  150 or 80 mg kg  before  during  or after cisplatin administration  
class4	647	the combined effect of cisplatin and fluorouracil on tumor growth and toxic effects was schedule dependent  
class4	647	consideration of both toxic effects and tumor growth inhibition  as assessed by reduction of the area under the growth curve  the optimal administration interval was found to be fluorouracil given 3 days after cisplatin administration  
class4	648	hla class i and class ii antigen expression on squamous cell carcinoma of the head and neck  
class4	648	we compared human major histocompatibility  hla  class i and class ii antigen expression on squamous cell carcinoma of the head and neck with that on normal mucosa  
class4	648	frozen sections of a consecutive series of 30 squamous cell carcinomas were stained with the monoclonal antibodies w6 32  class i  and anti dr  class ii  using an immunoperoxidase technique  
class4	648	normal mucosa showed class i and class ii expression in the basal layers only  
class4	648	class i expression on tumors was diffuse in 87   patchy in 10   and scattered in 3   
class4	648	class ii expression on tumors was diffuse in 20   patchy in 53   scattered in 20   and absent in 7   
class4	648	patterns of expression did not correlate significantly with clinical parameters  including survival  except that class ii diffuse and patchy patterns were found to correlate with more poorly differentiated tumors  
class4	649	computed tomography of metastatic cervical lymph nodes  a clinical  computed tomographic  pathologic correlative study  
class4	649	a retrospective comparative study of 63 neck dissections was undertaken to evaluate further the accuracy of high resolution computed tomography  ct  in the detection of nodal metastases  as previous studies have indicated a trend toward the superiority of ct scanning over palpation  
class4	649	the respective values of neck examination  ct scanning  and histopathologic examination were assessed in 51 patients with head and neck cancer who underwent a total of 63 neck dissections  
class4	649	the overall agreement between clinical examination findings and histopathologic findings was 92  vs 81  for ct scanning  
class4	649	a retrospective analysis of the ct findings failed to reveal greater accuracy  
class4	649	we found nodes measuring 10 mm or more with central low density always to be malignant  
class4	649	because ct scanning seems to offer little advantage over palpation in the nonirradiated neck  it should not be regarded as an essential tool in the staging of nodal disease  
class4	649	after radiation therapy  as neck dissection is only performed because of clinical or radiologic suspicion  ct scanning is of utmost importance  
class4	650	pseudocyst of the auricle  case report and world literature review 
class4	650	we treated a patient with pseudocyst of the auricle and reviewed the 113 cases previously published in the world literature  
class4	650	pseudocyst of the auricle is an asymptomatic  noninflammatory cystic swelling that involves the anthelix of the ear  results from an accumulation of fluid within an unlined intracartilaginous cavity  and occurs predominantly in men  93  of patients   
class4	650	characteristically  only one ear is involved  87  of patients   and the lesion is usually located within the scaphoid or triangular fossa of the anthelix  
class4	650	previous trauma to the involved ear is uncommon  
class4	650	the diagnosis may be suggested by the clinical features  and analysis of the aspirated cystic fluid and or histologic examination of a lesional biopsy specimen will confirm the diagnosis  
class4	650	therapeutic intervention that maintains the architecture of the patient s external ear should be used in the treatment of this benign condition  
class4	651	multiple intracranial mucoceles associated with phaeohyphomycosis of the paranasal sinuses  
class4	651	the purpose of this article is to alert clinicians to a new pathogenic fungus of the paranasal sinuses called exserohilum rostratum  
class4	651	exserohilum species are one of the etiologic agents of phaeohyphomycosis  a constellation of entities caused by dematiaceous fungi  
class4	651	this class of fungal sinus infection has emerged only in the past decade  it occurs primarily in immunocompetent individuals and produces a tenacious  progressive pansinusitis  
class4	651	to our knowledge  this study describes the first case of multiple intracranial mucoceles secondary to e rostratum  
class4	651	the diagnostic workup includes computed tomography and magnetic resonance imaging followed by direct microscopic examination of tissue biopsy specimens  
class4	651	a craniotomy followed by a bilateral external ethmoidectomy was necessary for complete extirpation of the infected mucoceles  
class4	651	aggressive surgical management of this mycotic infection is described  
class4	652	osteoma of the middle ear  report of a case  
class4	652	osteomas of the middle ear are rare  
class4	652	we report a case of a 7 year old boy with osteoma originating from the pyramidal eminence  combined with congenital cholesteatoma  
class4	652	the osteoma and cholesteatoma were successfully removed by tympanomastoidectomy  
class4	652	the long process of the incus and the superstructure of the stapes disappeared  
class4	652	the body of the incus was sculpted and used as a columella  
class4	652	histopathologically  the osteoma was much the same as an external auditory canal osteoma  
class4	652	the possibility of a primary congenital origin of this neoplasm is suggested  
class4	653	transoesophageal echocardiography improves the diagnostic value of cardiac ultrasound in patients with carcinoid heart disease  
class4	653	transthoracic and transoesophageal cardiac echocardiography and doppler investigations were performed in 31 consecutive patients with malignant midgut carcinoid tumours  
class4	653	the transoesophageal images allowed measurement of the thickness of the atrioventricular valve leaflets and the superficial wall layers on the cavity side of both atria  
class4	653	the mean thickness of the anterior tricuspid leaflet was significantly greater than that of the mitral valve  a difference not seen in a control group of age matched patients without carcinoid tumours and with normal cardiac ultrasound findings  
class4	653	in addition  the edges of the tricuspid leaflets were thickened giving them a clubbed appearance  
class4	653	tricuspid incompetence was detected transoesophageally in 71  of the patients with carcinoid compared with 57  by transthoracic investigation  
class4	653	the inner layer of the right atrial wall in the carcinoid patients was significantly thicker than that of the left atrium and that of both atria in the controls  
class4	653	furthermore  patients with other signs of severe carcinoid heart disease had significantly thicker mean right atrial luminal wall layer than those with less or no signs of right heart disease  
class4	653	transoesophageal cardiac ultrasound investigation improved the diagnostic accuracy and seemed to show the structural changes typical of carcinoid heart disease established by histopathological investigations  
class4	654	skin exudate levels of interleukin 6  interleukin 1 and other cytokines in mycosis fungoides  
class4	654	the role of locally released cytokines in inducing lymphocyte activation and infiltration in the skin lesions of mycosis fungoides has been investigated  
class4	654	the levels of selected cytokines were measured in chamber fluid samples from lesional and control skin  
class4	654	biologically active interleukin 6 was significantly elevated in lesional samples and a recombinant form of this cytokine was shown to induce lymphocyte migration in an in vitro assay  
class4	654	biologically active interleukin 1 was detected in all control chamber fluid samples  
class4	654	significantly reduced levels of this cytokine were present in lesional samples  which may be the result of the release of preformed material  
class4	654	interleukin 2 and tumour necrosis factor activity  and gamma interferon and granulocyte macrophage colony stimulating factor immunoreactivity  were not detectable in any of the samples  
class4	654	interleukins 1 and 6 may play a role in the pathogenesis of the lesional lymphocyte infiltrates in mycosis fungoides  
class4	655	invasive migration of epidemic kaposi s sarcoma cells in vitro  
class4	655	kaposi s sarcoma  ks  is a low grade malignant neoplasm which shows invasive growth and often occurs in immunosuppressed patients with the acquired immune deficiency syndrome  aids  epidemic ks   
class4	655	it is also found in elderly men where it is usually limited to the skin  classic ks   
class4	655	the present study investigated the chemotaxis and invasive migration of epidemic ks cells in vitro and compared them to cells grown from classic ks lesions and to fibroblasts  
class4	655	epidemic ks cells demonstrated invasive migration through reconstituted basement membrane  matrigel  as well as through interstitial connective tissue  collagen i  in early passages  whereas fibroblasts did not invade either barrier  
class4	655	epidemic ks cells in late passages did not show any invasive migration  
class4	655	following pretreatment with tumour necrosis factor alpha  tnf alpha  there was no enhanced migration through the matrigel and collagen i for epidemic ks cells  whereas classic ks cells showed an increased migration through the type i collagen barrier  
class4	656	lymphokine activated killer  lak  cell activity in b and t chronic lymphoid leukemia  defective lak generation and reduced susceptibility of the leukemic cells to allogeneic and autologous lak effectors  
class4	656	the capacity to generate lymphokine activated killer  lak  cells and the susceptibility of the neoplastic cells to both allogeneic and autologous lak effectors were studied in b and t chronic lymphoproliferative disorders  
class4	656	while in b cell chronic lymphocytic leukemia  b cll  the depressed natural killer function could be restored after a 7 day incubation with recombinant interleukin  il 2   b cll mononuclear cells showed a reduced lak activity compared with normal lak cells  
class4	656	furthermore  in all but 1 of the 20 b cll samples tested the leukemic cells were totally resistant to autologous lak effectors  
class4	656	in most cases the leukemic cells were also resistant to normal allogeneic lak cells  
class4	656	competition experiments demonstrated that the patients  lak cells  as well as normal lak effectors  were capable of recognizing b cll cells  pointing  therefore  to a postbinding cytolytic defect  
class4	656	in hairy cell leukemia  hcl  an overall reduced lak activity against allogeneic targets was documented  but  at variance from b cll  hairy cells were often susceptible to the lytic effect of normal lak cells  and in half of the cases tested the neoplastic population was also sensitive in an autologous system  
class4	656	similarly to b cll  in the great majority of t chronic lymphoproliferative disorders studied  the pathologic cells were resistant to normal and autologous lak effectors and a defective lak generation was found  
class4	656	these results demonstrate that in most b and t chronic leukemias the lak function is defective and  when inducible  does not appear directed against the leukemic population  
class4	656	the possibility of exploiting an immunotherapeutic approach with il 2 lak cells in the management of chronic lymphoproliferative disorders does not gain support by these findings  
class4	657	distinct characteristics of lymphokine activated killer  lak  cells derived from patients with b cell chronic lymphocytic leukemia  b cll   a factor in b cll serum promotes natural killer cell like lak cell growth  
class4	657	we show that lymphokine activated killer  lak  cell precursors derived from patients with b cell chronic lymphocytic leukemia  b cll  and cultured in the presence of recombinant interleukin 2 and normal human serum  nhs   develop into primarily nk cell like  cd 57   lak cells  whereas identically prepared lak cell precursors from normal subjects develop into mainly t cell like  cd 3   cd 8   lak cells  
class4	657	b cll lak cells exhibited greater proliferative capacity than did normal lak cells  
class4	657	when normal lak cells were grown in b cll serum instead of nhs  their proliferation increased  nk cell levels also increased to those found in b cll lak cells  suggesting that b cll serum contains a factor that promotes nk cell like growth  lak cells derived from normal or b cll patients demonstrated similar lytic activity toward k562 and raji cells  
class4	657	growth in b cll serum did not reduce their lytic potential  
class4	657	thus  the altered phenotype and growth exhibited by b cll lak cells and normal lak cells grown in b cll serum does not lead to abnormalities in their cytolytic functions  
class4	657	we propose instead that the predominance of nk like cells in b cll lak cell populations and the presence of an nk cell like growth factor in b cll serum reflect abnormalities related to nk cell mediated b cell regulation  ie  either inhibition of normal b cell growth and or growth stimulation of the leukemic clone in b cll  
class4	658	a new monoclonal antibody  ch f42  recognizes a cd7  subset of normal t lymphocytes and circulating malignant cells in adult t cell lymphoma leukemia and sezary syndrome  
class4	658	we describe a new rat immunoglobulin m monoclonal antibody  ch f42  that recognizes a subset  1 5  to 8   of normal peripheral blood t lymphocytes  
class4	658	the phenotype of these cells was determined  using dual color immunofluorescence  to be cd2   cd3   cd4   cd5   cd7   cd8   
class4	658	they do not express t cell activation markers  and are positive for uchl1  cd45ro   but negative for 2h4  cd45ra   
class4	658	the antigen was expressed on circulating malignant cells in sezary syndrome  four of four cases  and adult t cell lymphoma leukemia  atll   four of six cases  and negative in a variety of other hematologic malignancies tested  
class4	658	these included chronic and acute lymphoid leukemias of b and t lineage  together with chronic and acute myeloid leukemias  
class4	658	however  normal ch f42  cells do not display any of the ultrastructural features associated with sezary or atll cells  
class4	658	the marked similarities between these conditions together with the shared expression of an otherwise very restricted surface antigen  ch f42  provide strong evidence for the existence of a common normal counterpart  
class4	658	preliminary characterization studies of the antigen  which is also expressed by k562 and jurkat cells  suggest the ch f42 antigen is an o linked  sialated glycan on a glycoprotein  
class4	659	characterization of a factor dependent acute leukemia cell line with translocation  3 3  q21 q26   
class4	659	a strictly factor dependent cell line  ucsd aml1  was established from a patient with the syndrome of multilineage acute leukemia with high platelets  
class4	659	the patient s cells and the cell line karyotype were 45 xx  7 t 3 3  q21 q26   typical of the syndrome of acute leukemia with high platelets  
class4	659	the cell line expresses cd34  cd7  tdt  and myeloid  cd13  cd14  cd33  and megakaryocyte platelet  cd36  cd41  cd42b  cdw49b  antigens  
class4	659	in short term culture  ucsd aml1 cells proliferate in response to interleukin 3  il 3   il 4  il 6  macrophage colony stimulating factor  m csf   and granulocyte macrophage csf  gm csf   but not il 1  il 2  il 5  or g csf  
class4	659	in long term culture  proliferation can be sustained by gm csf  il 6  or m csf  
class4	659	when maintained in gm csf  a small percentage of cells form multinucleated megakaryocyte like giant cells  
class4	659	culture with gm csf combined with il 6  but not with il 6 alone  increased giant cell formation fourfold to sevenfold  
class4	659	il 6 alone or in combination with gm csf increased expression of platelet related antigens  
class4	659	in contrast  culture with phorbol ester induced formation of macrophage like cells  
class4	659	ucsd aml1 is the first human acute nonlymphocytic leukemia cell line established from a patient with an acute leukemia syndrome associated with a specific chromosome abnormality  
class4	660	expression of transcobalamin ii receptors by human leukemia k562 and hl 60 cells  
class4	660	plasma membrane receptors for the serum cobalamin binding protein transcobalamin ii  tcii  were identified on human leukemia k562 and hl 60 cells using immunoaffinity purified human tcii labeled with  57co cyanocobalamin  
class4	660	the bmax values for tcii receptors on proliferating k562 and hl 60 cells were 4 500 and 2 700 per cell  respectively  
class4	660	corresponding dissociation constants  kd  were 8 0 x 10  11  mol l and 9 0 x 10  11  mol l  
class4	660	rabbit tcii also bound to k562 and hl 60 cells but with slightly reduced affinities  
class4	660	calcium was required for the binding of transcobalamin ii to k562 cells  
class4	660	brief treatment of these cells with trypsin resulted in almost total loss of surface binding activity  
class4	660	after removal of trypsin  surface receptors for tcii slowly reappeared  reaching pretrypsin treatment densities only after 24 hours  
class4	660	reappearance of receptors was blocked by cycloheximide  
class4	660	tcii receptor densities on k562 and hl 60 cells correlated inversely with the concentration of cobalamin in the culture medium  
class4	660	this suggests that intracellular stores of cobalamin may affect the expression of transcobalamin receptors  
class4	660	nonproliferating stationary phase k562 cells had low tcii receptor densities  less than 1 200 receptors cell   
class4	660	however  the density of tcii receptors increased substantially when cells were subcultured in fresh medium  
class4	660	up regulation of receptor expression coincided with increased 3h thymidine incorporation  which preceded the resumption of cellular proliferation as measured by cell density  
class4	660	in the presence of cytosine arabinoside  which induces erythroid differentiation  k562 cells down regulated expression of tcii receptors  
class4	660	when hl 60 cells were subcultured in fresh medium containing dimethysulfoxide to induce granulocytic differentiation  the up regulation of tcii receptors was suppressed  
class4	660	this event occurred well before a diminution of 3h thymidine incorporation and cessation of proliferation  
class4	660	thus  changes in the regulation of expression of tcii receptors correlate with both the proliferative and differentiation status of cells  
class4	661	genotypic characterization of centrocytic lymphoma  frequent rearrangement of the chromosome 11 bcl 1 locus  
class4	661	centrocytic lymphomas are defined in the kiel classification as b cell lymphomas composed exclusively of cells resembling cleaved follicular center cells  fcc   
class4	661	these lymphomas have been shown to be histologically  immunophenotypically  and clinically distinct from other cleaved fcc lymphomas  
class4	661	dna from 18 centrocytic lymphomas  14 patients  was analyzed using southern blotting and probes for immunoglobulin heavy  jh  and kappa light chain  jk  joining gene  t cell receptor beta chain constant gene  cb   bcl 1  bcl 2  and c myc gene rearrangements  
class4	661	all of the lymphomas had jh and jk rearrangements  confirming their b cell origin  
class4	661	none of the specimens had detectable cb  bcl 2  or c myc rearrangements  
class4	661	however  4 of 14 patients  28 6   had rearrangement of the chromosome 11 bcl 1 locus  
class4	661	therefore  centrocytic lymphomas are genotypically distinguishable from the majority of other small cleaved fcc lymphomas by their lack of demonstrable bcl 2 rearrangements  
class4	661	this supports the distinct nature of centrocytic lymphomas and suggests the lack of importance for the putative oncogene bcl 2 in these cases  
class4	661	furthermore  the frequent rearrangement of bcl 1 suggests a possible role for this locus in the pathogenesis of at least some centrocytic lymphomas  
class4	662	biology and clinical significance of cytogenetic abnormalities in childhood acute lymphoblastic leukemia  
class4	662	virtually all cases of childhood all have chromosomal abnormalities and half contain translocations  which are nearly equally divided between random and nonrandom rearrangements  
class4	662	nonrandom chromosomal abnormalities have been correlated with leukemic cell lineage  the degree of cell differentiation  and the specific gene involved at the molecular level  
class4	662	many cytogenetic findings have prognostic significance  however  the adverse influence of certain changes  including most chromosomal translocations  may in fact be offset by the greater cytoreductive effects of intensified therapy  
class4	662	table 4 summarizes the relation of selected karyotypic findings to treatment outcome in patients treated on contemporary protocols  
class4	662	among all of the chromosomal abnormalities identified in childhood all  hyperdiploidy greater than 50 has been associated with the most favorable prognosis  
class4	662	at the opposite end of the spectrum  the treatment outcome for patients with classical ph  or hypodiploid all is very poor even in programs of intensive chemotherapy  alternative treatment such as bone marrow transplantation should be considered for such patients  
class4	662	cases with the t 4 11  q21 q23  also have a very poor clinical outcome  but the adverse prognosis may be limited to the infant or adolescent age groups  
class4	662	the prognostic significance of other nonrandom translocations  such as t 1 19  q23 p13  and several other abnormalities  needs to be further assessed in larger numbers of patients  
class4	662	finally  as more is learned about the molecular pathology underlying these rearrangements  it may be possible to develop new therapeutic agents that are specifically targeted to interfere with the aberrant gene products expressed by human leukemic cells  
class4	663	effects of recombinant human interleukin 3 on human hematopoietic progenitor and precursor cells in vivo  
class4	663	dna synthesis rates and concentrations of bone marrow  bm  and peripheral blood  pb  progenitor cells were studied in 22 patients treated with recombinant human interleukin 3  rhil3  as part of a clinical phase i ii study  
class4	663	recombinant hil3 at doses of 60 to 500 micrograms m2 was administered by subcutaneous bolus injection for 15 days to 13 patients with solid tumors and preserved hematopoietic function and to nine patients with bone marrow failure  including five with myelodysplastic syndromes  
class4	663	following treatment with rhil3  the percentage of actively cycling bm erythroid  bfu e  and multilineage  cfu gemm  progenitors in patients with preserved hematopoietic function increased from 16  to 36   p less than  05  and from 10  to 40   p less than  01   respectively  
class4	663	the dna synthesis rates of early and late granulocyte macrophage progenitor cells increased from 11  to 26   cfu gm day 14  p less than  02  and from 13  to 30   cfu gm day 7  p less than  05   
class4	663	there was an increase in bm cellularity from 37  to 58   and of the myeloid to erythroid ratio from 1 4 to 3 2  while the concentration of marrow progenitors on a per cell basis was unchanged or slightly decreased  
class4	663	the frequencies of blast cells in the bm were unchanged  
class4	663	mean levels of pb cfu gm day 14 and cfu gemm were 100  and 72  above baseline values after 7 days of rhil3 but only 25  and 28  above initial levels at the end of treatment  
class4	663	peripheral blood bfu e were reduced in the majority of patients with normal marrow after both 7 and 15 days of rhil3  
class4	663	no augmentation of circulating bfu e and cfu gemm was seen in 5 patients with mds who had few or no pb bfu e or cfu gemm initially  
class4	663	total leukocyte  neutrophil  and eosinophil counts increased significantly  p less than  01  in 21 of 22 patients with a peak response after a median of 13 days of rhil3  
class4	663	while a small increase in reticulocytes was not accompanied by an elevation of the hemoglobin or hematocrit  platelet counts increased by 50  in patients with preserved marrow function  
class4	663	thus  rhil3 induces a multilineage response in vivo  apparently by stimulating proliferation of multipotential and lineage restricted progenitors  
class4	663	it remains to be determined whether this is due to direct or indirect effects on the progenitor cells  
class4	664	the pharmacokinetics of plasminogen activator inhibitor 1 in the rabbit  
class4	664	the pharmacokinetics of the activated and latent forms of plasminogen activator inhibitor 1  pai 1  isolated from ht1080 fibrosarcoma cells  ht1080 pai 1  and a nonglycosylated form of human pai 1 isolated from a yeast expression system  rpai 1  were followed in the rabbit  
class4	664	as assessed by an immunologic assay specific for human pai 1  guanidine hci activated ht1080 pai 1 and rpai 1 entered the total plasma volume following intravenous bolus administration and exhibited a biphasic clearance pattern  
class4	664	the t1 2s of ht1080 pai 1 for the initial and beta phases equalled 6 0 and 24 8 minutes  respectively  
class4	664	the t1 2s of rpai 1 for the initial and beta phases equalled 8 8 and 34 0 minutes  respectively  
class4	664	similar results were obtained by measuring pai 1 activity in plasma and with trace amounts of 125i rpai 1  suggesting that the above pharmacokinetic behavior could also apply to endogenous pai 1  
class4	664	the liver was the main site of rpai 1 clearance  
class4	664	unactivated  latent pai 1 exhibited a very different pharmacokinetic profile  
class4	664	over 80  of latent rpai 1 cleared from the circulation within 10 minutes  t1 2   1 7 minutes   
class4	664	the difference in clearance behavior between activated and latent pai 1 may be related to the ability of activated pai 1  but not latent pai 1  to rapidly form high molecular weight complexes with plasma binding factors which were observed in vitro and in vivo  
class4	664	because pai 1 could potentially tilt the fibrinolytic balance toward a prothrombotic state  its rapid clearance may represent an important control mechanism governing the circulating levels of this key component of the fibrinolytic pathway  
class4	665	survival of premenopausal women with metastatic breast cancer  long term follow up of eastern cooperative group and cancer and leukemia group b studies  
class4	665	in premenopausal women with metastatic breast cancer  differences in survival curves early during follow up can be misleading  
class4	665	the authors therefore analyzed long term survival in 378 patients  entered in three randomized trials  started between 1973 and 1978  
class4	665	combined data from the three trials were used to increase the power for identifying prognostic variables  
class4	665	cancer and leukemia group b  calgb  trial 7382 randomized patients to oophorectomy plus either cyclophosphamide or combination chemotherapy or observation  
class4	665	eastern cooperative oncology group  ecog  2174 randomized patients who had not progressed 3 months after oophorectomy to combination chemotherapy or combination chemotherapy or observation  
class4	665	trial ecog 2177 randomized estrogen receptor  er  positive or er unknown patients to oophorectomy plus combination chemotherapy or immediate combination chemotherapy  and er negative patients were directly assigned to combination chemotherapy  
class4	665	hence er negative patients need not have been healthy enough to be randomized to oophorectomy  
class4	665	with only 14  of the patients still alive  median survival on the three studies was 30  24  and 28 months  
class4	665	the median survival of individual treatments changed noticeably in ecog 2174 and ecog 2177 with long term follow up  
class4	665	at this time there are no differences in survival between randomized regimens in any of the three trials  
class4	665	in a multivariate model  factors associated with significantly poorer survival were visceral dominant disease  nodal metastases  breast metastases  age younger than 45 years  er negativity  and not receiving chemotherapy immediately after oophorectomy  
class4	665	this treatment difference was thus not due to imbalances in the prognostic variables used in the model  but it may be due to imbalances of unknown prognostic factors or differences in patient selection  
class4	666	analysis of bladder carcinoma by subsite  cystoscopic location may have prognostic value  
class4	666	nine hundred fourteen cases of carcinoma of the urinary bladder registered from 1977 to 1988 with the kansas state tumor registry were evaluated by subsite for differences in grade  histology  sex  age at diagnosis  and survival  
class4	666	only initial occurrences of carcinoma were included  
class4	666	carcinoma of the lateral walls accounted for 37 1   the posterior wall  17 9   the trigone  12 6   the neck  11 1   the ureteric orifices  9 8   the dome  7 7   and the anterior wall  3 8   
class4	666	malignant neoplasms occurring in the neck of the bladder had a significantly poorer prognosis by survival analysis  p less than 0 05   
class4	666	malignancies of the dome were found to present as higher grade lesions  p   0 00003   and carcinoma of the ureteric orifices and lateral walls tended to be of lower grade  p   0 02 and p   0 05  respectively   
class4	666	carcinomas of the anterior wall and dome occurred in a more elderly population  mean ages  75 6 and 73 9 years  respectively   and carcinomas of the trigone and ureteric orifices occurred in a younger group  mean ages  68 3 and 67 5 years  respectively   
class4	666	on histologic evaluation the trigone gave rise to more squamous cell carcinoma than expected  p   0 001  325  of expected   
class4	666	no distribution difference was noted among subsites with respect to sex  
class4	666	these data show significant differences among subsites of the urinary bladder with regard to survival  grade  histology  and age at diagnosis  
class4	667	the management of pseudomyxoma peritonei  
class4	667	the management of nine patients with pseudomyxoma peritonei was reviewed  
class4	667	aggressive surgical resection of tumor is the standard of treatment  with many patients requiring multiple laparotomies  
class4	667	chemotherapy  including the use of cisplatin is not effective  
class4	667	long term nutritional support provides a better quality of survival for select patients  
class4	668	chondrosarcoma of bone in children  
class4	668	chondrosarcoma of bone rarely occurs in children  
class4	668	this report analyzes the clinicopathologic features in a series of 47 patients with conventional chondrosarcoma who were less than 17 years of age  
class4	668	of the 47 cases  14 were from the mayo clinic files  and 33 were from our consultation files  
class4	668	most of the lesions occurred in the trunk and upper ends of the long bones  with the humerus being the most frequent skeletal site  
class4	668	twelve of the 47 tumors were secondary  
class4	668	the radiographic findings were the same as those seen in adult chondrosarcoma  
class4	668	pathologically  the tumors were low grade  
class4	668	en bloc resection is the treatment of choice because of the high incidence of local recurrence with lesser surgical margins  
class4	668	prognosis in childhood chondrosarcoma is no different from that in adult chondrosarcoma  
class4	668	none of the patients with follow up data had metastasis  
class4	669	cancer mortality in a higher income black population in new york state  comparison with rates in the united states as a whole  
class4	669	in the 1980 census the median family income among blacks in suffolk county  new york  i e    19 604  was much higher than that for american blacks as a whole  i e    12 618  and 94 1  of that for american whites  i e    20 840   but the proportion below the poverty level was still higher for suffolk county blacks than for american whites  
class4	669	observed numbers of deaths from 1979 to 1985 for total cancers and most cancer sites in suffolk county black men and women were not lower than expected on the basis of age specific and gender specific death rates for blacks in the us  
class4	669	although numbers of deaths from cervical cancer and prostate cancer were slightly lower than expected in suffolk county blacks versus american blacks  these numbers were still significantly greater than expected on the basis of death rates among american whites  
class4	669	age specific death rates for age groups 25 to 44 years to 55 to 64 years tended to be lower in suffolk county for lung cancers in black men but not for breast cancer in black women  
class4	669	specific cancer sites  which differ in the direction of the association between incidence and socioeconomic status  age  and gender must be considered in comparisons of cancer mortality by race and socioeconomic level  
class4	669	implications of the comparisons were discussed with regard to the goal of reducing racial differences in cancer death rates  
class4	670	immunocytochemical estrogen and progestin receptor assays in breast cancer with monoclonal antibodies  histopathologic  demographic  and biochemical correlations and relationship to endocrine response and survival  
class4	670	breast cancer specimens from 600 women were assayed for estrogen receptors  er  using an immunocytochemical assay  ica  employing the monoclonal antiestrophilin antibody h222 sp gamma  
class4	670	results showed significant correlation with biochemical er determinations as well as with tumor grade and menopausal status  
class4	670	in 449 cases  results of progesterone receptor assay by ica using the monoclonal anti pgr antibody kd 68  also correlated significantly with biochemical pgr measurements  
class4	670	the erica pgrica positivity was significantly more frequent in postmenopausal white women  
class4	670	colloid carcinomas were most likely to be erica positive and pgrica positive whereas medullary carcinomas were most often negative  
class4	670	in 47 patients with advanced mammary carcinoma  results of erica and pgrica were more closely related to endocrine response than those of er and pgr by dextran coated charcoal assay  dcc   
class4	670	in 339 women with stage i or stage ii breast cancer  erica was significantly associated with disease free survival  
class4	670	analysis by cox s proportional hazard model  however  showed pgrica to be the best predictor of survival and disease free survival in 197 women at the same stages of disease  
class4	670	these data indicate that ica is more predictive of prognosis than biochemical er and pgr  
class4	670	the ease of ica performance coupled with these results indicate that the method is an acceptable substitute for dcc in analyzing breast cancers for er pgr  
class4	671	teniposide  vm 26  and continuous infusion cytosine arabinoside for initial induction failure in childhood acute lymphoblastic leukemia  a pediatric oncology group pilot study  
class4	671	twenty six evaluable children with newly diagnosed acute lymphoblastic leukemia  all  who failed to achieve initial remission after receiving two to seven drugs for at least a 4 week period were given teniposide  vm 26  and continuous infusion cytosine arabinoside  ara c   
class4	671	twenty two received 150 mg m2 of vm 26 on days 1 and 2 with 100 mg 2 of ara c as a continuous infusion on days 1 through 5  a second shortened course was given on day 14 to eight patients who had evidence of some antileukemic effect or were clinically judged able to tolerate a second course  
class4	671	the last four patients received three daily doses of vm 26 and a 7 day infusion of ara c at the same daily dosages  
class4	671	twelve  48   achieved complete remission  cr  of all  
class4	671	there was a trend toward decreasing response rates with an increasing number of drugs used in the initial induction regimen  i e   five cr among seven patients with a prior two drug induction attempt  six cr among 14 patients with a prior three  to four drug induction attempt  and one cr among four patients with a prior five  to seven drug induction attempt  p   0 14   
class4	671	ten of 17 non t cell patients and two of nine t cell patients achieved remission  p   0 10   
class4	671	the median time required to achieve a complete remission from the initiation of treatment was 26 days  range  14 72 days   
class4	671	this period was shorter in those who required one course compared with those who required two induction courses  i e   25 days median vs  
class4	671	44 days median  
class4	671	toxicity was significant and due mainly to marrow aplasia and infection  one patient had severe prolonged vm 26 induced hypotension  
class4	671	of the 12 patients entering remission  two were removed for marrow transplant and one was removed due to parental request  
class4	671	in the remaining nine patients  median remission duration was only 2 months  range  1 18 months   
class4	671	all nine patients relapsed in the marrow  
class4	671	among the entire group of 26 patients  only one patient is alive and a long term event free survivor  after allogeneic marrow transplant   
class4	671	due to the current use of more aggressive initial induction regimens and the extremely poor prognosis in children who fail to achieve initial remission  more intensive regimens of continuation therapy or alternative therapies  such as bone marrow transplant  should be considered  
class4	672	association of disease free survival and percent of ideal dose in adjuvant breast chemotherapy  
class4	672	the relationship between percent of ideal dose and disease free survival was examined in 256 stage ii and iii patients who participated in a 2 year breast adjuvant chemotherapy trial consisting of cyclophosphamide  methotrexate  and 5 fluorouracil  cmf  given postoperatively  
class4	672	when analyzed analogously to previous work  the results confirmed a dose response relationship  that is  there appeared to be an improved disease free survival for patients receiving higher doses of adjuvant chemotherapy  
class4	672	the major criticism of such an analysis is its bias  
class4	672	this bias was addressed by considering only patients who were still receiving therapy at 6  12  and 24 months  then  the dose response relationship was no longer seen  
class4	672	although causality cannot be inferred  the apparent differences in disease free survival among the dose groups can be attributed to recurrences in the first 2 years among patients receiving lower doses of chemotherapy  
class4	673	doxorubicin for unresectable hepatocellular carcinoma  a prospective study on the addition of verapamil  
class4	673	a prospective study was conducted to assess the safety and efficacy of the addition of oral verapamil to intravenous adriamycin  doxorubicin  for the management of patients with unresectable hepatocellular carcinoma  hcc   
class4	673	all 28 patients studied had histologically verified disease  and cirrhosis was present in 20 of the 21 patients with adequate tissue sampling  
class4	673	the overall median survival was 57 days  
class4	673	chemotherapy was terminated in seven patients after one course of treatment  
class4	673	partial response and complete response were noted in four patients  19   and one patient  4 8    respectively  among the 21 patients evaluated  
class4	673	side effects related to the chemotherapy were present in all patients studied  
class4	673	death from fulminating sepsis occurred in three of the 13 patients with leukopenia  
class4	673	symptomatic myocardial dysfunction developed in one patient  
class4	673	the addition of verapamil apparently did not potentiate the tumoricidal effect of systemic adriamycin on hcc but probably did increase its complications  
class4	674	a phase i trial of cisplatin in hypertonic saline and escalating doses of 5 fluorouracil by continuous intravenous infusion in patients with advanced malignancies  
class4	674	thirty four patients with incurable solid tumors were treated in a phase i trial with a fixed dose of high dose cisplatin  cddp  administered in hypertonic saline and escalating doses of infusional 5 fluorouracil  5 fu   
class4	674	five treatment levels of 5 fu  ranging from 500 to 900 mg m2 day for 5 days  were studied  
class4	674	leukopenia  thrombocytopenia  and oral mucositis were the dose limiting toxicities encountered  
class4	674	nephrotoxicity was minimal  
class4	674	ototoxicity and peripheral neuropathies were rare and mild in this patient group  but most patients received only a small number of treatment cycles  
class4	674	diarrhea was not dose limiting  
class4	674	two complete responses  one non small cell lung cancer and one sweat gland carcinoma  were observed  
class4	674	no other major responses were noted  
class4	674	with the dose of cddp set at 35 mg m2 day for 5 consecutive days  the maximum tolerated dose  mtd  of a concurrent 5 day 5 fu infusion was found to be 900 mg m2 day  
class4	674	the recommended dosages for phase ii trials are 35 mg m2 day cddp and 800 mg m2 day 5 fu for 5 consecutive days  
class4	674	cancers of the lung  breast  gastrointestinal tract  and genitourinary tract would be reasonable targets for phase ii studies  
class4	675	treatment of advanced squamous cell carcinoma of the skin with cisplatin  5 fluorouracil  and bleomycin  
class4	675	the authors treated 14 patients with advanced squamous cell carcinoma  scc  of the skin or lip with one to four cycles of combination chemotherapy consisting of cisplatin by bolus injection  and 5 fluorouracil  5 fu  and bleomycin by continuous 5 day infusion  
class4	675	objective responses were seen in 11 of the 13 evaluable patients  84    
class4	675	four patients had a complete remission  30   and seven patients  a partial remission  54    
class4	675	local control after definitive complementary radiation and or surgical treatment was achieved in seven patients  
class4	675	toxic side effects was acceptable  they consisted of nausea and vomiting in all patients  transient skin changes  hematologic  grade 3 4  abnormalities in four patients  and pulmonary fibrosis in one elderly patient  
class4	675	these results show that this chemotherapy combination could play a role in reducing the tumor mass and in facilitating definitive treatment to obtain better functional and cosmetic results in advanced scc of the skin  
class4	676	effect of intraarterial versus intravenous cisplatin in addition to systemic doxorubicin  high dose methotrexate  and ifosfamide on histologic tumor response in osteosarcoma  study coss 86   
class4	676	in osteosarcoma  intraarterial  ia  administration of systemic treatment has been advocated to improve local tumor response preparing for  or even obviating  definitive surgery  
class4	676	because data from the literature did not unequivocally support the local superiority of ia infusion  a comparative study was started in 1986  
class4	676	preoperative chemotherapy consisted of 45 mg m2 of doxorubicin on days 1 and 2  12 g m2 of high dose methotrexate on days 15 and 22  and 3 g m2 of ifosfamide on days 29  30  50  and 51 followed on days 31 and 52 by intravenous  iv  versus ia tourniquet infusion of cisplatin  ddp   
class4	676	a strict randomization of patients was not feasible  
class4	676	a balanced distribution of risk factors was strived for by stratifying and allocating the appropriate patients centrally  
class4	676	the infusion time was prolonged from 1 to 5 hours in the iv group  and the ddp dose was reduced from 150 to 120 mg m2 in both arms when intolerable ototoxicity became apparent  
class4	676	a multivariate analysis was performed to exclude a bias on the response rates from risk factor distribution and from modifications of ddp infusion time and dosage  
class4	676	the overall fraction of histologic good responders  greater than 90  necrosis  was not found to be different after ia versus iv treatment  34 50  68   vs  
class4	676	41 59  69     
class4	676	intraarterial instead of iv use of ddp within an aggressive systemic treatment does not seem to improve the local tumor response  
class4	677	topographic classification  clinical characteristics  and diagnostic delay of cancer of the larynx hypopharynx in torino  italy  
class4	677	the case series of a population based case control study of laryngeal and hypopharyngeal cancers in torino  italy  included 281 men with clinical and anamnestic data  
class4	677	two hundred fifteen  28  and 38 cancers originated from the endolarynx  epilarynx  and hypopharynx  respectively  
class4	677	regions invaded by the tumor were divided into 26 subsites  
class4	677	a classification based on the number of invaded subsites was proposed  which agreed well with the t classification of the tnm system  
class4	677	cancers originating from the hypopharynx invaded more subsites than cancers from the endolarynx  and among the latter  supraglottic were more invasive than glottic lesions  
class4	677	the number of invaded subsites was strongly associated with nodal involvement  
class4	677	among symptoms at onset of disease and at diagnosis  patients with endolaryngeal lesions reported dysphonia and dyspnea more frequently  and patients with lesions from other regions had a higher prevalence of dysphagia  odynophagia  otalgia  and adenopathia  
class4	677	clinical and epidemiologic results of this study suggest considering the endolarynx  epilarynx  and hypopharynx as separate anatomic entities  
class4	677	diagnostic delay was not associated with tumor size and showed a negative trend with involvement of cervical lymph nodes  suggesting that stage at diagnosis is due to intrinsic differences in tumor aggressiveness  
class4	678	long term follow up of 24 patients undergoing radical resection for ampullary carcinoma  1953 to 1988  
class4	678	potentially curative radical pancreaticoduodenectomy for ampullary adenocarcinoma was performed in 24 patients over a 35 year period  
class4	678	the overall operative mortality was 12 5   
class4	678	actuarial survival rate at 5 years was 61      13 4 standard error of the mean  sem  and subsequently remained unchanged  
class4	678	in the same time period  21 patients underwent potentially curative radical pancreaticoduodenectomy for periampullary tumors of pancreatic origin  
class4	678	similar analysis showed an overall operative mortality of 23 8  and a survival rate at 5 years of 27      12 5 sem  
class4	678	the results of radical pancreaticoduodenectomy for ampullary carcinoma in the most recent years  1976 to 1988  were compared with those of former years  1953 to 1975   
class4	678	there were no statistically significant differences in the 5 year survival rate  however  the operative mortality decreased from 25  in the former period to 6 3  in the recent period  
class4	678	survival was dependent on nodal status  
class4	678	the 5 year survival rate was 78      11 5 sem in the absence of nodal metastasis versus 50      25 sem in the presence of regional nodal metastasis  
class4	678	these findings support the concept that radical pancreaticoduodenectomy offers a realistic probability for cure in a selected group of patients with carcinomas of the ampulla of vater  
class4	679	radiographic microcalcification and parenchymal patterns as indicators of histologic  high risk  benign breast disease  
class4	679	breast tissue from a forensic autopsy series of 486 women  15 to 98 years of age  was studied radiographically and by histologic sampling  
class4	679	prevalence of wolfe p2 dy parenchymal patterns decreased with age  
class4	679	radiographic nonvascular microcalcification and histologic presence of marked ductal epithelial hyperplasia and lobular microcalcification increased with age  
class4	679	both of these histologic parameters of increased risk for breast cancer correlated with the presence of radiographic microcalcification and wolfe p2 dy parenchymal pattern  
class4	679	the predictive value of the radiographic parameters for presence of  high risk  proliferative fibrocystic change increased with age  
class4	680	human papillomavirus type 16 associated with oral squamous carcinoma in a cardiac transplant recipient  
class4	680	human papillomavirus type 16  hpv 16  has been associated with a variety of squamous carcinomas  particularly those involving the anogenital tract  
class4	680	the authors report the development of an oropharyngeal carcinoma in a 43 year old man approximately 20 months after cardiac transplantation while he was on a maintenance regimen of cyclosporine a and prednisone  
class4	680	the carcinoma was resistant to treatment  and he died of complications related to metastatic disease 3 years posttransplantation  
class4	680	molecular biologic studies using nonisotopic labeled viral dna probes were done  
class4	680	in situ hybridization demonstrated the presence of hpv 16 dna in the tumor cells  
class4	680	dna dot blot analysis confirmed the presence of multiple copies of hpv 16 dna within the tumor cells and their absence from adjacent normal appearing tissue  
class4	680	southern blot analysis suggested that the hpv 16 dna was integrated into the tumor cell genome  
class4	680	with increasing recognition of the carcinogenicity of hpv type 16 infection  a role for this virus in the development of squamous cell malignancies in immunosuppressed organ transplant recipients is likely to be noted with increasing frequency  
class4	681	expression of ki 1 antigen  cd30  in mesenchymal tumors  
class4	681	expression of cd30 ki 1  antigen has long been considered to be restricted to activated lymphocytes and related tumors  
class4	681	however  expression of this antigen has also been detected in embryonal carcinomas  in nonembryonal carcinomas  in malignant melanomas  and even in some myeloid cell lines and macrophages at late stages of differentiation  
class4	681	in this study  using monoclonal antibody ki 1  expression of cd30 antigen was immunohistochemically examined in frozen sections of 28 benign and 63 malignant mesenchymal tumors  
class4	681	the authors found cd30 expressed in two of four leiomyomas  seven of 11 leiomysarcomas  one of six rhabdomyosarcomas  two of two aggressive fibromatoses  one of three fibrosarcomas  two of four synovial sarcomas  one giant cell tumors of tendon sheaths  all five malignant fibrous histiocytomas  all three osteosarcomas  one of three ewing s sarcomas  in a tumor cell subpopulation of two of ten malignant schwannomas  and in the schwann cell compartment of one of two ganglioneuromas tested  
class4	681	furthermore  cd30 was consistently expressed in the myoepithelial compartment of 13 fibroadenomas  
class4	681	however  all five lipomas  all seven liposarcomas  all three neuroblastomas  both ganglioneuroblastomas  both chondrosarcomas  and tumors of disputed origin tested were consistently cd30 negative  
class4	681	these findings indicate that  outside the lymphatic system  cd30 antigen is not restricted to epithelial neoplasms but may also be present in tumors of mesenchymal origin  
class4	681	the authors conclude that cd30 antigen  although having limited utility in the differential diagnosis of tumors of questionable histogenesis  may eventually define relevant subgroups within the main tumor categories  
class4	682	immunophenotypes in  classical  b cell chronic lymphocytic leukemia  correlation with normal cellular counterpart and clinical findings  
class4	682	this study evaluates the expression of a series of membrane antigens  normally expressed by b lymphocytes of the lymphocytic mantle and marginal zone  in 90 selected cases of  classical   mouse red blood cell receptor   cd20   cd5   surface immunoglobulin      b chronic lymphocytic leukemia  b cll  with the aim of contributing toward identifying the normal counterpart of b cll and any correlations between surface antigen pattern and certain clinical characteristics  
class4	682	clustered  cd23  25  39  40  27  1c  w75  and unclustered  nub1  7f7  kib3  monoclonal antibodies  moab  were tested  
class4	682	almost all cases showed high reactivity to cd23  27  w75  39  40  and nub1  expression of cd1c was very low and that of 7f7  kib3  and cd25 was variable  
class4	682	the reactivity of 7f7 and kib3 was strictly correlated  and they correlated individually with cd25  
class4	682	results show that the most frequent b cll phenotype  cd19   5   23   27   39   nub1   kib3      7f7      and cd25      corresponds to one or more cellular subsets in the mantle zone  
class4	682	no correlation was found between moab expression  surface immunoglobulin  sig  class or type  clinical stage  disease activity  or age at diagnosis  
class4	682	the only difference  statistically borderline  was the expression of 7f7 and kib3  in young versus old patients   
class4	682	this suggests that modulations in the expression of surface antigens do not affect the clinical behavior of the disease  
class4	683	significance of blasts in low cell count cerebrospinal fluid specimens from children with acute lymphoblastic leukemia  
class4	683	the purpose of this study was to determine whether the presence of more than 5  blasts in a differential count of cytocentrifuged cerebrospinal fluid  csf  with less than 6 leukocytes microliter was predictive of central nervous system  cns  relapse in children with acute lymphoblastic leukemia  all   
class4	683	a double concentrate method of cytocentrifuge preparation was used to analyze 4543 consecutive csf specimens from 349 children with all between january 1  1982  and september 30  1988  
class4	683	one hundred nine csf specimens from 58 evaluable children had less than 6 leukocytes microliter and more than 5  blasts on cytocentrifuge differential count  low cell count specimen with blasts  lcb    
class4	683	during the study period  25 of 332 evaluable children  7 5   had cns leukemic recurrence  
class4	683	in 22 of 25  88    the cns relapse was preceded by at least one abnormal low cell count csf specimen  
class4	683	one of 34 patients with a single lcb at diagnosis  3   had subsequent cns relapse compared with five of eight patients  62 5   with a single lcb during remission  p   0 0002   
class4	683	of 16 children with two or more lcb during remission  nine  56   had cns relapse defined by standard criteria  whereas six additional patients in this group were declared to be in cns relapse on the basis of their repetitive lcb  
class4	683	whether diagnosing cns recurrence earlier in its course based on a modification of the definition of cns leukemia will change the frequency of subsequent adverse events or make possible decreased intensity of cns retreatment remains to be determined  
class4	684	prognostic implication of ecto 5  nucleotidase activity in acute lymphoblastic leukemia  
class4	684	ecto 5  nucleotidase  5  n  activity was determined in 191 patients  71 children and 120 adults  with acute leukemia  
class4	684	elevated values for 5  n were registered in common acute lymphoblastic leukemia  all   but blast cells of t cell all  t all  and common all antigen negative non t all had low enzyme activity comparable with the values of acute non lymphocytic leukemia  
class4	684	dependence of remission duration on 5  n activity was analyzed in 74 adults with all  treated similarly in a prospective multicenter trial  
class4	684	the remission curves for all patients with 5  n activity lower than 10 nmol h x 10 6  cells were substantially and significantly better than those of patients with high activity  greater than 10 nmol h x 10 6  cells   
class4	684	this difference was also evident in the immunologic subclass common all  
class4	684	statistical evaluation showed that an interaction between immunologic subtype of the blast cells and their 5  n activity had prognostic significance for remission duration  
class4	684	in addition to the independent factor  initial age  this interaction was also prognostic for survival  
class4	685	sex hormone receptors in human thyroid tissues  
class4	685	the behavior of sex hormone receptors was studied in the cytosol of thyroid tissue samples in order to clarify the effects of sex hormones on diseases of the thyroid  
class4	685	androgen receptor  ar   estrogen receptor  er   and progesterone receptor  pgr  were assayed using the dextran coated charcoal  dcc  method and analyzed by the method of scatchard  
class4	685	androgen receptor  er  and pgr were negative in all of the cytosol prepared from normal thyroid tissues  
class4	685	however  the positive rates for the receptors in the neoplastic and nonneoplastic tissues were 22  for ar  29  for er  and 18  for pgr  
class4	685	especially  the incidence of er was significantly higher in neoplastic lesions than normal tissues  
class4	685	these data suggest that sex hormones  especially estrogen  may play a role in diseases of the thyroid  
class4	686	lewis system alterations in gastric carcinogenesis  
class4	686	alterations in the expression of type 1 blood group related antigens  lewis a and b  were examined immunohistochemically in 371 consecutives gastric biopsy and 80 surgical specimens from patients of gastric carcinoma  
class4	686	the abh and lewis phenotype and secretor status of the patients were correlated with histologic findings  
class4	686	an anomalous expression of lewis a antigen was found in 88 of 249 gastric biopsy specimens of lewis  a b   phenotype patients  
class4	686	the prevalence of this anomaly increased with the evolution of the premalignant process  in agreement with the commonly accepted model of gastric carcinogenesis  
class4	686	thus  anomalous lewis a antigen appeared in 66 6  of gastric dysplasia cases  in 64 6  of intestinal metaplasia  in 15 4  of atrophic gastritis  and in 7 4  of superficial gastritis  
class4	686	no alterations were found in subjects with normal gastric mucosa  
class4	686	forty seven of the 49 lewis  a b   phenotype gastric carcinoma patients showed antigenic alterations in tumor cells  anomalous lewis a antigen in 36 and loss of lewis antigens in 11   
class4	686	in 26 of these gastric specimens an anomalous lewis a antigen was present in areas of intestinal metaplasia and or dysplasia away from the area of neoplastic transformation  
class4	686	the expression of lewis a antigen in lewis  a b   phenotype patients is a frequent phenomenon in gastric neoplastic cells and could result from the blocked synthesis of lewis b antigen with accumulation of its precursors  
class4	686	these findings suggest that  during gastric carcinogenesis  antigenic alterations may precede neoplastic transformation  
class4	686	an anomalous lewis a antigen could constitute a significant index of severity of the histologic lesion and contribute to identifying high risk individuals  
class4	687	comparison of dna content in gastric cancer cells between primary lesions and lymph node metastases  
class4	687	cytophotomtric dna contents of tumor cells in primary lesions and the corresponding metastatic lymph nodes were compared in 61 cases of gastric cancer to determine whether the dna content remains stable during lymph node metastasis  
class4	687	the dna distribution patterns were grouped into three types  according to the proportion of aneuploid cell population  
class4	687	changes in dna patterns between primary and metastatic lesions were evident in 36 of 61 patients  59 0    in the remaining 25  41 0    the same dna distribution patterns were noted for both lesions  
class4	687	in 33 of these 36  dna pattern in the primary carcinoma was transformed into a more narrowly scattered one in the metastatic lesion of the lymph node  
class4	687	mean and modal values and the frequency of cells over tetraploid  4c  or hexaploid  6c  were significantly higher in the primary lesion compared with findings in the metastatic lesions  
class4	687	this reduction in dna content in the metastatic lesions was a more frequent occurrence in differentiated  18 of 23  than in undifferentiated adenocarcinoma  15 of 35   p less than 0 01   
class4	687	therefore  in primary lesions with a widely scattered dna ploidy  the tumor cells with a smaller dna ploidy frequently metastasized to lymph nodes  particularly in cases of a differentiated carcinoma  
class4	687	such observations may be pertinent in future designing of treatment protocols  
class4	688	a clinical and flow cytometric analysis of patients with nasopharyngeal cancer  
class4	688	abnormal cellular dna content  a hallmark of malignancy  is known to be an important prognostic factor in many human solid tumors  however  no data have been published on whether cellular dna content carries prognostic significance for patients with nasopharyngeal cancer  npc   
class4	688	archival  formalin fixed  paraffin embedded pathology specimens representing pretreatment tissue biopsies from 55 patients  41 men and 14 women  with npc were analyzed for cellular dna content in a retrospective fashion from 1968 to 1988  
class4	688	individual tumors were classified as either lymphoepithelioma  squamous cell  or anaplastic carcinoma  and were staged according to international union against cancer  uicc  criteria  
class4	688	all patients were treated with curative intent using a 4 to 6 mev linear accelerator to total doses ranging from 50 to 60 gy in 4 to 6 weeks  
class4	688	the overall 5 year actuarial survival for all 55 patients was 44 4   men  41   women  52    
class4	688	survival by t stage was as follows  t1  65   t2  51   t3  36   and t4  27   
class4	688	similarly  the 5 year survival rate declined as the bulk of nodal metastases increased  n0  62   n2  50   n3  37   and n1  25   
class4	688	patients who had anaplastic carcinoma had a 5 year survival of 73   those with lymphoepithelioma had a 60  survival  and those with squamous cell cancer  scc  had a 30  survival  
class4	688	there was a statistically significant difference in 5 year survival between patients with scc and those with nonkeratinizing histologies  p less than 0 05   
class4	688	in addition  there was a significant association between patients older than 40 years of age with scc and patients younger than 40 years of age with nonkeratinizing malignancies  p less than 0 01   
class4	688	of the 55 tumors successfully analyzed  22  40   were diploid and 33  60   were aneuploid  
class4	688	the mean coefficient of variation  cv  of all 55 samples was 6 17   
class4	688	there was no significant difference in 5 year survival between patients with diploid and those with aneuploid tumors  48  versus 42    
class4	688	furthermore  there was no statistically significant survival difference between aneuploid and diploid tumors within any one histologic subgroup  
class4	688	there was also no significant survival difference related to the dna index  
class4	688	the results indicate that the extent of local tumor spread is still the most important prognostic factor for patients treated with radiotherapy for npc  
class4	688	the data support the conclusion that patients with lymphoepithelioma and anaplastic carcinomas have a superior survival to patients with squamous cell carcinoma  abstract truncated at 400 words   
class4	689	mucinous adenocarcinoma of the submandibular gland  
class4	689	a rare tumor not easily classifiable among published histologic categories for salivary gland tumors is reported  
class4	689	the neoplasm developed within the submandibular gland of a 78 year old woman with invasion of the mandible and metastasis to regional lymph nodes  
class4	689	histopathologically  cuboidal cells possessing clear cytoplasm and displaced round nuclei proliferated and exhibited an adenomatous pattern  
class4	689	many cystic spaces surrounded by tumor cell strands were seen  mucus substance filled in the cystic spaces  and the tumor cells seemed mucus secreting  but neither epidermoid cells nor papillary appearance could be observed  
class4	689	electromicroscopically  numerous mucous droplets of low electron density were prominent in the cytoplasm  and the tumor cells had sparse irregular microvilli on the luminal surface  
class4	689	mucin histochemistry  including paradoxical concanavalin a staining  revealed that the tumor cells contained neutral and acid mucins  and these were identified as class ii and iii mucosubstances  
class4	689	no other neoplastic lesion  except recurrent metastatic neck nodes  has been detected 6 years after the first examination  and it seems that the tumor is a rare primary mucinous adenocarcinoma of the submandibular gland  
class4	690	the use of flow cytometry for the prognosis of stage ii adjuvant treated breast cancer patients  
class4	690	characterization of breast cancer cells by histology  flow cytometry  and steroid receptors was performed on 197 stage ii breast node positive cancer patients given adjuvant chemotherapy  plus tamoxifen for patients with positive hormone receptors  
class4	690	histologic and steroid receptor assays were performed using standard techniques  flow cytometric analysis was performed from paraffin embedded blocks obtained from the primary tumor  
class4	690	quality control studies on reproducibility  tissue heterogeneity  and analysis procedures have been included  
class4	690	of the 197 patients studied  aneuploidy was found in 102  52    the median  s value was 8  with a range of 0 4  to 38   
class4	690	our results demonstrated that number of positive nodes  receptor status  and grade were of prognostic value  
class4	690	cell cycle kinetic data were not of independent prognostic value in this series  
class4	690	however  ploidy could differentiate in prognosis in the receptor negative subgroup  
class4	690	patients with receptor negative tumors had a significantly better overall survival if the tumor was diploid in nature  
class4	690	cell kinetics was not significantly prognostic for either receptor subgroup  although patients with higher  s tended to have better relapse free and overall survival  
class4	690	this is in disagreement with other studies and may demonstrate that treatment has confounded our results and diminished the ability of flow cytometry data to help predict outcome  
class4	691	immunocytochemical characterization of lung tumors in fine needle aspiration  the use of cytokeratin monoclonal antibodies for the differential diagnosis of squamous cell carcinoma and adenocarcinoma  
class4	691	in the current study  immunocytochemical typing of intermediate filaments was used for a differential diagnosis of human lung tumors from transthoracic fine needle aspiration biopsies  tfnab   
class4	691	the authors have compared the cytologic diagnosis of 53 lung cancer cases with the immunofluorescence patterns obtained using a panel of monoclonal antibodies  five of which  kg 8 13  km 4 62  ks b 17  ks 8 12  kk 8 60  react with specific cytokeratin polypeptides and one with vimentin  vim 13 2   
class4	691	only in six of 23 samples cytologically diagnosed as squamous cell carcinoma did the immunocytochemical typing of cytokeratins  ictc  confirm the cytologic diagnosis  
class4	691	in seven cases some of the tumor cells stained positively with antibody ks b 17 specific for simple epithelial keratin  no  18   suggesting the presence of some cells of glandular origin  
class4	691	in ten additional cases the ictc was in conflict with the cytologic diagnosis of squamous cell carcinoma  i e   antibodies ks 8 12 and kk 8 60 were negative  and antibody ks b 17  positive  supporting a diagnosis of adenocarcinoma  
class4	691	in 14 of 18 cases cytologically diagnosed as adenocarcinoma  the ictc confirmed the diagnosis whereas in four cases additional presence of some squamous cells was noticed  
class4	691	the ictc labeling of cases cytologically diagnosed as undifferentiated and large cell carcinomas was similar to that of the group of adenocarcinomas  
class4	691	thus  the application of cytokeratin typing for tfnab samples seems to provide a vital complementation to routine cytologic study  especially for cases cytologically diagnosed as squamous carcinoma  
class4	692	comparison of the conventional method of lymph node staging with a comprehensive fat clearing method for gastric adenocarcinoma  
class4	692	discrepant results in long term survival between united states and japanese patients with resectable gastric adenocarcinoma may result from more accurate staging in the japanese series  
class4	692	the authors compared a comprehensive fat clearing method with the conventional pathology method of lymph node sampling in 11 patients undergoing curative gastrectomy and extended lymphadenectomy at their institution  
class4	692	comprehensive fat clearing doubled total lymph node counts  p less than 0 01   identified smaller lymph nodes  p less than 0 001   and identified more histologically involved nodes of significantly smaller size  p less than 0 001   
class4	692	comprehensive fat clearing pathologically upstaged 29  of the authors  eligible specimens  
class4	692	accurate pathologic staging is necessary when comparing japanese and united states survival data for resectable gastric adenocarcinomas  
class4	693	neuropeptide y and neuron specific enolase levels in benign and malignant pheochromocytomas  
class4	693	neuron specific enolase  nse  is the isoform of enolase  a glycolytic enzyme found in the neuroendocrine system  
class4	693	neuropeptide y  npy  is a peptide recently discovered in the peripheral and central nervous systems  
class4	693	serum nse and plasma npy levels have been reported to be increased in some patients with pheochromocytoma  
class4	693	the authors evaluated whether the measurement of these molecules could help to discriminate between benign and malignant forms of pheochromocytoma  
class4	693	the nse levels were normal in all patients with benign pheochromocytoma  n   13  and elevated in one half of those with malignant pheochromocytoma  n   13   
class4	693	plasma npy levels were on the average significantly higher in the malignant  177 1     38 9 pmol l  n   16  than in the benign forms of the disease  15 7     389 pmol l  n   24   
class4	693	however  there was no difference in the percentage of patients with elevated npy levels  
class4	693	these results show that determination of serum nse may be useful for distinguishing between malignant and benign pheochromocytoma  the measurement of plasma npy is not useful for differentiating the two kinds of tumors  
class4	694	flow cytometric dna ploidy analysis of synchronously occurring multiple malignant tumors of the female genital tract  
class4	694	in this study the authors applied flow cytometric dna ploidy analysis to multiple female genital tract malignant tumors in 43 patients  most of whom  n   37  had bilateral ovarian cancer  
class4	694	an algorithm was developed for calculation of the likelihood ratio of the probabilities that measured dna index differences between multiple tumor localizations within the same patient could be attributed to measurement variation or to true biologic dna content differences  
class4	694	the results of this statistical analysis show that in 72  of the cases  31 of 43  this probability ratio exceeded 1  
class4	694	because the probability that two independent tumors will have a near identical aneuploid dna content is very low  this finding supports a metastatic process rather than the occurrence of multiple primary tumors in these patients  
class4	694	thus  flow cytometric dna ploidy analysis can be helpful in the identification of metastatic disease in patients with multiple female genital tract malignant tumors  
class4	695	the relationship between bone morphogenetic protein and neoplastic bone diseases  
class4	695	the monoclonal antibody against bovine bone morphogenetic protein was used for demonstration of bone morphogenetic protein  bmp  in neoplastic bone diseases  
class4	695	the avidin biotin peroxidase complex method demonstrated that bmp mainly exists in the cytoplasm of tumor cells of osteosarcoma and chondrosarcoma  
class4	695	immunostaining showed that a majority of osteosarcomas and all of the chondrosarcoma cells contained a large quantity of bmp  
class4	695	conversely  none of the fibrosarcomas showed positive staining  
class4	695	thus  it was possible to differentiate osteosarcomas from fibrosarcomas by immunostaining  
class4	695	in fibrous dysplasia of bone  bmp was abundant in the fibrocellular tissue that had osteogenic activity  
class4	695	in contrast  fibrous tissue of ossifying fibroma showed weak positive staining  only the osteoblasts rimming the bone showed a positive reaction  
class4	695	immunostaining showed that bmp was also detected in other neoplastic bone diseases such as osteoma  chondroma  and other tumors  
class4	696	a newly established human osteosarcoma cell line with osteoblastic properties  
class4	696	a human osteosarcoma cell line  huo9  was established from a tumor that was heterotransplanted into athymic nude mice  
class4	696	antiserum against nude mouse spleen cells was added to the early passage cultures to eliminate the host fibroblastic cells  
class4	696	the cell line retained a high activity of liver bone kidney type alkaline phosphatase  alp  and secreted osteocalcin  i e   bone gamma carboxyglutamic acid containing protein  bgp   into the medium  
class4	696	the addition of 1 25 dihydroxyvitamin d3  1 25 oh 2d3  increased the alp activity as well as the level of bgp secreted into the medium  
class4	696	the alp of 1 25 oh 2d3 treated cells has the same inhibition characteristics to heat and amino acids as that of untreated cells  
class4	696	synthetic human parathyroid hormone stimulated the production of intracellular adenosine 3  5  cyclic monophosphate  camp  approximately 100 fold within five minutes  
class4	696	however  the stimulation was not observed with a synthetic human thyrocalcitonin  
class4	696	when huo9 cells were transplanted into the back of a nude mouse  a tumor with an abundant osteoid formation and mineralization was produced  
class4	696	the results indicate that the huo9 cell line expresses well differentiated osteoblastic phenotypes  
class4	696	huo9 is the first established human cell line to produce bgp  and it provides a useful model for the studies of osteoblasts and the regulatory mechanisms of bgp production  
class4	697	combined laminoplasty and posterolateral fusion for spinal canal surgery in children and adolescents  
class4	697	spinal deformities  especially kyphosis and instability  after laminectomy for tumors and other diseases  are major clinical problems  
class4	697	since 1981  combined laminoplasty and posterolateral fusion for the prevention of postlaminectomy spinal deformities was performed on eight male and two female patients aged two to 26 years  average  13 9 years   
class4	697	the follow up period was from six months to seven years and three months  average  three years and five months   
class4	697	two patients died six and ten months postoperatively because of brain metastases  astrocytoma  and lung metastases  neuroblastoma   respectively  
class4	697	good alignment with no instability of the cervical or thoracic spine was obtained for all patients  including the two who died  
class4	697	laminoplasty combined with posterolateral fusion was found to be very effective in preventing the development of spinal deformities after spinal canal surgery for spinal cord tumors or other diseases in children and adolescents  
class4	698	oncocytic glomus tumor of the trachea  
class4	698	an oncocytic variant of glomus tumor of the trachea occurred in a 47 year old woman  
class4	698	she experienced intermittent cough and hemoptysis for about three years  
class4	698	bronchoscopy and chest ct scan showed a small reddish polypoid tumor on the lower end of the trachea  
class4	698	bronchoscopic biopsy was carefully done and was diagnosed as oncocytoma  
class4	698	a wedge resection of the tumor was done  
class4	698	tumor cells were characterized by strongly eosinophilic granular cytoplasm on light microscopy and by numerous closely packed round or ovoid mitochondria with prominent tubular cristae on electron microscopy  
class4	698	they were arranged in a sheet around small vessels  as a result of which the biopsy diagnosis of oncocytoma was changed to oncocytic glomus tumor  
class4	698	to our knowledge  this is the first report of an oncocytic glomus tumor arising from the trachea  
class4	699	multicentric endobronchial granular cell myoblastoma  
class4	699	granular cell myoblastoma  gcm  is a rare benign neoplasm involving the tracheobronchial tree  
class4	699	it is believed to arise from the schwann cell  
class4	699	four cases of tracheobronchial gcm  all of which were multicentric  are presented and a conservative therapeutic approach is suggested  
class4	700	preoperative radiotherapy in operable rectal cancer  
class4	700	the effect of preoperative radiotherapy  31 5 gy in 3 5 weeks  in operable rectal cancer was examined with respect to resectability and prognosis after two surgical procedures  abdominoperineal resection  or low anterior resection  
class4	700	preoperative radiation did not influence the surgeon s selection of low anterior resection  which was similar  40 percent  in each group  
class4	700	radiation improved five year survival probability and decreased the incidence of local recurrence significantly after low anterior resection  
class4	700	in contrast  no improvement of treatment results was found in patients treated by abdominoperineal resection after radiotherapy  
class4	701	relationship between blood plasma prostaglandin e2 and liver and lung metastases in colorectal cancer  
class4	701	the relationship of prostaglandin e2  of which a large amount is produced in various neoplasms  and hematogenous distant metastases was investigated in a total of 44 colorectal cancer patients because of its varied pathophysiologic potentials  
class4	701	the authors found significantly high levels of pge2 in local venous blood draining the carcinoma and in peripheral blood in cases with liver or lung metastasis  as well as a significantly large amount of pge2 production in the carcinoma tissue  
class4	701	the results suggest that increased local blood pge2 could enhance the metastasis formation  and increased peripheral blood pge2 may be useful in the detection of such metastasis in colorectal cancer  
class4	702	palliative operations for colorectal cancer  
class4	702	a review of 96 consecutive patients who underwent palliative surgery for primary colorectal cancer was undertaken to clarify the value of palliation achieved with surgical treatment  
class4	702	the overall rate of postoperative mortality was 8 percent  8 of 96  and the overall rate of postoperative morbidity was 24 percent  23 of 96   
class4	702	the mortality rate was 5 percent  3 of 66  after resective surgery and 17 percent  5 of 30  after nonresective surgery  
class4	702	three deaths were related to the malignant disease  three were related to the intra abdominal infection  and two were related to formation of intestinocutaneous fistulas  
class4	702	of the 8 patients who died  1 had a tumor with local visceral involvement only and 7 had a tumor with more distant spread  
class4	702	median survival was 10 months for all patients  15 months for patients treated with resective surgery  and 7 months for nonresected patients  
class4	702	five patients  5 percent  have survived for longer than 5 years  
class4	702	the median relief of preoperative cancer symptoms was 4 months  4 months after resective surgery and 1 month after nonresective surgery   
class4	702	twenty five patients have undergone second surgery  
class4	702	it is concluded that palliative resective surgery for colorectal cancer can improve patient comfort with an acceptable postoperative mortality rate when cancer growth is localized and in favorable cases with more distant spread  whereas nonresective surgery fails to achieve symptom relief  
class4	703	rectal bleeding  patient delay in presentation  
class4	703	patient delay in presentation of rectal bleeding has been identified as a factor in delayed diagnosis among patients with colorectal cancer  
class4	703	the aim of this study was to identify demographic or psychological factors  or beliefs or behaviors related to delay in presentation of rectal bleeding  
class4	703	in 93 patients presenting with this symptom to their general practitioner  delay ranged from 0 to 249 days with a median of 7 days  27  29 percent  delayed more than 14 days  
class4	703	delay was unrelated to age  sex  ethnic origin  competence in english  length of schooling  social status  availability of social support  measured psychologic traits  and to the belief that the cause might be cancer  
class4	703	the proportions delaying more than 14 days were statistically significantly elevated among those who were not worried by the bleeding  47 percent delayed   those who did not regularly look at their feces or the toilet paper after use  37 percent   and those who took some other action before presenting to their general practitioner  43 percent   
class4	704	endosonography of pararectal lymph nodes  in vitro and in vivo evaluation  
class4	704	one hundred thirteen patients with carcinoma of the rectum were evaluated for lymph node metastases by endorectal ultrasound  
class4	704	with the use of 7 5 mhz and based on different echo patterns  two main groups of lymph nodes can be differentiated  hypoechoic and hyperechoic lymph nodes  
class4	704	compared with pathologic findings  hypoechoic lymph nodes represent metastases  whereas hyperechoic lymph nodes are visualized due to unspecific inflammation  
class4	704	lymph node metastases can be predicted with a sensitivity of 72 percent and inflammatory lymph nodes with a specificity of 83 percent  
class4	704	the physical basis of the differentiation of lymph nodes was assessed in vitro by the determination of ultrasound parameters  speed of sound  acoustic impedance  attenuation  and backscattered amplitude   
class4	704	the attenuation coefficient of benign lymph nodes  2 5 db  mhz x cm   is significantly higher than the mean value of lymph node metastases  1 3 db  mhz x cm    
class4	704	the results demonstrate that involved nodes can principally be differentiated from not involved nodes  
class4	704	micrometastases  mixed lymph nodes  and changing echo patterns within inflammatory nodes explain the accuracy rate of 78 percent  
class4	705	anorectal malignant melanoma in sweden  report of 49 patients  
class4	705	clinicopathologic features and prognosis of 49 patients with anal malignant melanoma were investigated in the total swedish population between 1970 and 1984  
class4	705	median age was 71 years  range  50 to 87 years   and there was a female predominance  31 females  18 males   
class4	705	the most common symptom at presentation was bleeding  
class4	705	the majority of tumors ranged between 2 and 5 cm in diameter and all invaded at least into the submucosa and or the lamina propria  
class4	705	at diagnosis  one third of the patients had either regional or distant metastasis with a median survival of 5 months  
class4	705	the remaining patients were surgically treated with curative intent  either by abdominoperineal resection  apr  or local excision  
class4	705	median survival was poor in both treatment groups  apr  12 months  local excision  13 months   
class4	705	most patients died with distant metastasis  
class4	705	our results confirm the opinion that apr offers no more curative potential than a more conservative surgical approach  
class4	705	however  tumor sizes were on average smaller in the group treated by local excision  
class4	705	this could indicate that  in the absence of known distant metastasis  radical surgery should be performed  particularly since local recurrences tended to be more common after a local excision  
class4	706	gastric dysrhythmias following pylorus preserving pancreaticoduodenectomy  possible mechanism for early delayed gastric emptying  
class4	706	transient delayed gastric emptying is reported as a frequent complication following pancreas preserving pancreaticoduodenectomy  ppw   
class4	706	we placed serosal electrodes on the stomach of a patient undergoing ppw  
class4	706	myoelectric recordings were obtained postoperatively and correlated with simultaneous radionuclide liquid gastric emptying studies  
class4	706	the patient developed early postoperative gastric atony  associated with frequent gastric dysrhythmias  
class4	706	these dysrhythmias may have been exacerbated by a perihepatic abscess  
class4	706	the gastric dysrhythmias correlated with alterations in liquid gastric emptying  
class4	706	gastric dysrhythmias may be a mechanism for gastric dysfunction in the early postoperative period  
class4	707	characterization and significance of sulfonylurea receptors  
class4	707	this study describes and characterizes a putative sulfonylurea receptor  
class4	707	the radioligand used was  3h glipizide  9 ci mmol   
class4	707	the beta cell plasma membranes were derived from a transplantable rat insulinoma generated by subcutaneous injection of rinm5f cells and purified by ultracentrifugation on a 15 55  sucrose gradient  
class4	707	specific binding of  3h glipizide to purified beta cell plasma membranes was determined to be maximal at temperatures of 4 23 degrees c  ph 7 3  and an incubation of 2 h  
class4	707	scatchard analysis indicated a single binding site with kd   7 nm and sulfonylurea binding of 0 93 pmol mg membrane protein  
class4	707	displacement of  3h glipizide from the purified beta cell plasma membranes by various sulfonylureas and their analogues correlated well with their known hypoglycemic and insulin releasing activities  
class4	707	various agents  including nutrients  agents affecting ca2  flux  gastrointestinal hormones  and pancreatic hormones  had no effect on  3h glipizide binding to the beta cell plasma membranes  
class4	707	putative sulfonylurea receptors on beta cell and brain cell plasma membranes have been reported by several groups of investigators  
class4	707	sulfonylurea binding to the beta cell is hypothesized to close an atp sensitive k  channel  which leads to depolarization of the membrane and activation of a voltage dependent ca2  channel  
class4	708	the effect of metoclopramide on ovarian responsiveness to gonadotropin administration in patients with severe polycystic ovarian syndrome  
class4	708	six patients with poor ovarian response to menotropin after pretreatment with a gonadotropin releasing hormone analog exhibited improved ovarian responsiveness when metoclopramide was added on days 3  5  and 7 of the cycle  
class4	708	this was evidenced by a higher number of leading follicles  4 4 versus 0 6   a higher mean of maximal serum 17 beta estradiol levels  560 versus 178 pg ml   a shorter duration of menotropin treatment  7 versus 11 days   and fewer ampules of menotropin used  20 versus 37 ampules cycle  in metoclopramide treated cycles as compared with control cycles  respectively  
class4	708	serum prolactin levels reached a maximum of 172 ng ml within 1 hour after metoclopramide administration and declined to normal range within 6 hours  
class4	708	these results suggest that intermittent increased prolactin secretion may augment ovarian response to gonadotropins  
class4	709	aromatase activity of human granulosa cells in patients with polycystic ovaries treated with dexamethasone  
class4	709	the effect of dexamethasone  dex   9 alpha fluro 16 alpha methyl prednisolone  on secretion of steroids by human granulosa luteinized cells was studied by culturing cells from mature follicles of women with polycystic ovarian disease and treated for infertility in the in vitro fertilization program  
class4	709	patients were treated with dex 0 5 mg d until the day of human chorionic gonadotropin administration  
class4	709	the cells were cultured for 24 hours in the presence of androstenedione  10  7 m   
class4	709	after incubating for 24 hours  the medium was replaced and the cells were incubated for an additional 24 hours  
class4	709	the medium was then harvested and assayed for estradiol  e2  and progesterone  p   
class4	709	results were compared with those of a control group who was not treated with dex  
class4	709	estradiol production by cells was significantly lower in the study group treated with dex  
class4	709	progesterone production was not influenced by dex  
class4	709	follicular fluid levels  e2  and androgens did not vary with dex treatment  whereas cortisol levels markedly decreased and p levels increased with the treatment  
class4	709	these findings suggest that glucocorticosteroids can directly influence granulosa luteinized cell function  
class4	710	pregnancy after in vitro fertilization in a patient with stage i endometrial carcinoma treated with progestins  
class4	710	a 35 year old woman with chronic anovulation and bilateral tubal disease was found during infertility evaluation to have grade i endometrial carcinoma confined to an endometrial polyp  
class4	710	she was treated with polypectomy and endometrial curettage followed by high dose progestagens for 6 months  
class4	710	endometrial curettage at 3 and 6 months of therapy indicated regression of the lesion and the patient subsequently achieved successful pregnancy with ivf  
class4	711	strong association between diabetes and displacement of mouse anti rat insulinoma cell monoclonal antibody by human serum in vitro  
class4	711	in an attempt to identify novel pancreatic beta cell surface antigens  mouse monoclonal antibodies  moabs  were raised against rat insulinoma  rin5f  cells with standard techniques  
class4	711	several clones were identified whose antibodies bound specifically to rin5f cells but not to other rat  mouse  and human target cells  
class4	711	each of these moabs was radiolabeled  and the specificity of binding of each moab was determined by the ability of excess cold homologous moab to displace the labeled moab  
class4	711	six rin5f cell specific moabs of different epitopic specificities were identified  
class4	711	the relevance of these beta cell epitopes to human insulin dependent diabetes  iddm  was demonstrated by the differential ability of human serums from control and diabetic children to displace the radiolabeled moabs from the rin5f cells  
class4	711	serums from 333 children without diabetes or a family history of diabetes and from 156 newly diagnosed iddm patients were tested  
class4	711	only one igm moab was specifically displaced by the iddm serums  i e   146 of 156  compared to serums from control children  i e   10 of 333  
class4	711	with immunofluorescence  the serum component responsible for the displacement of the mouse moab was identified as igg  
class4	711	most of the positive control serums were from children with active autoimmune thyroiditis  
class4	711	serums from children with other forms of glucose intolerance did not displace moab 1a2  
class4	711	there was no correlation between age and the degree of displacement of 1a2  
class4	711	thus  the displacement of 1a2 is a specific and sensitive marker of diabetes susceptibility easily applicable to mass screening  
class4	712	pancreatic secretory trypsin inhibitor stimulates the growth of rat pancreatic carcinoma cells  
class4	712	pancreatic secretory trypsin inhibitor was examined for growth promoting activity on five cell lines using standard cell culture techniques  
class4	712	one cell line  ar4 2j  derived from a rat pancreatic acinar cell carcinoma  responded with significantly increased incorporation of  3h thymidine and colony formation  
class4	712	pancreatic secretory trypsin inhibitor stimulated the incorporation of  3h thymidine in liquid culture  the maximal increase was 61     10  above control  p less than 0 001  and was seen at a concentration of 10  9  mol l  
class4	712	using a soft agarose clonogenic assay  pancreatic secretory trypsin inhibitor also consistently stimulated  3 assays  colony formation  the peak activity occurred at a concentration of 10  10  mol l which caused a 150     55   mean     se  p less than 0 05  increase above control  
class4	712	aprotinin had no effect on the growth of ar4 2j cells and pancreatic secretory trypsin inhibitor did not bind to the epidermal growth factor receptor  
class4	712	ar4 2j cells were shown to produce pancreatic secretory trypsin inhibitor  
class4	712	the study raises the possibility that pancreatic secretory trypsin inhibitor provides autocrine stimulation of tumor cell growth  
class4	713	immunochemical characterization and quantitative distribution of pancreatic stone protein in sera and pancreatic secretions in pancreatic disorders  
class4	713	a fluorometric immunoassay has been established to quantitate pancreatic stone protein providing a sensitivity for concentrations from 0 015 to 0 5 micrograms ml  
class4	713	when concentrations of pancreatic stone protein were determined from pancreatic secretions obtained either from patients suffering from chronic pancreatitis  n   31   including the calcifying forms  n   10    pancreatic cancer  n   22   or nonpancreatic diseases  n   17   no significant differences were found  
class4	713	in contrast  increased concentrations were found in serum samples from patients with chronic  39 66  and acute pancreatitis  16 20  compared with control patients  
class4	713	the differences between these diagnostic groups and controls were highly significant  p less than 0 0001  and independent of pancreatic enzyme activity  
class4	713	immunochemical analyses of serum pancreatic stone protein showed an isoelectric point  ph 9  similar to that reported for the pancreatic thread protein  
class4	713	with respect to recent communications  these data do not support the etiopathogenic role postulated for pancreatic stone protein in chronic pancreatitis and chronic calcifying pancreatitis by other investigators  
class4	714	endoscopic retrograde brush cytology  a new technique  
class4	714	endoscopic retrograde cholangiopancreatography has been shown to be a very valuable adjunct in the diagnosis of malignancy involving the biliary and or pancreatic ductal system  
class4	714	however  characteristic endoscopic retrograde cholangiopancreatography radiographic findings associated with malignant strictures are frequently not specific and cytological confirmation becomes essential for the diagnosis  
class4	714	unfortunately  the current overall diagnostic yield of positive cytology in such circumstances ranges from 18  56  depending on the technique  
class4	714	a new brush device has been designed which is uniquely adapted to pancreaticobiliary strictures of varying anatomical configurations  
class4	714	this study shows results using this new cytology brush in a series of 53 patients with pancreaticobiliary malignancy  
class4	714	a significant improvement in the cytological yield of tumor confirmation was obtained with a diagnostic sensitivity of 70  and specificity of 100  using the new brush technique  
class4	715	resolution of inferior vena cava syndrome after embolization of a hepatic adenoma  
class4	715	a 77 year old man presented with severe pruritus and massive lower body edema  
class4	715	computerized axial tomography of the abdomen showed a large hepatic mass compressing the inferior vena cava  and a liver biopsy specimen showed hepatic adenoma  
class4	715	embolization of vessels feeding the hepatic tumor resulted in complete resolution of pruritus and ascites  and clinical remission has persisted for 1 year following partial obliteration of tumor vasculature  
class4	715	angiographic ablation of tumor blood supply represents a nonoperative means for inducing clinical remission in patients with symptomatic hepatic adenoma who are at high surgical risk  
class4	716	misdiagnosis of the zollinger ellison syndrome due to hyperlipidemia  
class4	716	most authorities feel that diagnosis of the zollinger ellison syndrome is established when the serum gastrin level is greater than 1000 pg ml  1000 ng l  in a patient with gastric acid hypersecretion and clinical manifestations consistent with the diagnosis  
class4	716	a patient with recurrent peptic ulcer disease is reported who was thought to have had the zollinger ellison syndrome based on two serum gastrin level measurements greater than 1000 pg ml  1000 ng l   
class4	716	subsequent evaluation revealed the gastrin elevation to be spurious because the sample was hyperlipidemic  
class4	716	lipemic serum samples may yield falsely elevated serum gastrin determinations as determined by radioimmunoassay  
class4	717	late recurrence of a hepatocellular carcinoma in a patient with incomplete alagille syndrome  
class4	717	in this study  the case of a patient presenting a second hepatocellular carcinoma 13 years after resection of a first tumor of the same type is reported  
class4	717	in this case  etiological investigations remained negative  but an incomplete form of syndromatic alagille syndrome with paucity of bile ducts in the nontumoral tissue was detected and associated with nodular regenerative hyperplasia and foci of dysplasia  
class4	717	malignant transformation in alagille syndrome seems to be extremely rare  
class4	717	the fact that such tumors evolve very slowly could be an argument for partial hepatectomy and  if necessary  liver transplantation  
class4	718	endoscopic ultrasonography for the evaluation of smooth muscle tumors in the upper gastrointestinal tract  an experience with 42 cases  
class4	718	before surgery  12 patients with suspected leiomyoma and 12 patients with suspected leiomyosarcoma were studied by endoscopic ultrasonography  eus   computed tomography  ct   endoscopy  and barium swallow  
class4	718	the results were correlated with surgery and histology  
class4	718	ten leiomyomas  one benign gastric ulcer  one carcinoid metastasis  eight leiomyosarcomas  two leiomyoblastomas  one mucus secreting adenocarcinoma  and one bronchial carcinoma were diagnosed  
class4	718	eighteen additional patients suspected to have benign submucosal lesions by endoscopy and barium meal were treated non surgically  and studied by eus and ct  
class4	718	eus was superior to other imaging techniques in the detection  staging  and follow up of submucosal smooth muscle tumors because of clear imaging of the intramural abnormality and adjacent lymph nodes  
class4	719	endoscopic palliative intubation of the esophagus invaded by lung cancer  
class4	719	thirty two patients with esophageal involvement by lung cancer were managed by endoscopic intubation  
class4	719	in 22 patients with extrinsic esophageal strictures  the success rate of intubation was 91   and 82  were discharged with their dysphagia relieved and esophageal patency restored  
class4	719	the mean survival rate was 4 4 months  
class4	719	in 10 patients with esophago bronchial fistulas  3 had the fistulous tract obliterated and lived a mean of 5 months  
class4	719	this low success rate of closing fistulas is due to failure to seal off the space between the stent and the fistula because of absence of tumor associated stenosis  
class4	719	the overall morbidity rate was 28 1   18 8  perforation  6 3  hemorrhage  and 3 1  tracheal obstruction   
class4	719	the overall mortality rate was 18 8   
class4	719	although complications were more frequent than in primary esophageal tumors  endoscopic intubation was the only way to palliate this desperate condition and provided 66 6  of patients with relief of symptoms  nutritional improvement  and a mean survival time of 4 5 months  
class4	720	low diacylglycerol values in colonic adenomas and colorectal cancer  
class4	720	the biochemical events that make colonic epithelial cells proceed along the adenoma carcinoma sequence are not well understood  
class4	720	the phosphoinositol signal transduction pathway is involved in the regulation of cell growth and differentiation  
class4	720	to determine its role in colonic neoplasias we performed mass measurements of its second messenger sn 1 2 diacylglycerol in biopsy specimens from normal mucosa and neoplasias of the colon  
class4	720	normal colonic mucosa was also investigated in patients without colonic abnormalities  n   10   
class4	720	compared with pooled diacylglycerol values from five colonic sites  100    values in patients with a normal colon were highest in the ascending colon  120  5    p less than 0 05  and lowest in the rectum  81  5    p less than 0 01   
class4	720	absolute diacylglycerol values in patients with normal colons  2 62  0 16  nmol mg protein  were not significantly different from those found in the normal mucosa of patients with colorectal neoplasias  2 45  0 17  nmol mg protein   
class4	720	both colonic adenomas  n   15  and colorectal carcinomas  n   14  showed significantly decreased diacylglycerol values compared with the adjacent normal mucosa of each patient  72  4    p less than 0 001  and 71  4    p less than 0 001 respectively   
class4	720	the appreciable decrease in mass diacylglycerol values clearly distinguishes adenomas and carcinomas of the colon from the surrounding normal mucosa  
class4	720	this finding suggests that profound metabolic changes of the phosphoinositol signal transduction pathway occur early in the adenoma carcinoma sequence and may be important in colonic carcinogenesis  
class4	721	adult hepatic fibropolycystic disease presenting as obstructive jaundice  
class4	721	obstructive jaundice caused by compression of the common hepatic duct by a simple hepatic cyst in a 31 year old europid man is reported  
class4	721	the jaundice and duct compression resolved after percutaneous aspiration of the cyst under ultrasound direction and the patient has been well for 12 months  
class4	722	high grade dysplasia of the gastric mucosa  a marker for gastric carcinoma  
class4	722	the natural history of gastric epithelial dysplasia and its relation to gastric cancer are ill defined  
class4	722	a consecutive series of 40 patients with an initial diagnosis of gastric epithelial dysplasia based on examination of endoscopic biopsies has been reviewed to determine the clinical outcome and to evaluate a two tier histological grading system as a predictor of the risk of cancer  
class4	722	on review  only 20 of the 40 patients were considered to have true dysplasia  seven patients had low grade dysplasia and 13 had high grade dysplasia  
class4	722	of the 13 patients with high grade dysplasia  11  85   were found to have gastric cancer within 15 months  
class4	722	of the 10 patients with high grade dysplasia who underwent gastrectomy  six were found to have early gastric cancer  three had cancer invading into the muscularis propria  and none had lymph node metastases  
class4	722	high grade dysplasia is thus a marker of gastric cancer  
class4	722	moreover  the cancers associated with high grade dysplasia are usually pathologically favourable and curable  
class4	722	the finding  by an experienced pathologist  of high grade dysplasia in two separate sets of endoscopic biopsies is therefore an indication for radical surgical treatment  provided that the patient s age and general condition permit such an approach  
class4	723	growth of group a rotaviruses in a human liver cell line  
class4	723	recent observations in children with rotavirus gastroenteritis and in infant mice given rotavirus vaccine by oral administration suggest that this well known gastrointestinal pathogen may infect the liver  
class4	723	to examine this possibility  the susceptibility of hep g2 cells to infection with a variety of rotavirus strains was tested  
class4	723	these cells were used because they are considered to be well differentiated and exhibit many liver specific functions  
class4	723	the hep g2 cells supported the growth of the simian strain rhesus rotavirus  mmu 18006   a strain currently being used in vaccine trails  but did not support the growth of any human strain  d  ds1  price or st3   
class4	723	the rhesus rotavirus infection was cytopathic and resulted in release of lactate dehydrogenase  
class4	723	rhesus rotavirus growth in hep g2 cells displayed trypsin enhanced infectivity and was inhibited by pretreatment of cells with arthrobacter ureafaciens neuraminidase but not with neuraminidase from clostridium perfringens  
class4	723	hep g2 cells were also permissive for another simian strain  sa11   a bovine strain  uk  and single gene substitution reassortants containing vp7  the major outer capsid neutralization protein  from a human rotavirus strain and the remaining 10 genes from either rhesus rotavirus or uk  
class4	723	in general  uk and its reassortants produced lower levels of antigen than did rhesus rotavirus and its reassortants  
class4	723	hep g2 cells and other hepatic cell lines may prove to be useful tools to explore the hepatotropic potential of wild type rotaviruses and candidate vaccine strains  
class4	724	hbv dna sequences in tumor and nontumor tissue in a patient with the fibrolamellar variant of hepatocellular carcinoma  
class4	724	one patient with the fibrolamellar variant of hepatocellular carcinoma was found to be seropositive for hbsag and anti hbe  
class4	724	dna from tumor and nontumor areas of the liver was examined by molecular hybridization for hepatitis b virus dna sequences  
class4	724	undigested dna from the tumor gave a high molecular weight smear  and restriction enzyme analysis indicated a single instance of integration  
class4	724	nontumor liver tissue was analyzed from three separate areas  
class4	724	hepatitis b virus dna was detected in two of these  restriction enzyme digestion suggested they contained different sites of viral integration  
class4	724	as with the typical hepatitis b virus related hepatocellular carcinoma  analysis of hepatitis b virus dna from nontumorous liver yielded a different pattern of high molecular weight bands  indicating that the virus genome had integrated at different chromosomal locations than that seen in the tumor  
class4	724	the finding of integrated hepatitis b virus dna  especially in tumorous but also in nontumorous liver  would be consistent with an oncogenic role for hepatitis b virus in certain instances of fibrolamellar tumors and in the more typical hepatitis b virus related hepatocellular carcinoma  
class4	725	prospective study of early detection of hepatocellular carcinoma in patients with cirrhosis  
class4	725	we prospectively monitored 140 cirrhotic patients for the development of hepatocellular carcinoma for 6 yr  using periodical screening by high resolution convex array ultrasonography and alpha fetoprotein  
class4	725	twenty eight patients were positive for hbs antigen  26 patients had received blood transfusions and were negative for hbs antigen and 26 patients had a history of heavy drinking  
class4	725	we detected hepatocellular carcinoma in 40 patients during this period  
class4	725	the overall cumulative incidence of hepatocellular carcinoma in the 6 yr was 39   the cumulative incidence was 59  in patients with hbsag  53  in patients who had had blood transfusions and were negative for hbsag and 22  in patients who had a history of heavy drinking and who were without hbsag  
class4	725	detection of the carcinoma in 85  of these 40 patients was based on results of ultrasonography  
class4	725	twenty six of the patients  65   had a small hepatocellular carcinoma of 2 cm or less  
class4	725	alpha fetoprotein levels were lower than 100 ng ml in 56  of these 40 patients  
class4	725	patients with cirrhosis are at high risk of developing hepatocellular carcinoma  especially patients with hbsag or with a history of blood transfusion who are negative for hbsag  
class4	725	periodic monitoring by use of ultrasonography in particular is recommended for early detection of hepatocellular carcinoma  
class4	726	diagnostic value of brush cytology in the diagnosis of bile duct carcinoma  a study in 65 patients with bile duct strictures  
class4	726	malignant strictures of the extrahepatic bile ducts are difficult to distinguish from benign strictures  particularly in patients with primary sclerosing cholangitis  
class4	726	because attempts at diagnosing small cancers with fine needle aspiration biopsy are not possible in the absence of an associated mass lesion and because the sensitivity of exfoliative biliary cytology is controversial  brush cytology has been used as a potential means of establishing a specific diagnosis of bile duct carcinoma  
class4	726	herein we report our experience with this technique when performed on 65 patients over a 5 yr period  
class4	726	each had at least one brushing  
class4	726	thirty seven were found to have bile duct carcinoma and 28 were found to have benign strictures  
class4	726	of these 37  the first brushing was positive for malignancy in 15  40    whereas four  11   had cells suspected but not diagnostic of malignancy  
class4	726	thirteen patients with bile duct carcinoma whose initial brushings were negative for malignancy had second brushings  
class4	726	of these  five  38   had malignant cells  whereas three  24   yielded suspicious cells  
class4	726	three of the eight whose first two brushings were negative for malignancy were found to have malignant cells on the third brushing  
class4	726	in contrast  of the 28 patients with benign strictures  malignant cells were never found  
class4	726	however  in two patients  suspicious cells were reported with the first but not the second brushing  
class4	726	a single negative or suspicious cytological finding decreased the probability of bile duct carcinoma to 43   
class4	726	two and three sequential negative tests reduced the probability to 32  and 0   respectively  
class4	727	prognostic factors of hepatocellular carcinoma in the west  a multivariate analysis in 206 patients  
class4	727	to investigate the prognostic factors in western patients with hepatocellular carcinoma  206 patients with confirmed diagnoses of hepatocellular carcinoma were studied in terms of survival  
class4	727	all patients were diagnosed between 1983 and 1987  
class4	727	a multivariate survival analysis  cox regression model  using clinical  biochemical  ultrasonographical and pathological data obtained at diagnosis disclosed that bilirubin  p   0 0001   ascites  p   0 0001   toxic syndrome  defined by the presence of weight loss greater than 10  premorbid weight  malaise and anorexia   p   0 009   blood urea nitrogen  p   0 025   tumor size  p   0 001   gamma glutamyltranspeptidase  p   0 0006   age  p   0 0005   serum sodium  p   0 003  and presence of metastases  p   0 002  were independent predictors of survival  
class4	727	according to the contribution of each of these factors to the final model  a prognostic index was constructed allowing division of patients in different groups according to their relative risk of death  rrd   exp  age x 0 03   ascites x 0 8281   bun x 0 0137   serum sodium x   0 0538    gamma glutamyltranspeptidase x 0 0019   bilirubin x 0 0734   tumor size x 0 33   toxic syndrome x 0 4965   metastases x 0 55   
class4	727	these results facilitate the stratification of hepatocellular carcinoma patients to design and evaluate future controlled trials  
class4	728	review of hepatic imaging and a problem oriented approach to liver masses  
class4	728	we believe that imaging of the liver is complicated  
class4	728	the sporadic appearance of incidental benign lesions and variability in scanning techniques  equipment and artifacts add difficulties to the evaluation of liver masses  
class4	728	therefore we emphasize the need to define the problem for which the patient is being imaged  
class4	728	this information helps in choosing the procedure of choice and the technique needed to give the most expedient  accurate answer  
class4	728	this will also help apply the lowest risk and most cost efficient care  
class4	728	imaging algorithms vary depending on the suspected pathological conditions  
class4	728	dynamic bolus enhanced ct is the modality of choice in most situations  
class4	728	tc99m sulfur colloid liver spleen scans are helpful in patients with suspected fnh  and tc99m tagged rbc spect scans are recommended to confirm cavernous hemangiomas  
class4	728	cysts are easily confirmed by us  
class4	728	although mri is competitive with ct  it has not become a primary modality because of cost  availability  patient selection and variability of scanner capabilities among the many manufacturers and models  
class4	728	it is hard to predict what future development of imaging techniques will bring  
class4	728	many feel that significant advances have plateaued  
class4	728	time and money will more likely be concentrated on improving image resolution  speed of scanning and ability to transfer this information to sites outside of the radiology department  
class4	728	in addition to faster scanning  we expect to soon have available safe intravenous and enteric contrast agents for mri  
class4	728	certainly this will lead to a new round of investigations to compare mri with ct scanning  
class4	729	a surgical approach to the cervicothoracic spine  
class4	729	we describe a method for approaching the lower cervical and upper thoracic spine  the brachial plexus and related vessels  
class4	729	the method involves the elevation of the medial corner of the manubrium  the sternoclavicular joint  and the medial half of the clavicle on a pedicle of the sternomastoid muscle  
class4	729	we have used this exposure in 17 cases with few complications and good results  
class4	729	its successful performance requires high standards of anaesthesia  surgical technique and postoperative care  
class4	730	unusual haemostasis for an unusual tumour  catastrophic bleeding from a tactile neurofibroma affecting the thoracic vertebrae  case report  
class4	730	the symptomatology of a typical acute descending thoracic aorta dissection was imitated by profuse haemorrhage caused by a benign tumour composed almost exclusively of wagner meissner like tactile corpuscles and fatty tissue  
class4	730	the tumour caused extensive destruction of the bodies of the fifth and sixth thoracic vertebrae at the level of the vertebro costal articulation  
class4	730	emergency cross clamping of the descending aorta and haemostasis of the bleeding from osteal defects by tamponade with bone polymethyl methacrylate appeared the only way to control the life threatening haemorrhage  
class4	730	it seems that an intrathoracic tactile neurofibroma with a similar case history has not been reported till now  
class4	731	left ventricular fibroma  echocardiographic diagnosis and successful surgical excision in three cases  
class4	731	the management of three patients with left ventricular fibromas is outlined  
class4	731	all were asymptomatic children  
class4	731	routine chest radiography suggested cardiac masses  
class4	731	m mode and two dimensional echocardiography were valuable adjuncts to conventional angiography in assessing these children  
class4	731	electrocardiographic changes  present in all cases  were shown to regress postoperatively  
class4	731	we stress the importance of these noninvasive aids in the initial investigation and outline our operative methods of reconstruction  
class4	732	deletion of alu sequences in the fifth c sis intron in individuals with meningiomas  
class4	732	an abnormality in the c sis protooncogene was identified in leukocyte dna from members of a family predisposed to the development of meningioma  and was found to be associated with the development of the tumor in those individuals  
class4	732	molecular analysis of this abnormality demonstrated a deletion within the fifth intron of the c sis gene  
class4	732	the normal c sis gene has an alu sequence in this region which includes two perfect 130 nucleotide repeated sequences separated by 5 bp  
class4	732	the deleted c sis allele is missing precisely one copy of the 130 bp repeat and the intervening 5 bp  
class4	732	an identical deletion was also found in dna from 1 of 13 sporadic meningiomas  
class4	733	use of monoclonal antibody kp1 for identifying normal and neoplastic human mast cells  
class4	733	the monoclonal antibody kp1  cd68  was used to stain normal and neoplastic monocytes and macrophages in routinely processed  paraffin wax embedded tissue  mast cells also exhibited strong  consistent cytoplasmic immunoreactivity  
class4	733	light microscopic findings were corroborated by electron microscopical and immunocytochemical findings  
class4	733	the predominant sites of immunoreactivity were the specific intracytoplasmic granules of the mast cells  
class4	733	all mast cell subtypes  that is  normal and reactive mast cells  such as those in lymph nodes exhibiting chronic non specific lymphadenitis  and malignant or neoplastic mast cells in various types of mastocytosis  reacted with this antibody  
class4	733	this finding is of diagnostic importance  because mast cell proliferation could be mistaken for histiocyte proliferation  
class4	733	it also supports the hypothesis that mast cells derive from the bone marrow  
class4	734	testicular sex cord stromal tumour with granulosa cell differentiation  detection of steroid hormone receptors as a possible basis for tumour development and therapeutic management  
class4	734	a testicular sex cord stromal tumour with granulosa cell differentiation  typical of granulosa cell tumours of the adult type  was investigated immunohistologically on snap frozen and paraffin wax embedded material  
class4	734	the predominance of vimentin and the additional expression of cytokeratin subtypes 8 and 18  as well as the negative staining for epithelial membrane antigen  accorded with results previously reported  for ovarian granulosa cell tumours  the lack of expression of desmoplakin  however  was a distinctive feature  
class4	734	together with negative staining for leucocyte common antigen  the antigen pattern facilitates the differential diagnosis between granulosa cell tumour and undifferentiated carcinoma or gonadal lymphoma  although its suitability for differentiating within the group of gonadal stromal tumours seems to be limited  
class4	734	the small growth fraction  shown by the monoclonal antibody ki 67  is typical of the clinical behaviour of granulosa cell tumours  
class4	734	the expression of oestrogen and progesterone receptors  also recently found in testicular leydig cell tumours  may provoke new approaches to the management of testicular granulosa cell tumours  as well as a new hypothesis on the development of these tumours  
class4	735	upper gastrointestinal pathology in familial adenomatous polyposis  results from a prospective study of 102 patients  
class4	735	multiple gastric and duodenal biopsy specimens from 102 asymptomatic patients with familial adenomatous polyposis  taken during a prospective endoscopic screening programme were examined  
class4	735	one hundred patients had microscopic gastroduodenal pathology  often in the absence of macroscopic lesions  
class4	735	adenomas were found in 94 patients in the duodenum  in the second and third parts  
class4	735	hyperplasia of villous and crypt epithelium was also seen  sometimes in the absence of adenomas  this may be a precursor of neoplastic change  
class4	735	in the stomach fundic gland polyps were the commonest abnormality  seen microscopically in 44 patients  
class4	735	chronic antral gastritis was common in patients without fundic polyps  
class4	735	gastric adenomas were present in six patients  all of whom also had duodenal adenomas  
class4	735	if duodenal adenomas in familial adenomatous polyposis have a similar malignant potential to those in the colorectum sequential endoscopy and biopsy are necessary to detect cancer in these patients  
class4	736	effect of sample volume on yield of positive blood cultures from adult patients with haematological malignancy  
class4	736	six hundred and sixteen blood samples from patients with haematological malignancy were each distributed equally among three identical cells in a malthus microbiological growth analyser  
class4	736	the mean  sd  volumes inoculated into sets in which one  two  or three of the three bottles were positive were 37 7  10 1  ml  37 4  12 9  ml  and 37 7  10 5  ml  respectively  
class4	736	overall  clinically important organisms were isolated from one bottle only with 18 cultures  from two bottles only with 19 cultures  and from all three bottles in a set with 104 cultures  
class4	736	if the yield from a single bottle inoculated with a mean volume of 12 6 ml blood is taken as 100   the yield from 25 2 ml in two bottles was 110 7  and the yield from 37 7 ml in three bottles was 115 6   
class4	736	the increased yield from increased volume was considerably lower than that reported from unselected groups of patients  which suggests that the magnitude of bacteriaemia is greater in patients with neutropenia  
class4	736	the isolation of infecting organisms from the blood of patients with neutropenia is  however  particularly important in directing chemotherapy and consequently 45 ml blood samples from these patients continue to be requested  
class4	737	activation and inducer subset phenotype of the lymphocytic infiltrate around epidermally derived tumors  
class4	737	an in situ analysis of the mononuclear cell infiltrate found in association with a range of benign  premalignant  and malignant epidermal tumors is described  
class4	737	the predominant cell phenotype was that of the recently described immunoregulatory helper inducer t lymphocyte  
class4	737	a large number of lymphocytes expressed antigens associated with cellular activation  suggesting an ongoing immunologic response by the host against the tumor  although evidence of in situ proliferation of these cells was lacking  
class4	737	these findings suggest that the infiltrate found in association with cutaneous tumors does not represent passive accumulation of lymphocytes from the circulation but rather an active antitumor response  
class4	738	benign lymphangioendothelioma  
class4	738	we have studied eight cases of an acquired lymphatic endothelial lesion for which we propose the name  benign lymphangioendothelioma   the lesions developed as solitary  slowly extending  erythematous macules and plaques  usually occurring on the extremities or the shoulders in adolescents or adults  
class4	738	the characteristic histopathologic feature is permeation of the dermal collagen by flattened  endothelium lined channels and spaces  
class4	738	hemorrhage  iron deposition  and inflammation were not part of the lesion  
class4	738	ulex europaeus agglutinin i labeled the lesional endothelial cells consistently  but factor viii related antigen labeling was negative  
class4	738	this histologic pattern and the special studies suggested a lymphatic lesion  
class4	738	surgical excision  performed in six patients  was not followed by recurrence  
class4	739	absence of estrogen receptors in dysplastic nevi and malignant melanoma  
class4	739	benign nevi  dysplastic nevi  and primary and metastatic malignant melanomas were evaluated for the presence of sex hormone binding and estrogen receptor protein  
class4	739	we have confirmed the observation of ellis et al  
class4	739	that some pigmented lesions possess sex hormone binding proteins  
class4	739	we could not demonstrate a true estrogen receptor in any benign nevi  dysplastic nevi  primary melanomas  or metastatic melanomas  
class4	739	thus the ability to bind estrogen or progesterone does not correlate with the presence of a true estrogen receptor  
class4	739	lack of nuclear estrogen receptors suggests that the influence of estrogen on the pathophysiology of melanoma or of benign melanocytic nevi may not be significant  
class4	740	incidence of cutaneous t cell lymphoma and other rare skin cancers in a defined population  
class4	740	between 1970 and 1984 in rochester  minnesota  rare skin cancers developed in 15 local residents  cutaneous t cell lymphoma  six subjects   dermatofibrosarcoma protuberans  four   adenocarcinoma of sweat glands  two   merkel cell carcinoma  one   liposarcoma  one   and extramammary paget s disease  one   
class4	740	these cases were identified through a unique computerized retrieval system that is maintained at the mayo clinic for the population of rochester  minnesota  
class4	740	the annual incidences of these cancers in the rochester population were 0 9  0 5  0 3  0 2  0 2  and 0 2 per 100 000 residents  respectively  standardized to 1980 u s  
class4	740	population   
class4	740	to our knowledge  this is the first report of the incidences of these rare skin cancers in a well defined population  
class4	741	cutaneous surgery and the pregnant patient  
class4	741	cutaneous surgery in 34 pregnant women is described  
class4	741	the main indication for surgery was the diagnosis and or treatment of malignancy  
class4	741	surgery during the period of organogenesis  15 to 56 days  should be avoided when possible  
class4	741	patients should be positioned on the left side during the procedure to avoid the supine hypotensive syndrome  
class4	741	monitoring of the fetal heartbeat is desirable  
class4	741	local anesthetics  penicillin  and erythromycin are safe if used carefully  
class4	741	acetaminophen is the analgesic of choice  
class4	741	exposure to the sun should be avoided during the perioperative period  
class4	742	comparison of methods for checking surgical margins  
class4	742	surgical margins of a cutaneous neoplasm can be evaluated by various combinations of three major types of sections  vertical  perpendicular   horizontal  parallel   and oblique  mohs method   
class4	742	vertical sections may run transversely through tumor  breadloaf method   longitudinally through tumor  breadloaf cross method   or peripheral to the tumor  
class4	742	the peripheral  perimeter  sectioning methods are the only methods that can evaluate almost 100  of the margin  but they have the disadvantage of not showing the relationship of the tumor to its margin  which can be seen clearly with the vertical transverse sections  
class4	742	seven methods of checking surgical margins are compared and contrasted  
class4	742	none of these is judged to be perfect or best  
class4	743	years of potential life lost  another indicator of the impact of cutaneous malignant melanoma on society  
class4	743	years of potential life lost  ypll  is an indicator of premature mortality that complements traditional incidence and mortality rates and that facilitates comparisons among different cancers  
class4	743	we calculated ypll from cutaneous melanoma and 11 other cancers routinely recorded and tracked by surveillance  epidemiology and end results  seer   
class4	743	ypll from cutaneous melanoma ranked eighth for persons younger than 65 years of age and fourth for those 20 to 49 years of age  
class4	743	an average of 17 1 ypll per death were due to melanoma  one of the highest rates for adult onset cancers  
class4	743	the results of our study  the first to apply ypll to cutaneous melanoma  emphasize the disproportionate impact of this cancer on young and middle aged adults and reemphasize the importance of this cancer as a public health priority  
class4	744	trends in basal cell carcinoma  squamous cell carcinoma  and melanoma of the skin from 1973 through 1987  
class4	744	major increases have occurred in the incidence of basal cell carcinoma and squamous cell carcinoma of the skin  as well as in cutaneous malignant melanoma during the period 1973 through 1987 in british columbia  
class4	744	the greatest increases in basal and squamous cell carcinomas are on the head and neck  
class4	744	this indicates that exposure to sunlight is the major causative factor  
class4	744	the greatest increase in melanoma is on the trunk in men and on the lower limbs in women  
class4	744	the dramatic increases in nonmelanoma skin cancers in british columbia  a relatively low sunlight area  suggest that major prevention programs are needed in areas that are not considered  sunspots    
class4	745	pigmented bowen s disease arising from pigmented seborrheic keratoses  
class4	745	we report three cases of pigmented bowen s disease that clinically and histologically had features of seborrheic keratoses  
class4	745	we speculate about the mechanism of pigmentation in these lesions and suggest that they arise from pigmented seborrheic keratoses  
class4	746	the relationship of pemphigus to neoplasia  
class4	746	a statistically increased incidence of malignancy has been observed in patients with pemphigus  
class4	746	a review of the literature reveals 42 cases of nonthymic malignancies and 18 cases of thymic malignancies  
class4	746	a significant predominance of men  with mean age at onset of 50 years  was observed  
class4	746	pemphigus vulgaris is more common in patients with nonthymic neoplasms  whereas pemphigus foliaceus or pemphigus erythematosus and pemphigus vulgaris are equally common in patients with thymic neoplasms  
class4	746	lymphoreticular malignancies  especially kaposi s sarcoma  are most frequently observed  
class4	746	the majority of patients with nonthymic neoplasms have pemphigus before the detection of the malignancy and have a favorable 5 year survival rate after tumor resection  
class4	746	the majority of the patients with thymic neoplasms have a thymoma before the development of pemphigus  
class4	746	in some patients pemphigus develops after thymectomy and myasthenia gravis is often associated  
class4	746	overall  37 of the 60 patients  or 61   had a neoplasm of the immune system  
class4	747	proliferative mass found in the gingiva  
class4	747	the clinical course of peripheral ossifying fibroma is slow and the growth of most lesions is limited in size  usually up to 1 5 cm  
class4	747	complaints are rare unless the surface becomes ulcerated  or the lesion compromises oral function or esthetic appearance  
class4	747	treatment is surgical excision with close postoperative follow up  
class4	747	tooth extraction is seldom necessary  
class4	747	proper surgical intervention  which includes excision of reactive tissue down to periosteum  affords a low recurrence rate of 14  to 16   
class4	748	effect of gastric mucus on the uptake of the carcinogen mnng by gastric mucosal dna  
class4	748	in prostaglandin e2  pge2    pirenzepine   and indomethacin administered rats  the incorporation of n  methyl 3h  n  nitro n nitrosoguanidine   methyl 3h mnng  into gastric mucosal dna was measured quantitatively by liquid scintillation counting after intragastric instillation of  methyl 3h mnng  
class4	748	the amount of incorporation was 25 4     5 9 pmol mg dna in control rats  11 7     3 8 pmol mg dna in pge2 administered rats  6 2     5 6 pmol mg dna in pirenzepine administered rats  and 42 9     14 4 pmol mg dna in indomethacin administered rats  
class4	748	pge2 and pirenzepine significantly decreased the incorporation as compared with the control group  
class4	748	in contrast  indomethacin increased the incorporation  
class4	748	in addition  gastric mucosa of these drug treated rats was studied histochemically  
class4	748	pge2 and pirenzepine increased secretion of gastric mucus whereas indomethacin decreased it  
class4	748	it is possible that gastric mucus has a protective effect not only against ulcerogenic agents but also against carcinogens  
class4	748	it is considered that gastric mucus plays an important role in the defense mechanism against carcinogenesis  
class4	749	campylobacter pylori interactions with gastric cell tissue culture  
class4	749	many investigators have reported that gastric mucosal biopsies of patients with chronic gastritis and peptic ulcer disease show the presence of campylobacter pylori in a large majority of cases  
class4	749	histologic examinations of such tissues indicate a close approximation of c  
class4	749	pylori with gastric surface epithelial cells  
class4	749	a recent report has described both adherence and cell invasion of gastric cells by c  
class4	749	pylori  
class4	749	using a transmission electron microscope  we have examined the interaction between c  
class4	749	pylori  c  
class4	749	jejuni  and e  
class4	749	coli in vitro with a gastric cancer cell line  kato iii  
class4	749	our results indicate marked toxicity of e  
class4	749	coli and moderate toxicity of c  
class4	749	jejuni for kato iii cells  
class4	749	c  
class4	749	pylori had only a minor effect on tissue culture viability  
class4	749	c  
class4	749	pylori was found to have a strong association with the kato iii cell membranes and evidence of occasional cell invasion  
class4	749	both c  
class4	749	jejuni and e  
class4	749	coli showed no attachment or association with the kato iii cells  
class4	749	we interpret these findings as indicating that c  
class4	749	pylori may have a specific adhesion for gastric cells  
class4	750	pelvic pain  lessons from anatomy and physiology  
class4	750	pelvic pain is often a difficult differential diagnosis in the emergency department  
class4	750	for physiologic reasons  pain in the pelvis is difficult to localize to a specific organ  and pelvic peritonitis is hard to recognize  
class4	750	on the other hand  differences in types of pain can be very useful in arriving at a correct diagnosis  
class4	750	the clinician must learn to recognize superficial and deep somatic pain  and differentiate between various types of visceral pain which originate from inflammation  ischemia  or colic  
class4	750	a review of the anatomy and physiology of pelvic pain helps identify some of the problems as well as potential aids in approaching the patient with pelvic pain  
class4	751	hypointense renal cell carcinoma  mr imaging with pathologic correlation  
class4	751	in two pathologically documented cases of renal cell carcinoma  the appearance of the tumors at magnetic resonance  mr  imaging was markedly hypointense relative to normal renal parenchyma on both t1  and t2 weighted spin echo images  
class4	751	pathologic examination of both tumors revealed diffuse iron scattered throughout the tumors  
class4	751	the paramagnetic effect of the iron may account for this unusual hypointense appearance at spin echo imaging  independent of pulse sequence  
class4	752	rectal carcinoma  ct staging with water as contrast medium  
class4	752	computed tomography  ct  was used to study 42 patients with rectal carcinoma  
class4	752	water was used as a contrast medium for studying the local extent of tumor in all patients  
class4	752	scans were read prospectively without knowledge of the histologic staging and then compared with pathologic specimens  
class4	752	ct depicted the tumor in all patients  
class4	752	comparison of ct and histologic results  following the dukes classification  showed that disease was correctly staged as a in three of four patients  as b in eight of 12  as c in 15 of 17  and as d in nine of nine  
class4	752	overall  carcinoma was correctly staged with ct in 35 of 42 patients  diagnostic accuracy  83 3    
class4	752	the accuracy in the assessment of local invasion was 97 6   41 of 42   
class4	752	in the detection of lymph node involvement  the accuracy was 78 6   sensitivity  88   specificity  64 7    
class4	752	ct is recommended in the preoperative staging of rectal carcinoma and as an aid in choosing the appropriate therapy  
class4	752	the use of water enema and complete distention of the rectum are reliable techniques for improving the accuracy of ct in the assessment of local invasion by cancer  
class4	753	segmented turboflash  method for breath hold mr imaging of the liver with flexible contrast  
class4	753	a method called segmented turboflash imaging allows high resolution  multisection  short inversion time  ti  inversion recovery  stir   t1  or t2 weighted magnetic resonance  mr  studies of the liver to be completed within a breath hold interval  
class4	753	the method was applied in a phantom and in 19 patients with hepatic lesions  
class4	753	sequence comparisons were performed among segmented turboflash  single shot turboflash  t1 weighted gradient echo with ultrashort echo time  and t2 weighted spin echo  se  techniques  
class4	753	signal from fat and liver could be nulled with the segmented turboflash method  with tis of 10 and 300 msec  respectively  signal from these tissues could not be eliminated with the single shot approach  
class4	753	signal difference to noise ratios and contrast for the best segmented sequences were comparable with those of the best t2 weighted se and t1 weighted gradient echo techniques  
class4	753	it is concluded that it is feasible to obtain breath hold images with arbitrary tissue contrast by means of segmented turboflash imaging  
class4	753	the method may prove helpful for the detection and characterization of hepatic lesions and will likely have applications to other anatomic regions such as the chest and pelvis  
class4	754	effect of somatostatin analogue  octreotide  on blood flow to endocrine tumors metastatic to the liver  angiographic evaluation  
class4	754	the effect of an octapeptide analogue of somatostatin  octreotide  on tumor blood flow was evaluated with angiography in eight patients with hepatic endocrine tumors  one patient had primary intrahepatic gastrinoma  two patients had hepatic metastases from gastrinomas  two patients had vipomas  vasoactive intestinal polypeptide secreting tumor   and three patients had carcinoid tumors  
class4	754	octreotide caused a marked decrease in tumor blood flow in two patients with gastrinomas and two with vipomas  
class4	754	one patient could not be evaluated due to the lack of a tumor blush on a control angiogram  
class4	754	in patients with carcinoid tumors  octreotide caused a slight reduction in blood flow through the tumors in two patients  while there was no change in one patient  
class4	754	octreotide markedly decreased gastrin and gastric acid secretion in two of three patients with gastrinomas  lowered vip and stopped the diarrhea in patients with vipomas  and controlled symptoms in two of three patients with carcinoid tumors  
class4	754	the vasoactive effect of octreotide on hepatic endocrine tumors may be a direct action on tumor blood supply or secondary to inhibition of the endocrine tumor cell secretion and consequent decreased blood flow  
class4	755	direct interaction of a ligand for the erbb2 oncogene product with the egf receptor and p185erbb2  
class4	755	the erbb2 oncogene encodes a 185 kilodalton transmembrane protein whose sequence is similar to the epidermal growth factor receptor  egfr   
class4	755	a 30 kilodalton factor  gp30  secreted from mda mb 231 human breast cancer cells was shown to be a ligand for p185erbb2  
class4	755	an antibody to egfr abolished the tyrosine phosphorylation induced by egf and transforming growth factor alpha  tgf alpha  but only partially blocked that produced by gp30 in sk br 3 breast cancer cells  
class4	755	in two cell lines that overexpress erbb2 but do not expresss egfr  mda mb 453 breast cancer cells and a chinese hamster ovary cell line that had been transfected with erbb2   phosphorylation of p185erbb2 was induced only by gp30  
class4	755	the gp30 specifically inhibited the growth of cells that overexpressed p185erbb2  
class4	755	an antibody to egfr had no effect on the inhibition of sk br 3 cell colony formation obtained with gp30  
class4	755	thus  it appeared that gp30 interacted directly with the egfr and erbb2  
class4	755	direct binding of gp30 to p185erbb2 was confirmed by binding competition experiments  where gp30 was found to displace the p185erbb2 binding of a specific antibody to p185erbb2  
class4	755	the evidence described here suggests that gp30 is a ligand for p185erbb2  
class4	756	protection from chemotherapy induced alopecia in a rat model  
class4	756	alopecia  hair loss  is among the most distressing side effects of cancer chemotherapy  
class4	756	little progress has been made  however  in its prevention or treatment  partly because of the lack of suitable experimental model  
class4	756	in recent work on the treatment of myelogenous leukemia in the rat  the following observations were made   i  treatment of 8 day old rats with cytosine arabinoside consistently produced alopecia  and  ii  imuvert  a biologic response modifier derived from the bacterium serratia marcescens  uniformly produced complete protection against the alopecia  
class4	756	in subsequent experiments  both cyclophosphamide and doxorubicin also produced alopecia in this model  and the doxorubicin induced alopecia was prevented by treatment with imuvert  
class4	756	the potential relevance of these observations to chemotherapy induced alopecia in the clinical setting should be examined  
class4	757	molecular analysis of acute promyelocytic leukemia breakpoint cluster region on chromosome 17  
class4	757	acute promyelocytic leukemia  apl  fab m3  is characterized by a predominance of malignant promyelocytes that carry a reciprocal translocation between the long arms of chromosomes 15 and 17  t 15 17   q22 q11 2 q12   
class4	757	this translocation has become diagnostic for apl  as it is present in almost 100 percent of cases  
class4	757	a not i linking clone was used to detect this translocation initially on pulsed field gel electrophoresis and subsequently with conventional southern  dna  analysis  
class4	757	the breakpoints in ten apl cases examined were shown to cluster in a 12 kb region of chromosome 17  containing two cpg rich islands  
class4	757	the region is the first intron of the retinoic acid receptor alpha gene  rara   
class4	758	anxiety levels and cancer fear in patients admitted for elective operations  
class4	758	patients who are to have elective operations project varying degrees of anxiety  and many spontaneously express fear  without basis  that their operation involves a diagnosis of malignancy  
class4	758	to measure total  covert  and overt anxiety objectively  we gave the institute for personality and ability testing anxiety test to 125 consecutive patients admitted for elective general surgical procedures  
class4	758	a simple survey of cancer fear was also completed  
class4	758	chi square and fisher s exact test were used to compare categoric data  and linear regression and analysis of variance were used where appropriate  
class4	758	total anxiety scores were in the upper quartile compared to the general population  
class4	758	scores indicating fear of cancer were elevated in 75  of patients who had no history of or reason to suspect malignancy  
class4	758	covert anxiety scores correlated with cancer fear scores  and both significantly decreased as age increased  p less than  05   
class4	758	also  as age increased  the cancer fear scores decreased  p less than  002   
class4	758	obese patients had higher scores of cancer fear than all other patients  p less than  0001   
class4	759	acute promyelocytic leukemia  impact of hemorrhagic complications on response to induction chemotherapy and survival  
class4	759	from 1976 to 1989  21 adult patients with previously untreated acute promyelocytic leukemia were seen at the university of virginia hospital  
class4	759	we reviewed their cases retrospectively to determine the impact of hemorrhagic complications and other factors on treatment outcome  
class4	759	we observed a complete remission rate of 35   the median survival in complete responders was 15 months  
class4	759	evidence of disseminated intravascular coagulation was found in 13  62   of the 21 cases at diagnosis  
class4	759	fatal intracranial hemorrhage was the leading cause of death  occurring in eight  40   of the 20 patients evaluated  
class4	759	initial leukocyte count greater than 4 0 x 10 9  l and platelet count less than 20 x 10 9  l were significantly associated with an increased risk of intracranial hemorrhage  
class4	759	in patients with disseminated intravascular coagulation  the rate of intracranial hemorrhage was reduced by treatment with heparin  
class4	759	the high mortality of 40   8 20  due to intracranial hemorrhage during induction was a major contributor to the low complete remission rate of 35   7 20  in this series of consecutive unselected patients with newly diagnosed acute promyelocytic leukemia  
class4	760	carcinoma of the male breast  a review of 41 cases  
class4	760	we reviewed the cases of 41 consecutive men treated for breast carcinoma from 1950 through 1987 at vanderbilt university affiliated hospitals to examine controversies in and methods of therapy for this disease  
class4	760	twenty two patients  52   had stage i or ii lesions potentially curable by operative therapy  
class4	760	the overall 5 year survival rates were 100  for stage i  65  for stage ii  56  for stage iii  and 0  for stage iv  
class4	760	radical mastectomy offered no advantage over modified radical mastectomy in terms of survival or rate of recurrence  
class4	760	diagnosis at an early clinical stage and no finding of disease in axillary lymph nodes were important factors in survival in this series of patients  
class4	760	all tumors evaluated for hormone receptors were positive  
class4	760	although experience was limited  encouraging results were obtained with the use of tamoxifen citrate in adjuvant as well as palliative roles  
class4	760	with the exception of a predominance of centrally located lesions and a uniquely high frequency of positive hormone receptor status  carcinoma of the male breast appears biologically similar to the disease in women  and treatment should be guided by similar principles  
class4	761	malignant melanoma and pigmented lesions  a diagnostic and management dilemma  
class4	761	we document two cases of malignancy occurring at the site of partially removed benign nevi  
class4	761	because of the difficulty in clinical diagnosis and the uncertainty in its behavior  we propose that any recurring melanocytic nevus expanding beyond the original surgical scar be re excised and the specimen carefully analyzed to ensure complete removal  
class4	762	results of conservative surgery and radiation therapy for breast cancer  
class4	762	for stage i or ii breast cancer  conservative surgery and radiation therapy are as effective as modified radical or radical mastectomy  
class4	762	in most cases  cosmetic considerations and the availability of therapy are the primary concerns  
class4	762	the extent of a surgical resection less than a mastectomy has not been a subject of a randomized trial and is controversial  
class4	762	it appears that removal of a quadrant of the breast for small lesions is safe but excessive  
class4	762	using histologic findings in the biopsy as a guide  it may be possible to limit the breast resection to gross tumor removal for most patients while using wider resections for patients with an extensive intraductal component or for invasive lobular carcinoma  
class4	762	it also appears that excluding patients from breast conservation on the basis of positive margins on the first attempt at tumor excision may be unnecessarily restrictive  
class4	762	although patients with an extensive intraductal component or invasive lobular carcinoma should have negative margins  it appears that a patient with predominantly invasive ductal carcinoma can be treated without re excision if all gross tumor has been resected and there is no reason to suspect extensive microscopic disease  
class4	762	patients with indeterminate margins should have a re excision  
class4	762	axillary dissection provides prognostic information and prevents progression of the disease within the axilla  
class4	762	axillary dissections limited to level i will accurately identify a substantial number of patients who have pathologically positive but clinically negative nodes  
class4	762	when combined with radiation therapy to the axilla  a level i dissection results in a limited number of patients with progressive axillary disease  
class4	762	patients with pathologically positive axillas and patients at particularly high risk for systemic disease because of the extent of axillary node involvement can be identified by dissections of levels i and ii  
class4	762	radiation therapy can be avoided safely in patients who have pathologically negative axillas by level i and ii dissection  
class4	762	there appears to be no advantage to routine dissection of level iii lymph nodes  
class4	762	lymphedema of the arm and breast increases with more extensive dissections and with radiation therapy  
class4	763	role of mastectomy in breast cancer  
class4	763	the surgical management of breast cancer continues to evolve in an attempt to define the ideal line between therapeutic efficacy and morbidity  
class4	763	it is clear that breast cancer is a biologically heterogeneous group of diseases  and no single hypothesis explains its behavior  
class4	763	the surgical options proposed to the individual patient must draw from the experience of retrospective clinical studies and prospective randomized trials in an attempt to optimize the treatment plan  
class4	763	most patients without distant disease are eligible to consider mastectomy  which can accomplish excellent local control and significantly improve survival for earlier stages of disease  
class4	763	however  breast conservation remains an appropriate alternative for a carefully defined subset of patients  
class4	763	today  with early stage disease  no patient need leave the operating room without a breast  
class4	763	recent advances in reconstructive surgery make mastectomy with immediate reconstruction or limited resection plus axillary dissection with postoperative radiation therapy the two principal treatment choices available  
class4	763	future studies will focus on the integration of other treatment modalities  
class4	763	clinical research into the use of preoperative chemotherapy to downstage the disease to permit less extensive surgery is of interest  
class4	763	recent application of molecular biologic techniques such as oncogene analysis  cytogenetic studies  proliferative indices  and the highly sensitive detection of distant micrometastases using monoclonal antibodies may assist in the design of innovative approaches to surgery  radiation therapy  and systemic drug treatment  
class4	763	these advances show great promise for improving the quality of life and the cure rate for patients with breast cancer  
class4	763	today  surgical treatment options have evolved that fulfill some of the objectives outlined by dr  
class4	763	james ewing of memorial hospital some 50 years ago  
class4	763	his concerns about breast cancer remain as relevant today as they were half a century ago   i have drawn the impression that in dealing with mammary cancer  surgery meets with more peculiar difficulties and uncertainties than with almost any other form of the disease  
class4	763	the anatomical types are so numerous  the variations in clinical course so wide  the paths of dissemination so free and diverse  the difficulties of determining the actual conditions so complex  and the sacrifice of tissues so great  as to render impossible in the majority of cases a reasonably accurate adjustment of a means to an end    
class4	764	selection of breast preservation therapy for primary invasive breast carcinoma  
class4	764	breast preservation treatment for primary breast cancer should not be used for all women  
class4	764	women frequently excluded from consideration for such treatment or who choose not to have it may be elderly and not concerned about cosmetic appearance or live at a distance so that 6 weeks of daily trips to radiotherapy would be inconvenient or even impossible  
class4	764	also  if radiotherapeutic expertise or facilities are not available  a breast preservation program is difficult  
class4	764	in massachusetts  a full course of just over 6000 cgy  4500 cgy to the whole breast and a 1600 cgy local boost  costs roughly  6000  
class4	764	thus  breast preservation is more expensive than mastectomy even with reconstruction  as patients still frequently require a hospital admission with general anesthesia for an axillary dissection  
class4	764	although insurance policies cover such expenses  patients who do not have insurance or have inadequate coverage may find the extra expense of the breast preservation technique burdensome or impossible  
class4	764	women with a small breast and a proportionately large cancer may have an unsatisfactory cosmetic outcome after appropriate lumpectomy  
class4	764	the cosmetic result in such patients frequently cannot be predicted beforehand  this fact adds emphasis to the need for a two step process of lumpectomy and then re evaluation of the cosmetic outcome as well as pathologic features for decisions regarding breast preservation  
class4	764	finally  women may have strikingly different attitudes toward breast preservation than expected by the surgeon  
class4	764	for some women  the urge to preserve the breast is so strong that they will accept virtually any risk to achieve this option  whereas for other women  the constant anxiety about a recurrence or undergoing radiation therapy is traumatic enough that they readily accept mastectomy  
class4	764	in our referral surgical oncology practice  roughly 60  of patients are currently treated with breast preservation techniques  the remainder undergo mastectomy  with immediate reconstruction in approximately three fourths of the cases  
class4	764	the proportion of patients who elect to have breast preservation depends greatly on local medical customs and attitudes  the radiotherapeutic skills available  women s attitudes  which frequently are dependent on the local press and publicity  and the surgeon s interest and enthusiasm for such a program  
class4	764	there is no appropriate proportion of patients who should be treated by breast preservation techniques  but clearly  the proportion of patients so treated increases with experience  acceptability  publicity  and availability  
class4	764	thus  the selection of breast preserving therapy for individual patients is a result of an extraordinary array of factors that need to be considered in each patient  abstract truncated at 400 words   
class4	765	selection of therapy for stage iii breast cancer  
class4	765	locally advanced breast cancer is a heterogenous group including both operable and inoperable lesions  
class4	765	local surgery or radiation alone produces poor survival rates  indicating micrometastases at diagnosis  
class4	765	systemic chemotherapy as part of multimodality regimens has increased the length and rate of disease free survival  
class4	766	adjuvant chemotherapy of breast cancer  
class4	766	many women will not be cured of breast cancer by even the best early detection and surgical techniques because of micrometastases present at diagnosis  
class4	766	adjuvant therapy has extended the disease free interval for most patients and lengthens overall survival for many  
class4	766	combination chemotherapy has become the standard form of adjuvant treatment for premenopausal women with breast cancer and positive lymph nodes after primary therapy  
class4	766	with minimal toxicity  disease free and overall survival are improved  
class4	766	results are less impressive or less clear cut for postmenopausal women or any woman with negative lymph nodes  
class4	766	long term toxicities of adjuvant chemotherapy may include second malignancies and cardiac dysfunction  
class4	766	although these complications probably are rare  they must be considered seriously when weighing chemotherapy for patients in whom its benefits may be slight  
class4	766	innovations likely to become standard in adjuvant therapy decision making include risk assessment with new prognostic indicators  growth fraction  oncogene expression  and investigation of dose intensification using bone marrow growth factors and autologous stem cell support  
class4	767	adjuvant antiestrogen therapy for breast cancer  past  present  and future  
class4	767	laboratory investigations using animal models of breast cancer growth have indicated that the antiestrogenic compound tamoxifen is a tumoristatic agent  
class4	767	it is therefore effective in suppressing  rather than destroying  the breast tumor  
class4	767	its use as an adjuvant in breast cancer management has been successful  with a proportion of women benefiting from long periods of tamoxifen treatment  
class4	767	all the initial studies recruited postmenopausal women  but tamoxifen is now proposed for the treatment of premenopausal women for an extended time  
class4	767	naturally  there are many aspects of the toxicology of tamoxifen to consider  however  careful monitoring of clinical trials will determine the safety of the drug for the general patient population  
class4	768	management of local and regional recurrence after mastectomy or breast conserving treatment  
class4	768	locoregional failures after primary treatment for breast cancer include a diverse group of lesions that represent different categories of failures with various prognoses  
class4	768	although patients with chest wall recurrences and regional nodal failures after traditional radical surgery have a poor prognosis  many patients can still achieve a significant degree of palliation and even long term survival or cure with carefully orchestrated multimodal treatment  
class4	768	in patients who have breast failures after breast conservation surgery and radiation  long term salvage and cure can be achieved for the majority with prompt detection and appropriate treatment  which  like treatment for primary breast cancer  includes a consideration not only of local control but also of the risk of subsequent systemic failure and its need for treatment  
class4	769	reconstruction after mastectomy  
class4	769	advances in materials and techniques  especially those involving transposition of muscle and skin flaps  have made breast reconstruction possible for most women who undergo mastectomy for breast cancer  
class4	769	the availability of this option can alleviate the breast and chest wall deformity that results from virtually all local treatment of breast cancer  
class4	769	it is essential that the reconstruction surgeon be part of the breast cancer management team from the beginning of treatment planning and that this surgeon work closely with the general surgeon  medical oncologist  and radiation therapist as well as the adjunctive treatment team members  
class4	769	the patient s clinical status and the type of local treatment will be significant determinants of the reconstructive options  
class4	769	for women with stage i breast cancer  these decisions may be based largely on the oncologist s local and adjunctive therapy procedures and the woman s desire to proceed or delay  
class4	769	for women with systemic disease  all members of the breast management team may need to agree on the advisability and timing of reconstruction  
class4	769	central to all of the numerous decisions described in this paper regarding the timing  type  and extent of breast reconstruction is the primary goal of the entire team  the best possible management of the breast cancer itself  
class4	769	the promise of attractive  symmetric  and natural appearing breasts  complete with a symmetric nipple areolar complex  has eased somewhat the diminishment of self esteem and the threat to femininity that can accompany the loss of a breast  
class4	769	by lowering fear  the widely recognized availability of breast reconstruction may encourage more women to monitor their breasts and seek diagnosis of changes and may influence selection of the type of local treatment if cancer is detected  
class4	769	because of the psychological and cultural significance of the breast  the reconstructive surgeon must be particularly sensitive to the psychological and aesthetic expectations of the patient  
class4	769	even in those patients with metastases and limited life expectancy  breast reconstruction can enhance the quality of life  
class4	770	bilateral breast cancer  
class4	770	a second primary breast cancer in the opposite breast can be either synchronous or metachronous  
class4	770	the majority are metachronous  
class4	770	a woman who has had breast cancer has a fivefold increase in risk for a second breast cancer  
class4	770	additional risk factors include multifocal cancer  lobular carcinoma in situ  and an original cancer at an early age with long survival  
class4	770	lobular carcinoma in situ is predominantly a marker for the subsequent development of a second primary breast cancer  
class4	770	the incidence of synchronous bilateral cancer is approximately 1  to 2  and that of metachronous cancer 5  to 6   
class4	770	the cancer can be invasive or noninvasive  
class4	770	mammography has increased the number of synchronous cancers found but not the overall incidence  
class4	770	the incidence of invasive cancer detected by random biopsy of the opposite breast is not high enough to justify routine adoption of this procedure  
class4	770	the remaining breast must be followed for the remainder of the patient s life by physical examination and annual mammography  
class4	770	the treatment of the secondary primary breast cancer should be that appropriate for the stage of the disease  
class4	770	the prognosis for the woman with a second primary breast cancer is quite favorable and is dependent on the stage of both the first and the second cancer  
class4	771	breast cancer during pregnancy and lactation  
class4	771	breast cancer is the most frequently seen cancer in pregnancy and lactation  but the incidence is low  the disease being seen in approximately 0 03  of pregnancies  
class4	771	only 1  to 2  of breast cancer overall is diagnosed during pregnancy or lactation  
class4	771	there is no evidence to implicate pregnancy or lactation in either the etiology or the progression of breast cancer  
class4	771	careful breast examination early in the pregnancy is very important to find solid masses that require biopsy before breast engorgement hides them  
class4	771	therapeutic options vary  depending on the stage of disease and the stage of the pregnancy  
class4	771	operable disease in the first 6 to 7 months of the pregnancy should be treated by mastectomy  as irradiation is contraindicated  
class4	771	late in the pregnancy  a lumpectomy and axillary dissection can be done  with irradiation being delayed until after delivery  
class4	771	general anesthesia is safe if the usual precautions are taken to compensate for the physiologic changes induced by pregnancy  
class4	771	unfortunately  delay in diagnosis is common  and 70  to 89  of patients with operable primary lesions have positive axillary lymph nodes  
class4	771	late stage appears to be the only reason for the generally worse prognosis in these patients  as stage for stage  they have a course similar to that of nonpregnant patients  
class4	771	adjuvant chemotherapy can be considered late in the pregnancy but should usually be delayed until after delivery  
class4	771	in patients with locally advanced or metastatic cancer diagnosed early in the pregnancy  for whom both chemotherapy and radiation therapy would normally be recommended  consideration must be given to termination of the pregnancy  
class4	771	there is no evidence that termination of pregnancy improves the outlook for the patients  but it does permit standard aggressive therapy in advanced disease  
class4	772	male breast cancer  
class4	772	male breast cancer is uncommon but important  
class4	772	the diagnosis is easily made by breast biopsy  and patients are presenting earlier in the course of the disease than in the past  
class4	772	despite this  patients are often first seen with tumors that have metastasized to the axillary nodes  which markedly decreases the survival rate  
class4	772	therapy of localized disease includes simple excision  modified radical mastectomy  and radical mastectomy  but there is no consensus for which operation is appropriate  
class4	772	radiation therapy should be strongly considered in patients with metastases to the axillary nodes  but the role of adjuvant hormonal therapy or chemotherapy is unclear  
class4	772	for treatment of disseminated disease  tamoxifen seems to be replacing orchiectomy  
class4	772	the favorable response rate  especially in patients with estrogen receptor positive tumors  the lack of side effects  and the high level of patient acceptability make it an attractive therapeutic choice  
class4	773	clinical problems in follow up of patients after conservative surgery and radiotherapy  
class4	773	patients treated with conservative surgery and radiotherapy for early stage breast carcinoma are at risk of developing an ipsilateral breast recurrence for a long period  
class4	773	fortunately  few such patients present with an inoperable recurrence or simultaneous distant metastases  
class4	773	salvage rates are high and may be improved by early detection  
class4	773	although usually unambiguous  physical examination of the treated breast may reveal changes attributable to surgery and radiotherapy that can mimic a recurrent cancer  
class4	773	there also is substantial overlap in radiologic appearance between benign and malignant lesions  
class4	773	it may be necessary to perform a biopsy when there is a question of recurrence  
class4	773	careful life long follow up of patients thus is a critical part of their care  
class4	774	trends in primary breast cancer management  where are we going  
class4	774	the treatment of cancer during any period has been based not on the whim of a clinician but on the therapeutic consequences of the dominant biologic model of the disease  
class4	774	until the 1960s  the dominant model of breast cancer was of a disease that spread centrifugally along anatomic pathways  with time being the only determinant of prognosis  
class4	774	an alternative model  that of biologic determinism  posits that the outcomes of treatment are determined by the extent of microscopic dissemination that occurred before the tumor became detectable  
class4	774	this model  too  has flaws  and the author suggests that it is time for a kuhnian paradigm shift  
class4	774	breast cancer exhibits a heterogeneity of phenotypes resulting from one or perhaps two mutations  
class4	774	the multiple prognostic variables may be epiphenomena  expressing different degrees of amplification of a limited domain of the genome  
class4	775	prognostic indicators in invasive breast cancer  
class4	775	tumor size and axillary lymph node involvement are the primary determinants of clinical course for most patients  
class4	775	receptors for estrogen and progesterone are important additional prognostic factors for disease free survival  overall survival  survival time after initial disease recurrence  and the likelihood of response to hormonal therapy  
class4	775	histologic grading has merit as a prognostic factor  although poor reproducibility limits its broad application  
class4	775	promising data have been emerging from the use of flow cytometry to analyze dna content and proliferative rate  
class4	775	patients with aneuploid tumors are more likely to have a shorter survival time than patients with diploid tumors  
class4	775	a high s phase fraction also identifies a subset of patients at increased risk for early relapse  
class4	775	a combined index of ploidy and s phase may be a more useful guide  together  diploidy and low s phase identify a subgroup of node negative patients at very low risk for disease recurrence  
class4	775	a number of oncogenes have been identified in breast cancer  amplification of the her 2 neu gene or overexpression of the gene product may be an important prognostic indicator for node positive patients  
class4	776	broad spectrum penicillin as an adequate therapy for acute cholangitis  
class4	776	in a previous study of patients with acute cholecystitis  we demonstrated equal efficacy with a broad spectrum penicillin  piperacillin  and a penicillin plus amino glycoside combination  
class4	776	whether a single agent broad spectrum penicillin is adequate treatment for more severe infections  such as acute cholangitis  however  is still unclear  
class4	776	we  therefore  conducted a three center  prospective  randomized trial to determine whether or not a broad spectrum penicillin alone is adequate therapy for patients with acute cholangitis  
class4	776	during a 36 month period  96 patients with sepsis and biliary obstruction were randomly assigned to receive either piperacillin  n   49  or ampicillin plus tobramycin  n   47   
class4	776	the two groups receiving antibiotics were similar with respect to all clinical and laboratory parameters  
class4	776	the incidence of blood cultures with positive results  20 versus 21 per cent  and underlying malignant lesions  51 versus 62 per cent  was also similar between the two groups  
class4	776	the percentage of patients with a clinical cure or significant improvement was the same in the two groups  69 versus 70 per cent   
class4	776	however  there was a significant difference in the cure rate between patients with benign and malignant biliary obstructions  83 versus 59 per cent  p less than 0 01   
class4	776	no significant differences were noted between the two antibiotic groups with respect to drug toxicity  but patients with malignant conditions were more prone to antibiotic related toxicities  2 versus 19 per cent  p less than 0 05   
class4	776	these data suggest that outcome of treatment in patients with acute cholangitis is similar with either a broad spectrum penicillin or a penicillin plus aminoglycoside combination and is dependent upon the nature of the biliary obstruction  
class4	777	synchronous carcinoma of the colon and rectum  
class4	777	reports on the incidence of synchronous carcinoma of the colon and rectum have varied from 2 to 11 per cent  
class4	777	the variability is a result of a lack of uniformity in criteria of diagnosis  differences in the population studied and differences in time period used  
class4	777	in this study  we evaluated the incidence and distribution of synchronous lesions during a recent time period before the use of colonoscopy became widespread  
class4	777	we reviewed the records of all patients with newly diagnosed adenocarcinoma of the colon and rectum who were operated upon at our institution between 1976 and 1981  
class4	777	in a total group of 1 000 patients of which 52 per cent were men  there were 54 patients or 5 4 per cent who had synchronous carcinomas  
class4	777	the group of patients with synchronous carcinomas were older than the group with nonsynchronous carcinomas  72 4 versus 68 8 years   
class4	777	there was also a higher incidence of associated benign polyps in the group with synchronous carcinomas  70 versus 30 per cent for a nonsynchronous carcinomas   
class4	777	the anatomic distribution of carcinomas of the colon and rectum in the group with synchronous lesions  111 in total  revealed a higher percentage of carcinomas located on the right side  29 7 versus 22 5 per cent   although the difference did not reach statistical significance  
class4	777	synchronous carcinomas were located in nonadjacent segments of the colon in 37 per cent  
class4	777	there was no difference in stage between the groups with and without synchronous carcinomas  
class4	777	the preoperative identification of synchronous lesions by either colonoscopy or barium enema is important for the proper treatment of patients with carcinoma of the colon and rectum  
class4	777	failure to locate these tumors may lead to the demise of the patient  
class4	778	congenital dilatation of the bile duct in 100 instances and its relationship with anomalous junction  published erratum appears in surg gynecol obstet 1991 mar 172 3  246  
class4	778	congenital dilatation of the bile duct  cdbd  or choledochal cyst has been demonstrated to be associated with an anomalous junction of the pancreaticobiliary ductal system  
class4	778	multifarious clinical signs and symptoms of cdbd have been shown to be closely related with the presence of this anomalous junction  
class4	778	in the present study  100 instances of cdbd treated surgically at our institutions during a 30 year period were classified into two types according to the morphologic features of dilatation of the bile duct  there were 77 instances of the cystic type and 23 of the cylindric type  
class4	778	morphologic features of the lesion  clinical signs and symptoms and laboratory findings in these 100 instances were clinically analyzed  
class4	778	in almost all of the patients who were less than one year of age  the disease was of the cystic type and patients presented with either a palpable mass or jaundice as the main symptom  
class4	778	in patients more than one year of age  the disease was of either the cystic or cylindric type  
class4	778	a history of episodes of characteristic abdominal pain accompanied by elevated levels of serum amylase was present in 70 of the patients with the cystic type of disease and in all of the patients with the cylindric type  
class4	778	histologic sections from the patients showed glandular formation with chronic inflammation  possibly a result of refluxed activated pancreatic juice  in contrast  histologic sections from the remaining patients of all ages showed only thickening of the fibrous layer  
class4	778	thus  such variable morphologic features and clinical signs and symptoms in cdbd are highly dependent on two factors  the age at onset and the reflux of pancreatic juice into the bile duct through the common channel  
class4	779	carcinoma of the thyroglossal duct  
class4	779	a review of 39 instances of excision of a cyst of the thyroglossal duct performed at st  
class4	779	paul medical center  dallas  texas  revealed two patients with carcinoma of the thyroglossal duct  
class4	779	a review of the english literature yielded 146 instances of this uncommon tumor  
class4	779	eighty four per cent were papillary adenocarcinoma of thyroid type and 5 per cent were squamous cell carcinoma  
class4	779	the patients were from six to 81 years old with a 2 1 female to male ratio  
class4	779	metastatic disease to lymph nodes was noted in 11 per cent and invasion of overlying strap muscles was found in 4 per cent  
class4	779	carcinoma of the thyroid gland occurred in 14 per cent  
class4	779	preoperative diagnosis was rare  
class4	779	the sistrunk procedure is recommended for initial surgical therapy with further surgical or adjuvant therapy dependent on associated clinical findings  
class4	779	prognosis for carcinoma of the thyroglossal duct of thyroid type parallels that of carcinoma of the thyroid gland  
class4	780	surgical management of islet cell dysmaturation syndrome in young children  
class4	780	islet cell dysmaturation syndrome  icds  encompasses the causes of infantile hyperinsulinemic hypoglycemia histologically described as islet cell hyperplasia  pancreatic adenomatosis and nesidioblastosis  
class4	780	eleven infants underwent 14 pancreatic resections for icds from 1965 to 1990 at the university of california at los angeles medical center for severe hypoglycemia unresponsive to medical therapy  
class4	780	seizures were the presenting symptoms of hypoglycemia in eight infants  
class4	780	six patients had nesidioblastosis  four had islet cell hyperplasia and one patient had an adenoma with histologically normal pancreatic islet cells  
class4	780	four neonates underwent 80 per cent pancreatic resection  three with nesidioblastosis required reoperation  90 to 95 per cent resection   
class4	780	four older infants underwent 80 per cent pancreatic resection but required diazoxide for less than six months postoperatively  
class4	780	three infants underwent 90 to 95 per cent pancreatic resection  
class4	780	none have required reoperation or postoperative medications  
class4	780	all infants are normoglycemic without pancreatic exocrine insufficiency and none had postoperative complications  
class4	780	five infants had preoperative neurologic impairment  with three having severe retardation  all showed some improvement postoperatively  but only one infant now has normal findings on neurologic examination  
class4	780	early diagnosis and aggressive surgical resection should minimize neurologic complications of the icds  
class4	781	nonendoscopic percutaneous gastrostomy  
class4	781	tight peritoneal adherence of the stomach to the abdominal wall as a prerequisite of percutaneous gastrostomy can be achieved by a newly developed cannula  
class4	781	it serves for puncture and fixation of the gastric wall  
class4	781	thus  percutaneous gastrostomy can be established safely even in instances of an endoscopically nonaccessible stomach  
class4	781	further applications of the device for the purpose of intestinopexy and facilitation of endoscopic procedures are being evaluated  
class4	782	management of the pregnant patient with carcinoma of the breast  
class4	782	the diagnosis of carcinoma of the breast during pregnancy poses a challenging dilemma  
class4	782	although once regarded as incurable  recent reports reveal similar long term survival rates for pregnant and nonpregnant patients who have carcinoma of the breast  
class4	782	when referred to a surgeon  a pregnant woman with a suspicious mammary mass deserves an expedient histologic diagnosis  delay may jeopardize the chances of survival  
class4	782	once the diagnosis is established  pregnant patients should be treated in a manner similar to nonpregnant patients because there is no evidence that carcinoma of the breast in pregnant women is biologically different than carcinoma of the breast in other premenopausal women  
class4	782	fears of fetal exposure to radiation should not deter a physician from ordering appropriate preoperative diagnostic tests to stage the patients  
class4	782	operation may be performed safely when general anesthesia is administered and postoperative adjuvant therapy should be administered when necessary  
class4	782	the involvement of multiple subspecialties in the management of these patients is highly recommended  
class4	783	an unusual epidural  vascular spinal lipoma in a 3 year old child  a case report and review of the literature  
class4	783	epidural lipomas are usually benign tumors affecting the spinal cord  
class4	783	we report the unusual presentation of a cervicothoracic spinal lipoma associated with a cervical dysraphism in a young boy  
class4	783	diagnostic options using magnetic resonance imaging and gadolinium diethylenetriaminepentaacetic acid are discussed as a pathway to early diagnosis of these and other occult spinal lesions  
class4	784	neonatal intracranial teratomas  
class4	784	two neonates with intracranial teratomas presented with cranial enlargements a few weeks after birth  
class4	784	both cases underwent surgery  one died intraoperatively  the other is the longest known survivor  alive 7 years and 9 months after subtotal excision of a mature teratoma of the left sylvian fissure  
class4	784	previous operations have been relatively few and nearly all have been unsuccessful  
class4	784	size and favorable location may be the most important prognostic features regardless of the histologic classification as mature or immature  
class4	784	one of our cases demonstrates that even subtotal excision of a mature teratoma can result in long term survival  
class4	785	spinal extradural cavernous hemangioma  
class4	785	three cases of isolated spinal extradural cavernous hemangiomas are reported  two in the thoracic and one in the lumbar region  
class4	785	one of them manifested as acute cord compression  the other two as chronic progressive myelopathy or radiculopathy  
class4	785	a total excision or subtotal excision with irradiation was performed  
class4	785	all of them had good functional recovery  
class4	785	the clinical picture  radiological diagnosis  and optimal method of treatment are discussed  
class4	785	the relevant literature is reviewed  
class4	786	prospective evaluation of clinical and pathologic detection of axillary metastases in patients with carcinoma of the breast  
class4	786	complete axillary dissection was performed in 287 patients undergoing modified radical mastectomy between 1984 and 1987 to identify patterns of axillary node metastases  as well as discontinuous axillary node   skip   metastases  
class4	786	positive pathologic findings were compared with preoperative clinical examinations in 266 patients and showed only 60 cases  22 6   clinically suspicious for tumor  in contrast to 131  45 6   with pathologically confirmed positive lymph nodes  
class4	786	axillary contents were classified level i  ii  or iii based on their relationship to the pectoralis minor muscle  
class4	786	an average of 24 2 nodes was resected per patient  level i  10  level ii  8 1  and level iii  5 3   
class4	786	tumors ranged in size from 0 5 to 12 0 cm  mean  2 6 cm   and increasing tumor size was associated with an increased likelihood of positive nodes  
class4	786	the data on 204 patients with complete clinical and pathologic data show that of 119 patients with negative level i nodes a limited axillary dissection  level i only  would fail to identify 6 with positive level ii and 2 with positive level iii nodes  whereas of 85 patients with positive level i nodes limited axillary dissection would fail to identify 17 with positive level ii nodes  7 with positive level iii nodes  and 27 with positive levels ii and iii nodes  
class4	786	complete axillary dissection  levels i  ii  and iii  should be performed to stage patients accurately  as well as to remove tumor involved nodes and diminish local axillary recurrences  
class4	786	clinical examination of the axilla appears to be a poor means of identifying axillary metastatic cancer  
class4	787	short term tamoxifen plus chemotherapy  superior results in node positive breast cancer  
class4	787	three hundred eleven patients with node positive breast cancer were randomized to one of three adjuvant treatments  cyclophosphamide  cytoxan   methotrexate  and 5 fluorouracil  all of the above with tamoxifen citrate  or all of the above with tamoxifen and bacillus calmette guerin vaccination  
class4	787	local therapy for all patients was a modified radical mastectomy  
class4	787	estrogen receptors were measured on all primary tumors  
class4	787	patients were stratified by the number of positive nodes  one to three nodes and more than three nodes  and estrogen receptor value  less than 3 femtomole mg and greater than or equal to 3 femtomole mg   
class4	787	follow up is available  with a mean of 9 1 and maximum of 14 2 years  
class4	787	in this study the efficacy of short term tamoxifen is apparent over that of chemoimmunotherapy alone and continues to be significant with prolonged follow up  
class4	787	the addition of tamoxifen to chemoimmunotherapy significantly prolonged disease free survival among patients with estrogen receptor positive tumors who were postmenopausal  who had larger tumors  greater than 3 cm   or who had more extensive axillary node involvement  more than three nodes   
class4	787	tamoxifen improved overall survival for patients with estrogen receptor positive tumors larger than 3 cm  
class4	787	the addition of bacillus calmette guerin cytoxan  methotrexate  5 fluorouracil  and tamoxifen did not significantly alter disease free or overall survival  
class4	788	the diagnosis and definition of hepatic malignancies by use of arterial enhanced computerized tomographic scanning  
class4	788	axial computerized tomography is a useful tool in the evaluation of either primary or metastatic hepatic neoplasms  
class4	788	an adjunct to this technique is visceral arterial enhanced computerized tomography  aect   
class4	788	to determine the effectiveness of this modality  bolus intravenous enhanced computerized tomography scans and aect were compared and correlated to operative findings  
class4	788	fifty four consecutive patients were evaluated by aect and bolus intravenous enhanced computerized tomography over a 30 month period  may 1986 to august 1989  for suspected primary or metastatic hepatic malignancies  
class4	788	forty four patients  81   had hepatic lesions  
class4	788	fifty two percent  23 of 44 patients  of the metastatic tumors were from colonic or rectal primary lesions  and 20  were hepatocellular primary lesions  
class4	788	the remainder of the lesions were metastases from a variety of primary lesions  
class4	788	when studies were compared  34  of the patients  15 of 44 patients  differed in either the location or total number of lesions noted  
class4	788	the lesions of three of the 15 patients  20   were determined unresectable on the basis of aect  
class4	788	of the remaining patients  planned resections were revised in seven patients to either lesser or greater procedures  
class4	788	the number of lesions found at laparotomy equaled the number found by aect in all but two cases  
class4	788	aect caused no complications  
class4	788	aect improved our ability to identify and localize primary and metastatic lesions of the liver  
class4	788	this technique offers the advantage of preoperative definition of the hepatic arterial and portal venous anatomy  
class4	789	is dna ploidy of prognostic significance in stage i cutaneous melanoma  
class4	789	recent studies have suggested that the presence of dna aneuploidy in stage i cutaneous melanoma carries a poor prognosis  
class4	789	to see if our experience correlated with these reports  we used dna analysis by flow cytometry of propidium iodide stained nuclei disaggregated from formalin fixed paraffin embedded tissue of biopsy specimens to retrospectively study 55 patients who had cutaneous stage i melanomas  
class4	789	the patients had been treated from 1977 to 1987 with a mean follow up of 5 4 years  
class4	789	thirty nine  71   of the 55 histograms were diploid  and 16  29   of the histograms were aneuploid  
class4	789	dna content was significantly associated with other conventional prognostic factors  including growth pattern  ulceration  pathologic stage  tumor thickness  and clark s level  
class4	789	dna aneuploidy was significantly related to disease free survival and predicted a poorer prognosis  p less than 0 05   but when stratified for tumor thickness it lost significance  
class4	789	a multivariate discriminant function analysis of 12 factors in melanoma showed six factors to be independently significant in determining prognosis  
class4	789	dna content  p   0 034  ranked fifth in importance behind growth pattern  p less than 0 001   ulceration  p less than 0 001   thickness  p   0 001   and pathologic stage  p less than 0 005   
class4	789	dna content  although significantly associated with conventional prognostic factors and disease free survival  is not the best indicator of biologic behavior of melanomas in this study  
class4	789	further investigation into its usefulness is necessary before dna content can become a routine diagnostic modality in the work up of stage i cutaneous melanomas  
class4	790	long term results of surgical resection of locally advanced colorectal carcinoma  
class4	790	this study was undertaken to review the long term results of multivisceral resection of locally advanced colorectal carcinoma  
class4	790	between 1964 and 1980  1042 patients underwent exploratory surgery for colorectal cancer  
class4	790	of these  58 patients  5 5   underwent curative multivisceral resection for suspected contiguous invasion by the primary tumor  
class4	790	follow up was complete for all patients  
class4	790	the primary tumors were located in the rectum  38 patients   sigmoid  9 patients   left colon  6 patients   and right colon  5 patients   
class4	790	en bloc resection of other viscera included uterus  adnexa  bladder  vagina  small intestine  abdominal wall  liver  stomach  kidney  and ureter  
class4	790	the operative morbidity and mortality rates were 31  and 1 7   respectively  
class4	790	resection margins were free of tumor in 54 patients  
class4	790	in the four patients with tumor positive resection margins  recurrence of disease was evident between 8 and 22 weeks after surgery  mean survival time  8 2 months   
class4	790	carcinomatous invasion of the resected contiguous organ was confirmed in 49 patients  84    
class4	790	the mean survival time for patients without lymph node metastases was 100 7 months  but it was only 16 2 months  p less than 0 01  for patients with lymph node metastases  
class4	790	actuarial 5 year disease free survival rate for patients without lymph node metastases was 76   36 of 47 patients   
class4	790	none of the patients  0 of 11  with lymph node metastases survived for 5 years  
class4	790	three of 36 of the 5 year survivors experienced recurrence of disease before the seventh postoperative year  no cancer related deaths occurred between 7 and 25 years  
class4	790	these data suggest that survival in locally advanced colorectal carcinoma is more dependent on lymph node status than on the extent of local invasion  
class4	790	effective disease control associated with survival in the long term can be achieved by multivisceral resection  
class4	791	local recurrence after curative resection of colorectal adenocarcinoma  
class4	791	a total of 853 patients with 861 colorectal adenocarcinomas were operated on at our institution between 1965 and 1981  
class4	791	complete follow up information was obtained in all but six patients  99 4    and all available histologic slides were reviewed to determine pathologic stage and characteristics  
class4	791	six hundred fifty one patients  76 3   underwent a potentially curative procedure  and their operative mortality rate was 2 8   
class4	791	of the 627 patients available for analysis  50  8   had a local recurrence  
class4	791	the median time to local recurrence was 18 months  and only 16  of local recurrences were diagnosed 5 years after the original resection  
class4	791	median survival of patients with a local recurrence was 3 1 2 years from the original resection  and 16 patients  32   survived 5 years or longer  
class4	791	a multivariate logistic regression analysis was conducted to examine the influence of several clinical and pathologic characteristics on local recurrence among dukes  stages b and c adenocarcinomas  n   539  after exclusion of patients with synchronous tumors  n   8   postoperative deaths  n   18   loss to follow up  n   6   or incomplete data  n   11   
class4	791	this analysis revealed that the local recurrence rate was significantly related to depth of invasion  b1   c1   0   b2   c1   10   p less than 0 01   site of origin  right plus transverse colon   6   left plus rectosigmoid colon   10   rectum   12   p less than 0 05   and lymphatic or capillary microinvasion  absent  6   present  14   p less than 0 05   
class4	791	this analysis attempts to identify patients at high risk for development of local recurrent disease to select candidates for postoperative adjuvant therapy  
class4	792	follicular cell predominance in the cytologic examination of dominant thyroid nodules indicates a sixty percent incidence of neoplasia  
class4	792	the interpretation of aspiration cytologic smears that contain a predominance of follicular components often presents a dilemma to the clinician who is treating a patient who has a dominant thyroid nodule  especially when thyroid stimulating hormone suppression does not produce any significant involution of the dominant nodule  
class4	792	we reviewed a consecutive series of 555 fine needle aspiration cytologic examinations of dominant thyroid nodules  
class4	792	all specimens that contained colloid or follicular cells mixed with lymphocytes or hurthle cells were excluded from this review  
class4	792	additionally  nine aspirates contained degenerated follicular cells with insufficient material for cytologic diagnosis  
class4	792	the remaining 76 specimens contained a predominance of follicular cells  27 specimens were interpreted as containing  normal  follicular cells  and the remaining 49 specimens were read as  atypical  follicular cells  
class4	792	histopathologic examination of the resected specimens indicated a 60  incidence of neoplasia  30  carcinoma  30  adenoma  in which the aspiration cytologic study was interpreted as  normal  follicular cells  
class4	792	on the other hand  a 63  incidence of neoplasia  27  carcinoma  36  adenoma  occurred in which the cytologic study was read as  atypical   in conclusion  aspirates showing a predominance of follicular cells  whether  normal  or  atypical  indicate a 60  incidence of neoplasia in dominant thyroid nodules that do not decrease significantly in size with thyroid stimulating hormone suppression  
class4	793	management of recurrent malignant pleural effusion in the united kingdom  survey of clinical practice  
class4	793	malignant pleural effusions are often symptomatic and tend to recur after simple aspiration  
class4	793	pleurodesis may prevent recurrence of the effusion  many agents and techniques have been described  
class4	793	a questionnaire was sent to 448 clinicians in the united kingdom to determine how pleurodesis is performed in practice  
class4	793	there was a 56  overall response  with replies from 101 respiratory physicians  88 general physicians  29 thoracic surgeons  and 35 general surgeons  
class4	793	general surgeons saw few cases of malignant pleural effusion and rarely performed pleurodesis  
class4	793	a patient with recurrent malignant pleural effusion would usually be managed with pleurodesis by 76  76   respiratory physicians  26  30   general physicians  and 23  81   thoracic surgeons  a further 29  33   general physicians would refer such patients to another specialist  
class4	793	most medical pleurodesis were performed by junior staff  whereas consultant thoracic surgeons were more likely to be concerned with the procedure  
class4	793	all the thoracic surgeons used an intercostal tube drain  usually with suction  
class4	793	an intercostal tube drain was used routinely by only 54  54   of the respiratory physicians and 28  32   general physicians  
class4	793	thoracic surgeons preferred talc for pleurodesis whereas physicians most commonly used tetracycline  
class4	793	the variety of methods in use supports the need for randomised  controlled studies to determine the most effective technique of pleurodesis  
class4	794	pulmonary disease following intravesical bcg treatment  
class4	794	bacillus calmette guerin  bcg  is an attenuated strain of mycobacterium bovis that has been used in the treatment of malignant disease for over 20 years and for the treatment of bladder cancer since 1976  
class4	794	major complications of this treatment are infrequent  
class4	794	we report two cases of systemic illness with pulmonary manifestations after treatment with intravesical bcg  
class4	795	effective ultraviolet irradiation of platelet concentrates in teflon bags  
class4	795	several plastic materials used in blood storage were evaluated for their ability to transmit ultraviolet b  uvb  light  
class4	795	a plastic bag manufactured from sheets of transparent teflon efficiently  78 86   transmitted uvb light and was employed in subsequent functional studies of lymphocytes and platelets exposed to uvb light while contained in these bags  
class4	795	in vitro experiments showed a uvb dose dependent abrogation of lymphocyte responder and stimulator functions  with concurrent preservation of platelet aggregation responses  
class4	795	in a phase i pilot study  uvb treated platelet concentrates were administered to four bone marrow transplant recipients  
class4	795	adverse effects attributable to the transfusions were not observed  and patients showed clinically effective transfusion responses  
class4	795	no patient developed lymphocytotoxic hla or platelet antibodies  
class4	795	these studies suggest that platelets can be effectively irradiated with uvb light in a closed system  
class4	795	however  numerous variables  including container material  volume and composition of contents  steady exposure versus agitation  and exact uv wavelength  must be considered  
class4	796	management of stage a prostate cancer  
class4	796	transrectal ultrasonography has defined a new category of stage a disease  namely nonpalpable lesions diagnosed by needle biopsy  
class4	796	how this type relates to classic stage a disease is unclear  
class4	796	stage a1 carcinoma becomes clinically significant only in a distinct minority of patients  and even in this group  progression does not necessarily mean significant morbidity or death from prostate cancer  
class4	796	an aggressive approach is not justified  
class4	796	in contrast  stage a2 cancer is usually virulent  and aggressive therapy with curative intent is justified in patients of appropriate age and health  
class4	796	both radical prostatectomy and external irradiation appear to provide long term survival rates superior to those obtained with observation alone  but nearly 20  of these patients will die of cancer despite therapy  
class4	796	unfortunately  forecasting the outcome in an individual case is still not possible  and efforts to identify prognostic features must continue  
class4	796	in the meantime  emotional arguments in favor of the treatment of all discovered cancers must be suppressed by an informed and objective understanding of the natural history of nonpalpable prostate cancer and the potential impact of treatment  
class4	797	selection of patients with stage b prostate cancer for radical prostatectomy  
class4	797	there are several areas of concern in dealing with clinical stage b disease  
class4	797	first  understaging is common  
class4	797	second  recognition of extension into the seminal vesicles is important  
class4	797	third  the patient s predicted life expectancy must be taken into account  
class4	797	moreover  even clinically localized prostate cancer may have metastasized  and the need for surgical staging by lymph node dissection has been a significant factor in the authors  preference for radical retropubic rather than radical perineal prostatectomy  
class4	797	neither of the two serum markers in clinical use is an absolute predictor of stage  
class4	797	analysis of tumor ploidy may prove useful  and transrectal ultrasound warrants further study  
class4	797	in the elderly patient  the urologist certainly may elect to monitor the tumor without definitely deciding on operative versus conservative treatment  
class4	798	significance and treatment of positive margins or seminal vesicle invasion after radical prostatectomy  
class4	798	the periprostatic soft tissue involvement described in the older urologic literature differs from that now recognized  a much  earlier  pathologic stage c is being identified  
class4	798	apparent microscopic extension of the cancer to the margin of the specimen yields an approximately 25  risk of local recurrence  
class4	798	postoperative radiation apparently is effective in reducing this risk  and if patients are properly selected  such treatment is well tolerated  
class4	798	whether adjuvant radiation affects overall survival is not known  
class4	798	new observations on pathologic extension of the disease need to be refined  
class4	799	prostate specific antigen for staging prior to surgery and for early detection of recurrence after surgery  
class4	799	the exact usefulness of prostate specific antigen for staging before radical prostatectomy is still unclear  
class4	799	perhaps the marker s most exciting feature is its value in detecting residual disease after radical prostatectomy  
class4	799	the author also discusses the technical questions in testing and interpretation  
class4	800	local failure and related complications after definitive treatment of carcinoma of the prostate by irradiation or surgery  
class4	800	the authors review their institution s experience with the failure of definitive treatment to achieve local tumor control and with the distant dissemination and local morbidity associated with such failure  
class4	800	the causes of local failure are various  incomplete resection  implantation of spilled cells  and  possibly  selective implantation of circulating tumor cells in traumatized tissues after surgery and totally or partially resistant cells  new tumors  or radiologic misses after radiation  
class4	800	treatment of local failure may be prophylactic or therapeutic and differs depending on the stage of the disease  
class4	800	failure to control the tumor locally in the presence of distant metastases does not alter the length of survival  but it can profoundly affect the quality of survival  
class4	801	new concepts in the treatment of stage d1 adenocarcinoma of the prostate  
class4	801	stage d1 disease will be encountered in 20 per cent of patients by those who treat prostate cancer  
class4	801	there is marked heterogeneity among cancers discovered at this stage  with 5 year disease free survival rates ranging from 0 to 95 per cent  
class4	801	generally  when prostate cancer has escaped the confines of the gland  metastasis occurs  and widespread systemic disease prevails  
class4	801	any significant chance for long term cure will then depend on systemic therapy  
class4	801	from maturing data in retrospective reviews  preliminary data from prospective trials  and recent well conducted animal studies  chemotherapy and hormonal deprivation appear most effective when tumor volumes are the smallest  
class4	801	this evidence supports the removal of all cancer possible and the early institution of systemic treatment  
class4	801	caution must be exercised in extrapolating the aforementioned evidence to include cases of more extensive prostate cancer  i e   patients with bulky pelvic or retroperitoneal disease  distant metastasis  or significant elevation of serum markers   
class4	801	it is doubtful that  debulking  with removal of the prostate and lymph nodes will provide any justifiable advantages in these patients  
class4	801	whether removal of the prostate affords any local palliative benefit is an issue for debate  
class4	801	certainly  the primary tumor  if left untreated  will progress locally and cause symptoms necessitating further procedures in more than half these patients  whereas the incidence of local recurrence and the adverse effects of these recurrences in patients with d1 disease after radical prostatectomy and adjuvant therapy is less than 10 per cent  
class4	801	surgical refinements coupled with acceptably low morbidity now associated with radical prostatectomy have led some authors to endorse the palliative benefits of removing the primary tumor in selected patients  
class4	801	the purpose of this article is not to endorse or disparage the aggressive treatment of patients with stage d1 prostate cancer  
class4	801	the evidence suggests that if long term survival is the endpoint used to compare treatment groups  then to date no treatment option offers significant advantages  
class4	801	on the contrary  if progression rates or disease free survival are compared  then cytoreductive surgery and early systemic adjuvant treatment  testosterone deprivation or chemotherapy  provides significant advantages for selected patients with stage d1 disease  
class4	801	although ploidy analysis  receptor mapping  and oncogene assays are promising  today  there is no practical way to identify patients who will benefit most from multimodality treatment approaches  abstract truncated at 400 words   
class4	802	low incidence of asymptomatic brain metastases in patients with renal cell carcinoma  
class4	802	brain metastases from renal cell carcinoma are uncommon  
class4	802	the present study was undertaken to determine the value of routine computerized tomographic  ct  scanning of the brain in patients with renal cell carcinoma  
class4	802	a review of 106 patients with renal cell carcinoma who had undergone ct scan of the brain revealed brain metastases in only 13 2 percent  
class4	802	brain metastases were accompanied by central nervous system  cns  symptoms in 78 6 percent of patients  with headaches constituting the most common presenting symptom  64 3    
class4	802	brain metastases were detected in only 3 3 percent of patients who had no cns symptoms at the time of evaluation  
class4	802	it is concluded that ct scanning of the brain should be performed routinely only for those patients who report cns symptoms at the time of evaluation  
class4	803	is urethral sparing at cystectomy a safe procedure  
class4	803	urethrectomy is performed with cystectomy when the neoplasm is multifocal  at the bladder neck  or associated with carcinoma in situ  cis   
class4	803	the records of the most recent 20 patients treated by radical cystectomy at our institution were reviewed  
class4	803	in 50 percent of the cases  the extent of disease within the bladder was found to have been underestimated to the point that a urethral sparing operation  i e   to maintain urinary continence with an intestinal segment and an intact urethra  might have been dangerous  
class4	804	neodymium yag laser treatment of bladder hemangiomas  
class4	804	we present 3 cases of bladder hemangiomas  one single and two multiple  with a long term history of recurrent hematuria  treated with endoscopic neodymium yag  yttrium  aluminum  garnet  laser photocoagulation  and obtaining good results  
class4	805	squamous cell carcinoma antigen  ta 4  in penile carcinoma  
class4	805	ta 4 antigen  originally isolated from women with squamous cell carcinoma of the cervix  is elevated in the sera of patients with squamous cell carcinomas of several sites  including esophagus  lungs  and head and neck  
class4	805	in this study  we compared the serum levels of ta 4 in normal volunteers  patients with resected penile squamous cell carcinoma  and patients with metastatic penile squamous cell carcinoma  
class4	805	ta 4 values were elevated in 5 of 11 patients  45   who had metastatic disease  
class4	805	in 2  ta 4 was normal the first time metastasis was clinically detected but rose as the disease progressed  
class4	805	moreover  in 3 patients in whom serial determinations were made  serum ta 4 values correlated well with disease progression and response to treatment  
class4	805	we conclude that ta 4 values are elevated in some patients with metastatic squamous cell carcinoma of the penis and may become a useful marker for monitoring response to therapy  
class4	806	inverted papilloma of renal pelvis  flexible ureteroscopic diagnosis and treatment  
class4	806	a case is reported of inverted papilloma of the renal pelvis in a patient with previous transitional cell carcinoma of the bladder  
class4	806	the renal pelvic lesion was diagnosed and treated with a flexible ureteropyeloscope  
class4	806	although nephroureterectomy was avoided  the patient must be carefully followed endoscopically and radiographically for recurrence of lesions throughout the urinary tract  
class4	806	this case represents the first report of the endoscopic diagnosis and treatment of an inverted papilloma of the renal pelvis  
class4	806	it demonstrates the vast potential for endoscopic diagnosis  treatment  and surveillance throughout the urinary tract  
class4	807	improved early detection of recurrence in prostatic carcinoma following hormonal therapy  combined use of palpation and fine needle aspiration cytology  
class4	807	fifty nine hormonally treated prostatic carcinoma patients were prospectively followed by rectal examination and fine needle aspiration cytology at six month intervals for periods ranging from six to one hundred twenty months  median follow up 48 mos   
class4	807	the cytologic findings and clinical impressions were divided into four or five categories  respectively  ranging from benign to clearly malignant  
class4	807	cytologic material and clinical descriptions suitable for evaluation were available for 306 follow up examinations  
class4	807	of these  209 were cytologically benign  including 191 without and 18 with clinical evidence of malignancy   
class4	807	the remaining 97 examinations showed cytologic evidence of malignancy of which 50 were clinically apparent  51 5    
class4	807	while the correlation of clinical and cytologic findings was good  91 4   in cases with no evidence of disease activity  our findings indicate that many recurrences which are occult to clinical examination may be detected by cytologic examination  
class4	808	staging of ureteral transitional cell carcinoma by ct and mri  
class4	808	intravenous urography and retrograde pyelography are the primary radiologic studies for detecting ureteral carcinoma but give limited information regarding stage of disease  
class4	808	computed tomography  ct  and magnetic resonance imaging  mri  delineate the extent of ureteral carcinomas with a high degree of accuracy by depicting the periureteral fat and presence or absence of lymphadenopathy  
class4	808	in selected cases  ct and mri are valuable for assessing the presence or absence of tumor in a ureteral stump and for the differential diagnosis of ureteral obstruction  
class4	808	five cases of ureteral carcinoma and 2 cases of stump carcinoma are presented with preoperative ct and or mri evaluation and staging  
class4	809	uneventful delivery following series of successive treatments for virilized cushing syndrome due to adrenocortical carcinoma  
class4	809	a twenty one year old virilized woman with cushing syndrome due to a huge adrenocortical carcinoma was successively treated with trilostane  3 beta hydroxysteroid dehydrogenase inhibitor   subsequent adrenalectomy  and postoperative cis platinum  
class4	809	clinical or biochemical abnormalities peculiar to cushing syndrome gradually subsided  and three and one half years after the adrenal surgery  the patient delivered a normal female infant  
class4	809	this study points out some of the clinical and biochemical responses of each treatment  
class4	810	single polypoid cystitis cystica and glandularis presenting as benign bladder tumor  
class4	810	a case report of a ten year old boy with a benign polypoid bladder tumor is presented  
class4	810	the rarity of benign or malignant bladder tumors in children is reviewed  as well as the possible etiology of this unique lesion  
class4	811	transitional cell carcinomatous meningitis after m vac  methotrexate  vinblastine  doxorubicin  and cisplatin  chemotherapy  
class4	811	the m vac  methotrexate  vinblastine  doxorubicin  and cisplatin  regimen has been utilized at our two institutions to treat 17 patients with advanced stage transitional cell carcinoma of the bladder  
class4	811	we report 2 cases of carcinomatous meningitis resulting from metastatic transitional cell carcinoma which occurred in patients treated with m vac  
class4	811	review of the literature suggests that our experience with central nervous system metastases is not unique  and that treatment of advanced stage transitional cell carcinoma of the bladder with m vac may enhance the incidence of meningeal metastases  
class4	811	carcinomatous meningitis  although rare  is a rapidly fatal manifestation of metastatic transitional cell carcinoma if left untreated  
class4	811	however  prompt diagnosis and early aggressive therapy may result in palliation and stabilization of neurologic status  
class4	811	we review the pathophysiology  diagnosis  and treatment of transitional cell carcinomatous meningitis  
class4	812	selenium  nutritional  toxicologic  and clinical aspects 
class4	812	despite the recent findings of environmental contamination  selenium toxicosis in humans is exceedingly rare in the united states  with the few known cases resulting from industrial accidents and an episode involving the ingestion of superpotent selenium supplements  
class4	812	chronic selenosis is essentially unheard of in this country because of the typical diversity of the american diet  
class4	812	nonetheless  because of the growing public interest in selenium as a dietary supplement and the occurrence of environmental selenium contamination  medical practitioners should be familiar with the nutritional  toxicologic  and clinical aspects of this trace element  
class4	813	apocrine mammary carcinoma  a clinicopathologic study of 72 cases  
class4	813	apocrine carcinoma  ac  is an uncommon  poorly characterized type of breast tumor  
class4	813	in this review  55 patients with intraductal  id  ac and 17 patients with infiltrating  if  ac were analyzed retrospectively to define the histologic features and clinical course of this neoplasm  
class4	813	recurrences in the breast occurred in 3 of 20 id ac patients treated by biopsy alone  but not in the 2 patients who received local radiation therapy after biopsy  
class4	813	one patient with id ac had axillary metastases at the time of treatment by mastectomy and died of disease five years later  
class4	813	the remaining patients with id ac treated by mastectomy have remained disease free  
class4	813	one of the three patients with if ac treated by biopsy alone died of disease  and one of two patients with if ac treated by biopsy and radiotherapy was alive with carcinoma  
class4	813	twelve patients with if ac were treated by mastectomy  
class4	813	ten of them were recurrence free at the time of last observation  
class4	813	more than one third of the cases of id ac and if ac were detected by mammography alone  
class4	813	survival analysis of if ac cases compared with nonapocrine duct carcinoma cases matched for stage revealed no statistical difference in estimated recurrence free survival or estimated survival probability  
class4	813	ac is a distinct morphologic entity with a natural history similar to that of nonapocrine ductal carcinoma  
class4	814	characterization of the morphonuclear features and dna ploidy of typical and atypical carcinoids and small cell carcinomas of the lung  
class4	814	the authors analyzed several cytomorphonuclear parameters related to chromatin distribution and dna ploidy in typical and atypical carcinoids and in small cell lung cancers  
class4	814	nuclear measurements and analysis were performed with a samba 200  titn  grenoble  france  cell image processor with software allowing the discrimination of parameters computed on cytospin preparations of feulgen stained nuclei extracted from deparaffinized tumor tissues  
class4	814	the authors  results indicate a significant increase in dna content  assessed by integrated optical density  iod   from typical carcinoids to small cell lung carcinomas  with atypical carcinoids showing an intermediate value  
class4	814	parameters related to hyperchromatism  short and long run length and variance of optical density  also characterize the atypical carcinoids as being intermediate between typical carcinoids and small cell lung cancers  
class4	814	the systematic measurement of these cytomorphonuclear parameters seems to define an objective  reproducible  scale  of differentiation that helps to define the atypical carcinoid and may be of value in establishing cytologic criteria for differential diagnosis  
class4	815	merkel cell carcinoma metastatic to the testis  
class4	815	tumor metastases to the testes are rare and are usually found incidentally at autopsy or after orchiectomy for prostatic carcinoma  
class4	815	it is even more unusual for testicular metastases to be clinically detected or symptomatic  
class4	815	the authors report two cases of clinically detected testicular metastases from merkel cell carcinoma of the skin  
class4	815	merkel cell carcinoma metastatic to the testes has not been reported previously  
class4	815	the two tumors  to some degree  resembled testicular lymphomas and the interstitial type of seminoma  
class4	816	bcr abl recombinant dna analysis versus karyotype in the diagnosis and therapeutic monitoring of chronic myeloid leukemia  
class4	816	karyotype and bcr abl recombinant dna analyses are two means of detecting the chromosomal aberration in chronic myeloid leukemia  
class4	816	the authors compared these two methods in a retrospective study of 36 patients with cml in which they found the bcr abl dna recombinant event in 100   29 of 29  of those patients who had the philadelphia chromosome  
class4	816	to achieve this sensitivity  a battery of two bcr probes and three restriction enzymes is necessary  
class4	816	the authors propose a sequential algorithm for efficient use of these probes and enzymes  
class4	816	in 76  of the patients  bcr abl rearrangement can be detected with a bgl ii digest and a 3  commercial probe  
class4	816	an additional 21  of patients can be detected by a second assay in which the same membrane is rehybridized to a 3  and 5  combination bcr probe  
class4	816	one patient  3   required an additional restriction enzyme digest with bamh i to detect the recombinant event by the same 3  probe  
class4	816	karyotype analysis is used to determine cytogenetic remission in patients with cml under therapy  
class4	816	the authors studied the use of dna analysis by the southern blot technique to detect a decrease in the relative number of leukemic cells  
class4	816	by dilution studies and densitometric scanning of autoradiographs  the authors were able to detect a 15  decrease in the relative number of cells having the bcr abl recombinant event  
class4	816	the authors report the preliminary results of three patients in whom they compared the karyotype and recombinant dna analysis at multiple time points in their clinical course  
class4	816	in conclusion  the bcr abl recombinant dna analysis is superior to karyotype for the diagnosis of cml and can be used for monitoring treated patients  
class4	817	free alpha subunit of the pituitary glycoprotein hormones  measurement in serum and tissue of patients with pituitary tumors  
class4	817	a solid phase radioimmunoassay was developed that measures the free alpha subunits of pituitary glycoprotein hormones  alpha pgphs  and has negligible cross reactivity with the intact hormones  less than 0 014  for thyroid stimulating hormone  tsh   less than 0 1  for human chorionic gonadotropin  hcg   0 8  for luteinizing hormone  lh   and 2 0  for follicle stimulating hormone  fsh    
class4	817	the assay is standardized with the alpha subunit of hcg but also reacts well with the alpha subunits of the other glycoprotein hormones  84  for alpha tsh  77  for alpha fsh  and 64  for alpha lh   
class4	817	concentrations as low as 0 3 micrograms l can be reliably measured  and the 97 5  reference range in 27 healthy adults  including postmenopausal females  is less than or equal to 1 2 micrograms l  
class4	817	elevated preoperative alpha pgph concentrations were found in 45  9 4   of 479 sera from patients with pituitary adenoma and 3  4 5   of 66 patients with nonadenomatous sellar lesions  
class4	817	postoperative alpha pgph levels were lower in 30 of 39 adenoma patients and 2 of 3 nonadenoma patients  
class4	817	in five  1   of the patients with pituitary adenomas  alpha pgph was the only elevated serum hormone marker  
class4	817	serum values of alpha pgph correlate weakly with alpha subunit immunocytochemical staining  95  of those with negative staining have normal alpha pgph values  but only 18  of those with positive staining have elevated alpha pgph values  
class4	818	the use of molecular probes to distinguish new primary tumors from recurrent tumors in gynecologic malignancies  
class4	818	this is the first report using dna molecular probe technology to distinguish between recurrent tumor and a second primary malignancy in a patient  
class4	818	tumor dna was extracted from squamous cell carcinoma of the cervix at the time of radical hysterectomy  
class4	818	eighteen months later a squamous cell cancer was found in a vaginal apex biopsy from which dna was extracted  
class4	818	tumor dna from both lesions was subjected to restriction enzyme digestion and dna molecular hybridization with human papillomavirus  hpv  probes  
class4	818	although both lesions were positive for hpv 16  their respective restriction enzyme patterns had different hpv genetic arrangements  thereby demonstrating their distinctness  
class4	819	the frequency of uterine leiomyomas  
class4	819	as a leading cause of hysterectomy in premenopausal women  
class4	819	uterine leiomyomas are a major public health problem  
class4	819	however  very little work has been done on their epidemiology  
class4	819	indeed  their true frequency has never been established using systematic and meticulous methods  
class4	819	in this study  gross serial sectioning at 2 mm intervals was applied as an adjunct to routine pathology processing in 100 consecutive total hysterectomy specimens  
class4	819	this tripled the number of leiomyomas noted in routine pathology reports  
class4	819	there were 649 leiomyomas in 77 of 100 uteri  with multiplicity of leiomyomas in 84   
class4	819	although leiomyomas were more numerous and larger in women with a clinical diagnosis of myomatous uterus  the incidence was no higher than in uteri removed for other reasons  
class4	819	the postmenopausal incidence of leiomyomas was no lower than the premenopausal incidence  although postmenopausal leiomyomas were smaller and fewer  
class4	819	these findings suggest that epidemiologic studies of leiomyomas may not be valid if they are based only on clinical diagnoses or routine pathology reports  
class4	820	thyroid carcinoma with mixed tall cell and columnar cell features  
class4	820	tall cell and columnar cell carcinomas have been regarded as aggressive variants of papillary thyroid carcinoma  
class4	820	in the present case report the authors describe a composite tumor where these forms of differentiation coexisted  with transitional changes occurring within single follicular structures  
class4	820	this finding indicates that the two variants are closely related  
class4	820	in local recurrences  one or the other feature appeared in separate lesions  
class4	820	lung metastases developed  and the patient died 5 1 2 years after diagnosis and primary treatment  
class4	821	anaplastic large cell  ki 1  lymphoma with histiocytic phenotype simulating carcinoma  
class4	821	histiocytic and epithelial cell types share many cytomorphologic and functional characteristics  it is predictable  therefore  that corresponding malignancies might be difficult to distinguish  
class4	821	described is the case of a 52 year old woman in whom disseminated anaplastic large cell lymphoma simulated carcinomatosis by conventional morphologic criteria  
class4	821	evidence of histiocytic differentiation was derived from immunocytochemical  fine structural  and genetic probe analyses  
class4	821	the diagnosis of histiocytic neoplasia is discussed in relation to categories previously termed malignant histiocytosis   ki 1  lymphoma  and regressing atypical histiocytosis  and comparisons are made with animal tumor models  
class4	822	isolation of measles virus in primary rhesus monkey cells from a child with acute interstitial pneumonia who cytologically had giant cell pneumonia without a rash  
class4	822	the isolation of measles virus in primary rhesus monkey kidney cells  prmk  in patients with documented giant cell pneumonia who have presented without a rash is limited  
class4	822	the diagnosis usually is made by cytologic examination of nasal or bronchial secretions in which characteristic multinucleated giant cells with intranuclear and intracytoplasmic inclusion bodies are observed  
class4	822	the diagnosis of giant cell pneumonia has been associated with measles virus but not exclusively  
class4	822	canine distemper  herpes group viruses  and parainfluenza infections have been associated with these cells  
class4	822	in addition  vitamin a deficiency also has been cytologically associated with multinucleated giant cells  
class4	822	the authors describe the isolation of measles virus from bronchial washing and sputum in prmk cells at 4 days from an 11 year old child with acute interstitial pneumonia who was in remission for acute lymphocytic leukemia  
class4	822	classic cytopathologic effect  cpe  consisting of syncytial and hole formation on the prmk monolayer was apparent  
class4	822	in addition  a foamy appearance of the monolayer was noted in an otherwise clean lot of monkey cells  
class4	822	confirmatory testing with measles antibody of the infected areas of the monolayer by indirect immunofluorescence  ifa  was positive for measles antigen and negative for mumps  parainfluenza  types i  ii  and iii  and influenza a and b virus  
class4	822	serologic studies for measles antibody revealed an ifa igg titer of greater than 1 10 240  and an igm titer of 1 128  
class4	822	cytologic examination of the same bronchial fluid revealed the typical giant cells with characteristic inclusions associated with measles virus  
class4	822	because this disease usually is severe  and often fatal  prompt recognition of this virus is essential  not only to the patient  who can be treated with immunoglobulin and or antiviral therapy  but also to prevent the spread of the virus to other patients and medical personnel  
class4	822	these findings also support direct evidence for the etiologic role of measles virus in giant cell pneumonia that has been detected either histologically or cytologically and in tissue culture at autopsy  
class4	823	a diagnostic expert system for colonic lesions  
class4	823	the diagnostic expert system for colonic lesions  descl  was designed to discriminate colonic adenoma and adenocarcinoma from normal colonic tissue  
class4	823	although it was originally developed for use in conjunction with a machine vision analytic system  the descl has evolved into a teaching tool and a model for conceptual machine learning  
class4	823	the expert system is table driven and consists of a shell and a knowledge base  
class4	823	the latter comprises a series of architectural and cytologic observations and a quantitative estimate of diagnostic importance relating these observations to diagnostic outcome  
class4	823	in a validation study of 100 colonic lesions  the expert system achieved a success rate of 98   
class4	823	it has the flexibility to allow individual pathologists to  customize  the knowledge base to suit their diagnostic criteria  
class4	824	estimation of pr and er by immunocytochemistry in breast cancer  comparison with radioligand binding methods  
class4	824	immunocytochemical assays for progesterone receptor  pr  using monoclonal antirabbit pr antibodies  pr ica  and for estrogen receptor  er   er ica  were compared with radioligand binding  dextran coated charcoal  dcc   methods for receptor determination in patients with breast cancer  
class4	824	immunocytochemical staining for pr was exclusively nuclear in localization  
class4	824	in this regard  pr staining is similar to previous findings for er  pr ica showed a sensitivity of 89  and specificity of 100   
class4	824	er ica was also 89  sensitive and similarly specific  
class4	824	there was good correlation between the degree and intensity of staining and quantitative binding of radioligand  
class4	824	receptor positive tumors  however  show considerable variation of immunocytochemical staining  suggesting heterogeneity of cellular pr content  
class4	824	the availability of an immunocytochemical assay for pr increases the discriminatory potential for these methods of receptor determination  
class4	825	brake mechanics  asbestos  and disease risk  
class4	825	health risks posed by inhalable asbestos fibers are known to exist in a variety of industrial and nonindustrial settings  
class4	825	although early studies described an increased risk of asbestosis  lung cancer  and mesothelioma in asbestos industry workers  subsequent research revealed the existence of a potential asbestos related health hazard in nonasbestos industries such as the textile and railroad industries  
class4	825	brake mechanics and garage workers constitute a large work force with potential exposures to levels of asbestos capable of producing disease  
class4	825	unfortunately  the health risk faced by these workers has received little attention  
class4	825	this article briefly discusses currently available information on the asbestos health risks of workers in this setting  and highlights the need for further investigations of this occupational group  
class4	826	clinical significance of colonic fermentation  
class4	826	recent evidence of the potential benefits of short chain fatty acids has prompted renewed interest in the area of human colonic fermentation  
class4	826	this paper reviews the clinical and metabolic consequences of colonic fermentation  
class4	827	features distinguishing secondary achalasia from primary achalasia  
class4	827	eighteen patients with cancer induced or secondary achalasia  sa  were compared to 421 patients with idiopathic or primary achalasia  pa   
class4	827	the aim of the study was to detect any differences in clinical presentation between the two groups  
class4	827	mean age of patients with sa was 57 1  range 15 78  and 47 1  range 1 90  in patients with pa  p   0 02   
class4	827	three patients with sa were 15  24  and 36 yr old  respectively  
class4	827	symptom frequency was comparable in sa versus pa  
class4	827	mean duration of symptoms in sa was 4 5 months  with 15 of the 18 patients experiencing symptoms for six months or less  
class4	827	weight loss occurred in 88 2  of patients with sa and 57 3  of patients with pa  p less than 0 05   
class4	827	cancer was at the gastroesophageal junction in 16 patients  duodenum in one  and breast in one  
class4	827	endoscopy showed tumor in 12  67    
class4	827	the esophagram was suspicious for tumor in only 25   
class4	827	we conclude that patients with sa are older  more likely to lose weight  and have a short duration of symptoms  
class4	827	however  sa may occur in younger patients  and endoscopy with biopsy is necessary in any newly diagnosed case of achalasia  
class4	828	the value of push type jejunal endoscopy in familial adenomatosis coli gardner s syndrome  
class4	828	push type jejunal endoscopy using a long forward viewing duodenofiberscope was performed in 10 patients with familial adenomatosis coli gardner s syndrome  
class4	828	jejunal polypoid lesions were detected in nine of the 10 patients  90    
class4	828	the lesions appeared sessile  whitish  and measured 3 mm or less in diameter  
class4	828	histologic findings of the biopsy specimens from these polypoid lesions revealed tubular adenoma in all nine patients  
class4	828	in addition  this method led to the detection of duodenal adenomas in one patient  in whom duodenofiberscopy with the side viewing instrument revealed no polypoid lesions in the bulb and second portion of the duodenum  
class4	828	in view of these results  we recommend that push type jejunal endoscopy  as well as side viewing duodenofiberscopy  should be added to the usual preoperative examinations done in patients with this disease  
class4	829	comparison of a new immunoassay for determining serum pancreatic isoamylase with two standard techniques  
class4	829	a method has recently been developed for measuring serum pancreatic  p  isoamylase  using two monoclonal antibodies specific for salivary isoamylase  
class4	829	we performed this test on 67 healthy controls and 133 patients  15 with acute pancreatitis  53 with chronic pancreatitis  20 during painful relapse and 33 in clinical remission   18 with pancreatic cancer  41 with nonpancreatic disease with abdominal pain  five with macroamylasemia  and one with total pancreatectomy  
class4	829	results were compared with those of a wheat germ inhibition method and with electrophoresis on cellulose acetate  
class4	829	a close correlation was found between the results of immunoinhibition assay and those of the other two tests  
class4	829	all patients with acute pancreatitis had abnormally high values in all three tests  
class4	829	in the group with chronic pancreatitis studied during painful relapse  16 had an increase in p isoamylase  as determined with the immunoinhibition assay  13 with the wheat germ inhibition test  and 15 with electrophoresis  
class4	829	in the group with chronic pancreatitis in clinical remission  we found low values in one patient  by immunoinhibition assay  but found low values in 17 and 19 patients by wheat germ inhibition and electrophoresis  respectively  
class4	829	low p isoamylase values corresponded to a severe exocrine pancreatic insufficiency  
class4	829	in the group with pancreatic cancer  the three tests showed similar results  and the majority of the patients had normal values  
class4	829	in the patients with nonpancreatic diseases  abnormally high levels were found in five  by immunoassay  in four by electrophoresis  and in three by the wheat germ inhibition method  
class4	829	in the five cases with macroamylasemia  both inhibition assays erroneously demonstrated an abnormal p isoamylase elevation  
class4	829	the results show that the three tests are equally useful for the diagnosis of acute pancreatitis  or chronic pancreatitis during an acute relapse  
class4	829	in these diseases  the immunoinhibition test would be the preferred assay because it is simple and rapidly performed  
class4	830	in vivo evaluation of monopolar versus bipolar electrosurgical polypectomy snares  
class4	830	the energy required and tissue damage in bipolar and monopolar polypectomy snares were compared in a canine model  
class4	830	the bipolar snare required an average of 34 joules of energy  whereas the monopolar snare required 228 joules to cut the same diameter of gastric mucosa tended into a polypoid structure  p   0 0005   
class4	830	the reduced energy delivered to the tissue from the bipolar procedure resulted in only 32  average depth of damage to the underlying gastric wall  whereas the monopolar procedure caused an average 69   p   0 001   
class4	830	surgically created polyps required 247 joules and 69 joules for corresponding monopolar and bipolar polypectomy  p   0 001   
class4	830	the decreased energy required and the correspondingly reduced damage caused to the underlying bowel wall by the bipolar snare should reduce the incidence of perforation and post polypectomy syndrome  
class4	830	the bipolar snare completes a local circuit about the snare  eliminating the return electrode and  consequently  the possibility of any return electrode burns  
class4	830	the bipolar snare thus provides an added safety margin during polypectomy  
class4	831	endoscopic ultrasonography in staging rectal cancer  
class4	831	endoscopic ultrasonography  eus  was used to stage rectal cancer by assessing depth of invasion through bowel wall layers and or involvement of lymph nodes  
class4	831	eus findings were correlated with histopathologic findings to discern the usefulness of this modality in predicting which patients could be candidates for sphinctersaving procedures and the avoidance of abdominoperineal resection  
class4	831	the olympus eu m3 endoscopic ultrasound system was used to assess depth of penetration through rectal wall layers and to identify lymph nodes  
class4	831	comparison of eus findings to histopathologic findings was possible in 13 patients  
class4	831	eus agreed with histopathology in 9 of 13 cases  69 3     p   0 07  kappa statistic   
class4	831	eus agreed with histopathology as the presence or absence of lymph nodes in 9 of 13 cases  69 3    p   0 07   
class4	831	however  the presence of lymph nodes could not necessarily predict metastatic involvement of these nodes  
class4	831	in one patient  invasion of vaginal cuff was correctly predicted  
class4	831	in nine cases  computed tomographic analysis  ct  was available for comparison to eus in detection of penetration beyond the bowel wall  
class4	831	ct agreed with histopathology in 3 of 9  33    whereas eus agreed with histopathology in 7 of 9  78    
class4	832	hyperplastic gastric polyps associated with persistent helicobacter pylori infection and active gastritis  
class4	832	we report two cases of patients with 3 yr histories of upper gastrointestinal symptoms  hyperplastic gastric polyps  and active chronic gastritis  
class4	832	biopsies retrospectively stained with giemsa revealed the persistent presence of helicobacter pylori  hp  in gastric biopsies of both patients throughout the 3 yr  
class4	832	after treatment with amoxicillin and bismuth subsalicylate  both became asymptomatic  one demonstrating disappearance and recurrence of the gastric polyps in conjunction with the hp  
class4	832	these cases demonstrate 3 yr of hyperplastic gastric polyps associated with hp and active gastritis  
class4	833	gallbladder carcinoma producing human chorionic gonadotropin  
class4	833	a primary carcinoma of the gallbladder producing human chorionic gonadotropin  hcg  was encountered in an 83 yr old japanese woman  with elevation of hcg beta hcg in urine and serum  
class4	833	remarkable elevation of serum estradiol was an associated finding  with increased hcg  
class4	833	at autopsy  we found that the primary carcinoma of the gallbladder extensively involved the liver  
class4	833	histologically  the tumor revealed adenosquamous cell carcinoma in the primary site  and moderately to poorly differentiated adenocarcinoma in metastatic foci  
class4	833	immunohistochemical staining for beta hcg showed a positive reaction in adenocarcinoma components  
class4	833	this is an extremely rare case of an hcg producing gallbladder carcinoma  which leads us to speculate that hcg positive tumor cells may occur due to dedifferentiation  
class4	834	hepatic giant cavernous hemangioma with microangiopathic hemolytic anemia and consumption coagulopathy  
class4	834	we describe a case of hepatic giant cavernous hemangioma with both microangiopathic hemolytic anemia  maha  and consumption coagulopathy  but without thrombocytopenia  which was completely cured by surgical resection of the tumor  
class4	834	the patient was a 54 yr old japanese woman whose chief complaint was right upper abdominal discomfort  
class4	834	angiography and dynamic computed tomography revealed typical findings of hepatic cavernous hemangioma  
class4	834	the patient also had hematological disorders  
class4	834	at surgery  we performed an atypical right lobectomy to preserve as much normal liver tissue as possible  
class4	834	the patient has been well  with no related complaints or abnormal laboratory findings  5 yr since her operation  
class4	834	this case indicates that giant cavernous hemangioma of the liver should be considered in the differential diagnosis of maha  and if surgical treatment is adequate  hematological abnormalities may be eliminated  
class4	835	genitourinary cancer in the elderly  
class4	835	the subject of genitourinary cancer in the elderly becomes increasingly more important as our population of patients older than 50 years expands  
class4	835	carcinoma of the kidney  bladder  and prostate all have an increasing incidence over the age of 50 and have a predilection for afflicting men more commonly than women  
class4	835	etiologic factors  especially with bladder and kidney carcinomas  are well documented and in some cases preventable  
class4	835	screening the urine for hematuria and careful digital rectal examinations may uncover a higher percentage of these malignancies in earlier  more curable stages  
class4	835	recent advances in the treatment of all of these malignancies have improved survival and quality of life for these patients  
class4	836	prevention of renal disease and conservation of renal function  
class4	836	in summary  we have reviewed some of the most frequently encountered areas of prevention of renal failure in the elderly  
class4	836	they include obstruction  hypertension  drug interaction  and inappropriate use of drugs and the silent killer of the elderly  renal carcinoma  
class4	836	only by a thorough understanding of the altered physiology of the aging kidney can the physician avoid making the same mistakes when new drugs are developed or new types of diseases are encountered  
class4	836	proper early diagnosis and understanding the guidelines to therapy in these conditions  can save huge human costs in terms of mortality  morbidity  and money  
class4	837	genetics and biology of human ovarian teratomas  i  cytogenetic analysis and mechanism of origin  
class4	837	one hundred and two benign  mature ovarian teratomas and two immature  malignant teratomas were karyotyped and scored for centromeric heteromorphisms as part of an ongoing project to determine the chromosomal karyotype and the genetic origin of ovarian teratomas and to assess their utility for gene centromere mapping  
class4	837	karyotypic analysis of the benign cases revealed 95 46 xx teratomas and 7 chromosomally abnormal teratomas  47 xxx  47 xx  8  two cases   47 xx  15  48 xx  7  12 91 xxxx  13  mosaic   47 xx  15  21  mar   
class4	837	our study reports on the first cases of tetraploidy and structural rearrangement in benign ovarian teratomas  
class4	837	the two immature cases had modal chromosome numbers of 78 and 49  
class4	837	centromeric heteromorphisms that were heterozygous in the host were homozygous in 65 2   n   58  of the benign teratomas and heterozygous in the remaining 34 8   n   31   
class4	837	chromosome 13 heteromorphisms were the most informative  with 72 7  heterozygosity in hosts  
class4	837	the cytogenetic data indicate that 65  of teratomas are derived from a single germ cell after meiosis i and failure of meiosis ii  type ii  or endoreduplication of a mature ovum  type iii   35  arise by failure of meiosis i  type i  or mitotic division of premeiotic germ cells  type iv   
class4	838	genetics and biology of human ovarian teratomas  ii  molecular analysis of origin of nondisjunction and gene centromere mapping of chromosome i markers  
class4	838	chromosomal heteromorphisms and dna polymorphisms have been utilized to identify the mechanisms that lead to formation of human ovarian teratomas and to construct a gene centromere map of chromosome 1 by using those teratomas that arise by meiotic nondisjunction  
class4	838	of 61 genetically informative ovarian teratomas  21 3  arose by nondisjunction at meiosis i  and 39 3  arose by meiosis ii nondisjunction  
class4	838	eight polymorphic marker loci on chromosome 1p and one marker on 1q were used to estimate a gene centromere map  
class4	838	the results show clear linkage of the most proximal 1p marker  nras  and the most proximal 1q marker  d1s61  to the centromere at a distance of 14 cm and 20 cm  respectively  
class4	838	estimated gene centromere distances suggest that  while recombination occurs normally in ovarian teratomas arising by meiosis ii errors  ovarian teratomas arising by meiosis i nondisjunction have altered patterns of recombination  
class4	838	furthermore  the estimated map demonstrates clear evidence of chiasma interference  
class4	838	our results suggest that ovarian teratomas can provide a rapid method for mapping genes relative to the centromere  
class4	839	equal parental origin of chromosome 22 losses in human sporadic meningioma  no evidence for genomic imprinting  
class4	839	inactivation of tumor suppressor genes can occur either by mutation at the gene locus or by loss of part or all of the chromosome region containing the gene  
class4	839	the latter is most frequently detected by dna markers as loss of heterozygosity in the tumor tissue  
class4	839	in several reports  the paternal homologue was preferentially retained in embryonal tumors associated with loss of particular chromosomal regions  suggesting genomic imprinting of the corresponding tumor suppressor loci  
class4	839	to explore the generality of these findings and the possible role of genomic imprinting in adult tumors of the nervous system  we have determined the parental origin of chromosome 22 loss in sporadic meningioma  
class4	839	of nine cases studied  five tumors retained the maternally derived chromosome 22 homologue while four retained the paternally derived chromosome 22  
class4	839	thus  in contrast to the embryonal tumors  the meningioma locus on chromosome 22 is inactivated by random mutation in sporadic adult meningiomas  
class4	840	the effect of large uterine fibroids on urinary bladder function and symptoms  
class4	840	fourteen patients with large uterine fibroids and urinary symptoms were treated with monthly injections of  d trp6  luteinizing hormone releasing hormone microcapsules  
class4	840	the average uterine size before treatment was 728 ml  it dropped to 323 ml  a drop of 55   after treatment  
class4	840	urinary symptoms of diurnal frequency disappeared in 11 of 12 patients  p less than 0 005  after the reduction of uterine size  
class4	840	urgency decreased in 11 of 13  p less than 0 005  and nocturia in eight of 10  p less than 0 02   
class4	840	no differences were found before and after treatment in the symptoms of urge incontinence and stress incontinence in the cystometric and urethral pressure profile measurements  
class4	840	urinary symptoms of frequency  urgency  and nocturia may be caused by the direct pressure exerted on the bladder by the enlarged uterus  
class4	840	symptoms of urge incontinence and stress incontinence deserve a more specific treatment as they are not related to uterine size  
class4	841	successful conservative management of primary nonmetastatic cervical choriocarcinoma  
class4	841	primary cervical choriocarcinoma is a rare disease  since 1915 only about 60 cases have been published  
class4	841	the case presented here can be defined as primary cervical choriocarcinoma since it fulfills all the criteria delineated previously  
class4	842	the prognostic significance of ca 125 half life in patients with ovarian cancer who have received primary chemotherapy after surgical cytoreduction  
class4	842	fifty four patients with advanced epithelial ovarian cancer were monitored with serial serum ca 125 levels after surgical cytoreduction and during multi agent chemotherapy with cisplatin containing regimens  
class4	842	ca 125 half life of less than 20 days was associated with prolonged overall survival  p less than 0 015   
class4	842	in those patients who eventually were found to be disease free at surgical surveillance procedures  normalization of serum ca 125 levels to less than 35 u ml within 65 days of primary operation also suggested an improved survival  p less than 0 059   
class4	843	colon cancer in pregnancy with elevated maternal serum alpha fetoprotein level at presentation  
class4	843	a case of colon cancer in pregnancy is presented in which the maternal serum alpha fetoprotein level was elevated  
class4	843	failure to evaluate colon cancer as a cause of the elevated maternal serum alpha fetoprotein may have accounted for the poor outcome  
class4	844	spontaneous infarction of placental chorioangioma and associated regression of hydrops fetalis  
class4	844	we report a case of a large chorioangioma diagnosed prenatally with concomitant meconium peritonitis and hydrops fetalis in the second trimester  
class4	844	spontaneous regression of the tumor occurred  associated with some resolution of the fetal hydrops and delivery near term with good neonatal outcome  
class4	845	suppression of serum insulin level by diazoxide does not alter serum testosterone or sex hormone binding globulin levels in healthy  nonobese women  
class4	845	suppression of serum insulin levels with diazoxide is associated with a decrease in serum testosterone and an increase in serum sex hormone binding globulin in obese women with the polycystic ovary syndrome  
class4	845	to determine whether physiologic insulin levels play a regulatory role in the androgen status of nonobese women with normal menses  the androgen status of five nonobese normal women was assessed on two occasions  during a control study and after 10 days of oral diazoxide  100 mg  three times daily  administration  
class4	845	insulin release in response to 100 gm oral glucose administration decreased from 108 0     28 2 to 49 3     5 2 nmol min l  p   0 05  after diazoxide administration  
class4	845	however  despite suppression of insulin release  diazoxide administration did not affect serum total testosterone  diazoxide  0 73     0 10  control  0 69     0 11 nmol l  p   ns  or sex hormone binding globulin  diazoxide  79 7     16 6  control  70 2     12 6 nmol l  p   ns  concentrations  
class4	845	these observations suggest that physiologic insulin levels in nonobese healthy women do not regulate testosterone metabolism and that diazoxide does not exert a direct or independent effect on serum testosterone or sex hormone binding globulin levels  
class4	846	collagen metabolism in gynecologic patients  changes in the concentration of the aminoterminal propeptide of type iii procollagen in serum  
class4	846	we have previously found the serum concentration of the aminoterminal propeptide of type iii procollagen  an indicator of collagen metabolism  to be increased in advanced ovarian cancer  
class4	846	in this study we measured the serum aminoterminal propeptide of type iii procollagen concentration in healthy women during the menstrual cycle and in patients with salpingo oophoritis  leiomyomas  endometriosis  and benign ovarian tumors  
class4	846	the concentration was higher in the luteal phase than that in the follicular phase  suggesting an association of collagen metabolism with ovarian steroid hormones  
class4	846	severe salpingo oophoritis increased the serum level of the aminoterminal propeptide of type iii procollagen with a decrease to normal during recovery  
class4	846	elevated values were occasionally seen in endometriosis and leiomyomas  
class4	846	these findings indicate that the aminoterminal propeptide of type iii procollagen is a relatively unspecific indicator of ovarian carcinoma  
class4	847	autologous antibodies eluted from membrane fragments in human ovarian epithelial neoplastic effusions  iii  cytotoxic potential in vitro and characterization of antigen s   
class4	847	cyst and ascites fluids from patients with ovarian epithelial neoplasms contain immunoglobulins with antitumor activity  
class4	847	autologous antibodies bound to the cellular membrane fragments obtained from human ovarian neoplastic effusions react with cell surface antigens on different human ovarian cell lines  surgical specimens of human ovarian adenocarcinoma  and human ovarian tumors grown in athymic balb c mice  
class4	847	the antibodies do not react with tissue preparations from normal human ovaries  other nonovarian normal or neoplastic tissues  and nonovarian human cell lines  
class4	847	these studies indicate that these antibodies are capable of complement mediated lysis of human ovarian tumor cell lines in vitro  
class4	847	preliminary characterization of the autologous ovarian tumor associated antigen s  indicates that it may be composed of three large molecular weight proteins of 182 000  164 000  and 122 000 d  
class4	848	the use of in situ hybridization to show human papillomavirus deoxyribonucleic acid in metastatic cancer cells within lymph nodes  
class4	848	southern blot hybridization has been used to identify human papillomavirus types in both primary tumors and lymph node metastases  
class4	848	however  this technique requires fresh frozen tissue and is incapable of localizing deoxyribonucleic acid sequences to specific cell types in the tumor sample  
class4	848	in contrast  in situ hybridization precisely locates viral sequences within tumor cells while preserving cellular architecture  
class4	848	further  in situ hybridization requires only small samples of formalin fixed  paraffin embedded tissues  
class4	848	five lymph nodes  from four patients  containing metastatic cervical squamous tumor cells  identified with hematoxylin and eosinophil staining  were analyzed with in situ hybridization techniques with human papillomavirus type 16 deoxyribonucleic acid probes labeled with sulfur 35  
class4	848	the primary cervical cancer from all four patients had been shown to contain human papillomavirus type 16 sequences by southern blot  
class4	848	three specimens from two patients clearly showed the presence of human papillomavirus type 16 sequences within the nuclei of metastatic tumor cells  whereas two specimens were nondiagnostic most likely as a result of the small volume of cancer relative to the size of the lymph node  
class4	848	this information indicates that it is the tumor cells themselves that contain viral deoxyribonucleic acid and provides additional evidence linking human papillomavirus with cervical carcinogenesis  
class4	849	oral contraceptives and breast cancer  
class4	849	among women in general the risk of breast cancer through 59 years of age does not appear to be affected appreciably by the use of oral contraceptives  
class4	849	nonetheless  concern continues to be expressed about the effects of early age at first use  long term duration of use  formulation  and a variety of other factors thought to influence breast cancer risk in the presence of oral contraception  
class4	849	a number of recent studies restricted to young women suggest that long term use may increase the risk of disease occurring very early  but the present lack of consistent findings in well conducted epidemiologic studies prevents any certain conclusion with regard to cause and effect  
class4	849	however  if an increased risk were indeed present  the most plausible interpretation is that long term oral contraception promotes earlier clinical manifestation of breast cancer in some women while having no net impact on their lifetime risk of the disease  
class4	850	vitrectomy retinotomy aspiration biopsy of choroidal tumors 
class4	850	we used an investigational technique for the biopsy of intraocular tumors to aid in the diagnosis of three choroidal tumors  
class4	850	a three port trans pars plana vitrectomy was performed in conjunction with retinotomy  tumor biopsy  endophotocoagulation  and air fluid exchange  
class4	850	vitrectomy was used to decrease the amount of traction secondary to retained vitreous after intraocular surgery  
class4	850	retinotomy sites were chosen under microscopic control to avoid large caliber retinal vessels  
class4	850	then a modified tumor aspiration technique  together with endophotocoagulation and aspiration of intraoperative vitreous hemorrhages  provided an opportunity to sample tumor tissue continually at varied depths  
class4	850	we have added standard vitreous surgery concepts  techniques  and instrumentation to produce vitrectomy retinotomy aspiration biopsy of choroidal tumors  
class4	851	correlations of acoustic tissue typing of malignant melanoma and histopathologic features as a predictor of death  
class4	851	forty six eyes with uveal melanoma were scanned with a computerized diagnostic ultrasound system before enucleation  and light microscope sections were obtained  
class4	851	tumors were characterized by ultrasonically measured dimensions and power spectrum analysis  which provided information not available in conventional a  or b scan ultrasonography  
class4	851	histopathologic features  including cell clustering pattern  cell type  pigmentation  vascularity  and necrosis  were quantified  
class4	851	statistically significant correlations were found between parameters derived from the power spectrum and histologic characteristics  
class4	851	patients were followed up for up to ten years with 14 deaths occurring because of metastases  
class4	851	using a cox relative risk model with histopathologic data  a risk model comprising pigmentation and cell type  p less than  0001  was obtained  
class4	851	using ultrasonic characteristics  a model comprising tumor volume and scatterer concentration  p    0062  was obtained  
class4	851	the results suggest that ultrasonic tissue characterization and three dimensional biometry may provide improved in vivo prognostic indicators for uveal melanoma  
class4	852	magnetic resonance imaging of radiation optic neuropathy  
class4	852	three patients with delayed radiation optic neuropathy after radiation therapy for parasellar neoplasms underwent magnetic resonance imaging  
class4	852	the affected optic nerves and chiasms showed enlargement and focal gadopentetate dimeglumine enhancement  
class4	852	the magnetic resonance imaging technique effectively detected and defined anterior visual pathway changes of radionecrosis and excluded the clinical possibility of visual loss because of tumor recurrence  
class4	853	limbal autograft reconstruction after conjunctival squamous cell carcinoma  
class4	853	two patients who had squamous cell carcinoma with extensive limbal and corneal involvement were treated with surgery and cryotherapy  
class4	853	rarely large areas of the cornea are involved by this tumor  
class4	853	visual prognosis in such patients is poor  
class4	853	in these two patients  autologous limbal transplants were effective in restoring an excellent corneal surface and good visual function  
class4	853	this technique may be useful in the reconstruction of eyes with extensive neoplastic involvement of the corneoscleral limbus and cornea  
class4	854	an immunohistochemical study of pi class glutathione s transferase expression in normal human tissue  
class4	854	glutathione s transferases  gsts   a family of isoenzymes that play an important role in protecting cells from cytotoxic and carcinogenic agents  can be separated by biochemical and immunologic characteristics into three distinct classes named alpha  mu  and pi  
class4	854	previous studies have indicated that there is marked heterogeneity in the expression of different gst isoenzymes in different normal and malignant tissues  
class4	854	to better understand the regulation of the human pi class glutathione s transferase isoenzyme  gst pi   the tissue distribution of this protein wa studied by an immunohistochemical technique using an anti gst pi polyclonal antibody in normal paraffin embedded human tissues  
class4	854	these studies indicate that there is a broad distribution of gst pi in normal human tissues and establish a precise localization within the different organs studied  
class4	854	gst pi was expressed predominantly in normal epithelial cells of the urinary  digestive  and respiratory tracts  suggesting a possible role for gst pi in detoxication and elimination of toxic substances  
class4	854	previous studies have indicated that gst pi and the putative drug efflux pump p glycoprotein are both overexpressed in multidrug resistant human breast cancer cells and in xenobiotic resistant preneoplastic rat hyperplastic liver nodules  
class4	854	results from this study indicate that there are also similarities between the normal tissue distribution gst pi and that previously reported for mammalian p glycoprotein  particularly in secretory epithelia  
class4	854	this finding suggests that these two gene products  which have been implicated in the development of resistance to cytotoxic drugs  may be coregulated in normal and malignant cells  
class4	855	decreased expression of integrin adhesive protein receptors in adenocarcinoma of the breast  
class4	855	the integrin superfamily represents a major class of receptors mediating cell substrate adhesion  
class4	855	our recent study of the tissue distribution of the alpha 2 beta 1 integrin  a cell surface collagen receptor  revealed that high levels of receptor expression were associated with orderly  regulated epithelial cell proliferation  
class4	855	those observations prompted the present investigation of alpha 2 beta 1 and other integrins in adenocarcinoma of the breast  
class4	855	the alpha 2 beta 1 integrin was highly expressed on the epithelium of the ducts and ductules of normal breast tissue  
class4	855	normal or nearly normal levels of the receptor were expressed in fibroadenomas  
class4	855	in contrast  markedly decreased or undetectable alpha 2 beta 1 expression was typical of poorly differentiated adenocarcinomas  
class4	855	well differentiated lesions exhibited intermediate levels of expression  
class4	855	similar  but less extensive  decreases in expression were observed for the alpha 5 beta 1  fibronectin receptor  and alpha v beta 3  vitronectin receptor   
class4	855	significant expression of the beta 1 subunit on even poorly differentiated tumors suggests that the expression of other undefined members of the beta 1 family is not reduced to the same low level as alpha 2 beta 1 and alpha 5 beta 1  
class4	855	expression of the alpha 2 beta 1 integrin was highly correlated with estrogen receptor expression  
class4	855	decreased expression of alpha 2 beta 1 and other integrin adhesive protein receptors probably contributes to the altered adhesive properties of tumor cells characteristic of the malignant phenotype  
class4	856	expression of the human nephron differentiation molecules in renal cell carcinomas  
class4	856	the authors tested frozen sections from 28 renal cell carcinomas  rcc   21 clear  1 eosinophilic  4 basophilic  and 2 spindle shaped cell type  with monoclonal antibodies  mab  reacting against cytokeratin  vimentin  cd24  calla cd10  villin  cd26  and hla class i and class ii molecules  
class4	856	these molecules are markers of specific segments of the mature kidney  and their loss or acquisition reflects the different steps of human nephrogenesis  
class4	856	ki67 mab was used to evaluate cell proliferating activity  
class4	856	all rcc cases expressed cytokeratin  
class4	856	coexpression of vimentin was observed in 21 of 28 cases  
class4	856	whether of clear or chromophilic type  all tumoral cells strongly expressed cd24 molecule  present on primitive blastema cells  
class4	856	all clear type rccs expressed calla cd10 and 60  were also villin positive  some were faintly positive for cd26  
class4	856	calla  villin  and cd26 were not detected in basophilic cell type  
class4	856	hla class i molecules were variably expressed in almost all cases  but hla class ii were never detected on tumoral cells  
class4	856	except for the spindle shaped population  cell proliferating activity was low  
class4	856	these results favor the hypothesis that rccs derive from cells that have  recovered  the different options of metanephric differentiation  
class4	856	clear cells show evidence of maturation toward proximal type  while basophilic cells do not  
class4	856	it would be of interest to evaluate the usefulness of serum measurements of villin and or calla as markers in clear cell type rcc  
class4	857	initial failure of surgical exploration in patients with primary hyperparathyroidism  
class4	857	to determine the causes of failures of cervical exploration for primary hyperparathyroidism  we reviewed 892 patients operated on by one surgeon from 1953 to 1990  
class4	857	twenty seven patients  3   remained hypercalcemic or developed hypercalcemia within 6 months of surgery  
class4	857	of these  five patients had one adenoma removed initially  at reoperation  three patients had a second adenoma that was successfully removed  whereas the other two patients had hyperplasia and required subtotal parathyroidectomies  
class4	857	no enlarged parathyroid glands were identified in 22 patients  
class4	857	eventually  six patients became normocalcemic spontaneously  seven patients underwent re exploration with a successful outcome in all but one case  two patients had ectopic hyperparathyroidism associated with carcinoma elsewhere  and seven patients refused reoperation and remain hypercalcemic  
class4	857	the failure rate of surgical exploration for primary hyperparathyroidism can be reduced by systematically exploring all four parathyroid glands  
class4	857	all abnormal parathyroids should be removed with histologic verification  
class4	857	when no abnormal glands are found  localization studies should be performed before re exploration  
class4	858	lymph node metastasis from papillary follicular thyroid carcinoma in young patients  
class4	858	a total of 117 patients under 20 years of age with papillary and or follicular thyroid cancer presented to the m  
class4	858	d  
class4	858	anderson cancer center between 1949 and 1987  
class4	858	the most common presenting symptom was a cervical mass  
class4	858	twenty percent of the patients had a history of prior irradiation  
class4	858	sixty percent initially had palpable lymph nodes  while 26  who had clinically negative examinations had pathologically positive lymph nodes  
class4	858	recurrence was highest in regional lymph nodes at 24   with only a 4  recurrence rate at the primary site and a 3  recurrence rate at distant sites  
class4	858	there were no deaths due to the thyroid cancer  
class4	858	to maintain a low rate of recurrence  near total thyroidectomy with neck dissection followed by iodine 131 treatment should be considered in these young patients  
class4	859	survival discriminants for differentiated thyroid cancer  
class4	859	since 1975  the american cancer society  illinois division  has published end results of major cancer sites drawn from patient data contributed voluntarily by hospital cancer registries throughout the state  
class4	859	the current study was undertaken  in part  to apprehend information regarding contested areas in the management of patients having differentiated  papillary follicular  thyroid cancer  
class4	859	a total of 2 282 patients with either papillary or follicular carcinoma of the thyroid from 76 different illinois hospitals and providing 10 years of follow up information  life table analysis  were retrospectively analyzed for demographic  disease  and treatment related predictors of survival  
class4	859	multivariate analysis using the cox proportional hazards method was made for stage  age  race  sex  morphology  history of radiation exposure  presence of positive lymph nodes  initial surgical treatment  postoperative iodine 131 therapy  and replacement suppressive thyroid hormone treatment  
class4	859	statistically significant  p less than or equal to 0 05  predictors of favorable survival after thyroid cancer were low stage  i and ii   young age  less than 50 years   white race  female sex  and the administration  postoperatively  of either thyroid hormone or radioactive iodine  
class4	859	factors that had no influence on survival were lymph node status  choice of initial surgical treatment  and a history of prior irradiation  
class4	859	we suggest that where a prospective clinical trial is impracticable  a retrospective analysis of a large and detailed database  such as that available from cooperating hospital based tumor registries  may yet provide useful insights to solutions of cancer management problems  
class4	860	long term effects of radiotherapy in childhood and adolescence  
class4	860	the records of 50 selected pediatric patients who were treated and followed at m  
class4	860	d  
class4	860	anderson cancer center were reviewed to study the late effects of nonsurgical treatment of cancer in children  
class4	860	there were 26 girls and 24 boys ranging in age between 2 months and 16 years  
class4	860	patients with head and neck cancer received chemotherapy and radiotherapy for rhabdomyosarcoma  n   27   retinoblastoma  n   8   or nasopharynx cancer  n   2   
class4	860	median follow up was 13 years  
class4	860	the most severe side effects were noted in the fields of radiation and included hypoplasia of the jaw  orbit  or hemi face with varying degrees of atrophy of the overlying soft tissues  
class4	860	a wide range of endocrine  dental  and psychologic abnormalities was also documented  
class4	860	since 1 in every 1 000 adults older than 20 years today is likely to be a survivor of childhood cancer  recommendations are made for this  new  class of patients whom the head and neck surgeon will be seeing in the future  
class4	861	complications of the pectoralis major myocutaneous flap in head and neck reconstruction  
class4	861	a retrospective review of the complications in 211 patients undergoing pectoralis major myocutaneous flap reconstruction is presented  
class4	861	the flap was used for mucosal lining of the oral cavity or oropharynx in 109 patients  for pharyngoesophageal reconstruction in 44  for skin coverage in 47  and for other locations in 14 patients  
class4	861	flap related complications developed in 63  of the patients  
class4	861	these included flap necrosis  suture line dehiscence  fistula formation  infection  and hematoma  
class4	861	analysis of risk factors for the development of flap complications showed the following factors to be significant  age over 70  female gender  nomographic overweight  albumin less than 4 g dl  use of the flap in reconstruction of the oral cavity after major glossectomy  and presence of other systemic diseases  
class4	861	the median length of hospitalization for those developing complications was 33 days compared with 16 days for those who did not develop any complications  
class4	861	thirty five  26   of the 135 patients developing complications required reoperation and only 2 among these required a second flap  
class4	861	similarly  only 13 of the 61 patients who developed fistulas required surgical closure  
class4	862	soft tissue sarcomas of the head and neck in adults  
class4	862	we reviewed the clinical records and pathologic material of 176 adults with primary soft tissue sarcomas treated at memorial sloan kettering cancer center between 1950 and 1985  
class4	862	seventy two patients  41   had low grade sarcomas and 104  59   had high grade sarcomas  
class4	862	all but 18 patients underwent some form of excision as initial therapy  
class4	862	adjuvant radiotherapy and chemotherapy combined with surgical excision showed no significant effect  
class4	862	a significantly increased risk of treatment failure was associated with large tumor size  positive surgical margins  bone involvement  local recurrence  metastatic spread  and high histologic grade  
class4	862	except for recurrence  the p value by univariate analysis in the log rank test for comparison of survival according to these clinical and pathologic characteristics was p less than 0 0001  
class4	862	although the overall survival was 75  at 2 years  55  at 5 years  and 46  at 10 years  only 20  of the patients with high grade sarcomas were alive 10 years after treatment  
class4	862	most patients with rhabdomyosarcoma  high grade peripheral nerve tumor  and high grade fibrous histiocytoma and all patients with high grade angiosarcoma died of disease less than 5 years after diagnosis  
class4	862	new therapeutic strategies are needed to improve the survival of adult patients with high grade soft tissue sarcomas of the head and neck  
class4	863	multimodality preoperative treatment for advanced stage iv  mo  cancer of the head and neck  
class4	863	sixty three patients with advanced unresectable squamous cell carcinoma of the head and neck were treated with a combination of chemotherapy  radiation  and surgery  
class4	863	we observed a 75  response to neoadjuvant chemotherapy  
class4	863	the 5 year survival rate for all 63 patients was 20   and only 3 patients were alive at 8 years  
class4	863	the 5 year survival rate for patients who completed the treatment plan and received chemotherapy  radiation  and surgery was 43  compared with 20  for those who had chemotherapy and radiation but refused surgery  
class4	863	development of a second primary cancer was the cause of death in 62  of the patients who survived more than 24 months  
class4	864	definitive mandibular replacement using reconstruction plates  
class4	864	mandibular defects following radical cancer surgery continue to provide challenges to head and neck surgeons  
class4	864	twenty seven patients with advanced oral cancer underwent primary mandibular replacement with metal reconstruction plates without the use of bone  
class4	864	twenty one patients  78   had successful reconstruction with primary soft tissue healing  
class4	864	six patients required removal of the plate in the postoperative period  
class4	864	two of these patients had their reconstruction plates replaced as a secondary procedure following soft tissue healing  
class4	864	thus  23 of 27 patients  85   had final mandibular reconstruction and were followed for an average of 19 months  
class4	864	functional and cosmetic results were satisfactory  
class4	864	for patients with advanced disease  this technique compares favorably with microvascular transfer in terms of operating time and donor defect  
class4	864	despite problems with plate exposure  the initial and overall success rates of 78  and 85   respectively  make the use of these plates a reasonable choice for immediate reconstructive needs in patients with difficult tumors  
class4	865	mandibular reconstruction with composite microvascular tissue transfer  
class4	865	microvascular free tissue transfer has provided a variety of methods of restoring vascularized bone and soft tissue to difficult defects created by tumor resection and trauma  
class4	865	over 7 years  26 patients have undergone 28 free flaps for mandibular reconstruction  15 for primary squamous cell carcinoma of the floor of the mouth or tongue  7 for recurrent tumor  and 6 for other reasons  lymphangioma  1   infection  1   gunshot wound  1   and osteoradionecrosis  3    
class4	865	primary reconstruction was performed in 19 cases and secondary in 9  
class4	865	all repairs were composite flaps including 12 scapula  5 radial forearm  3 fibula  2 serratus  and 6 deep circumflex iliac artery  
class4	865	mandibular defects included the symphysis alone  7   symphysis and body  5   symphysis body ramus condyle  2   body or ramus  13   and bilateral body  1   
class4	865	fourteen patients had received prior radiotherapy to adjuvant or curative doses  
class4	865	eight received postoperative radiotherapy  
class4	865	all patients had initially successful vascularized reconstruction by clinical examination  28  and positive radionuclide scan  22 of 22   
class4	865	bony stability was achieved in 25 of 26 patients and oral continence in 24 of 26  
class4	865	one complete flap loss occurred at 14 days  
class4	865	complications of some degree developed in 22 patients including partial skin necrosis  3   orocutaneous fistula  3   plate exposure  1   donor site infection  3   fracture of reconstruction  1   and fracture of the radius  1   
class4	865	microvascular transfer of bone and soft tissue allows a reliable reconstruction  despite previous radiotherapy  infection  foreign body  or surgery  in almost every situation in which mandible and soft tissue are absent  
class4	865	bony union  a healed wound  and reasonable function and appearance are likely despite early fistula  skin loss  or metal plate or bone exposure  
class4	866	reconstruction of mandibular defects in irradiated patients  
class4	866	in this prospective study  mandibular reconstruction using titanium plates was evaluated in 31 patients treated between july 1988 and january 1990  
class4	866	sixteen patients had prior surgery  13 had prior radiotherapy  
class4	866	in 11 patients  prior radiation and surgery had failed  
class4	866	sixteen patients received postoperative radiotherapy either in standard or accelerated fractions  
class4	866	twelve patients had complications of either intraoral  8   extraoral  5   or combined  1  plate exposure or fistula formation  2   
class4	866	factors significantly related to complications were poor nutrition  accelerated radiation  and recurrence  
class4	866	sixty one percent of all patients healed uneventfully  
class4	866	when patients with complications secondary to recurrence who subsequently died were excluded  the success rate was 73   
class4	866	only one patient had an unacceptable result that produced a cosmetic and functional deformity despite secondary repair  
class4	867	sequential connection of flaps  a logical approach to customized mandibular reconstruction  
class4	867	microsurgery has improved the success rate for reconstruction of composite defects in the head and neck  
class4	867	restoration of mandibular continuity alone is not adequate for reconstruction  
class4	867	replacement of the oral lining with thin tissue is necessary to improve tongue mobility and to set the stage for later dental restoration  
class4	867	there is currently no ideal osteocutaneous free flap that provides unlimited length of bone  can undergo multiple osteotomies to produce the proper curve to the reconstructed mandible  and provides thin skin for oral lining  
class4	867	combining free flaps can take advantage of the strengths of the individual donor sites and eliminate some of the problems with current osteocutaneous flaps  
class4	867	in six patients  a fibular osseous free flap was combined with either a radial forearm flap or a lateral arm flap to provide bone and oral lining in reconstruction of mandibular composite defects  
class4	867	in these selected patients  the fibula provided the blood supply for the second free flap  which was placed sequentially  
class4	867	the distal peroneal vessels were used to anastomose to the radial forearm vessels or the lateral arm pedicle  
class4	867	this approach allows the surgeon to customize the defect by improving both the functional and aesthetic aspects of reconstruction and is of use in cases where vascular access is limited  such as following head and neck surgery and radiation  
class4	868	patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract  
class4	868	a consecutive series of 1 081 previously untreated patients undergoing 1 119 radical neck dissections  rnds  for squamous carcinoma of the head and neck was reviewed to study the patterns of nodal metastases  
class4	868	primary tumors were located in the oral cavity in 501 patients  in the oropharynx in 207 patients  in the hypopharynx in 126 patients  and in the larynx in 247 patients  
class4	868	lymph node metastases were confirmed histologically in 82  of 776 therapeutic neck dissections  and micrometastases were discovered in 33  of 343 elective rnds  
class4	868	lymph node groups in the neck were described by levels  i to v   
class4	868	predominance of certain levels was seen for each primary site  
class4	868	levels i  ii  and iii were at highest risk for metastasis from cancer of the oral cavity  and levels ii  iii  and iv were at highest risk for metastasis from carcinomas of the oropharynx  hypopharynx  and larynx  
class4	868	supramohyoid neck dissection  clearing levels i  ii  and iii  for no patients with primary squamous cell carcinomas of the oral cavity and anterolateral neck dissection  clearing levels ii  iii  and iv  for no patients with primary squamous cell carcinomas of the oropharynx  hypopharynx  and larynx are recommended  
class4	869	significance of positive margins in oral cavity squamous carcinoma  
class4	869	three hundred ninety eight consecutive  previously untreated patients undergoing surgery for epidermoid carcinoma of the oral cavity from 1979 to 1983 were reviewed  
class4	869	one hundred twenty nine patients were classified as having positive surgical margins  
class4	869	of these  83 patients had tumor within 0 5 mm of the surgical margin  9 had premalignant changes at the margin  9 had in situ carcinoma at the margin  and 28 had invasive cancer at the margin  
class4	869	the remaining 269 patients had uninvolved margins  
class4	869	the significance of positive margins relating to survival  subsequent clinical course  local recurrence  and patterns of treatment failure was examined  along with the impact of adjuvant postoperative radiotherapy on positive margins  
class4	869	the percentage of patients having positive margins progressively increased with increasing t stage  21  in t1 versus 55  in t4 primary cancer  
class4	869	the overall 5 year survival for patients with negative margins was 60   
class4	869	for patients with positive margins  5 year survival was 52   
class4	869	this difference was statistically significant  
class4	869	the incidence of local recurrence in patients having positive surgical margins was twice as much as in those with negative margins  36  versus 18    
class4	869	metastasis rates in the neck and at distant sites were not significantly influenced by the status of the surgical margin  
class4	869	of the 129 patients with positive margins  49 received postoperative radiotherapy  
class4	869	in those patients so treated  a trend toward lower recurrence rates was noted  
class4	869	differences were not statistically significant  
class4	869	this retrospective review confirms the importance of adequate resection of the primary tumor as well as the relative ineffectiveness of adjuvant postoperative radiotherapy in the improvement of local control in patients with positive surgical margins  
class4	870	treatment selection for carcinoma of the base of the tongue  
class4	870	between 1974 and 1984  173 patients were treated for squamous cell carcinoma of the tongue base  
class4	870	fifty four patients had t1 or t2 primaries  while 115 patients had t3 or t4 tumors  4 were not staged   
class4	870	lymph node metastasis was present in 120 patients  
class4	870	early primary tumors treated with surgery or radiotherapy had a control rate of 83   5 of 6 tumors  and 89   40 of 45 tumors   respectively  
class4	870	for advanced primary tumors  definitive radiotherapy produced a local control rate of 55   42 of 76 tumors   compared with 79   23 of 29 tumors  for surgery and postoperative radiotherapy  
class4	870	if primary control was obtained  the regional failure rate was less than 10   
class4	870	tumor growth patterns were predictive of the response to radiotherapy  
class4	870	the primary control rate at 2 years for 21 patients with exophytic tumors was 84  as opposed to 58  for 62 patients with ulcerative infiltrative tumors  p   0 04   
class4	870	radiotherapy is effective for early stage or exophytic tumors  whereas for advanced or deeply invasive tumors combined therapy enhances local control  
class4	871	squamous carcinoma of the posterior pharyngeal wall  
class4	871	we have reviewed a 12 year experience with 295 patients treated for squamous carcinoma of the pharynx in order to focus on 78 patients whose lesions arose in the posterior wall  
class4	871	surgery was the definitive therapy for the primary tumor in 57  73    including 3 treatment groups  
class4	871	thirty two patients had limited resections that preserved the larynx  involving local excision  7 patients   anterior pharyngotomy  7 patients   lateral pharyngotomy  6 patients   median labiomandibular glossotomy  6 patients   or median mandibulotomy with paralingual extension  6 patients   
class4	871	the second group consisted of 21 patients with more extensive tumors who required a laryngectomy and complex reconstruction  often with postoperative radiotherapy  
class4	871	finally  there were four patients who developed metachronous second primaries in the pharynx subsequent to a laryngectomy  
class4	871	all required flap reconstruction  
class4	871	of the 21 patients whose primary treatment was radiotherapy  5 had lesions that were implanted after access was provided by a mandibulotomy  
class4	871	cumulative 5 year survival was 32  and ranged from 44  in those with favorable lesions to 15  in those with extensive tumors  
class4	871	our experience highlights the variety of treatment approaches available in patients with pharyngeal carcinomas confined to the posterior wall  
class4	871	surgery in this setting carries acceptable morbidity and yields survival rates that compare favorably with those achieved by external radiation therapy alone  
class4	871	results in patients with extensive lesions still leave much to be desired  despite radical surgery and aggressive radiotherapy  
class4	871	innovative brachytherapy techniques using surgery for access deserve further investigation  
class4	872	flow cytometric evaluation of chemosensitive and chemoresistant head and neck tumors  
class4	872	for patients with head and neck squamous carcinoma  a clinical response to induction chemotherapy has correlated with a survival advantage  
class4	872	similarly  patients with diploid tumors have displayed a survival advantage when compared with patients with aneuploid tumors  
class4	872	this study examined dna content in 33 patients who had undergone induction chemotherapy as part of two clinical protocols to determine if there was a correlation between the patients with diploid tumors and the patients with a clinical response to chemotherapy  
class4	872	although patients with stage iii tumors had a longer disease free survival than stage iv patients  p less than 0 0002   the addition of dna content information did not improve the ability to predict response  
class4	872	specifically  there was no correlation between dna content and the response to chemotherapy  
class4	872	in addition  for this group of patients  a diploid dna content was not correlated with a survival advantage  
class4	872	we conclude that dna content information did not add significantly to the prediction of clinical outcome in these patients who received induction chemotherapy  
class4	873	lateral temporal bone resections  
class4	873	eighteen consecutive patients underwent a lateral temporal bone resection for the treatment of tumors originating in the auricle  the external auditory canal  the periauricular skin  or the parotid and were retrospectively analyzed  
class4	873	the different lateral temporal bone resections performed have been categorized into four types  
class4	873	the type i resection consists of the removal of the tympanic bone and the external auditory canal lateral to the tympanic membrane  
class4	873	the type ii resection consists of the removal of the entire tympanic bone  the tympanic membrane  the incus  and the malleus  preserving the facial nerve and the inner ear  
class4	873	type iii resections remove  in addition to the those structures removed in type ii resections  the distal facial nerve and fallopian canal  the mastoid tip  the styloid process  and the stylomastoid foramen  
class4	873	the type iv resection consists of the removal of only the mastoid tip and the inferior portion of the tympanic bone  
class4	873	when the techniques of lateral temporal bone resection are used appropriately  adequate surgical treatment of patients with selected advanced and recurrent malignant tumors of the external ear  the periauricular skin  and the parotid is possible with low morbidity and a high probability of local regional control  
class4	874	serologic determinants of survival in patients with squamous cell carcinoma of the head and neck  
class4	874	specific circulating serum proteins may reflect unique properties governing the growth and progression of head and neck cancers  
class4	874	one hundred three previously untreated patients with squamous cell carcinoma of the head and neck were prospectively evaluated for serum iga  igg  and igm and c1q binding macromolecules  
class4	874	immunoglobulins were assessed by the immunoturbidimetric technique  
class4	874	c1q binding macromolecules  c1qbm  were measured utilizing the iodine 125 assay of zubler et al  j immunol 1976  116  232 5   
class4	874	neither the level of serum immunoglobulins nor c1qbm values were correlated with the primary site  ajc  american joint committee on cancer  stage of disease  or size of primary lesion  
class4	874	likewise  comparison of serum iga with c1qbm values demonstrated that these laboratory parameters were independent variables  r   0 15 by pearson linear regression   
class4	874	univariate statistical analysis  utilizing the cox proportional hazard model  showed serum iga and c1qbm values to each contribute significantly to the ability to predict survival in patients with advanced squamous cell carcinoma of the head and neck  p   0 01 and 0 003  respectively   
class4	874	furthermore  multivariate analysis reveals that both c1qbm and serum iga levels contribute significantly to the hazards model beyond staging in predicting survival  p less than 0 001   
class4	874	predictive results were most apparent in patients with stage iv disease and related to the probability of both regional and distant metastatic recurrences  
class4	874	conversely  serologic analysis provided no information in patients who were staged early  
class4	874	these results support pretreatment multiparametric serologic analysis of patients with squamous cell carcinoma of the head and neck  
class4	875	efficacy of radical neck dissection for the control of cervical metastasis after radiotherapy for nasopharyngeal carcinoma  
class4	875	fifty one patients who had persistent or recurrent neck disease from nasopharyngeal carcinoma after radiotherapy underwent radical neck dissection  
class4	875	the follow up period ranged from 0 5 to 9 years  median  2 years   
class4	875	multiple cervical lymph node involvement was present in 51  of the patients  26 of 51   
class4	875	malignant cells were detected in 88  of the resected specimens  45 of 51   
class4	875	the clinical sign of fixation of lymph node is the only factor that affects the successful control of neck disease  p   0 04   
class4	875	extracapsular extension of the nodal disease was present  and 35  of the lymph nodes were adherent to surrounding structures at operation  18 of 51   
class4	875	there was one hospital mortality and the overall morbidity was minimal  
class4	875	the actuarial survival at 5 years was 38   and the probability of control of neck disease was 66   
class4	875	radical neck dissection is effective in controlling post irradiation cervical metastasis from nasopharyngeal carcinoma  
class4	876	cervical lymph nodes from an unknown primary tumor in 190 patients  
class4	876	over 10 years  475 patients with isolated lateral neck masses were evaluated  190 with lymph nodes from an unknown primary tumor  lnup   188 with neck lymphomas  78 with benign tumors  10 with sarcomas  and 9 with chemodectomas  
class4	876	this study focused on the patients with lnup  
class4	876	only 86 patients were treated with surgery  plus radiotherapy   
class4	876	other patients were treated with radiotherapy  84  or chemotherapy  13  or had no treatment  7   
class4	876	for the overall population  failures in the neck occurred in 51  of the patients and distant metastases in 27   while primary tumors appeared in 16   
class4	876	survival rates at 3  5  and 10 years were 27   19   and 7   respectively  for the overall population and 45   35   and 19   respectively  for the surgical group  
class4	876	the diagnosis and therapeutic approach had a direct effect on neck control  failure in the neck occurred in 7 of 47 patients  15   when fine needle aspiration and radical neck dissection with radiotherapy were performed  in 5 of 12 patients  42   when fine needle aspiration and modified neck dissection with radiotherapy were used  in 5 of 12 patients  42   when adenectomy diagnosis and radiotherapy treatment were performed  and in 6 of 11 patients  54   when diagnosis by incisional biopsy was performed prior to admission  despite subsequent radical neck dissection and radiotherapy treatment  
class4	876	in our opinion  panendoscopy and fine needle aspiration should be the first line diagnostic approach  
class4	876	when cytologic diagnosis proves impossible  the second line approach must consist of cervical exploration with frozen section examination and excisional biopsy  followed by immediate appropriate treatment  
class4	876	in cases of lnup  radical neck dissection seems to be preferable  
class4	877	delayed reconstruction following mohs  chemosurgery for skin cancers of the head and neck  
class4	877	the case records of 52 patients with 55 cutaneous neoplasms treated by mohs  chemosurgery and subsequently reconstructed by plastic surgeons were reviewed to determine if delay between resection and reconstruction adversely affected the outcome of reconstruction  
class4	877	reconstruction was performed from 5 to 61 days after mohs  chemosurgery for 45 basal cell carcinomas and 10 other cutaneous neoplasms  
class4	877	there were no complications during the interval between resection and reconstruction  
class4	877	following reconstruction  minor wound complications occurred in 6  of patients  there were no major complications  
class4	877	microscopic examination of the re excised wound revealed residual disease in 2 of 45 cases of basal cell carcinoma and 0 of 10 other cutaneous malignancies  
class4	877	both patients with residual basal cell carcinomas  i e   false negative margins after mohs  surgery  had presented to the mohs  surgeon with recurrent tumors  
class4	877	during a follow up period of 3 months to 3 years after complete resection  recurrent tumor developed in 2 of 45 cases of basal cell carcinoma and 3 of 8 cases of squamous cell carcinoma  
class4	877	delayed reconstruction  usually 5 to 20 days after mohs  chemosurgery  can be performed without significant morbidity  
class4	877	re excision of the mohs  chemosurgical wound for pathologic examination can detect residual disease and may be especially indicated for large recurrent wounds  
class4	878	parascapular free flaps for head and neck reconstruction  
class4	878	we report our experience with single stage  primary reconstruction of the head and neck in 29 consecutive patients using parascapular free flaps  
class4	878	the commonest indications were for craniofacial defects  9   oropharyngeal soft tissue defects  10   and combined mandibular and soft tissue losses  4   
class4	878	ablative surgery was performed for squamous carcinoma  22   melanoma  2   and malignant fibrous histiocytoma  2   
class4	878	seven patients died of recurrent disease during a 3 1 2 year follow up  
class4	878	seven patients are alive with recurrence  
class4	878	flap complications included total loss  2  due to unsalvageable microvascular thrombosis  wound breakdown with oropharyngeal fistula  2   mandibular osteomyelitis  1   trismus  2   neck contracture  1   and donor site wound dehiscence  1   
class4	878	the overall success of this reconstruction was 93   
class4	878	primary wound healing was the general rule with lower morbidity than with other reconstructive techniques  
class4	878	the flap is thin  pliable  and conforms well to three dimensional defects  
class4	878	the lateral border of the scapula can be incorporated on the same vascular pedicle for single stage mandibular reconstruction  
class4	878	no muscle is sacrificed  and the posterior donor defect is an added advantage  
class4	878	the parascapular flap is our first choice for reconstruction of major defects in the head and neck  
class4	879	a hepatocellular carcinoma of massive arterioportal shunts without tumor stain treated with cddp two route chemotherapy  a case report  
class4	879	massive arterioportal shunts without tumor vessels or tumor stain are sometimes encountered in advanced cases of liver cirrhosis  
class4	879	massive arterioportal shunts without tumor stain that responded well to intensive chemotherapy with cis diamminedichloroplatinum ii are reported  
class4	880	functional character and augmentation of lymphocytes in regional lymph nodes of patients with lung cancer  
class4	880	it appears that lymph node metastases are more frequent in lung cancer than in other cancers because of impaired defensive mechanisms in the regional lymph nodes  
class4	880	however  little is known about the immunologic function of regional lymph node lymphocytes  rlnl  in patients with lung cancer  
class4	880	we have studied the immunologic properties of rlnl in comparison with peripheral blood lymphocytes  pbl   
class4	880	we measured the natural killer  nk  cell activity of rlnl and pbl in patients with lung cancer and found that the nk activity was significantly more depressed in the rlnl than in the pbl  
class4	880	in contrast  interleukin 2  il 2  production was markedly higher in the rlnl than in the pbl  
class4	880	the cytotoxic effect of rlnl in nonmetastatic lymph nodes on target cells  such as k562 cells  or pc 3 and pc 10 cells  nk resistant  human lung cancer of adenocarcinoma and epidermoid carcinoma  respectively  was significantly enhanced by in vitro incubation with recombinant il 2  ril 2   
class4	880	furthermore  we clarified that both ril 2 and ok 432  which is a biologic response modifier and il 2 inducer as well  augmented the cytotoxicity of rlnl and that these effector cells were lymphokine activated killer  lak  cells  
class4	880	the depletion of lymphocyte subsets by pretreatment with specific monoclonal antibody showed that the lak activity in rlnl was mediated by cd3  and cd8  cells  whereas the lymphocyte subsets contributing the lak activity in pbl were cd3  and cd16  cells  
class4	880	it was concluded that a majority of the effector cells in rlnl were lak cells of the cytotoxic t cell population  
class4	881	lung lobe torsion following lobectomy  
class4	881	three cases of postoperative pulmonary lobe torsion were reported  
class4	881	two of three showed hemorrhagic infarctions  and as a result underwent rethoracotomies and removal of the affected lobes  
class4	881	from these experiences  we consider that computed tomography  ct  and bronchofiberscopic examinations are useful for the diagnosis of advanced torsion  
class4	882	histopathologic study of otitis media in individuals with head and neck tumors  
class4	882	five temporal bones  each including the eustachian tube  were obtained from five adults with advanced malignant tumors of the head and neck  
class4	882	the specimens were from the side on which the tumor had occurred  
class4	882	otitis media had been detected clinically in two cases  and was detected histopathologically in the other three  
class4	882	we discuss the possibility that otitis media might have been caused by tumor invasion of the paratubal area  by postoperative inflammation in the nasopharynx  or by an inflammatory reaction of tubal structures to radiotherapy  or that these conditions may have coexisted  
class4	883	histopathologic grading of salivary gland neoplasms  i  mucoepidermoid carcinomas  
class4	883	histopathologic grading of salivary gland neoplasms has been done with various degrees of success and hence various degrees of acceptance among pathologists and otolaryngologists head and neck surgeons  
class4	883	given their histopathologic diversity  three carcinomas  mucoepidermoid  adenoid cystic  and acinic cell  would seem to be suitable candidates for grading  
class4	883	in this  the first of a three part series  the authors present a three level grading scheme for mucoepidermoid carcinomas  
class4	883	it combines histocytologic and growth features of the carcinomas that independently or together  in other grading proposals  have shown prognostic value  
class4	884	human central nervous system primitive neuroectodermal tumor expressing nerve growth factor receptors  chp707m  
class4	884	a primitive neuroectodermal tumor  pnet  presented as a cerebral hemispheric mass in a 33 year old man  
class4	884	bone marrow metastases were discovered 11 months later  
class4	884	a cell line  chp707m  was derived from these metastases  
class4	884	in culture  the cells showed features of neuronal differentiation  forming short neurites and synthesizing low molecular weight neurofilament protein  
class4	884	northern blotting showed the tumor cells express nerve growth factor  ngf  receptor messenger rna  and fluorescence activated cell sorting demonstrated ngf receptors on the cell surface  
class4	884	western blotting showed chp707m ngf receptors are truncated  
class4	884	the receptors are functional  they bind iodine 125 labeled mouse ngf with an affinity of 1 6 x 10  9  m  and short term treatment with ngf induces expression by the tumor cells of the proto oncogene  c fos  
class4	884	although chp707m is the first central nervous system pnet cell line proven to express ngf receptors  immunohistological survey of tissue sections prepared from human central nervous system pnets showed that 13 of 35 contained ngf receptor positive tumor cells  
class4	884	thus  more than one third of such tumors might be responsive to the effects of ngf  
class4	885	a clinical triad to diagnose paraneoplastic retinopathy  
class4	885	two elderly men developed photosensitivity and light induced glare  transient visual symptoms  and progressive visual loss several months before small cell carcinoma of the lung was discovered  
class4	885	both patients had impaired visual acuity and color vision  ring scotomas  and attenuated retinal arteriole caliber  
class4	885	electroretinography demonstrated abnormal cone and rod mediated responses  
class4	885	antiretinal antibodies were identified in their serum  
class4	885	their visual sensory function improved following therapy with immunosuppressive agents  
class4	885	the triad of photosensitivity  ring scotomatous visual field loss  and attenuated retinal arteriole caliber should alert one to a paraneoplastic disorder affecting the retina  
class4	886	soluble interleukin 2 receptors in cerebrospinal fluid from individuals with various neurological disorders  
class4	886	soluble interleukin 2  il 2r  levels in the cerebrospinal fluid  csf  were studied in infectious  inflammatory  degenerative  and neoplastic disorders to evaluate their usefulness as a marker for the presence of activated t cells  thus indicating an inflammatory process  
class4	886	csf from control subjects and patients with stationary  progressive  and treated multiple sclerosis  ms   aseptic meningitis  lymphoid and nonlymphoid central nervous system  cns  tumors  alzheimer s disease  as well as serum from ms patients and control subjects were studied for levels of soluble il 2r  
class4	886	a significant increase in csf il 2r levels was observed in patients with ms  meningitis  and lymphoid cns tumors  the ms group showed the highest values  
class4	886	csf from individuals with alzheimer s disease and from patients with nonlymphoid tumors did not show significantly elevated values  
class4	886	serum il 2r levels were significantly higher in ms patients than in control subjects  but there was no significant correlation between individual serum and csf il 2r levels  
class4	886	this study suggests the presence of activated t lymphocytes in the cns of patients with ms  
class4	887	bactericidal effect of doxycycline associated with lysosomotropic agents on coxiella burnetii in p388d1 cells  
class4	887	there is no consistently reliable treatment for endocarditis resulting from chronic coxiella burnetii infection  the causative agent of q fever  
class4	887	although certain antibiotics are recommended on the basis of their in vitro bactericidal activities  results of therapy with these antibiotics are often disappointing  
class4	887	to evaluate whether the currently recommended antibiotic susceptibility tests for c  
class4	887	burnetii give misleading results because of continued division of uninfected cells  thereby resulting in the dilution of infected cells and  hence  a false picture of antibiotic efficacy  we blocked cell division during antibiotic susceptibility testing with cycloheximide  
class4	887	using this new method  we found that the currently recommended antibiotics for the treatment of q fever  doxycycline  pefloxacin  and rifampin  did not reduce the ratio of infected to noninfected cells  either l929 or p388d1  by 9 days postinfection  
class4	887	to test the hypothesis that this lack of antibacterial activity is due to antibiotic inactivation by the low ph of the phagolysosomes in which c  
class4	887	burnetii is found  we used alkalinizing lysosomotropic agents  chloroquine or amantadine  concurrently with doxycycline  
class4	887	this resulted in the sterilization of c  
class4	887	burnetii infection in p388d1 cells  
class4	887	this finding seems to confirm our suspicion that the acidic conditions of the phagolysosomes in which c  
class4	887	burnetii is located inhibit antibiotic activity  
class4	887	this inhibition can be reversed in vitro when lysosomotropic alkalinizing agents are used  
class4	888	histopathologic spectrum of clinically atypical melanocytic nevi  ii  studies of nonfamilial melanoma  published erratum appears in arch dermatol 1990 dec 126 12  1616  
class4	888	we studied the clinically most atypical pigmented lesion removed from each of 142 patients with newly diagnosed sporadic melanoma  
class4	888	the specimens were categorized as to the type of nevus  ie  junctional or compound  presence of congenital features  and degree of nuclear atypicality  presence of nuclear enlargement  nuclear pleomorphism  hyperchromatism  and prominent nucleoli  of intraepidermal nevomelanocytes  
class4	888	the frequency of nuclear abnormality was graded as 1  rare cells   2  10  to 50  of cells   or 3  greater than 50  of cells  for each nuclear parameter  
class4	888	among all lesions  42  29 6   were junctional nevi  74  52 1   were compound nevi  and 14  9 9   were dermal nevi  
class4	888	eighteen percent of the total were either dysplastic nevi  23 cases  or malignant melanoma in situ  three cases   
class4	888	fourteen nevi  9 9   had congenital features  
class4	888	there were 12 junctional and 39 compound nevi and one dermal nevus that exhibited nuclear abnormality  but only four junctional nevi compared with 19 compound nevi had sufficient atypia for a designation of dysplastic nevus  
class4	888	only two nevi with congenital features demonstrated any nuclear abnormality  and these were clearly nondysplastic  
class4	888	thus  among nevi surgically removed as the clinically most atypical lesion in this study  compound nevi were much more likely to demonstrate nuclear atypia  and dysplasia  than were other nevi  ie  junctional or dermal nevi  or nevi with congenital features  
class4	889	compound blue nevus  a variant of blue nevus with an additional junctional dendritic component  a clinical  histopathologic  and immunohistochemical study of six cases  
class4	889	we studied six cases of heavily pigmented melanocytic lesions with features of blue nevi within the dermis  but with an additional junctional dendritic component  
class4	889	this compound variant of blue nevus is an uncommon lesion that has not been previously identified as a distinct histologic entity  
class4	889	immunoperoxidase staining for s100 protein and counterstaining with azure b distinguished the presence of melanocytes among numerous melanophages within the dermis  
class4	889	the compound variant of blue nevus can be distinguished histologically from combined blue nevus  pigmented spindle cell nevus  malignant melanoma  and melanosis due to a regressed malignant melanoma  
class4	889	the six lesions were from three men and three women whose ages ranged from 11 to 51 years  mean  31 years   
class4	889	three lesions were located on the trunk  two on the extremities  and one on the head  
class4	889	after a mean follow up period of 47 months  range  38 to 58 months   there was no evidence of recurrence  
class4	890	magnetic resonance imaging in neurological disorders  
class4	890	to investigate the role of magnetic resonance imaging  mri  in neurological disorders  115 children were studied in two groups  
class4	890	group a  78 patients  was studied by paired computed tomography and mri cranial scans  
class4	890	group b  37 patients  was studied by paired computed tomography assisted myelography  ctm  and mri spinal scans  
class4	890	in group a  the scans were generally equivalent for supratentorial tumours and for investigating fits  hydrocephalus  benign intracranial hypertension  and cerebral atrophies  but mri scanning was superior for posterior fossa tumours and cysts  
class4	890	in group b  mri scans were superior for intramedullary spinal tumours  spinal dysraphic problems with tethering or syrinx  and were complementary to ctm in diastematomyelia  
class4	891	long term course of patients with persistent hypercalcitoninemia after apparent curative primary surgery for medullary thyroid carcinoma  
class4	891	thirty one patients with persistent hypercalcitoninemia after seemingly adequate primary operation for medullary thyroid carcinoma  mtc  were followed for a mean period of 11 9 years after operation  
class4	891	ten patients had sporadic mtc and the remaining patients were members of families with multiple endocrine neoplasia  men   either men 2a  15 patients  or men 2b  six patients   
class4	891	overall 5  and 10 year survival rates were 90  and 86   respectively  
class4	891	only four patients died at the completion of the study  two of mtc and two of unrelated causes  
class4	891	eleven patients  35 5   underwent surgical re exploration after demonstration of recurrent disease clinically or radiologically  
class4	891	in no patient did the calcitonin level return to normal after re exploration  
class4	891	the presence of more than three metastatic nodes at the time of initial operation was a statistically significant  p   0 003  predictor for disease recurrence  
class4	891	factors approaching statistical significance were patients younger than age 35  p   0 06  and the percentage of cells in the s phase of cell division  0 07   
class4	891	this data supports a conservative surgical philosophy in the management of the patient with persistent hypercalcitoninemia after resection of mtc  
class4	892	cystic tumors of the pancreas  new clinical  radiologic  and pathologic observations in 67 patients  
class4	892	within a 12 year period we treated 67 patients  49 women  18 men  mean age  61 years  with cystic neoplasms of the pancreas  including 18 serous cystic adenomas  15 benign mucinous cystic neoplasms  27 mucinous cystadenocarcinomas  3 papillary cystic tumors  2 cystic islet cell tumors  and 2 cases of mucinous ductal ectasia  
class4	892	mean tumor size was 6 cm  2 to 16 cm   
class4	892	in 39  the patients had no symptoms  and in 37  the lesions had been misdiagnosed as a pseudocyst  
class4	892	computed tomography was useful for detection  for distinguishing the microcystic subgroup of serous cystadenoma  and for showing rim calcification  all 7 cases were malignant  but was not reliable for distinguishing neoplasm from pseudocyst  serous from mucinous tumors  or benign from malignant  
class4	892	arteriography showed hypervascularity in 4 of 10 serous adenomas  3 of 11 mucinous carcinomas  and 1 of 1 papillary cystic tumors  
class4	892	endoscopic pancreatography showed no communication with the cyst cavity in 37 of 37 cases of cystic neoplasms but opacified the ectatic ducts in 2 of 2 cases of mucinous ductal ectasia  
class4	892	stenosis or obstruction of the pancreatic duct indicated cancer  
class4	892	the tumor was resected by distal pancreatectomy in 25 patients  by proximal resection in 29  and by total pancreatectomy in one  with no operative deaths  
class4	892	forty four per cent of the tumors were malignant  
class4	892	in 10 cases the tumor was unresectable because of local extension or distant metastases  and those patients died at a mean of 4 months  
class4	892	seventy five per cent of those resected for cure are alive without evident recurrence  
class4	892	because the epithelial lining of the tumor was partially  5  to 98   absent in 40  to 72  of cases of the major tumor types  and the mucinous component comprised only about 65  of mucinous cystadenoma lining  misdiagnoses on frozen and even permanent sections were made  
class4	892	mitoses and histologic solid growth correlated with malignancy  
class4	892	neuroendocrine elements were seen in 87  of benign and 47  of malignant mucinous tumors  
class4	892	it is recommended that the terms macrocystic and microcystic be abandoned in favor of the histologic designations serous and mucinous  
class4	892	incomplete examination of the cyst wall can be misleading  however  
class4	892	it is suggested that mucinous ductal ectasia be recognized separately from cystic tumors and that all of these lesions be resected  with the possible exception of asymptomatic confirmed serous cystadenomas  
class4	893	experience with cardiopulmonary bypass and deep hypothermic circulatory arrest in the management of retroperitoneal tumors with large vena caval thrombi  
class4	893	from june 1984 to september 1989  43 patients with large vena caval tumor thrombi from retroperitoneal malignancies underwent surgical treatment with cardiopulmonary bypass  cpb  and deep hypothermic circulatory arrest  dhca   
class4	893	the primary malignancies were renal cell carcinoma  rcc   n   39   renal pelvic transitional cell carcinoma  n   1   adrenal pheochromocytoma  n   1   and renal  n   1  or retroperitoneal  n   1  sarcoma  
class4	893	the level of the caval thrombus was either suprahepatic  n   27   intrahepatic  n   14   or subhepatic  n   2   
class4	893	in all cases the primary tumor and caval thrombus were completely removed  
class4	893	concomitant procedures included coronary artery bypass grafting  n   5   pulmonary resection  n   2   and hepatic lobectomy  n   1   
class4	893	the time of circulatory arrest ranged from 10 to 44 minutes  mean  23 5 minutes   
class4	893	there were two operative deaths  4 7    neither of them due to to the use of dhca  
class4	893	major postoperative complications occurred in 13 patients  30 2    
class4	893	there were no ischemic or neurologic complications and no cases of perioperative tumor embolization  
class4	893	the median postoperative hospital stay was 9 days  
class4	893	twenty two patients  51   are alive and enjoying a good quality of life  
class4	893	the 3 year patient survival rates in patients with localized  n   24  versus metastatic  n   15  rcc are 63 9  and 10 9   respectively  p   0 02   
class4	893	we conclude that cpb with dhca facilities excision of retroperitoneal malignancies with large caval thrombi and provides the potential for cure with low morbidity and mortality rates  
class4	894	surgical therapy in barrett s esophagus  
class4	894	seventy six patients with barrett s esophagus were cared for during a 10 year period  
class4	894	fifty six patients  74   presented with complications of the disease  
class4	894	there were 20 strictures  7 giant ulcers  11 cases of dysplasia  and 29 patients with carcinoma  
class4	894	in patients with benign disease  93  had mechanically defective sphincters and 83  had peristaltic failure of the lower esophageal body  
class4	894	esophageal ph monitoring showed excessive esophageal exposure to ph less than 4 in 93  and excessive exposure to ph more than 7 in 34  of the patients tested  
class4	894	ninety three per cent of patients with excessive alkaline exposure had complications  compared to only 44  with normal alkaline exposure  p less than 0 01   
class4	894	gastric ph monitoring  serum gastrin levels  and gastric acid analysis supported a duodenal source for the alkaline exposure  
class4	894	antireflux surgery was performed using nissen fundoplication in 30  belsey partial fundoplication in 3  and collis belsey gastroplasty in 2  
class4	894	six required resection with colon interposition  
class4	894	good symptomatic control was achieved in 77  after antireflux surgery  
class4	894	four patients had symptoms and signs of duodenogastric reflux  three required a bile diversion procedure  
class4	894	fifteen patients had an en bloc curative resection with colon interposition  
class4	894	one patient with high grade dysplasia on biopsy was found to have intramucosal carcinoma after simple esophagectomy  
class4	894	five tumors were intramucosal  seven were intramural  and four were transmural  
class4	894	lymph node involvement occurred only in the latter two  
class4	894	actuarial survival 5 years after curative resection was 53   
class4	894	median survival time for patients after palliative resection or no resection was 12 months  
class4	894	study of en bloc specimens indicated that extent of resection should be adapted to extent of disease  esophagectomy for intramucosal disease  en bloc esophagectomy with splenic preservation for intramural and transmural disease  
class4	894	serum cea was useful in detecting recurrent disease after surgery when the primary tumor stained positively for cea  
class4	895	analysis of prognostic factors and clinicopathological staging of thymoma 
class4	895	the prognostic value of four clinical variables  age and sex of patients  association with myasthenia gravis  and clinical stage  and histological type was analyzed in 83 consecutive patients with thymoma  histologically classified as cortical  medullary  and mixed  
class4	895	age  sex  and association with myasthenia gravis did not prove to represent significant prognostic factors  clinical stage and histological type  on the contrary  had a highly significant prognostic value  p less than 0 001   
class4	895	a model of clinicopathological staging  based on both clinical stage and histological type  in which three major prognostic groups are considered is proposed  
class4	895	the degree of significance of this model is higher  p less than 0 0001  than that of clinical stage and histological type considered individually  its validity is further supported by the results of multivariate analysis according to the cox regression model  p   0 0001   
class4	895	we think it represents a prognostically valuable approach to the problem of management of thymoma  
class4	896	surgical treatment of cardiac myxomas  long term results  
class4	896	between 1965 and 1988  22 patients underwent 24 operations for cardiac myxomas  
class4	896	two patients had the complex myxoma syndrome  
class4	896	mitral valve replacement was required at initial operation in 2 patients  
class4	896	one patient died perioperatively  and 5 others died subsequently  
class4	896	the 16 surviving patients recently underwent evaluation at a mean duration of 9 years after operation  
class4	896	ten are asymptomatic and 6 have new york heart association class ii symptoms  
class4	896	nine patients continue to be employed  
class4	896	eleven are in sinus rhythm  3 have permanent pacemakers  and 2 have chronic atrial arrhythmias  
class4	896	echocardiography showed atrioventricular valve insufficiency in 3 patients and reduced contractility in 4  but no new tumor recurrences  
class4	896	the long term prognosis of this relatively large group of patients with cardiac myxomas has been good  
class4	896	patients without the complex myxoma syndrome had no recurrence  whereas 2 patients did require reoperation for mitral valve replacement  
class4	896	long term disability and chronic arrhythmias have been infrequent  and functional status and employability of these patients have been very good  
class4	897	diagnostic imaging and surgical treatment of dumbbell tumors of the mediastinum  
class4	897	we describe the diagnostic procedures and surgical approaches employed in 5 patients with dumbbell tumors of the mediastinum  
class4	897	magnetic resonance imaging accurately described the existence and longitudinal extension of the intraspinal component of the tumor and assisted in choosing the appropriate surgical approach  
class4	897	both the intrathoracic and intraspinal components of the tumor were resected at one time by a thoracic and neurosurgical team  
class4	897	we employed the grillo technique three times and a separate laminectomy and thoracotomy approach  
class4	897	magnetic resonance imaging proved the most useful diagnostic technique for suspected dumbbell mediastinal tumors  
class4	897	in our experience  the extended thoracotomy proposed by grillo and co workers worked well for small tumors involving only one foramen in which the intraspinal extension was limited to 2 to 3 cm  and when no more than two laminectomies were required  
class4	897	on the other hand  thoracotomy and a longitudinal paravertebral incision are preferable for larger tumors  more than 4 cm  involving more than one foramen in which the intraspinal extension exceeds 2 to 3 cm  for tumors requiring multiple laminectomy  and when bony infiltration is present  
class4	898	coexisting thymic carcinoid tumor and thymoma  
class4	898	thymic carcinoid tumors are unusual neoplasms that are different from thymomas  
class4	898	we report a case of coexisting thymic carcinoid tumor and thymoma associated with myasthenia gravis  
class4	898	the clinicopathological findings are discussed with a review of the literature  
class4	899	left superior vena cava  a pitfall in computed tomographic diagnosis with surgical implications  
class4	899	we report 2 cases in which computed tomography of the mediastinum demonstrated an abnormality originally misinterpreted as lymphadenopathy but subsequently shown to represent a left superior vena cava  
class4	899	misinterpretation may result in errors in optimum treatment and may complicate surgical exploration of the mediastinum  
class4	899	these 2 cases are presented to remind radiologists and surgeons of the possibility of this unusual anatomy  
class4	900	resection of the superior vena cava for primary lung cancer  5 years  survival  
class4	900	we describe a patient with squamous cell carcinoma of the right lung that required a resection of the superior vena cava combined with a tracheal sleeve pneumonectomy  
class4	900	the superior vena cava was totally replaced with a polytetrafluoroethylene graft with 115 minutes cross clamping of the superior vena cava  
class4	900	the patient remains healthy and the polytetrafluoroethylene graft remains patent 5 years 4 months after operation  
class4	901	risk of gastric cancer after gastric surgery for benign disorders  
class4	901	the objective of this review was to evaluate published evidence for the association between gastric resection for benign disorders and subsequent cancer of the gastric remnant  
class4	901	we searched the literature through medline  1970 to 1988  and through the references of relevant articles  
class4	901	fifty eight studies consisting of case series  uncontrolled surveys  and case control or cohort analyses were identified and critically assessed using defined methodological criteria  
class4	901	there were no consistent differences between the expected and observed number of cancers occurring within 15 years after gastric resection  
class4	901	however  all case control studies and seven of the eight cohort analyses  in which the prevalence of cancer was stratified by time since gastric resection  indicated a twofold to fourfold increase in the risk of gastric cancer in patients who survived 15 or more years after gastric surgery  
class4	901	we conclude that most studies of the association of gastric surgery with subsequent gastric cancer have relatively weak designs  
class4	901	still  the repetitive demonstration of this association by different investigators using different research designs supports the hypothesis that gastric resection increases the risk of cancer in the gastric remnant  
class4	902	morbidity  mortality  and quality of life for patients treated with levothyroxine 
class4	902	in a population study of 1462 middle aged women initiated in 1968 and 1969 we identified 29 women treated with levothyroxine from 1 to 28 years  
class4	902	in a 12 year follow up in 1980 and 1981 we investigated the subjects for end point myocardial infarction  diabetes mellitus  stroke  cancer  and death  the status of 99 7  of the initial participants was established   
class4	902	the women treated with levothyroxine showed no increase in morbidity or mortality  
class4	902	of the 24 women still receiving levothyroxine in 1980 and 1981  22 had serum thyrotropin and triiodothyronine concentrations with in reference limits  
class4	902	these individuals were compared with the 968 women from the population study having no history of thyroid disease  and appeared identical as to laboratory and clinical data  with the exception of a slightly higher body mass  taller stature  and lower serum cholesterol concentration  
class4	902	the treated group did not differ in a life quality estimate based on 19 questions regarding life satisfaction and sensory function  
class4	902	we conclude that the levothyroxine treated woman suffers no side effects from her life long therapy  
class4	903	fast and effective treatment of malignant hypercalcemia  combination of suppositories of calcitonin and a single infusion of 3 amino 1 hydroxypropylidene 1 bisphosphonate  
class4	903	seventeen patients with malignant hypercalcemia were treated with a combination of a single dose of 3 amino 1 hydroxypropylidene 1 bisphosphonate  apd  also known as ahprbp or palmidronate disodium   and salmon calcitonin given as suppositories for 3 days  
class4	903	to assess whether such a combined short treatment has a significant benefit leading to earlier normalization of the plasma calcium level than does apd alone  17 additional patients matched for the type of tumor  initial plasma calcium level  urinary hydroxyproline level  and the dose of apd served as controls  
class4	903	all patients receiving the combination of calcitonin and apd achieved normalization of the plasma calcium level within 9 days  with a decrease from 3 22     0 90 mmol l  mean     sem  to 2 29     0 03 mmol l  
class4	903	in the group receiving apd alone  the plasma calcium level normalized in only 14 of 17 patients by day 9  
class4	903	in the group receiving calcitonin and apd  the drop in the plasma calcium level occurred more rapidly  and the plasma calcium values were lower from days 2 to 4  
class4	903	this advantage was explained by the calciuric effect of calcitonin  as reflected by a significant decrease in the notional setting of renal reabsorption of calcium  reaching 2 16     0 06 mmol l compared with 2 34     0 06 mmol l in the group receiving apd alone  
class4	903	there were no side effects of both treatments  in particular neither flushing nor nausea induced by the suppositories of calcitonin  
class4	903	clinical improvement occurred after 2 days in the group receiving the combined treatment  
class4	903	in conclusion  the combined treatment is rapidly effective and safe in the treatment of patients with hypercalcemia  particularly when the notional setting of renal tubular reabsorption of calcium is increased and a rapid correction of the plasma calcium level is needed  
class4	904	the technicon h6000 analyzer discriminates chronic lymphocytic leukemia from other b cell leukemias through automatic assessment of large unstained cells  
class4	904	the separation of chronic lymphocytic leukemia of b cell origin from other chronic b cell leukemias is subjective  being largely based on the morphologic features of the lymphoid cells in the peripheral blood  
class4	904	the percentage of large unstained cells determined with a technicon h6000 analyzer  an automated blood cell differential analyzer  technicon instruments corp  tarrytown  ny  was used as a cell volume variable in an investigation of 70 cases of chronic lymphocytic leukemia of b cell origin and of other chronic b cell leukemias  
class4	904	the significant degree of correlation between the percentage of large unstained cells and morphoimmunophenotypic diagnosis  although obtained for a relatively small number of cases  suggests that this method of cell volume analysis can be used to improve diagnostic reproducibility in chronic b cell leukemia  
class4	905	sensitivity and specificity of various morphological features of cervical condylomas  an in situ hybridization study  
class4	905	fifty seven cervical biopsy specimens or endocervical curettings showing condyloma  changes suggestive of condyloma  or no changes of condyloma were analyzed for presence of nuclear atypia  nuclear enlargement and irregularity in superficial epithelium   presence of multinucleated cells  and presence of perinuclear cytoplasmic clearing in superficial squamous epithelium  
class4	905	the findings were correlated with results of in situ hybridization with biotin labeled human papillomavirus dna probes  
class4	905	moderate nuclear atypia was significantly more specific than perinuclear cytoplasmic clearing and 100  sensitive for predicting cases positive for human papillomavirus  
class4	905	of the various morphological features analyzed  perinuclear cytoplasmic clearing had the lowest specificity for predicting positive results on in situ hybridization  
class4	906	study of preneoplastic changes of liver cells by immunohistochemical and molecular hybridization techniques  
class4	906	the status of hepatitis b virus dna was investigated by in situ hybridization in multifocal areas of a noncancerous hepatitis b virus associated cirrhosis  
class4	906	this liver exhibited a marked degree of dysplasia and adenomatous hyperplasia  
class4	906	the results of these studies were correlated with the histopathology and immunohistochemical stains for hepatitis b core and surface antigens  
class4	906	there was clear evidence of a marked reduction to absence of hepatitis b viral dna by in situ hybridization and absence of hbc and hbsag in the foci of liver cell dysplasia and adenomatous hyperplasia  
class4	906	these results support the hypothesis that liver cell dysplasia and adenomatous hyperplasia are preneoplastic in nature  
class4	907	persistence of mucosal gastric carcinomas for 8 and 6 years in two patients  
class4	907	a small gastric carcinoma was detected in a man  but he refused surgery  
class4	907	eight years later  he was readmitted for a check up  and a partial gastrectomy was performed  
class4	907	pathologic examination revealed a well differentiated adenocarcinoma restricted within the mucosa  
class4	907	in another man  an irregularly shaped  grossly depressed lesion indicating a malignancy was present at the gastric angle  and 6 years later he agreed to a partial gastrectomy  
class4	907	the lesion proved to be a well differentiated adenocarcinoma confined to the mucosa  
class4	907	retrospective examination of the original biopsy specimen revealed a small area of adenocarcinoma  presumably overlooked at the initial examination  
class4	907	thus  some gastric carcinomas of the well differentiated type can grow at an extremely slow rate  without extensive spread or invasion  
class4	907	findings in these cases contribute to knowledge of the biological behavior of gastric carcinomas  
class4	908	solid and cystic ultimobranchial body remnants in the thyroid  
class4	908	in this study we determined the incidence rate  89   and characterized the morphology of ultimobranchial body  ubb  remnants found in 18 serially sectioned neonatal thyroid glands  
class4	908	although ubb remnants are often referred to as solid cell nests  we found cystic features in 55   
class4	908	ciliated columnar cells were seen in 23   
class4	908	one contained a large pseudo papilla  
class4	908	the ubb cells had nuclei with features reminiscent of papillary carcinoma nuclei in that they were enlarged  oval  and contained finely dispersed chromatin when compared with follicular cell nuclei  
class4	908	both papillary carcinomas and ubb remnants are common  occur as tiny  solid  or cystic thyroid entities in patients of all ages  may contain papillary structures  and share some common nuclear features  
class4	908	therefore  it is important to include ubb remnants in the differential diagnosis of minute thyroid entities and to recognize their morphologic features  
class4	909	mucinous cystadenoma of the lung  a report of two cases with immunohistochemical and ultrastructural analysis  
class4	909	we describe two patients who presented with solitary pulmonary masses that consisted of unilocular cysts lined by columnar mucinous epithelium  
class4	909	the cysts contained copious mucus  
class4	909	the epithelial lining of the cysts showed foci of stratification and papillary infolding  
class4	909	histologically identical lesions have previously been termed unusual mucous cysts or mucinous cystadenomas  
class4	909	we believe that these tumors are true neoplasms differentiating toward the respiratory epithelial mucous cell  
class4	909	they should be distinguished from a variety of pulmonary neoplasms including bronchoalveolar carcinoma  bronchial mucous gland adenoma  mucoepidermoid carcinoma  and metastatic adenocarcinoma  
class4	910	tumor of the atrioventricular nodal region  a clinical and immunohistochemical study  
class4	910	autopsy specimens of 17 tumors of the atrioventricular nodal region were studied  
class4	910	sudden death occurred in 14 children and adults  seven of these patients had a history of atrioventricular block or syncope  
class4	910	three tumors were incidental findings in infants with other congenital anomalies  diaphragmatic agenesis  pulmonary hypoplasia  and meckel s diverticulum in one patient  mitral atresia in one  and congenital hydrocephalus  ventricular septal defect  patent ductus arteriosus  coarctation of the aorta  and patent omphalovitelline duct in the third  
class4	910	immunohistochemical stains demonstrated strong positivity for carcinoembryonic antigen in 13 of 13 cases  b72 3 antigen in 5 of 7 cases  and cytokeratin in 11 of 11 cases  
class4	910	twenty control cases of mesothelioma and mesothelial hyperplasia were all negative for b72 3  one showed focal carcinoembryonic antigen staining  
class4	910	ultrastructural analysis of one case demonstrated short rudimentary microvilli not characteristic of mesothelial cells  
class4	910	we conclude that so called mesotheliomas of the atrioventricular nodal region are not of mesothelial origin  because of strong carcinoembryonic antigen positivity and occasional positivity with b72 3  as these antibodies react with glycoproteins found in endodermally derived tissue and generally not with mesothelial tissue  
class4	910	conduction system tumors are most likely congenital rests of endodermal origin  can be associated with other congenital anomalies  and often cause symptoms of heart block and sudden death  
class4	911	a signet ring cell carcinoma of the ampulla of vater  
class4	911	we describe a variant of carcinoma of the ampulla of vater  which  to our knowledge  has not been previously described  
class4	911	classic signet ring cells represented the predominant cell type  and were admixed with more poorly differentiated tumor cells that were chromogranin positive  
class4	911	these findings raise the possibility of an amphicrine tumor of the ampulla  
class4	912	pulmonary blastoma with malignant melanoma component  
class4	912	pulmonary blastomas are rare primary tumors that consist of tubular or glandular structures embedded in an undifferentiated mesenchymal stroma  
class4	912	focal cartilage  bone  and skeletal muscle as well as squamous differentiation have been described in these tumors  
class4	912	we report a unique case of a pulmonary blastoma showing a malignant melanoma component  
class4	912	immunohistochemical stains for s100 protein and hmb 45 were positive in the areas of melanocytic differentiation  
class4	913	neonatal intracranial choriocarcinoma  
class4	913	a 1 month old infant died from extensive intracerebral hemorrhage due to a metastatic choriocarcinoma to the brain that presumably originated in the placenta  
class4	913	the clinical course was characterized by hyperbilirubinemia  repeated episodes of seizures  and intracranial hemorrhage  
class4	913	a computed tomographic scan revealed a large vascular mass in the left parieto occipital region and a small lesion in the left frontal lobe  
class4	913	the placenta was expelled during the delivery and was not examined  
class4	913	in view of the high level of maternal human chorionic gonadotropic hormone and the autopsy finding of metastasis  we presumed that the mass was a metastatic choriocarcinoma that had originated in the maternal placenta  
class4	913	to our knowledge  only one previous instance of this phenomenon has been reported  
class4	914	is liver transplantation justified for the treatment of hepatic malignancies  
class4	914	twenty eight patients received orthotopic liver transplants for malignant disease between february 1  1984  and december 31  1989  
class4	914	preoperative diagnoses included hepatocellular carcinoma  n   16   cholangiocarcinoma  n   3   other primary hepatic tumors  n   6   and metastatic diseases to the liver  n   3   
class4	914	overall actuarial survivals at 6 months  1 year  and 5 years were 67 3   51   and 31   respectively  
class4	914	long term survival longer than 5 years was achieved in 3 patients  
class4	914	the recurrence rate in patients surviving longer than 3 months is 48   median  7 months   
class4	914	hepatocellular carcinoma and cholangiocarcinoma had the poorest survival and highest recurrence rates  
class4	914	specific prognostic factors correlating with survival or recurrence could not be elucidated  
class4	914	these results indicate that orthotopic liver transplants can provide long term cure and palliation for malignant disease  however  patient selection is extremely important in predicting outcome  
class4	915	the impact of microinvasion on axillary node metastases and survival in patients with intraductal breast cancer  
class4	915	a rational approach to the local treatment of intraductal breast cancer continues to generate considerable debate  
class4	915	however  the finding of an invasive component in intraductal breast cancer is widely regarded as an appropriate indication for axillary node dissection as part of the local treatment and staging of this disease  
class4	915	despite this view  the natural history of patients with intraductal breast cancer with foci of microinvasion is poorly defined  
class4	915	between 1965 and 1988  41 patients with this pathologic finding of intraductal carcinoma with foci of microinvasion were seen at the ucla medical center  
class4	915	twenty three patients presented with mammographic abnormalities  while 17 patients presented with a palpable mass  
class4	915	one patient presented with paget s disease of the nipple  
class4	915	thirty three patients underwent axillary node dissection as part of their local treatment  
class4	915	no lymph node metastases were identified  
class4	915	the median follow up in 37 patients was 47 months  
class4	915	there have been no local recurrences and no deaths from recurrent breast cancer  
class4	915	intraductal breast cancer associated with microinvasion appears to be an extremely favorable lesion with minimal risk of nodal metastases  
class4	916	immediate breast reconstruction following mastectomy is as safe as mastectomy alone  
class4	916	we evaluated wound complications and potential risk factors after mastectomy with immediate breast reconstruction and compared them with similar data after modified radical mastectomy  
class4	916	the incidences of infection  seroma  hematoma  and epidermolysis were compared among 395 patients  305 with modified radical mastectomies and 90 with mastectomy with immediate breast reconstruction  from virginia mason medical center  seattle  wash  between 1983 and 1989  
class4	916	obesity  age  60 years or older   smoking  antibiotics  and wound drainage were examined as possible risk factors  
class4	916	there were more wound complications in the modified radical mastectomy group  48  vs 31    and specifically  more seromas  30  vs 13    
class4	916	in the modified radical mastectomy group  age of 60 years or older was associated with seroma and infection  drainage greater than 30 ml per day  at time of drain removal  with seroma  and smoking with epidermolysis  
class4	916	in the mastectomy with immediate breast reconstruction group  obesity was associated with seroma and epidermolysis  
class4	916	we conclude that mastectomy with immediate breast reconstruction appears to be as safe as modified radical mastectomy alone with respect to wound complications  
class4	917	the operative management of coexisting thyroid and parathyroid disease  
class4	917	three hundred eight patients who underwent operation for hyperparathyroidism were studied  
class4	917	fifty two  17   were identified who had a concomitant thyroid nodule  
class4	917	all 52 underwent parathyroidectomy and thyroid resection in a single operation  
class4	917	eleven of these patients  21  of those with a thyroid nodule  had differentiated thyroid cancer  
class4	917	one patient with parathyroid hyperplasia developed permanent hypocalcemia  
class4	917	none had permanent vocal cord paralysis and none required tracheostomy  
class4	917	thorough visual inspection and palpation of the entire thyroid gland should be performed during operations for hyperparathyroidism  
class4	917	incidentally discovered thyroid nodules should prompt formal lobectomy with frozen section diagnosis  unanticipated thyroid malignancies should then be treated as independent entities  
class4	917	treating simultaneous hyperparathyroidism and nodular thyroid disease with a single operation can be done safely  it avoids the expense and risk associated with neck reexploration and can detect unsuspected cancers  
class4	918	the recalcitrant perineal wound after rectal extirpation  applications of muscle flap closure  
class4	918	perineal wounds developing after abdominoperineal resection result in chronic purulent drainage and intermittent episodes of sepsis and are generally unresponsive to conservative medical and surgical treatment  
class4	918	thirteen consecutive patients  aged 27 to 74 years  mean  48 years  who underwent debridement and immediate muscle flap closure of these wounds were analyzed to identify risk factors for delayed healing and to evaluate the effectiveness of muscle flap coverage  
class4	918	three risk factors were identified  preoperative or postoperative radiation therapy  resection for recurrent carcinoma  and inflammatory bowel disease  
class4	918	a total of 19 muscle flaps  11 gracilis  five gluteal thigh  two gluteus maximus  and one rectus abdominis  were used to close these wounds  
class4	918	during an average 3 5 year follow up  four  31   minor complications and one  8   recurrence were noted to occur  
class4	918	muscle flaps provide safe  effective  single stage procedures for the closure of chronic perineal wounds  
class4	919	failure to detect human t cell leukemia virus related sequences in multiple sclerosis blood  
class4	919	we tested 11 patients with multiple sclerosis for the presence of human t cell leukemia virus type i  htlv i   or type ii  htlv ii  related sequences  
class4	919	dna from blood mononuclear cells was analyzed by the polymerase chain reaction utilizing three different oligonucleotide primer pairs  
class4	919	two of these primer pairs detect sequences shared between htlv i and htlv ii in either p24  gag protein  or in p21  env transmembrane protein  
class4	919	the third primer pair was synthesized based on regions in the pol gene where amino acid sequences are conserved between htlv i  htlv ii  and the related bovine leukemia virus  
class4	919	the multiple sclerosis samples were consistently negative while appropriate control samples were positive  
class4	919	we conclude that viruses related to htlv i  htlv ii  or bovine leukemia virus are not present in the blood of patients with multiple sclerosis and  therefore  that htlv bovine leukemia virus related viruses are not likely to be involved in the pathogenesis of multiple sclerosis  
class4	920	metastatic carcinoma to the retina  clinicopathologic findings in two cases  
class4	920	two cases of metastatic carcinoma to the neuroretina are reported  
class4	920	one patient had an oat cell carcinoma of the lung that was metastatic to the brain and retina  this was confirmed postmortem  
class4	920	the other patient had metastatic breast carcinoma with seeding of tumor cells into the vitreous from a focus of retinal embolism  
class4	920	the diagnosis was confirmed from a vitrectomy specimen  
class4	921	cellular immune response toward human articular chondrocytes  t cell reactivities against chondrocyte and fibroblast membranes in destructive joint diseases  
class4	921	articular cartilage is one of the major targets in destructive joint diseases in humans  
class4	921	we studied cellular immune reactions against cartilage cell surface membranes  because it has recently been suggested that these represent possible antigenic structures  based upon the observation of autoantibodies with this specificity in certain joint diseases  
class4	921	a striking t cell reactivity toward chondrocyte membranes was found both in blood and synovial tissue from patients with rheumatoid arthritis  
class4	921	this reactivity was strongly dependent on the presence of monocytes and had all the characteristics of an antigen driven process  
class4	921	clonal analysis demonstrated high precursor frequencies in peripheral blood t cells that were reactive against chondrocyte membranes  
class4	921	this response to chondrocyte membranes greatly exceeded the t cell stimulation induced by membranes from other sources such as fibroblasts or epithelial cells  
class4	921	in contrast to patients with rheumatoid arthritis  individuals with osteoarthritis showed a strong peripheral blood and synovial fluid t cell response not only to chondrocyte membranes  but also to fibroblast membrane material  
class4	921	however  there was no reactivity to epithelial cell membranes  
class4	921	normal donors generally did not show significant responses to any membrane preparation  
class4	921	these data indicate that there is a strong t cell reactivity toward chondrocyte membranes in destructive joint disorders  and this may significantly contribute to the pathogenetic processes that occur in these diseases  
class4	922	pseudotumor of the craniocervical junction during long term hemodialysis  
class4	922	a systematic study of the upper cervical spine was performed using magnetic resonance imaging in 25 patients  15 men and 10 women  who had been undergoing hemodialysis for more than 10 years  
class4	922	seven pseudotumors of the periodontoid soft tissue were disclosed  which were similar to the pannus recently described in rheumatoid arthritis  
class4	922	bone cystic radiolucencies were observed in association with these pseudotumors in 5 patients  
class4	922	the radiolucencies were located in the atlas  1 in the lateral mass and 1 in the anterior branch  and in the axis  3 in the odontoid process and 1 in the vertebral body   
class4	922	no horizontal or vertical atlantoaxial subluxation was demonstrated  
class4	922	these features were observed only in patients who had amyloid arthropathy  
class4	922	they could be a frequent  yet thus far little recognized  feature of beta 2 microglobulin amyloidosis  
class4	923	atrial fibrillation with cardiac tamponade as the initial manifestation of malignant pericarditis 
class4	923	this article describes the case of a 72 year old woman with cardiac tamponade and atrial fibrillation as the initial manifestation of a lymphoid malignancy  
class4	923	the pathogenesis of cardiac tamponade  various diagnostic modalities  and therapy of this condition are reviewed  
class4	924	platelet norepinephrine and epinephrine concentration in patients with pheochromocytoma  
class4	924	platelet and plasma catecholamine concentrations were determined in 17 patients with surgically proven pheochromocytoma  mean age 42 3 years   in 31 patients with borderline hypertension  mean age 35 3 years  and in 9 healthy controls  mean age 39 3 years   
class4	924	both platelet norepinephrine and epinephrine were significantly increased in patients with pheochromocytoma when compared with hypertensive and control groups  p less than  001   
class4	924	no correlation between platelet and plasma catecholamines was detected in all studied groups  
class4	924	the diagnostic accuracy of platelet catecholamine in pheochromocytoma is limited since increased platelet norepinephrine was found in 35 5  and increased platelet epinephrine was found in 19 4  of patients with essential hypertension  
class4	925	a risk of malignancy index incorporating ca 125  ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer  
class4	925	age  ultrasound score  menopausal status  a clinical impression score and serum ca 125 level were assessed to see how they could best distinguish between patients with benign  n   101  and malignant  n   42  pelvic masses  
class4	925	each criteria used alone provided statistically significant discrimination  
class4	925	the most useful individual criteria were a serum ca 125 level of 30 u ml  sensitivity 81   specificity 75   and an ultrasound score of 2  sensitivity 71   specificity 83    
class4	925	three criteria could be combined in a risk of malignancy index  rmi  which is simply calculated using the product of the serum ca 125 level  u ml   the ultrasound scan result  expressed as a score of 0  1 or 3  and the menopausal status  1 if premenopausal and 3 if postmenopausal   
class4	925	this index was statistically virtually as effective a discriminant between cancer and benign lesions as more formal methods  
class4	925	using an rmi cut off level of 200  the sensitivity was 85  and the specificity was 97   
class4	925	patients with an rmi score of greater than 200 had  on average  42 times the background risk of cancer and those with a lower value 0 15 times the background risk  
class4	926	serum ca 125 levels during the menstrual cycle  
class4	926	serum concentrations of ca 125 were measured in different phases of the menstrual cycle in 16 women with ovulatory and 12 women with anovulatory cycles  
class4	926	ca 125 levels were significantly elevated during menstruation in both groups  
class4	926	in women with anovulatory cycles  but not in those with ovulatory cycles  ca 125 levels were already increased in the premenstrual phase  
class4	926	a negative correlation was found between serum ca 125 and progesterone concentrations in the premenstrual phase of the cycle  
class4	926	we suggest that premenstrual elevation of serum ca 125 in women with anovulatory cycles is related to premature endometrial vascular changes which are the result of the low serum progesterone concentration leading to insufficient endometrial control  
class4	926	thus the effect of progesterone seems to be indirect rather than a direct effect on ca 125 synthesis  
class4	926	when the ca 125 assay is used for diagnosis of cancer  sampling should not be done immediately before or during menstruation because the physiological elevation of the ca 125 levels may give false positive results  
class4	927	the effect of abdominal surgery on the serum concentration of the tumour associated antigen ca 125  
class4	927	the ca 125 assay is used to monitor the course of disease in women with adenocarcinoma of the genital tract  
class4	927	we measured serum ca 125 levels longitudinally in three different groups of patients who had normal serum ca 125 levels  less than or equal to 16 u ml  before extensive intraperitoneal abdominal surgery  group 1  second look laparotomy in 28 women with ovarian cancer  group 2  radical hysterectomy in 42 patients with cervical cancer  group 3  13 men and one woman who had aortic surgery for atherosclerotic occlusive disease or aneurysm formation   
class4	927	following surgery  rising serum ca 125 levels were observed in 69 out of the 84 patients  82    irrespective of the primary diagnosis  type of operation or sex  
class4	927	the highest levels were found during the second week after the operation  range 3 336 u ml  and decreased gradually thereafter  to become normal at 8 weeks after surgery  
class4	927	it was concluded that abdominal surgery interferes with the specificity of ca 125 as a tumour marker during the early postoperative period  
class4	928	choroidal osteoma  osseous choristoma   an atypical case  
class4	928	a case of choroidal osteoma presenting in a 22 year old girl is reported  
class4	928	the tumour  unilateral and in a juxtapapillary site  appeared markedly elevated on the retinal plane  not flat or slightly elevated as in previous reports  
class4	928	visual acuity was not affected  and there was a complete absence of subjective symptoms  
class4	928	echography  fluorangiography  computerised tomography  and visual field tests were performed  
class4	928	echography is the best method for identifying and differentiating this lesion from a malignant tumour  
class4	929	all trans retinoic acid as a differentiation therapy for acute promyelocytic leukemia  i  clinical results  
class4	929	twenty two patients with acute promyelocytic leukemia were treated with all trans retinoic acid  ra  45 mg m2 per day  for 90 days  
class4	929	of the 22  four patients were previously untreated  two were resistant after conventional chemotherapy  and 16 were in first  n   11   second  n   4   or third  n   1  relapse  
class4	929	we observed 14 complete response  four transient responses  one failure  and three early deaths  
class4	929	length of hospitalization and number of transfusions were notably reduced in complete responders  
class4	929	correction of coagulation disorders and an increase of wbcs were the first signs of all trans ra efficacy  
class4	929	morphologic analysis performed at days 0  15  30  45  60  and 90 showed that complete remissions were obtained without bone marrow  bm  hypoplasia  
class4	929	presence of auer rods in the maturing cells confirmed the differentiation effect of the treatment  
class4	929	at remission  the t 15 17  initially present in 20 patients was not found  
class4	929	the in vitro studies showed a differentiation in the presence of all trans ra in 16 of the 18 tested cases  
class4	929	the single nonresponder to all trans ra in vitro did not respond in vivo  
class4	929	adverse effects of ra therapy  skin and mucosa dryness  hypertriglyceridemia  and increase of hepatic transaminases  were frequently noted  
class4	929	we also observed bone pain in 11 patients and hyperleukocytosis in four patients  
class4	929	whether maintenance treatment consisted of low dose chemotherapy or all trans ra  early relapses were observed  
class4	929	five patients are still in complete remission  cr  at 4 to 13 months  
class4	929	our study confirms the major efficacy of all trans ra in m3  even in relapsing patients  
class4	929	remissions are obtained by a differentiation process  
class4	930	all trans retinoic acid in acute promyelocytic leukemias  ii  in vitro studies  structure function relationship  
class4	930	all trans retinoic acid induces leukemic cells from patients with acute promyelocytic leukemia  m3  to differentiate in vitro to mature granulocytes which express the cd15 antigen and are capable of respiratory burst function  
class4	930	of 35 m3 samples  only one failed to respond  
class4	930	in eight cases  we compared the efficacy of two naturally occurring isomers of retinoic acid  all trans ra and 13 cis ra  
class4	930	both isomers induce maximal differentiation at 10  6  mol l  
class4	930	the maximal response was maintained at 10  7  mol l for the all trans but not for the 13 cis ra  
class4	930	we also observed that the metabolites 4 oxo all trans and 4 oxo 13 cis were effective at 10  6  mol l  
class4	930	this 1 order of magnitude difference in the in vitro differentiating potencies of all trans ra and 13 cis ra in the blasts of promyelocytic leukemias predicts a difference in the clinical efficacy of the two drugs  
class4	931	autologous bone marrow transplantation in high risk remission t lineage acute lymphoblastic leukemia using immunotoxins plus 4 hydroperoxycyclophosphamide for marrow purging  
class4	931	fourteen patients with high risk t lineage acute lymphoblastic leukemia  all  in complete remission underwent autologous bone marrow transplantation  bmt  in an attempt to eradicate their residual disease burden  
class4	931	a combined immunochemotherapy protocol using a cocktail of two immunotoxins directed against cd5 tp67 and cd7 tp41 t lineage differentiation antigens in combination with the in vitro active cyclophosphamide congener 4 hydroperoxy cyclophosphamide  4 hc  was used to purge autografts  
class4	931	despite high dose pretransplant radiochemotherapy and effective purging of autografts  9 of 14 patients relapsed at a median of 2 5 months  range  1 2 to 16 8 months  post bmt  
class4	931	two patients remain alive and disease free at 26 and 28 months post bmt  
class4	931	we used a novel quantitative minimal residual disease  mrd  detection assay  which combines fluorescence activated multiparameter flow cytometry and cell sorting with leukemic progenitor cell  lpc  assays  to analyze remission bone marrow  bm  samples from t lineage all patients for the presence of residual lpcs  
class4	931	notably  high numbers of residual lpc detected in remission bm before bmt constituted a poor prognostic indicator  providing the first evidence for the biologic significance and clinical value of in vitro t lineage all lpc assays  
class4	931	the median value for the residual leukemia burden before bmt  was approximately 8 6 x 10 3  lpc 10 8  mononuclear cells  mnc   approximately 0 0086  lpc   
class4	931	patients with a residual leukemia burden less than this median value appeared to have a better outlook for remaining free of relapse after autologous bmt than patients with a greater leukemia burden  53     25  v 14     13   p    006  mantel cox   
class4	931	by comparison  the log kill efficacy of purging  the remaining numbers of lpc in purged autografts  or the estimated numbers of reinfused lpc  did not correlate with the probability of disease free survival  dfs   
class4	931	these results indicate that the primary reason for the recurrence of leukemia was inefficient pretransplant radiochemotherapy rather than inefficient purging of autografts  
class4	932	human basophils express interleukin 4 receptors  
class4	932	interleukin 4  il 4   a multipotential lymphokine reputed to play an important role in the regulation of immune responses  interacts with a variety of hemopoietic target cells through specific cell surface membrane receptors  
class4	932	the present study was designed to investigate whether human basophils express il 4 binding sites  
class4	932	for this purpose  basophils were enriched to homogeneity  93  and 98  purity  respectively  from the peripheral blood of two chronic granulocytic leukemia  cgl  donors using a cocktail of monoclonal antibodies  moabs  and complement  
class4	932	purified basophils bound 125i radiolabeled recombinant human  rh  il 4 in a specific manner  
class4	932	quantitative binding studies and scatchard plot analysis revealed the presence of a single class of high affinity il 4 binding sites  280     40 sites per cell in donor 1 and 640     45 sites per cell in donor 2  with an apparent dissociation constant  kd  of 7 12 x 10  11      2 29 x 10  11  and 9 55     3 5 x 10  11  mol l  respectively  
class4	932	ku812 f  a human basophil precursor cell line  was found to express a single class of 810 to 1 500 high affinity il 4 binding sites with a kd of 2 63 to 5 54 x 10  10  mol l  
class4	932	no change in the numbers or binding constants of il 4 receptors was found after exposure of ku812 f cells to rhil 3  a potent activator of basophils  for 60 minutes  
class4	932	no effect of rhil 4 on 3h thymidine uptake  release or synthesis of histamine  or expression of basophil differentiation antigens  bsp 1  cd11b  cd25  cd40  cd54  on primary human cgl basophils or ku812 f cells was observed  
class4	933	developmental regulation of granulocytic cell binding to hemonectin  
class4	933	hemonectin  hn   a component of the bone marrow  bm  extracellular matrix which promotes adhesion of cells in the granulocytic lineage  was purified to near homogeneity and tested for its ability to mediate attachment of normal and leukemic cells of granulocytic lineage  
class4	933	purified hn immobilized on plastic substrates promoted serum free attachment of normal granulocyte macrophage progenitor cells  cfc gm   using an in situ attachment assay in which cell attachment is inhibited by specific polyclonal antisera  
class4	933	when unfractionated bm cells were allowed to attach to purified hn and stained in situ  hn preferentially bound cells at earlier stages of granulocytic differentiation  
class4	933	these observations were confirmed using cells of the hl 60 progranulocytic cell line which mirrored this differentiation stage specific binding to hn  
class4	933	hn promoted attachment of 60  of uninduced hl 60 cells which were arrested at the progranulocyte stage  whereas only 15  of uninduced hl 60 cells attached to uncoated plastic and 4  to attached plastic coated with equal microgram quantities of bovine serum albumin  bsa   
class4	933	when hl 60 cells were induced to differentiate along the granulocytic pathway by incubation with dimethylsulfoxide  dmso   attachment to hemonectin was reduced  
class4	933	thus  both primary bm granulocytic cells and a granulocytic cell line show preferential attachment of those cells at earlier stages of differentiation  
class4	933	this developmentally regulated binding suggests a mechanism for release of maturing bm into the peripheral circulation  
class4	934	human macrophage colony stimulating factor induces macrophage colonies after l phenylalanine methylester treatment of human marrow  
class4	934	macrophage colony stimulating factor  m csf  has well known effects on murine bone marrow  but its colony stimulating activity for human bone marrow is controversial  
class4	934	after treatment of human bone marrow with l phenylalanine methylester  pme   macrophage colonies  cfu m  were induced by m csf in a dose dependent fashion  
class4	934	the optimal concentration of recombinant human macrophage colony stimulating factor  rhm csf  was 1 000 u ml  
class4	934	purified human urine m csf had colony stimulating activity similar to rhm csf  
class4	934	further studies were performed to determine the factors responsible for the enhanced cfu m formation from pme treated marrow  
class4	934	compared with nylon wool and carbonyl iron monocyte depletion methods  pme eliminated significantly more monocytes and myeloid cells  
class4	934	this observation suggested that these cells may release hematopoietic inhibitory factors for cfu m  
class4	934	low concentrations  1   but not normal  10   concentrations of blood monocytes were inhibitory  mean inhibition  48   to cfu m  
class4	934	high concentrations of monocytes  50   augmented cfu m colonies  
class4	934	hl 60 conditioned media was used to simulate secretory products of early myeloid cells  
class4	934	hl 60 conditioned media  1   inhibited cfu m formation but not granulocyte macrophage or granulocyte colonies  
class4	934	we conclude that m csf has colony stimulating activity for human marrow that can be recognized after removal of inhibitory cells by pme treatment  
class4	935	immunophenotypic characteristics of cerebrospinal fluid cells in children with acute lymphoblastic leukemia at diagnosis  
class4	935	the presence of meningeal involvement in children with acute lymphoblastic leukemia  all  may have important prognostic and therapeutic implications  
class4	935	conventional methods of diagnosing central nervous system  cns  leukemia rely on the interpretation of cerebrospinal fluid  csf  cell morphology  which may produce ambiguous results in the presence of minimal leukemic involvement  
class4	935	a methodology has been developed for immunophenotyping small numbers of csf cells while preserving cell morphology  
class4	935	csf samples from 33 children with cd10  common all antigen  calla   positive all were examined at initial presentation using both conventional morphology and this combined immunohistopathologic technique  
class4	935	six  18   of the samples contained lymphoblasts or cells considered morphologically suspicious for leukemic involvement  
class4	935	nine additional samples  27  of the total  had normal csf morphology  but contained increased numbers of calla positive cells  
class4	935	twelve of the 33 samples were also examined for the simultaneous presence of nuclear terminal deoxynucleotidyl transferase  tdt  and demonstrated increased numbers of cells positive for both tdt and cd10  
class4	935	these data suggest that a large proportion of children with all may have abnormalities of csf cells at initial diagnosis consistent with the presence of occult leukemic involvement  
class4	936	ph negative chronic myeloid leukemia  molecular analysis of abl insertion into m bcr on chromosome 22  
class4	936	leukemic cells from a patient with ph negative chronic myeloid leukemia  cml  had a normal karyotype  
class4	936	m bcr was rearranged and chromosome in situ hybridization showed an abl insertion between 5  and 3  m bcr on an apparently normal chromosome 22  
class4	936	the association of 5  bcr and 3  abl at the 5  junction of the chromosome 9 insert was typical of that found for the bcr abl fusion gene in other patients with the standard t 9 22  and cml  
class4	936	with an m bcr 3  probe  we cloned and characterized a 3  junction fragment  
class4	936	field inversion gel electrophoresis and chromosome in situ hybridization studies using a probe isolated from genomic dna 5  of the junction showed that 3  m bcr was joined to a region of chromosome 9q34 rich in repetitive sequences and lying some distance 3  of abl  
class4	936	the chromosome 9 insert was at least 329 kilobases long and included 3  abl and a larger portion of chromosome 9q34  
class4	936	our results allowed us to exclude transposon  or retroviral mediated insertion of abl into chromosome 22  
class4	936	instead  we favored a two translocation model in which a second translocation reconstituted a standard t 9 22  q34 q11  but left the chromosome 9 insert  including 3  abl  in chromosome 22  
class4	937	new type of bcr abl junction in philadelphia chromosome positive chronic myelogenous leukemia  
class4	937	a new and rare type of bcr abl junction between exon c3 of the 3  portion of the bcr gene and abl exon 2 has been identified in the leukemic cells of two ph1 positive chronic myelogenous leukemia patients in chronic phase  
class4	937	this is the fourth type of bcr abl junction so far identified in ph1 positive hematologic malignancies and is a consequence of an unusual breakpoint position on chromosome 22 that falls approximately 20 kb downstream of the major breakpoint cluster region  bcr  of the bcr gene  
class4	937	the new hybrid mrna is 540 base pairs  bp  longer than that expressed by the k562 cell line and could codify for a bcr abl protein carrying 180 additional aminoacids with respect to the larger p210 protein so far identified  
class4	937	the hematologic phenotype expressed by the two patients carrying this unusual type of bcr abl rearrangement does not significantly differ from that commonly seen in chronic myelogenous leukemia  
class4	938	shared idiotype expression by chronic lymphocytic leukemia and b cell lymphoma  
class4	938	antiidiotype  id  antibodies identify unique determinants within the surface immunoglobulin  ig  that are present on b cell tumors  
class4	938	anti ids have been used for diagnosis and therapy of b cell lymphoma and leukemia  
class4	938	a panel of 29 anti id monoclonal antibodies  moabs  that recognize shared idiotypes  sids  on b cell lymphomas was tested for reactivity with both b cell leukemias and lymphomas  
class4	938	ten of 40  25   cases of chronic lymphocytic leukemia  cll  reacted with at least one of the 29 anti sid moabs  
class4	938	three cases reacted with more than one anti sid moab  but there was no repetitive pattern of a single anti sid moab reacting with a large proportion of cll cases  
class4	938	in contrast  for b cell lymphoma  in which 11 of 31  36   cases reacted  one anti sid  b4 1  reacted with five of the positive cases  all were diffuse histology  
class4	938	restricted anti sid reactivity may lead to important insights into the etiology of certain b cell lymphomas  
class4	938	in addition  these anti sids may obviate the need to develop  tailor made  antibodies for individual patients  
class4	939	in vitro rosetting  cytoadherence  and microagglutination properties of plasmodium falciparum infected erythrocytes from gambian and tanzanian patients  
class4	939	to understand the molecular mechanisms that lead to sequestration of red blood cells infected with mature stages of plasmodium falciparum and to examine the relevance of earlier studies on adherence properties of laboratory derived p falciparum parasites to the natural parasite population  we analyzed gambian and tanzanian isolates for in vitro cytoadherence and antibody mediated microagglutination  
class4	939	eighteen cryopreserved isolates of ring stage parasites were cultured for 20 to 30 hours in vitro  in the patients original erythrocytes  to the trophozoite and schizont stage  
class4	939	all parasites were positive in the microagglutination assay with at least one of four african hyperimmune sera  
class4	939	in a rosetting assay  only 2 of the 18 isolates were strongly positive  35  and 41  of parasitized erythrocytes with more than two uninfected cells bound   
class4	939	thirteen isolates showed either intermediate  5  to 18   or low  less than 5   rosetting while three isolates did not form rosettes  
class4	939	infected cell binding of the different isolates to immobilized cd36 or thrombospondin  or c32 melanoma cells correlated with the percentage of mature parasites in the blood samples  r    932 for cd36  r    946 for thrombospondin  and r    881 for c32 melanoma cells   
class4	939	there was a high correlation between binding to cd36 and thrombospondin  r    982   
class4	939	the extent of infected cell rosetting with uninfected cells in these blood samples was not correlated with these other receptor properties  
class4	939	we also observed coexpression of rosetting and cytoadherence receptors on the same parasitized erythrocytes  
class4	940	autologous bone marrow transplantation in multiple myeloma  identification of prognostic factors  
class4	940	multiple myeloma remains a universally fatal malignancy with a median survival time not exceeding 3 years  
class4	940	a clinical trial was undertaken to determine feasibility and efficacy of marrow ablative chemoradiotherapy supported by unpurged autologous bone marrow  abmt  and to define prognostic variables  
class4	940	total body irradiation and either melphalan or thiotepa were administered to 55 patients  median age 53 years  range 20 to 66 years   
class4	940	the group of 21 patients with resistance to standard melphalan prednisone and to continuous infusions of vincristine and adriamycin with high dose dexamethasone  vad  included 7 with primary unresponsive disease and 14 with resistant relapse  among the 34 patients achieving remission with the vad regimen  14 were in first and 20 in a subsequent remission  
class4	940	marked cytoreduction by greater than or equal to 75  was observed among all 21 patients with refractory myeloma  whereas further cytoreduction of this magnitude was noted in only 56  of the 34 patients already in remission after vad  
class4	940	five of the 6 early deaths among all 55 patients occurred in the 14 patients with resistant relapse  none of whom achieved complete remission and who  as a group  had median durations of relapse free and overall survival of only 8 and 7 months  respectively  
class4	940	among the 41 remaining patients  there was only one early death  and 27  achieved complete remission including a 36  incidence among the 14 patients treated in first remission  their projected 4 year survival rate was 82  regardless of their disease status  first or later remission or primary resistance   
class4	940	when information about sensitivity to prior therapy is unavailable  the presence before abmt of both high beta 2 microglobulin levels  greater than 3 mg l  and non igg isotype helped identify 9 among the 55 patients with a very poor prognosis  all 8 responders relapsed within 9 months  and 8 patients died within 15 months  
class4	940	by contrast  a 4 year projected survival rate of over 70  for the other patients  about 80  of this series  justifies further investigation of this novel treatment approach in comparison with standard dose regimens  
class4	940	our results indicate that marrow ablative therapy cannot be recommended for myeloma patients with resistant relapse or those with a combination of risk factors  advanced tumor burden  absence of igg isotype   
class4	940	the apparent lack of an adverse effect of even marked plasmacytosis in autografts  up to 30   emphasizes the need for better cytoreduction rather than bone marrow purging  
class4	941	induction of donor type chimerism in murine recipients of bone marrow allografts by different radiation regimens currently used in treatment of leukemia patients  
class4	941	three radiation protocols currently used in treatment of leukemia patients before bone marrow transplantation  bmt  were investigated in a murine model  c57bl 6    c3h hej  for bm allograft rejection  
class4	941	these include  a  a single dose of total body irradiation  8 5 gy tbi delivered at a dose rate of 0 2 gy min    b  fractionated tbi  12 gy administered in six fractions  2 gy twice a day in 3 days  delivered at a dose rate of 0 1 gy min  and  c  hyperfractionated tbi  14 4 gy administered in 12 fractions  1 2 gy three times a day in 3 days  delivered at a dose rate of 0 1 gy min   
class4	941	donor type chimerism 6 to 8 weeks after bmt and hematologic reconstitution on day 12 after bmt found in these groups were compared with results obtained in mice conditioned with 8 gy tbi delivered at a dose rate of 0 67 gy min  routinely used in this murine model  
class4	941	the results in both parameters showed a marked advantage for the single dose 8 5 gy tbi over all the other treatments  
class4	941	this advantage was found to be equivalent to three  to fourfold increment in the bm inoculum when compared with hyperfractionated radiation  which afforded the least favorable conditions for development of donor type chimerism  
class4	941	the fractionated radiation protocol was equivalent in its efficacy to results obtained in mice irradiated by single dose 8 gy tbi  both of which afforded a smaller but not significant advantage over the hyperfractionated protocol  
class4	941	this model was also used to test the effect of radiation dose rate on the development of donor type chimerism  
class4	941	a significant enhancement was found after an increase in dose rate from 0 1 to 0 7 gy min  
class4	941	further enhancement could be achieved when the dose rate was increased to 1 3 gy min  but survival at this high dose rate was reduced  
class4	941	these results demonstrated indirectly that dose rate affects the expression of host type pluripotent stem cells  the progeny of which appear 3 to 6 weeks after treatment with 8 gy tbi delivered at a dose rate of 0 1 gy min  but which are eradicated if radiation is delivered at a dose rate of 1 3 gy min  
class4	942	contamination of peripheral blood stem cell harvests by circulating neuroblastoma cells  
class4	942	peripheral blood stem cells  pbsc  are being used as one alternative to autologous marrow rescue for patients with neuroblastoma and other solid malignancies  
class4	942	some physicians prefer use of pbsc because less risk of tumor contamination is believed to exist  
class4	942	this hypothesis was evaluated by immunocytologic analysis of blood samples and concurrently drawn bone marrow  bm  samples and of pbsc harvests obtained from 31 patients with disseminated neuroblastoma  
class4	942	we found circulating neoplastic cells in 75  of specimens analyzed at diagnosis  in 36  during therapy  and in 14  of pbsc harvests  
class4	942	tumor cells in blood obtained during therapy did not appear until 3 months after the time of diagnosis  
class4	942	clearance of circulating neuroblastoma cells was documented after two courses of induction chemotherapy  
class4	942	six of 13 patients with minimal or no bm disease had positive blood specimens  
class4	942	we conclude that substantial risk of tumor contamination of pb harvests exists and recommend that induction chemotherapy be administered before hematopoietic progenitor cells are collected from blood  
class4	943	four and a half year follow up of women with dyskaryotic cervical smears  
class4	943	objective  to determine the proportion of women with mild or moderate dyskaryosis in cervical smears who  a  progress to cervical intraepithelial neoplasia grade iii or worse or  b  regress  
class4	943	design  four and a half year cytological follow up study of women with mild or moderate dyskaryosis in cervical smears  
class4	943	setting  666 women  mean age 28  sd 8  years  range 14 74  found to have borderline  mild  or moderate dyskaryosis on routine screening  
class4	943	results  45 women  6 8   had a cone biopsy recommended on the basis of an abnormal follow up smear  severe dyskaryosis suggestive of cervical intraepithelial neoplasia grade iii or invasive cancer   and in one patient cervical intraepithelial neoplasia grade iii was reported in a biopsy specimen after dilatation and curettage  
class4	943	life table analysis gave a 14  probability of a patient being recommended for a biopsy after four and a half years of follow up  95  confidence interval 12  to 15    
class4	943	there was a significant excess incidence of invasive cancer of the cervix in the series compared with the general population  five cases observed compared with less than 0 1 expected   
class4	943	157 patients  24   showed reversion to a normal cell pattern sustained in several smears over more than 18 months but a single negative smear was an unreliable indicator of apparent regression  
class4	943	having two successive smears showing mild dyskaryosis or a smear at any time showing moderate dyskaryosis was a significant predictor of a subsequent severely dyskaryotic smear  
class4	943	conclusions  women found to have mild or moderate dyskaryosis in cervical smears should be kept under regular surveillance  
class4	943	the optimum management of these patients  by cytology or colposcopy  needs to be determined by randomised controlled trials  
class4	944	distribution of bony metastases in prostatic carcinoma  
class4	944	fifty five prostate cancer and 55 breast cancer patients with positive bone scintigrams were studied  
class4	944	the pattern of spread in the axial skeleton and pelvis showed differences between the 2 groups  
class4	944	this difference was not related primarily to bone volume at the site of metastasis  
class4	944	the difference in distribution of bony metastases between breast and prostate is explained by our knowledge of batson s vertebral venous plexus  
class4	945	increased survival of patients with massive lymphadenopathy and prostate cancer  evidence of heterogeneous tumour behaviour  
class4	945	the survival of patients with prostate cancer and radiologically detectable lymph node enlargement has been studied prospectively over an 8 year period  
class4	945	computed tomography in 108 patients presenting with symptoms  signs or biochemical results suggesting lymphatic spread revealed pelvic or abdominal node masses in 60 patients  in 29  48    the masses measured more than 4 cm and the maximum node diameter was 15 cm  
class4	945	two thirds of patients had advanced  t3 t4  tumour stage  
class4	945	following treatment  actuarial survival in all 60 patients with nodal enlargement was 40  at 5 years  
class4	945	within this group  survival in 22 patients with lymphadenopathy but negative bone scans at diagnosis was significantly better than that of 38 patients with both node and bone disease  70  vs 20  at 5 years   
class4	945	this improvement was related both to an apparent inability of certain tumours initially to progress and seed within bone and to a marked sensitivity of the node masses to subsequent hormonal manipulation  
class4	945	primary tumour grade was proportionally similar in both groups  
class4	945	unexpectedly  6 of the 38 patients with combined disease obtained a complete remission after treatment  
class4	945	the reason for this heterogeneous biological behaviour remains unclear  but these observations underscore the importance of vigorous treatment in all patients with advanced lymph node disease  
class4	946	persistent carcinoma in situ of the testis after chemotherapy for advanced testicular germ cell tumours  
class4	946	the chemosensitivity of testicular carcinoma in situ  cis  was analysed in 25 testes excised 10 weeks to 4 5 years following platinum based chemotherapy  
class4	946	cis was present in 8 of the 23 evaluable cases  35    in 5 of which the lesion coexisted with invasive germ cell tumour  
class4	946	it is concluded that cis may persist or recur after chemotherapy  
class4	946	this has implications for occult presentation of metastatic germ cell tumours and also for the management of the contralateral testis in patients with testicular germ cell tumours  
class4	947	the importance of prognostic factors in the individual treatment of patients with disseminated germ cell tumours  
class4	947	following chemotherapy for disseminated testicular cancer  55 patients underwent surgery because of residual tumour  
class4	947	the histological findings were viable tumour in 12 patients  mature teratoma in 12 and fibrosis and or necrosis in 31  
class4	947	retroperitoneal abdominal masses were evaluated radiographically before and after chemotherapy  
class4	947	the reduction in size of these masses after chemotherapy appeared to have prognostic significance  
class4	947	a decrease of more than 70  was always associated with fibrosis  
class4	947	a residual mass over 50 mm indicated viable tumour or mature teratoma  
class4	947	seminoma or embryonal carcinoma was more likely to result in fibrosis necrosis in the resected tissue  
class4	947	both the indiana and the eortc classification models can be used for prognosis  
class4	947	radiographic measurements before and after chemotherapy are of considerable prognostic significance  
class4	947	these objective indicators help in planning treatment and so diminish the side effects of therapy and maintain or even increase the high cure rate in disseminated testicular cancer  
class4	948	bile acids and the increased risk of colorectal tumours after truncal vagotomy  
class4	948	an association between colorectal cancer and previous peptic ulcer surgery is reported  
class4	948	in a prospective screening study  100 asymptomatic patients  80 men and 20 women  who had undergone truncal vagotomy at least 10 years previously were investigated by barium enema  colonoscopy and gallbladder ultrasonography  
class4	948	control data were obtained from forensic autopsy subjects  
class4	948	the incidence of neoplasms greater than or equal to 1 0 cm in the vagotomized group was 14 per cent  11 adenomas  3 carcinomas  and 3 per cent in controls  p   0 01   
class4	948	duodenal bile obtained at endoscopy from 21 vagotomized patients with normal gallbladders and from 21 control patients undergoing endoscopy was analysed by high performance liquid chromatography  
class4	948	the mean percentage of cholic  ca   chenodeoxycholic  cdca   deoxycholic  dca  and lithocholic  lca  acids in the bile of vagotomized patients was 32 3  45 6  20 7 and 1 4 per cent respectively compared with 45 3  36 2  17 9 and 0 7 per cent respectively in controls  
class4	948	the increased proportions of cdca and lca and decreased proportions of ca in the duodenal bile of vagotomized patients were significant  p less than 0 001  p   0 02  p   0 007   
class4	948	abnormalities in bile acid metabolism may help to explain the increased risk of colorectal neoplasia 10 years after truncal vagotomy  
class4	949	urinary tissue factor activity in colorectal disease  
class4	949	procoagulant activity  pca  in normal urine has been recognized for over 50 years  
class4	949	although tissue factor  tf  is produced by certain tumours  and is increased in both tumour associated macrophages and blood monocytes  the possibility that it might also be increased in urine has not been studied in patients with cancer  
class4	949	we have measured urinary pca in hospital controls without inflammatory or neoplastic disease  n   79   in patients with rheumatoid arthritis  n   8   inflammatory bowel disease  n   19   colorectal cancer  n   70  and in patients undergoing colonoscopy  n   50   
class4	949	urinary pca was higher  p less than 0 001  in patients with colorectal cancer and inflammatory bowel disease than controls or patients with rheumatoid arthritis  
class4	949	fourteen  88 per cent  out of 16 colonoscopy patients subsequently found to have carcinoma or inflammatory bowel disease had levels above the control upper quartile  compared with 8  24 per cent  out of 34 with normal colonoscopy  p less than 0 001   
class4	949	tf inhibitors confirmed the nature of the pca and western blotting studies indicated a urinary tf molecular weight of approximately 38 000  
class4	949	these studies provide further evidence of abnormal haemostasis in malignancy and suggest that determination of urinary tf may provide a useful screening test in patients undergoing colonoscopy  
class4	950	malignant left sided large bowel obstruction managed by subtotal total colectomy  
class4	950	of 60 patients presenting with acute obstructing carcinoma of the left colon  49 underwent immediate resection either by radical subtotal total colectomy  31 patients  group i  or by radical segmental resection  18 patients  group ii  of whom three had immediate anastomosis after on table bowel irrigation and 15 had a planned staged procedure  
class4	950	the operative mortality rate was 3 per cent in group i and 11 per cent in group ii  not a statistically significant difference   
class4	950	however  substantial differences were found for major morbidity  6 versus 44 per cent in groups i and ii respectively  p less than 0 01  and mean length of hospital stay  17 days in group i versus 35 days in group ii  p less than 0 05   
class4	950	all three patients who had on table lavage developed anastomotic leaks which necessitated a second operation to form a stoma  
class4	950	six patients  19 per cent  in group i required antidiarrhoeal medication in the immediate postoperative period  
class4	950	however  subsequent improvement in stool frequency was noted in all patients  
class4	950	it is concluded that subtotal total colectomy is an acceptable means of managing patients with obstructing carcinoma of the left colon in that it is associated with a low morbidity and mortality rate and good functional results  
class4	951	blood transfusion and recurrence of colorectal cancer  the role of platelet derived growth factors  
class4	951	efforts to explain the possible effects of blood transfusion on the recurrence of colorectal cancer have been based entirely on the immunosuppressive effects of blood transfusion  
class4	951	however  the relationship between solid tumour development and the immune system is inconclusive  
class4	951	we have investigated an alternative mechanism involving the potential role of growth factors in this phenomenon  
class4	951	using a human fibroblast   125i deoxyuridine uptake mitogenesis assay  the relative amounts of growth factor in the plasma of stored blood were measured  
class4	951	there was a progressive increase in mitogenesis from day 0  n   6  to day 28  n   6  p less than 0 001  mann whitney u test   
class4	951	the effect of growth factors on the development of liver and intraperitoneal metastases was studied in hooded lister rats  
class4	951	following an intraportal injection of 10 5  mc28 tumour cells  the experimental group  n   25  received 2 ml of syngeneic serum intravenously for 4 days  
class4	951	likewise  colonic anastomoses were performed on omentectomized rats and the peritoneal cavity seeded with 10 3  cells  
class4	951	the experimental groups  n   20  received either 2 ml serum intravenously repeatedly or 3 ml serum intraperitoneally  n   19   
class4	951	there was no significant increase in liver metastases or peritoneal disease following intravenous infusion of serum but serum delivered intraperitoneally resulted in a significant increase in tumour from 22 per cent in the controls to 89 per cent in the study group  p less than 0 01   
class4	951	growth factors released from platelets following blood loss into the peritoneal cavity may be important in enhancing local recurrence of colorectal cancer  
class4	952	laser recanalization versus endoscopic intubation in the palliation of malignant dysphagia  
class4	952	forty patients with widely disseminated or locally advanced malignant obstruction of the middle or lower third of the oesophagus underwent endoscopic treatment by either ndyag laser recanalization or intubation  
class4	952	groups were matched on the basis of tumour location and swallowing was graded clinically before and after treatment  
class4	952	technical success was achieved in 17 of 20 laser treated and 18 of 20 intubated patients  
class4	952	pretreatment swallowing ability  histology  tumour location and overall length were unrelated to functional outcome in both groups  
class4	952	however  circumferential tumour length identified endoscopically strongly influenced the quality of swallowing after laser recanalization  
class4	952	patients with excellent swallowing quality  n   7  had significantly shorter circumferential tumour lengths  3 1 1 0  cm  than those with poorer quality swallowing  n   10   6 3 1 6 cm   p less than 0 001   
class4	952	both methods of treatment had low complication rates and there was one death in the series in the laser treated group  
class4	952	laser recanalization provides a better functional result than intubation for short  less than 4 cm  circumferential tumour  
class4	952	intubation at a single session seems more appropriate than repeated laser therapy when tumour length exceeds 4 cm  
class4	953	aetiology of pancreatic cancer 
class4	953	curative surgery is possible in only a small minority of patients with pancreatic cancer and  to date  responses to chemotherapy and radiotherapy have been disappointing  
class4	953	to make any impact on the incidence of the disease a clearer understanding of its aetiology is required  
class4	953	this review explores present knowledge of the aetiology and epidemiology of pancreatic cancer  
class4	954	premorphological metabolic changes in human breast carcinogenesis  
class4	954	malignant breast tissue is characterized by morphological and metabolic changes when compared with normal breast tissue  
class4	954	in this study  the cytochemical measurement of glucose 6 phosphate dehydrogenase  g6pd  activity was used to detect abnormal metabolism in breast tissue and to determine whether abnormal metabolic activity precedes morphological change during human breast carcinogenesis  
class4	954	normal and benign breast tissue  morphologically normal tissue from cancer containing breasts  and malignant breast tissue were studied  
class4	954	in malignant tissue  mean s e m   g6pd activity was significantly increased when compared with normal and benign tissue  9 69 2 3  versus 27 02 1 7  mean integrated extinction  mie  x 100  p less than 0 01   
class4	954	g6pd activity was increased in morphologically normal tissue from cancer containing breasts when compared with normal and benign breast tissue from breasts with no known cancer  27 02 1 7  versus 18 42 2 6  mie x 100  p less than 0 05   
class4	954	these findings suggest that metabolic abnormalities precede morphological changes in breast carcinogenesis  
class4	954	abnormal metabolism can be detected widely within a cancer containing breast  
class4	954	the detection of such abnormality may prove helpful in identifying patients at high risk of developing breast cancer  
class4	955	a phase i study of a new cisplatin derivative for hematologic malignancies  
class4	955	dwa2114r  dwa  is a new derivative of platin compounds that is currently being used in phase ii studies of solid tumors in japan  
class4	955	the dose limiting factor is myelotoxicity with mild extramedullary toxicity  
class4	955	this phase i study consisted of adult patients with relapsed hematologic malignancies  
class4	955	eight patients received a total of 15 treatment courses of dwa  
class4	955	the starting dose was 800 mg m2 over 24 hours by continuous infusion  
class4	955	the dose was first increased to 1200 mg m2 and then to 1600 mg m2  
class4	955	clinical toxicity and urinary excretion studies of dwa suggested that 1200 mg m2 d for successive days would be the best type of administration  
class4	955	when 1200 mg m2 d was given for 5 days  grade 2 to 3 diarrhea and nausea and vomiting were encountered requiring parenteral fluids and nutritional support  
class4	955	this suggested that the dose limiting factor with this schedule was gastrointestinal toxicity  
class4	955	myelotoxicity was severe  as expected  but tolerable  
class4	955	one of the five patients with acute nonlymphocytic leukemia  anll  entered into complete remission and one patient with chronic myelogenous leukemia  cml  in crisis returned to the chronic phase  
class4	955	a phase ii trial of dwa is warranted for hematologic malignancies  especially in myeloid diseases  
class4	956	toxicity of high dose cytosine arabinoside in the treatment of advanced childhood tumors resistant to conventional therapy  a pediatric oncology group study  
class4	956	experience with high dose cytosine arabinoside  hdac  in pediatric solid tumors is limited  
class4	956	sixteen children with solid tumors resistant to conventional therapies were registered in a pilot pediatric oncology group  pog  study that required the administration of hdac at 3 g m2 every 12 hours for four doses  
class4	956	there were four cases of rhabdomyosarcoma  two cases of fibrosarcoma  four cases of neuroblastoma  and one case each of germ cell tumor  wilm s tumor  retinoblastoma  hepatocellular carcinoma  ewing s sarcoma  and burkitt s lymphoma  
class4	956	all eligible patients had advanced diseases and had previously received extensive chemotherapy  
class4	956	thirteen patients received one course of hdac and three patients received two courses of hdac  
class4	956	due to prior treatments  patients had less than normal marrow reserves  
class4	956	short term toxicity included nausea  vomiting  suppression of hemopoiesis  drug fever  and increased blood urea nitrogen  bun   creatinine  and liver enzymes  
class4	956	all evaluable patients recovered from their toxicities  
class4	956	there were no drug related deaths  
class4	956	none of the patients had neurologic problems  including the only patient with prior irradiation to the skull  
class4	956	with the above schedule  hdac appears to have manageable toxicity  
class4	957	endoscopic screening of early esophageal cancer with the lugol dye method in patients with head and neck cancers  
class4	957	the poor prognosis for esophageal cancer could be improved if lesions were detected at an early stage  
class4	957	to detect early esophageal cancer  endoscopic screening of the esophagus with the lugol dye method was performed in patients with head and neck cancers who were asymptomatic but regarded as being at high risk for synchronous or metachronous esophageal cancer  
class4	957	of 178 patients screened  9 had esophageal cancer  5 1    
class4	957	eight of these patients  89   were at early stages with no lymph node metastasis  
class4	957	most of the lesions  9 of 13 lesions  were not detectable by barium studies or ordinary endoscopic study  
class4	957	the epidemiologic statistical analysis of the patients confirmed that they had a significantly high observed and expected number  o e  ratio  39 7  p less than 0 001   
class4	957	these results demonstrate the value of endoscopic screening of the esophagus with the lugol dye method in patients with head and neck cancers and imply that endoscopic screening with the lugol dye method may be useful for detecting early esophageal cancer in individuals at risk for other causes  
class4	958	primary chemotherapy with or without radiation therapy and or surgery for children with localized sarcoma of the bladder  prostate  vagina  uterus  and cervix  a comparison of the results in intergroup rhabdomyosarcoma studies i and ii  
class4	958	a major objective of the second intergroup rhabdomyosarcoma study  irs ii   1978 to 1984  was to preserve the bladder without compromising the survival of children with localized genitourinary sarcomas arising in or near the bladder  
class4	958	after incisional biopsy  109 patients with localized  gross residual sarcoma of the prostate  43 patients   bladder  43 patients   vagina  20 patients   or cervix uterine corpus  3 patients  were treated with vincristine  dactinomycin  and cyclophosphamide  vac   
class4	958	after two to four drug courses  radiation therapy and or surgery were used to treat patients with residual or recurrent tumor  
class4	958	the 3 year survival rate of patients treated on this primary chemotherapy regimen  70   was similar to that of the primary surgery regimens of irs i  78   p   0 46   but the 3 year disease free survival rate was significantly inferior  52  versus 70   p   0 02   
class4	958	since the irs ii encouraged bladder preservation at the onset of therapy  the percentage of patients with bladder and prostate tumors who retained the bladder was initially substantially higher in irs ii  97   than in irs i  58    
class4	958	however  the percentages of 95 patients with bladder prostate  bp  tumors in irs ii who retained the bladder and were alive at 2 and 3 years after starting treatment were only 33  and 22   respectively  compared with 26  and 23   respectively  in the 66 patients with bp tumors in irs i  
class4	958	thus  sequential treatment with primary chemotherapy  followed by radiation therapy and or surgery as given in irs ii  failed to improve the eventual bladder salvage rate  
class4	959	a phase i study of 4  0 tetrahydropyranyladriamycin  clinical pharmacology and pharmacokinetics  
class4	959	a phase i study of intravenous  iv  bolus 4  0 tetrahydropyranyladriamycin  pirarubicin  was done in 55 patients in good performance status with refractory tumors  
class4	959	twenty six had minimal prior therapy  good risk   23 had extensive prior therapy  poor risk   and six had renal and or hepatic dysfunction  
class4	959	a total of 167 courses at doses of 15 to 70 mg m2 were evaluable  
class4	959	maximum tolerated dose in good risk patients was 70 mg m2  and in poor risk patients  60 mg m2  
class4	959	the dose limiting toxic effect was transient noncumulative granulocytopenia  
class4	959	granulocyte nadir was on day 14  range  4 22   
class4	959	less frequent toxic effects included thrombocytopenia  anemia  nausea  mild alopecia  phlebitis  and mucositis  
class4	959	myelosuppression was more in patients with hepatic dysfunction  
class4	959	pharmacokinetic analyses in 21 patients revealed pirarubicin plasma t 1 2 alpha      se  of 2 5     0 85 minutes  t beta 1 2 of 25 6     6 5 minutes  and t 1 2 gamma of 23 6     7 6 hours  
class4	959	the area under the curve was 537     149 ng ml x hours  volume of distribution  vd  3504     644 l m2  and total clearance  clt  was 204   39 3 l hour m2  
class4	959	adriamycinol  doxorubicin  adriamycinone  and tetrahydropyranyladriamycinol were the metabolites detected in plasma and the amount of doxorubicin was less than or equal to 10  of the total metabolites  
class4	959	urinary excretion of pirarubicin in the first 24 hours was less than or equal to 10   
class4	959	activity was noted in mesothelioma  leiomyosarcoma  and basal cell carcinoma  
class4	959	the recommended starting dose for phase ii trials is 60 mg m2 iv bolus every 3 weeks  
class4	960	successful treatment of metastatic thymic carcinoma with cisplatin  vinblastine  bleomycin  and etoposide chemotherapy  
class4	960	thymic carcinomas are rare malignant neoplasms of the thymic epithelium that are distinguished from the malignant thymomas by the presence of cytologic atypia  
class4	960	thymic carcinomas may metastasize outside of the thorax and are associated with a very poor prognosis  
class4	960	complete responses of thymic carcinoma to chemotherapy alone have not been reported  
class4	960	a 21 year old man with metastatic undifferentiated carcinoma of probable thymic origin is presented who achieved a pathologic complete response with cisplatin  vinblastine  and bleomycin chemotherapy  
class4	960	additional consolidative chemotherapy with cisplatin and etoposide was administered  
class4	960	the patient remains disease free 5 years after diagnosis  
class4	960	cisplatin  vinblastine  and bleomycin chemotherapy appears to have significant activity against thymic carcinoma  
class4	961	testicular relapse in children with acute nonlymphoblastic leukemia  
class4	961	the clinical course and other distinctive features of five children who developed a testicular relapse 4 months to 25 months after the diagnosis of acute nonlymphoblastic leukemia  anll  are described  
class4	961	the chief presenting feature at relapse was painless testicular enlargement  as is also seen in children with acute lymphoblastic leukemia who relapse in the testes  
class4	961	by french american british convention  the malignant cells were classified as m4  myelomonoblastic  in four cases and m2  myeloblastic  in one  
class4	961	all children received a course of multiagent reinduction chemotherapy and all but one received local irradiation to the testes  
class4	961	only one of these children  whose relapse was a late event after elective cessation of therapy  is a long term survivor  
class4	961	a comparison with six previously published cases shows similar clinical characteristics and outcome  
class4	961	given the poor responses of such patients to conventional treatment  it seems worthwhile to consider the use of intensive reinduction chemotherapy with concomitant bilateral testicular irradiation followed by remission intensification and an autologous or allogenic marrow transplant  
class4	962	structural and ultrastructural study of the ovary in childhood leukemia after successful treatment  
class4	962	ovarian biopsy specimens from ten girls  three postmenarcheal  who had undergone antiblastic treatment for acute lymphoblastic leukemia  all  and were in complete remission were examined by light microscope  
class4	962	the biopsy specimens from four of these patients  three postmenarcheal  were also observed by electron microscope  
class4	962	the structural and ultrastructural analysis showed a reduction in the number of follicles which were otherwise normal  
class4	962	no follicles were found in the thin sections from two of the three postmenarcheal girls  whereas normal follicles were observed in the third  
class4	962	the cortical stroma showed moderate to severe signs of fibrosis and changes of capillaries  
class4	962	all of these alterations were more evident in patients where all was diagnosed at an older age and this finding suggests that they are at a higher risk for low fertility or early menopause  
class4	963	surgical treatment of brain metastases in malignant melanoma  
class4	963	the authors report the results of a retrospective review of 13 patients who underwent 19 craniotomies for resection of metastatic malignant melanoma at the university of colorado  denver  co  between 1983 and 1989  
class4	963	there was preoperative evidence of extracranial disease in 11 patients  
class4	963	eight patients had more than one intracranial metastasis at operation  
class4	963	intraoperative ultrasound was used in 18 of the 19 craniotomies to minimize surgical trauma to the brain  
class4	963	the 30 day mortality was zero  
class4	963	the 30 day morbidity was minimal  
class4	963	no patient acquired a new neurologic deficit as a result of surgery  
class4	963	all patients regained at least their preoperative level of functioning  
class4	963	six of the patients who were living at the time of review have been followed for 4 to 25 months  median  7 5 months   
class4	963	the seven patients who were dead at the time of review survived 4 to 18 months  median  10 months   
class4	963	these results compare favorably with the survival of untreated patients with metastatic melanoma to the brain  median  1 month   patients treated with radiation therapy alone  median  2 4 months   and those treated with chemotherapy alone  median  2 4 months   
class4	963	the excision of metastatic melanoma from the brain  although not curative  may increase survival in patients with this problem with little morbidity and mortality even in the presence of other metastases  
class4	964	expression of major histocompatibility complex class ii antigens and interleukin 1 by epithelial cells of warthin s tumor  
class4	964	the immunoreactivity for class ii antigens of the major histocompatibility complex and interleukin 1  il 1  in warthin s tumor  wt  cells was studied  
class4	964	in addition to macrophages  dendritic cells  and capillary endothelia  the luminal tumor cells and some keratinocytes in the metaplastic squamous foci exhibited immunoreactivity for both class ii antigens and il 1  
class4	964	the distribution of the class ii antigens in the luminal tumor cells was limited to their basolateral membrane  
class4	964	these data  together with previous findings  strongly suggest that the luminal tumor cells of wt introduce the luminal antigen to the underlying lymphoid tissue and  thus  act as an antigen presenting cell  
class4	965	loss of expression of blood group antigen h is associated with cellular invasion and spread of oral squamous cell carcinomas  
class4	965	membrane bound carbohydrates may influence the metastatic behavior of cancer cells  
class4	965	forty two squamous cell carcinomas  scc  of the buccal and maxillary alveolar mucosa were studied retrospectively using a monoclonal antibody  be2  that reacts with blood group h  type 2 chain  structure and an immunoperoxidase  avidin biotin peroxidase complex  staining technique  
class4	965	h antigen staining within the entire tumor did not correlate with the stage of the tumor  i e   tumor spread  
class4	965	however  loss of staining within the most invasive sites of the tumors correlated significantly with the stage of tumor development and histologic grade of malignancy  
class4	965	these findings support the view that features regarding the cells of deeper parts of the carcinomas are very important for the clinical behavior of the tumors and that loss of h antigen expression is related to the stage of the tumor and invasion of carcinoma cells  
class4	966	occurrence of beta hexachlorocyclohexane in breast cancer patients  
class4	966	the residues of polycyclic aromatic hydrocarbon  pah  and neutral organochlorine compounds in breast fat of 44 breast cancer patients and 33 women free of cancer were determined  
class4	966	no statistically significant differences appeared between the two comparison groups with regard to occurrence of pah compounds  
class4	966	of the neutral organochlorine compounds  residues of beta hexachlorocyclohexane  hch  were found more frequently in breast cancer patients  
class4	966	after adjusting for age and parity by stepwise logistic regression  beta hch remained a significant risk factor of breast cancer  
class4	966	using a cutoff point for the residue level of beta hch in breast adipose tissue of more than 0 1 mg kg fat  the odds ratio was 10 51  95  ci  2 00 55 26   
class4	967	cell lineage markers in human pancreatic cancer  
class4	967	the normal pancreas consists of three major cell types or lineages that share a common embryologic origin from pluripotent endodermal precursors  
class4	967	the type of cell that undergoes neoplastic transformation to form a pancreatic carcinoma is controversial and may influence the phenotype and biologic behavior of the tumor  
class4	967	in this study  immunohistologic techniques were used to determine the cell lineage differentiation expressed in 29 primary exocrine pancreatic adenocarcinomas  five metastatic exocrine pancreatic adenocarcinomas  and five islet cell neoplasma  
class4	967	specimens of normal pancreas and chronic pancreatitis were used for comparison  
class4	967	the cell lineage markers consisted of monoclonal and polyclonal antibodies against trypsin and lipase  acinar cells   secretory component  carbonic anhydrase ii  and pancreatic cancer mucin span 1  ductal cells   and chromogranin a and somatostatin  islet cells   
class4	967	the expression of carcinoembryonic antigen  cea  and lysozyme were also determined  
class4	967	this collection of markers allowed the differentiation between acinar  ductal  and islet cells of normal pancreas and chronic pancreatitis specimens  
class4	967	the expression of cell lineage markers in islet cell tumors was homogeneous and restricted to chromogranin a  
class4	967	in contrast  the expression of these markers in primary and metastatic exocrine pancreatic adenocarcinomas was variable  
class4	967	reactivity with monoclonal anti cea was absent in normal pancreas  and was present in 83  of chronic pancreatitis specimens as well as 90  of exocrine pancreatic adenocarcinomas  
class4	967	in addition  lysozyme reactivity was absent in normal pancreas  however  lysozyme was expressed in one case of chronic pancreatitis  17 cases of primary carcinoma  and three cases of metastatic carcinoma  
class4	967	these findings support the concept that the original transformed cell type in many pancreatic exocrine carcinomas resemble endodermal  stem cells  that retain the capability of differentiation along more than one cell lineage pathway  
class4	968	expression of pancreatic secretory trypsin inhibitor gene in human colorectal tumor  
class4	968	expression of pancreatic secretory trypsin inhibitor  psti  gene was examined by northern blotting analyses in 31 human colorectal tumors that included two benign adenomas and 26 adenocarcinomas  
class4	968	among the total of 28 cases which proved to be adequate for mrna analyses  all but one showed the expression of psti at various levels  
class4	968	in contrast  psti expression was not detected in two malignant lymphomas of the rectum  
class4	968	the level of psti expression was not correlated with the patient s age  sex  tumor location or size  stage of differentiation  lymph node metastasis  or progression stage  
class4	968	some colorectal adenocarcinomas were also shown to express genes that can hybridize with human trypsinogen cdna probe  
class4	968	it looks as though in these tumors  a protease s  and its inhibitor are produced simultaneously as part of a cellular self defense mechanism  
class4	969	an analysis of abnormalities of the retinoblastoma gene in human ovarian and endometrial carcinoma  
class4	969	the altered expression of the human retinoblastoma  rb  gene has been demonstrated to play an important role in the pathogenesis of rb and other tumors  
class4	969	to determine whether the rb gene might be involved in the pathogenesis of human ovarian and endometrial cancer  dna from 24 human ovarian tumors  3 normal ovaries  3 endometrial carcinomas  and 1 endometrial hyperplasia was examined with an rb complementary dna probe  
class4	969	evidence for homozygous deletion of the rb gene was observed in only one specimen  
class4	969	interestingly  the specimen was an endometrioid tumor of the ovary of low malignant potential  lmp   
class4	969	this patient experienced rapid progression of the tumor and died 8 months after diagnosis  
class4	969	abnormalities of the rb gene may be involved in the aggressive biologic behavior of certain forms of ovarian carcinoma  particularly those of lmp  
class4	970	the physical state of human papillomavirus 16 dna in cervical carcinoma and cervical intraepithelial neoplasia  
class4	970	cervical carcinomas and cervical intraepithelial neoplasias  cin  were analyzed for the presence of human papillomavirus  hpv  dna using southern blot hybridization  
class4	970	of the five hpv types examined  hpv types 6  11  16  18  and 33   hpv 16 dna was detected most frequently  
class4	970	in most hpv 16 positive carcinomas examined  hpv 16 dna was present in an integrated state in cellular dna with or without the coexistence of episomal species  
class4	970	in one case  however  only episomal species were detected  
class4	970	among seven cases of hpv 16 positive cin  four contained hpv 16 dna only in the episomal state and the rest contained hpv 16 dna only in the integrated state  but the coexistence of both states was not found  
class4	970	these results suggest that the integration of hpv 16 dna is not necessary for cells to become malignant  although it is frequently associated with malignant cells  
class4	971	the world health organization s histologic classification of gastrointestinal tumors  a commentary on the second edition  
class4	971	the world health organization s  who  histologic classification of gastrointestinal tumors has been revised  
class4	971	although the general basis of classification and the overall outline remain similar to the first edition  advances in the last decade justified changes in classifying certain entities  among them were malignant lymphomas  endocrine tumors  and dysplasias  
class4	971	several newly recognized entities have also been added  
class4	972	distribution of immunoglobulins and secretory component in gastric cancer of the aged  
class4	972	the secretory immune system plays an important role in the local humoral immunity of the gastrointestinal tract  
class4	972	in order to evaluate humoral immunity in gastric cancer  distribution of immunoglobulins  ig  and secretory component was immunohistochemically studied in 74 early and 15 advanced primary gastric cancers  
class4	972	in non cancerous gastric mucosa  iga and igm  and secretory component were mainly identified in the cytoplasm of the intestinal metaplasia  
class4	972	in early gastric cancer of well differentiated type  the localization of iga and igm  and secretory component was similar to that of intestinal metaplasia  
class4	972	in advanced gastric cancer  they were faintly observed and showed low positivity  
class4	972	the number of ig containing cells infiltrating cancerous stroma was enumerated  
class4	972	immunoglobulin a containing cells were dominant in the stroma of early gastric cancer  
class4	972	on the other hand  there were few ig containing cells in the stroma of advanced gastric cancer  and the number of iga containing and igm containing cells was also decreased  
class4	972	these results suggest that local humoral immunity is suppressed in gastric cancer  especially in advanced gastric cancer  
class4	973	growth and spread of hepatocellular carcinoma  a review of 240 consecutive autopsy cases  
class4	973	all 240 consecutive cases of hepatocellular carcinoma  hcc  that underwent autopsy at the national cancer center hospital  tokyo  japan  between september 1962 and august 1986 were reviewed  
class4	973	among these cases  162  for which photographs of cut surfaces of the primary tumors were available  were grossly classified using a combination of both eggel s classification and our own into three major types  i e   nodular  massive  and diffuse as described by eggel  eggel h  beitr pathol anat 1901  30 506 604   and three subgroups of nodular type  i e   single nodular type  type 1   single nodular type with extranodular growth  type 2   and contiguous multinodular type  type 3  by our classification  kanai t et al   cancer 1987  60 810 819   
class4	973	seventy eight cases were classified as nodular type  comprising seven cases of type 1  61 cases of type 2  and ten cases of type 3  
class4	973	sixty seven and 17 cases were classified as massive and diffuse type  respectively  
class4	973	of the 78 nodular type tumors  59 measured less than 10 cm  whereas 64 of 67 massive type tumors were 10 cm or more in size  
class4	973	the incidence of intrahepatic and extrahepatic tumor spread of hcc was significantly higher for tumors measuring more than 5 cm  
class4	973	as to the relationship between macroscopic type and tumor spread  the frequency of spread was lowest for type 1 tumors  and high for the other types  
class4	973	intrahepatic metastasis was detected in 28 6  of type 1  93 4  of type 2  100  of type 3  and 98 5  of massive type tumors  
class4	973	lymph node metastasis was detected in 14 3  of type 1  24 6  of type 2  70  of type 3  38 8  of massive type and 52 9  of diffuse type tumors  
class4	973	hematogenous extrahepatic metastasis was detected in 14 3  of type 1  47 5  of type 2  70  of type 3  74 6  of massive type and 82 4  of diffuse type tumors  
class4	973	it appears that not only primary tumor size but also its macroscopic type has an important influence on the growth and spread of hcc  
class4	974	dna analysis of multiple synchronous renal cell carcinomas  
class4	974	the authors used retrospective quantitative dna analysis to study interrelationships between multiple synchronous renal cell carcinomas in seven patients  
class4	974	dna content was determined by image analysis on feulgen stained nuclear smears prepared from multiple paraffin blocks from each tumor  
class4	974	tumors were unilateral in four cases and bilateral in three  
class4	974	ten tumors had homogeneous  and four heterogeneous dna stemlines  
class4	974	intertumoral heterogeneity in four cases suggested multifocal origin  
class4	974	identical dna aneuploid indices in bilateral tumors in one case suggested metastasis from a solitary origin  
class4	974	abnormal dna content and heterogeneous populations began to appear in the size range 2 0 to 5 0 cm  
class4	974	all tumors over 5 0 cm contained nondiploid populations  
class4	974	although the interrelationships between these multiple synchronous neoplasms are not entirely clear  the dna analysis suggests that the occurrence of nondiploid stemlines and heterogeneous dna content may parallel both tumor growth and more aggressive behavior  
class4	975	giant cell tumor of bone  a clinicopathologic and dna flow cytometric analysis  
class4	975	flow cytometric dna analysis was performed on 60 cases of giant cell tumor of bone and the results were correlated with the clinicopathologic features  
class4	975	tumors studied were from 31 men and 29 women whose ages ranged from 18 to 62 years  median  29 years   
class4	975	the most common sites were the distal end of the femur and proximal end of the tibia  accounting for 75  of the lesions  
class4	975	treatment consisted of resection in 29 patients  48    curettage with bone chip packing in 15 patients  25    or curettage with cement packing in 16 patients  27    
class4	975	ten patients  17   had local relapse within 1 to 3 years  and two had lung metastases  
class4	975	forty two patients  70   exhibited tumors with a diploid dna content  16 aneuploid  27    and two tetraploid  3    
class4	975	six  37 5   of the aneuploid patients had relapses  one of those had been treated by resection of the tumor and five by curettage  
class4	975	of the remaining ten  62 5   unrelapsed aneuploid patients  nine had been treated by resection of the tumor and one by curettage  
class4	975	four of the 42 diploid patients  9 5   had relapses  all had been treated by curettage of the tumor  
class4	975	the two tetraploid tumors were treated by resection and none relapsed  
class4	975	histologic parameters did not correlate with relapse rate or dna pattern  
class4	975	although relapse was more common among aneuploid tumors  our study shows that this appears to be influenced by the treatment modality rather than the ploidy status  
class4	975	based on this study the dna analysis of giant cell tumor of bone has a limited utility for predicting the tumor s biologic behavior  
class4	976	hyperthermia alone in the treatment of recurrences of malignant tumors  experience with 60 lesions  
class4	976	localized hyperthermia alone has been used for the treatment of cancer recurrences in which previous conventional therapies have failed  
class4	976	since 1983 and 1988  57 patients with 60 lesions have been heated by means of a microwave and radiofrequency system  
class4	976	treatment protocol provided 45 minutes of heating at the intratumor temperature of at least 42 degrees c  twice a week  for a total number of six  eight  or ten heating sessions  
class4	976	invasive intratumor thermometry was performed for all lesions  
class4	976	complete response  cr  was obtained in ten cases  16 6   and partial response  pr  in 14  23 4    
class4	976	higher rates of cr were observed in the chest wall  38 5   compared with the head and neck area  11 4    trunk  10    and limbs  none   
class4	976	adenocarcinoma was the most responsive histologic type  40    
class4	976	squamous cells carcinoma had 7 7  cr  
class4	976	the only case of undifferentiated carcinoma showed cr  there were none on five sarcomas  
class4	976	long term local control  24 months  was approximately 7   
class4	976	the multivariate analysis showed the statistical significance of the histologic variety  adenocarcinoma versus others  p less than 0 0001   
class4	976	side effects and complications of the treatment were minimal  
class4	977	effectiveness of periodic checkup by ultrasonography for the early diagnosis of hepatocellular carcinoma  
class4	977	periodic checkup by ultrasonography was conducted on patients with chronic liver diseases for early detection of hepatocellular carcinoma  
class4	977	in 19 months  a total of 2004 examinations were performed on a total of 660 cases  179 cases with liver cirrhosis in the compensatory stage  younger than 70 years  481 cases with chronic hepatitis  aged 40 to 70 years for men and 50 to 70 years for women   
class4	977	of the 660 cases  22 hcc cases  3 3   were detected and finally diagnosed by angiography and or histologic examination  
class4	977	four of those cases  18   had a single nodule smaller than 1 cm in diameter  and 11 cases  50   had a single nodule smaller than 2 cm  
class4	977	surgical resection was performed on 12 cases  55    
class4	977	in comparison with the control group  83 hcc cases not receiving any periodic checkup   the frequency of small liver cancer and the surgical resection rate in the study group were significantly higher  
class4	977	this examination system by periodic ultrasonography checkup of patients with chronic hepatic diseases was effective for early detection and permitted aggressive therapy of hepatocellular carcinoma  
class4	978	clear cell adenocarcinoma of the lower genital tract  correlation of mother s recall of diethylstilbestrol history with obstetrical records  
class4	978	the written obstetric records of maternal exposure to diethylstilbestrol  des  were used as a criterion standard and compared with the des exposure history recalled by mothers of women with vaginal  cervical  or indeterminable vaginal exocervical clear cell adenocarcinoma  
class4	978	among cervical cases  the sensitivity of maternal recall was 50   n   2   and its specificity was 100   
class4	978	among vaginal and vaginal exocervical cases  this sensitivity was 72   specificity was 60   and the majority of these mothers who said they did not take des were des positive by written records  
class4	978	thus investigators should avoid using maternal recall alone to measure des exposure  
class4	978	among subjects for whom written maternal obstetric records were available  88  of vaginal cases and 46  of cervical cases were des positive  
class4	978	the authors conclude that few cases of vaginal clear cell adenocarcinoma should occur in young women as the cohort of women exposed in utero to des continues to age  whereas cases of cervical origin may continue to occur  
class4	979	sarcoid reaction mimicking intrathoracic dissemination of testicular cancer  
class4	979	the close observation of patients treated for testicular cancer led to the suspicion of intrathoracic and or mediastinal metastases on radiologic examination in a number of patients without other evidence of relapse  
class4	979	this report presents two patients with combined seminomatous and nonseminomatous germ cell tumors with isolated sarcoid reactions of hilar and interlobular lymph nodes  detected concomitant with diagnosis and 12 months after diagnosis  respectively  
class4	979	histologic examination appears to be imperative in these cases to avoid unnecessary chemotherapy  
class4	980	multiple spinal metastases from paraganglioma  
class4	980	isolated vertebral body metastases from paraganglioma are exceedingly rare  
class4	980	they have been reported to occur in the presence of active primary tumor in the neck  local recurrence  or widespread metastases  
class4	980	a unique case of carotid body tumor  paraganglioma  is reported with the following features   1  multiple vertebral body metastases  c6  t9  and l3  presenting with spinal cord compression  and no evidence of local recurrence or other metastatic disease   2  absence of mitoses on the original specimen or the metastatic deposit  and  3  a prolonged interval  9 years  to the development of symptomatic metastases  
class4	981	malignant fibrous histiocytoma developing in bone 44 years after shrapnel trauma  
class4	981	tumors induced by foreign bodies are uncommon in humans  but they are a relatively common occurrence in some experimental animals  
class4	981	the development of sarcoma in association with metallic foreign bodies has rarely been reported  
class4	981	the development of a malignant fibrous histiocytoma in a 65 year old man 44 years after shrapnel fragments lodged in his left arm is described  
class4	981	the literature regarding metallic foreign body induced cancer in humans is reviewed  
class4	982	genetic diagnosis of lynch syndrome ii in an extended colorectal cancer prone family  
class4	982	knowledge of colon cancer genetics  with particular attention to precision in hereditary cancer syndrome diagnosis  can often enable highly targeted surveillance and management strategies for patients at high genetic risk  
class4	982	unfortunately  the patient s family history of cancer is often given minimal attention  and knowledge of hereditary cancer syndromes is frequently limited  
class4	982	indeed  many physicians still consider familial adenomatous polyposis  fap  as the only genetic risk factor for colorectal cancer  
class4	982	this concern with fap was noted in a colorectal cancer prone kindred which for decades had been thought to manifest that syndrome  
class4	982	however  after meticulous genetic  medical  and pathologic studies  the cardinal phenotypic characteristics of lynch syndrome ii were observed  
class4	982	the potential for cancer control in current and future generations of families like this one clearly mandates the need for computerized registries which could transmit current information about hereditary colon cancer syndrome diagnosis  surveillance  and management  
class4	983	cancer in the families of children with soft tissue sarcoma  
class4	983	the cancer experience among 754 first degree relatives  mothers  fathers  and siblings  of a population based series of 177 children with soft tissue sarcoma is reported  
class4	983	the current study represents an extension of our earlier work in which the authors found an excess of breast cancer in the mothers of 143 of these children  
class4	983	there were 40 cancers among all first degree relatives  compared with 24 82 expected  relative risk  rr  1 61  p   0 006   
class4	983	there was no excess in fathers  but an excess of borderline significance was seen in mothers  rr 1 67  p   0 0545   and a significant excess in siblings  rr 4 55  p   0 0002   mainly due to carcinoma of the breast and pediatric tumors  
class4	983	results of a step forward cox multivariate analysis identified three variables in the index child which were independently associated with high cancer risk in relatives  as follows  age younger than 24 months at diagnosis  histologic type  embryonal rhabdomyosarcoma or other and unspecified soft tissue sarcoma  and male sex  
class4	983	it was possible  therefore  to identify a subgroup of children whose relatives are at high risk of early onset cancer  rr in this group 10 14   
class4	983	the pattern of cancers is consistent with the li fraumeni syndrome  
class4	983	the authors conclude that a marked proportion of childhood soft tissue sarcoma has a genetic basis  
class4	984	cholecystectomy and right colon cancer in puerto rico  
class4	984	a case control study was undertaken to evaluate the possible relationship between cholecystectomy and right colon cancer  
class4	984	two hundred patients with adenocarcinoma of the cecum or ascending colon  diagnosed between 1984 and 1989  were compared with 200 matched neighborhood controls  
class4	984	cholecystectomy history was obtained through interviews using structured questionnaires and subsequently validated from hospital records  
class4	984	a statistically significant association  odds ratio   2 14  was found between right colon cancer and a history of prior cholecystectomy  
class4	984	the altered bile metabolism which occurs after removal of the gallbladder may have a carcinogenic effect on the right colon  
class4	984	dietary habits of the colon cancer patients in our study were consistent with prior reports in the literature  showing that this group has a lower intake of vegetables and cereal fiber than the control population  
class4	985	concomitant cisplatin chemotherapy and radiotherapy in advanced mucosal squamous cell carcinoma of the head and neck  long term results of the radiation therapy oncology group study 81 17  
class4	985	one hundred twenty four eligible patients with advanced mucosal squamous cell carcinoma of the head and neck were entered into a pilot study of concomitant cisplatin  100 mg m2 given every 3 weeks for three doses  and standard irradiation  
class4	985	the initial complete response  cr  was 71  with an additional two cases salvaged by surgery for an overall 73  cr  
class4	985	when no keratin was identified in the histologic specimen  41 patients  the cr was 90   
class4	985	the nasopharynx showed the best cr  89   among the sites  
class4	985	at 4 years after treatment  the estimated locoregional tumor control rate was 43  and the survival  34   
class4	985	when no keratin was present in the specimen  the estimated locoregional control of tumor was superior  56  versus 38  with keratin identified  p   0 02  and the estimated survival was also superior  48  versus 26   p   0 008   
class4	985	acute treatment related toxicities included one death due to renal damage and two patients with life threatening renal damage  
class4	985	the delivery of radiotherapy was not altered  
class4	985	late toxicity included necrosis  3   fibrosis  4   and one fistula  
class4	985	the results of this study justify a randomized trial for the comparison of this combination of cisplatin and radiotherapy versus radiotherapy alone in advanced mucosal carcinomas of the head and neck  
class4	986	treatment of the acquired immune deficiency syndrome related kaposi s sarcoma with bleomycin as a single agent  
class4	986	a nonrandomized trial was conducted to assess the efficiency and toxicity of bleomycin as a single agent in treatment of non life threatening aids related kaposi s sarcoma  ks   
class4	986	sixty patients were enrolled in this study  
class4	986	they all had a disseminated and progressive non life threatening aids related ks associated with systemic symptoms and or cd4 lymphocyte count less than 400 mm3  
class4	986	thirty patients were treated with intramuscular bleomycin  5 mg d for 3 days every 2 or 3 weeks  and 30 others with a slow continuous intravenous infusion of bleomycin  6 mg m3 d for 4 days every 4 weeks   
class4	986	the mean duration of therapy was 5 months  range  2 to 24 months   
class4	986	a partial response was observed in 29 patients  48 3   and the disease was stabilized in 18 additional patients  30    
class4	986	bleomycin failed in 21 6  of patients  
class4	986	therapy had to be discontinued in two patients because of side effects  
class4	986	thus bleomycin as a single agent is a good alternative therapy for aids related ks  
class4	987	final report of the french multicenter phase ii study of the nitrosourea fotemustine in 153 evaluable patients with disseminated malignant melanoma including patients with cerebral metastases  
class4	987	one hundred sixty nine patients with histologic evidence of disseminated malignant melanoma  including patients with cerebral metastases  were entered into a phase ii study of the nitrosourea fotemustine  
class4	987	the treatment regimen consisted of a 100 mg m2 1 hour iv infusion every week for 3 consecutive weeks  followed by a 4  to 5 week rest period  induction therapy   
class4	987	in responding or stabilized patients  maintenance therapy consisted of 100 mg m2 every 3 weeks until the disease progressed  
class4	987	one hundred fifty three patients were evaluable for response  
class4	987	three complete responses and 34 partial responses were observed  according to the world health organization criteria   leading to an objective response rate of 24 2   95  confidence interval  17 4  to 31 0    
class4	987	responses were also documented on cerebral  25 0    visceral  19 2    or nonvisceral  31 8   metastatic sites  
class4	987	the median duration of response was 22 weeks  range  7 to 80 weeks   
class4	987	the objective response rate in previously untreated patients was 30 7   19 of 62 patients   
class4	987	the main toxicity was hematologic with delayed and reversible leukopenia and or thrombopenia  
class4	987	the objective response rate observed  especially in untreated patients   the activity on cerebral metastases  and the small amount of extra hematologic toxicity encountered suggest that fotemustine is an effective drug in disseminated malignant melanoma  
class4	988	treatment of advanced neuroblastoma with emphasis on intensive induction chemotherapy  a report from the study group of japan  
class4	988	one hundred nine newly treated patients with advanced neuroblastoma were entered in this study between january 1985 and may 1989  
class4	988	the eligible patients included infants younger than 12 months of age with stage iva disease  bone cortex  distant lymph node  and or remote organ metastases  and patients aged 12 months or older with stage iii or iv disease  iva plus ivb with tumor crossing the mid line and with metastases confined to bone marrow  liver  and skin   
class4	988	the patients first received six cyclic course of intensive chemotherapy  regimen a1   consisting of cyclophosphamide  1200 mg m2   vincristine  1 5 mg m2   tetrahydropyranyl adriamycin  pyrarubicin  40 mg m2   and cisplatin  90 mg m2   
class4	988	original tumors and the regional lymph node metastases were removed some time during these first six cycles of chemotherapy  
class4	988	the patients were further divided into three groups  
class4	988	patients in course 1 received alternating treatment by regimen b  cyclophosphamide and acnu  and intensified regimen a1  and those in course 2 were treated with alternating administration of regimen c  cyclophosphamide and dtic  and intensified a1  
class4	988	patients in course 3 were treated with bone marrow transplantation  bmt  preceded by high dose preconditioning chemotherapy  
class4	988	survival rates were 77  in stage iii and 54  in stage iv at 2 years  and 70  in stage iii and 45  in stage iv at 3 years  
class4	988	the major toxicities encountered were bone marrow suppression with leukocyte counts down to 100 mm3  mild cystitis  and hearing impairment  
class4	988	the 2 year survival rate was 78  in 21 patients who underwent bmt when complete remission was achieved  
class4	988	we concluded that our intensive induction chemotherapy is of significant value in increasing the rate of complete response  and in widening the indications for and achieving improved results of treatment with bmt  
class4	989	toxic dermatitis induced by 10 ethyl 10 deaza aminopterin  10 edam   a novel antifolate  
class4	989	a new methotrexate analog  10 ethyl 10 deaza aminopterin  10 edam   was found to induce a particular form of skin toxicity different than the skin rash reported to result from methotrexate  
class4	989	at histologic examination  it was found to be a toxic dermatitis that clinically most often first appears on the lower legs but can occur anywhere in the body  especially if treatment is continued  
class4	989	nine cases are reported  
class4	989	a specific risk factor could not yet be identified  
class4	989	discontinuation of 10 edam administration leads to complete healing  concomitant corticosteroid treatment also induces healing  
class4	990	chemotherapy related hemolytic uremic syndrome after the treatment of head and neck cancer  a case report  
class4	990	a 62 year old woman who was being treated for squamous cell carcinoma of the head and neck developed a chemotherapy related hemolytic uremic syndrome during the second cycle of neoadjuvant chemotherapy consisting of cisplatin  bleomycin  and methotrexate  
class4	990	though the syndrome was suspected early  attempts at reversing the hematologic and renal abnormalities were unsuccessful  
class4	990	at postmortem examination  the characteristic microvascular lesions of the hemolytic uremic syndrome were found in the kidneys  
class4	991	primary carcinoma of the upper urinary tract  effect of primary and secondary therapy on survival  
class4	991	the pathologic material and medical records of 76 patients with primary upper urinary tract carcinomas were reviewed to identify the role of grade and stage in predicting survival  to determine any differences in survival between ureteral and renal pelvic carcinoma  to understand the role of local therapy in low grade  low stage tumors  and to establish the usefulness of adjuvant therapies in metastatic disease  
class4	991	kaplan meier survival curves with cox mantel analysis for statistical significance revealed both grade and stage to be excellent predictors of survival  
class4	991	no differences in survival were noted between renal pelvic and ureteral carcinomas for equivalent stage tumors  
class4	991	for low grade  low stage tumors  although there was an increased risk of local recurrence with local therapy  there were no differences in survival between patients treated with local therapy or radical surgery  
class4	991	finally  cisplatin based chemotherapy seemed to improve survival in patients with metastatic disease  
class4	992	osteosarcoma of the maxilla in hong kong chinese postirradiation for nasopharyngeal carcinoma  a report of four cases  
class4	992	postirradiation osteosarcoma of the maxilla was seen in four hong kong chinese patients treated for nasopharyngeal carcinoma  
class4	992	these cases represent four of 42  9   cases of osteosarcoma at all sites in this institution during the period 1979 to 1989  when more than 1000 patients were treated with radiotherapy for nasopharyngeal carcinoma  
class4	992	the latent periods varied from 8 to 11 years from completion of radiotherapy treatment to development of osteosarcoma  
class4	992	the radiation dosage varied from 6000 to 6280 cgy in three of the patients  
class4	992	these cases fit the criteria for diagnosis of postirradiation sarcomas  
class4	992	maxillary osteosarcomas after irradiation for nasopharyngeal carcinoma do not appear to have been described  
class4	992	the very high incidence of nasopharyngeal carcinoma  for which radiotherapy is the treatment of choice  in hong kong chinese would make the occurrence of such tumors more likely in hong kong  although the small risk does not contraindicate the use of radiation in the treatment of nasopharyngeal carcinoma in view of its well documented efficacy  
class4	993	the significance of low grade prostate cancer on needle biopsy  a radical prostatectomy study of tumor grade  volume  and stage of the biopsied and multifocal tumor  
class4	993	twenty one cases showing only low gleason grade prostate carcinoma on needle biopsy were identified  
class4	993	in 15 cases radical prostatectomy was performed with the entire prostate embedded for thorough evaluation of grade  volume  and stage of tumor at the needle biopsy site as well as of multifocal tumor  
class4	993	eight specimens had solitary low grade and low volume tumor  with only one of these cases showing minimal capsular penetration and the others confined to the prostate  
class4	993	four cases had low grade tumor at the biopsy site  yet multifocal higher grade tumor  
class4	993	all of these tumor nodules were low volume and confined to the prostate  
class4	993	in three cases there was both low grade and high grade tumor in the nodule sampled by needle biopsy  
class4	993	in two of these cases the tumor was large and in the third it was small but mostly higher grade  with two of these cases showing capsular penetration  
class4	993	although transrectal ultrasound and repeat needle biopsy would most likely have identified either the tumors  large size or high grade component in these latter three cases  it is unlikely that these techniques would have identified the cases of multifocal higher grade tumor because of their relatively small size  
class4	993	furthermore  preoperative serum prostate specific antigen levels and clinical stage failed to distinguish those cases with higher grade tumor  
class4	993	because of the difficulty in identifying these areas of high grade tumor preoperatively  it is uncertain whether expectant therapy could be recommended even for patients with very low grade cancer on needle biopsy  
class4	994	perinatal infection of human t lymphotropic virus type i  the etiologic virus of adult t cell leukemia lymphoma  dna amplification of specific human t lymphotropic virus type i sequences  
class4	994	a gene amplification technique  polymerase chain reaction  was used to detect human t lymphotropic virus type i  htlv i   the etiologic agent of adult t cell leukemia lymphoma  in mononuclear cells in peripheral blood and breast milk of ten htlv i carrier gravida  
class4	994	the dna in umbilical cord blood mononuclear cells of the neonates born to the htlv i carrier gravida were also amplified and examined for the possibility of htlv i infection via placenta during pregnancy  
class4	994	the htlv i sequences were detected both in the peripheral blood and milk of all ten carrier gravida by southern blot analysis of amplified dna  
class4	994	however  htlv i proviral dna could not be detected in the cord blood of the carriers  neonates  indicating that transplacental infection of htlv i should be rare and that postpartum infection via breast milk is a likely major perinatal transmission route  
class4	995	impaired production of tumor necrosis factor in breast cancer  
class4	995	spontaneous and lipopolysaccharide  lps  induced production of tumor necrosis factor  tnf  by peripheral blood macrophages was investigated in breast cancer  
class4	995	whereas spontaneous tnf production by macrophages derived from patients with breast cancer was comparable with the one found in healthy controls  p greater than 0 1   lps stimulated macrophages derived from patients in the disease free interval as well as with metastatic breast cancer were found to produce significantly lower amounts of tnf  as compared with macrophages derived from healthy control individuals  p less than 0 0005   
class4	995	however  the production of tnf did not significantly differ between the two patient populations  p greater than 0 05   
class4	995	the impairment of lps induced tnf production did not depend upon such characteristics of the primary tumor as size  axillary lymph node and estrogen receptor status  or upon the fact of administration of adjuvant chemotherapy and  in patients with metastatic disease  hormone treatment  
class4	995	to further investigate cytokine production by macrophages  spontaneous and lps induced interleukin 1  il 1  production was investigated also  
class4	995	however  no difference was found between patients and controls concerning il 1 generation  
class4	995	the authors thus conclude that lps induced tnf production was impaired in breast cancer independent of the presence of detectable metastatic disease  whereas il 1 production remained unimpaired  
class4	996	medroxyprogesterone acetate lowers plasma corticotropin and cortisol but does not suppress anterior pituitary responsiveness to human corticotropin releasing factor  
class4	996	the endocrine action of medroxyprogesterone acetate  mpa  has been claimed to be of a glucocorticoid like nature  
class4	996	upon clinical observation  mpa has been shown to improve life quality and overall well being in patients with advanced breast cancer  renal carcinoma  prostatic carcinoma  and uterine adenocarcinoma  
class4	996	the authors have evaluated mpa endocrine action by the administration of human corticotropin releasing factor  hcrf  in a 90 minute assay in 15 patients with advanced breast cancer or renal cell carcinoma both  before the initiation of oral high dose mpa treatment  1000 mg mpa  as well as after at least 10 days of therapy  
class4	996	the curves for corticotropin  beta endorphin  and cortisol responses to hcrf of tumor patients who were tested before the initiation of mpa treatment were parallel to the curves of a healthy control group of probands tested under equal conditions  although at significantly higher respective hormone levels  
class4	996	in patients with malignant disorders assayed after mpa administration  both basal and peak hormone levels were found to be comparable with values obtained in healthy controls  
class4	996	in conclusion  mpa appeared to act at a suprapituitary level since pituitary responsiveness to hcrf was preserved under mpa treatment  
class4	996	moreover  it appeared that mpa brought the hormonal stress state found in patients with malignant tumors back to normal  
class4	997	possible involvement of the retinoblastoma gene in undifferentiated sinonasal carcinoma  
class4	997	retinoblastoma tumor formation is initiated by the loss of function of both alleles of the rb 1 gene on chromosome 13  
class4	997	patients with the hereditary form of retinoblastoma carry a germ line mutation at one of the two homologous gene loci in all cells and have an increased risk for nonocular tumors  mainly osteosarcoma and other mesenchymal tumors  in later life  
class4	997	the authors studied a 38 year old patient with sinonasal undifferentiated carcinoma  snuc  who had been treated for bilateral retinoblastoma by enucleation  left eye  and irradiation  right eye   respectively  
class4	997	using molecular probes for the rb 1 gene and other loci on chromosome 13  the authors detected a deletion at the rb 1 locus in metastatic snuc cells that was not present in normal tissue  
class4	997	these findings indicate that somatic mutations at rb 1 locus may be involved in the formation or progression of ectodermal tumors  
class4	998	sialosyl tn  a novel mucin antigen associated with prognosis in colorectal cancer patients  
class4	998	colon cancers typically produce mucin  
class4	998	however  it is not known whether tumor mucin plays a biological role in cancer cell behavior  
class4	998	to address this issue  the expression of a mucin associated antigen  sialosyl tn  was examined by immunohistochemical study in 128 primary colorectal carcinoma specimens from 137 patients who underwent curative surgical resection  
class4	998	antigen expression was correlated with disease free and overall 5 year survival  
class4	998	sialosyl tn antigen expression occurred in 112  87 5   tumors  and was independent of age  gender  tumor location  dukes  stage  depth of invasion  degree of differentiation  and ploidy status  
class4	998	survival at 5 years for patients with sialosyl tn negative versus sialosyl tn positive tumors was 100  versus 73   p less than 0 05  and disease free survival was 94  versus 73   respectively  p   0 12   
class4	998	although more advanced dukes  stage  deeper invasion  and aneuploidy were all associated with poorer overall 5 year survival  antigen negative tumors within each of these groups had much better prognoses than antigen positive tumors  
class4	998	multivariate regression analysis revealed that tumor ploidy  p less than 0 001  and sialosyl tn expression  p less than 0 05  were the two variables of most importance for predicting both disease free and overall survival  
class4	998	the authors conclude that sialosyl tn expression is an independent predictor of poor prognosis in colon cancer  and therefore suggest that qualitative mucin alterations may reflect important differences in the biological behavior of these neoplasms  
class4	999	characterization of epidermal growth factor receptor in normal and neoplastic human endometrium  
class4	999	growth factors  including epidermal growth factor  egf   have been implicated in the growth of several types of cancer  
class4	999	this study compares egf receptors in normal and neoplastic endometrium  
class4	999	membrane fractions were isolated from surgical specimens  
class4	999	radioreceptor assays demonstrated the presence of receptors with a dissociation constant of 0 64 nmol l in normal endometrium  
class4	999	affinity cross linking revealed receptor molecular weight of 150 to 170 kilodaltons  kd   
class4	999	a survey of samples  n   37  revealed progressive decrease of egf receptors in cancers of increasing grade  grade 1 2 adenocarcinoma decreased 34  from control  n   6  p less than 0 01   whereas grade 3 adenocarcinoma decreased 90   n   7  p less than 0 01  and sarcoma decreased by 72   n   3  p less than 0 01   
class4	999	the dissociation constant and molecular weight of the receptor in neoplastic endometrium did not differ significantly from normal  
class4	999	the inverse relationship with grade suggests receptor alteration or down regulation by hormones and or growth factors  
class4	1000	parathyroid hormone like peptide in normal and neoplastic mesothelial cells  
class4	1000	mesothelioma has not been commonly reported as a cause of hypercalcemia of malignancy  
class4	1000	we have studied a patient with malignant mesothelioma and hypercalcemia in association with elevated plasma concentrations of parathyroid hormone like peptide  plp   
class4	1000	immunohistochemical analysis of the tumor and seven of eight other mesotheliomas that were not associated with hypercalcemia revealed the presence of plp cytoplasmic immunopositivity  
class4	1000	plp immunopositivity was also detected in normal and reactive mesothelial cells  
class4	1000	the results of these studies suggest that plp immunoreactivity is common in normal and neoplastic mesothelial cells and raises the possibility that plp production may play a role in the pathogenesis of hypercalcemia associated with mesothelioma  
class4	1001	increased expression of the multidrug resistance gene in undifferentiated sarcoma  
class4	1001	we analyzed multidrug resistance gene  mdr1 gene  expression in a patient with undifferentiated sarcoma of the liver using the cloned cdna for the mdr1 gene  
class4	1001	tissue samples were available at the time of initial diagnosis and of two intracranial relapses after chemotherapy with a regimen including doxorubicin and teniposide  
class4	1001	the level of mdr1 gene expression was increased sevenfold in the intracranial tumor at the time of first relapse and 11 fold at the second relapse  
class4	1001	this case may be an example of acquired multidrug resistance associated with overexpression of the mdr1 gene  
class4	1002	diffuse intermediate lymphocytic lymphoma  a clinicopathologic study and comparison with small lymphocytic lymphoma and diffuse small cleaved cell lymphoma  
class4	1002	controversy has recently arisen as to whether diffuse intermediate lymphocytic lymphoma  ill  should be considered a low grade or an intermediate grade non hodgkin s lymphoma for clinical purposes  
class4	1002	therefore  the authors performed a clinicopathologic study to determine the biologic course of diffuse ill  40 cases  and compared it with small lymphocytic lymphoma  sll  51 cases  and diffuse small cleaved cell lymphoma  dsccl  14 cases   
class4	1002	they found that patients with diffuse ill having pseudofollicular proliferation centers  pc  had a significantly longer median survival  84 months  than those without pc  46 5 months  p   0 03   
class4	1002	the median survival of patients with sll was 72 months  whereas those with dsccl had a median survival of only 18 months  
class4	1002	based on these findings  the authors conclude that diffuse ill with pc should be included in the low grade category of sll for clinical purposes  whereas diffuse ill without pc  true diffuse ill  should be considered an intermediate grade non hodgkin s lymphoma  
class4	1002	true diffuse ill is similar to centrocytic lymphoma in the kiel classification and should be accorded a similar status in a modified working formulation  
class4	1003	intraoperative pathologic diagnosis of thyroid neoplasms  report on experience with 504 specimens  
class4	1003	intraoperative pathologic examination with frozen section  fs  was performed on 504 specimens of thyroid tissue obtained from 457 patients over a period of 9 years  
class4	1003	after examination of permanent sections  ps  a malignant neoplasm was diagnosed in 57 specimens  11 3    50  87   of these were primary thyroid carcinoma  four  8   metastatic carcinoma  and three  5   malignant lymphoma  
class4	1003	the fs diagnosis was  benign  in 448  88 9     malignant  in  30  5 9   and  deferred  in 26  5 2    
class4	1003	the sensitivity of fs diagnosis of malignancy was 53  and the specificity and positive predictive value 100   
class4	1003	the negative predictive value was 97 8  and overall accuracy 97 9   
class4	1003	the ps disclosed a malignant neoplasm in 62  of specimens in which fs diagnosis was  deferred   sixty eight percent of papillary carcinomas  87  of undifferentiated carcinomas  and a single case of medullary carcinoma were diagnosed with fs examination  
class4	1003	a fs diagnosis of malignancy was not made in any of the ten specimens containing follicular carcinoma  in all ten the neoplasms were well differentiated and eight were encapsulated and minimally invasive  
class4	1003	the inability to diagnose follicular carcinoma intraoperatively with fs is the most significant factor accounting for the relatively low sensitivity of fs diagnosis of malignant thyroid neoplasms  
class4	1004	cerebral tumor staging in patients with bronchial carcinoma by computed tomography  
class4	1004	computerized tomographic  ct  scans of 271 patients with histologically proven bronchial carcinoma accomplished for initial tumor staging were retrospectively evaluated for signs of cerebral metastasis  
class4	1004	the results for the histologic subtypes were quite different  
class4	1004	in 13 8  of patients with small cell carcinoma and limited disease the authors found signs of brain metastasis  
class4	1004	however  routine cerebral staging in these patients did not seem to be useful because of lack of therapeutic consequences  
class4	1004	on the other hand  no patient with non small cell carcinoma  n scc  and tumor stage i or ii had brain metastases  
class4	1004	all patients with brain metastasis from n scc had been classified as tumor stage iii before cerebral imaging  
class4	1004	among these patients  however  the authors found brain metastasis in 17 5  of those without known distant metastatic disease  iii m0   especially in large cell carcinoma and in adenocarcinoma  
class4	1004	stage iii m0 patients should undergo routine cerebral imaging if their tumor is surgically resectable and thoracotomy is planned  
class4	1005	infiltration of dendritic cells in relation to tumor invasion and lymph node metastasis in human gastric cancer  
class4	1005	the infiltration of dendritic cells determined in 210 patients with gastric carcinoma was investigated from the standpoint of tumor invasion  lymph node metastasis  and prognosis  
class4	1005	dendritic cell infiltration was graded as  slight  and  marked   the 39  frequency in the marked infiltration group at the mucosal stage did not change in proportion to invasion into the deeper layers  
class4	1005	the 5 year survival rate was 60 4  in patients with marked infiltration and 38 8  in those with slight infiltration  which was statistically different  p less than 0 01   
class4	1005	the difference in survival rates was only statistically significant in those with cancer emerging from the serosa  p less than 0 001   
class4	1005	there was a similar incidence of lymph node metastasis between the marked and slight infiltration groups in each grade of tumor invasion  
class4	1005	however  marked infiltration of dendritic cells prevented widespread nodal involvement beyond the primary node in cases of advanced carcinoma  p less than 0 05   
class4	1005	these findings indicate that infiltrating dendritic cells do not prevent the spread of tumor invasion but do prevent nodal involvement  therefore  for patients with a gastric cancer emerging from the serosa  the prognosis will be good  
class4	1006	changes in gastric mucosa that antedate gastric carcinoma  
class4	1006	endoscopic biopsy specimens of the gastric mucosa from 13 patients who were found at follow up examination to have gastric carcinoma were compared for abnormal histologic features  type of intestinal metaplasia  and presence of immunoreactive carcinoembryonic antigen  cea   with specimens from 40 tumor free controls  
class4	1006	villus like changes and angular infolding  cytologic nuclear pleomorphism  distinct nuclear border  irregular thickness of the nuclear membrane  irregular chromatin clumping  prominent nucleoli  and distinct nucleoli were manifestations of the carcinoma group  
class4	1006	angular infolding  distinct nuclear border  irregular thickness of the nuclear membrane  and distinct nucleoli were also observed in the latent stage before detection of carcinoma  
class4	1006	the individual features  however  lacked specificity  
class4	1006	histochemically  a iib subtype of intestinal metaplasia  and immunoreactive cea in the cytoplasm of foveolar epithelium appeared exclusively in the patients with carcinoma  
class4	1006	these findings indicate that the gastric epithelium of patients with gastric carcinoma tends to be morphologically and histochemically abnormal even before the recognition of classical dysplasia  
class4	1006	this can be described as abnormal epithelium and is believed to provide the soil on which gastric carcinoma develops  
class4	1007	intraoral adenoid cystic carcinoma  the presence of perineural spread in relation to site  size  local extension  and metastatic spread in 22 cases  
class4	1007	twenty two patients with an intraoral adenoid cystic carcinoma  acc   initially treated by surgery with or without postoperative radiotherapy  were examined for the presence of perineural spread in relation to primary site  size  local extension  histologic status of the surgical margins  and metastatic spread of the tumor  
class4	1007	there seems to be no correlation between perineural spread and the primary site or size of the tumor  
class4	1007	however  perineural spread occurred more often in tumors with local extension and in cases with surgical margins with positive results  
class4	1007	there seems to be no statistically significant correlation between perineural invasion and distant metastatic disease  
class4	1008	predicting distant metastases in operable breast cancer patients  
class4	1008	risk factors for distant metastases following mastectomy and axillary node dissection for breast cancer were analyzed in a review of 1022 women  
class4	1008	from diagnosis until the end of the adjuvant treatment  six stages were identified that corresponded well to patient data acquisition  
class4	1008	at each stage  a prognosis study based on the cox model was carried out using all acquired information from the first stage  
class4	1008	the results demonstrated that tumor size  nuclear pleomorphism  mitotic index  and nodal status at the top of axilla were stable independent risk factors in predicting metastasis free survival  mfs   
class4	1008	these analyses also revealed those factors that were significantly related to mfs at one or several stages and losing their significance at a subsequent stage  
class4	1008	this was the case with clinical node status  age  and vascular tumor emboli  
class4	1008	other factors such as estrogen  progesterone  histologic grade  and clinical stage were never identified as independent factors at any stage  
class4	1008	the four major stable risk factors were used to define a stratification of reference  
class4	1008	the results demonstrated that the mere knowledge of clinical information such as tumor size  clinical node status  and age would enable 51  of the patients to be universally well classified according to that stratification  
class4	1008	knowledge of additional factors  such as nuclear pleomorphism and mitotic index  would bring the rate up to 61   and then to 64  if supplementary information such as vascular tumor emboli were acquired  
class4	1008	these percentages did not appear high enough to claim that the physician may make a reliable prognosis of operable breast cancer patients before acquiring information from the axillary node dissection  
class4	1008	however  it was proven that there exist some subsets of patients with stable prognosis  i e   subsets of patients who will belong permanently to the same risk group through the stages  
class4	1009	familial occurrence of gastric cancer in the 2 year experience of a population based registry  
class4	1009	the authors studied the familial occurrence of tumors in 154 individuals with gastric cancer by reviewing the clinical data and the genealogical tree of all patients registered in 1986 through 1987 in the local health care district of modena  italy  for cancer of the stomach  
class4	1009	crude and age adjusted  world population  incidence rates of gastric cancer were 34 0 and 21 4 new cases 100 000 year  respectively  in men  and 24 5 and 10 9 in women  respectively  
class4	1009	among first degree relatives of the registered patients there were 30 cases of gastric carcinoma versus 15 cases in a control group matched for age and sex  mantel haenszel odds ratio  m h or  3 14  p less than 0 01   
class4	1009	this excess of gastric neoplasms was observed in siblings  17 versus 7  m h or 4 33  p less than 0 02  but not in parents  13 versus 8  not significant   
class4	1009	besides gastric cancer  there was no significant excess of other type of tumors in case families  
class4	1009	the familial occurrence of gastric cancer tended to be more frequent in patients with  diffuse  carcinoma  52   than in subjects with  intestinal  cancer  33    although the difference was not statistically significant  
class4	1009	in conclusion  the current investigation suggests that a  family history  for gastric neoplasms is usually observed in approximately 10  to 15  of the registered cases  
class4	1009	as already described for other common malignancies  therefore  the familial occurrence of gastric carcinoma suggests the existence of a genetic susceptibility to cancer of the stomach  at least in a fraction of these patients  
class4	1010	the prophylactic use of octreotide in a patient with ovarian carcinoid and valvular heart disease  
class4	1010	this case report describes the use of octreotide  a long acting somatostatin analogue  in the management of a patient with an ovarian carcinoid tumour and severe cardiac valvular disease  
class4	1010	this patient underwent laparotomy and tumour resection without complication  
class4	1010	anaesthesia was induced with midazolam  fentanyl  and vecuronium  and maintained with isoflurane as well as additional fentanyl and vecuronium  
class4	1010	however  we feel that it was the use of octreotide that prevented a life threatening crisis intraoperatively  and recommend its use in patients with carcinoid syndrome undergoing anaesthesia and surgery  
class4	1011	elevated serum bromide concentrations following repeated halothane anaesthesia in a child  
class4	1011	a 20 month old child received 25 brief halothane general anaesthetics over a five week period to allow cranial irradiation treatments for a posterior fossa ependymoma  
class4	1011	personality change during the last week of the treatment protocol raised the question of possible bromide intoxication  
class4	1011	serum bromide concentrations  using a gold chloride assay technique  were monitored at that time  and at four  and six week intervals thereafter  
class4	1011	serum bromide concentrations demonstrated a four fold change during this period ranging from peak levels of 2 2 meq l 1  176 micrograms kg 1  during the fifth week of treatment decreasing to less than 0 5 meq l 1  less than 40 micrograms ml 1  six weeks following the end of treatments  
class4	1011	this demonstrates the possibility for repetitive  short halothane exposures to result in elevations of serum bromide and the potential of bromide intoxication in paediatric neuro oncology patients  
class4	1012	the presence of human papillomavirus  hpv  in solitary adult laryngeal papillomas demonstrated by in situ dna hybridization with sulphonated probes  
class4	1012	human papilloma virus  hpv  types 6 and 11 have been repeatedly demonstrated in multiple laryngeal papillomas  and there is little doubt that these lesions are caused by hpv  
class4	1012	it has been clearly demonstrated in recent reports that the clinical course of solitary adult onset laryngeal papillomas is entirely different from that of multiple papillomas of juvenile as well as of adult onset  
class4	1012	we here report the presence of hpv types 6 and 11 in 19 out of 20 solitary papillomas from 16 patients  while hpv types 16 and 18 were totally absent  
class4	1012	we conclude that the milder clinical course in such patients is most likely to be due to host factors  rather than to viral factors  
class4	1013	chondrosarcoma complicating total hip arthroplasty in maffucci s syndrome  
class4	1013	a 70 year old woman who was followed for 60 years for maffucci s syndrome required a total hip arthroplasty  tha  of the right hip for degenerative arthritis  
class4	1013	this did not relieve pain  
class4	1013	three years later  chondrosarcoma of the femur developed around the femoral component and was fatal  
class4	1013	the roentgenographic changes after the tha were incorrectly interpreted as being caused by infection  
class4	1014	treatment of manifest and impending pathologic fractures of the femoral neck by cemented hemiarthroplasty  
class4	1014	thirty four patients with manifest or impending pathologic fractures of the femoral neck were treated between 1971 and 1987  
class4	1014	breast carcinoma was the primary tumor in the majority of patients  
class4	1014	all patients were treated with cemented hemiarthroplasty  
class4	1014	twenty seven patients  79   could walk at an average of nine days postoperatively  
class4	1014	all patients experienced relief of pain  
class4	1014	two superficial wound dehiscences  one loosening of the prosthesis  and two prosthetic dislocations were encountered  
class4	1014	mean survival was 17 6 months overall  12 months for manifest fractures and 40 months for impending fractures   
class4	1014	these results indicate that cemented hemiarthroplasty for pathologic fractures is a safe procedure resulting in long lasting palliation without necessitating postoperative irradiation  
class4	1014	the importance of tumor excochleation and the advantages of bone cement are emphasized  
class4	1015	complications associated with limb salvage for extremity sarcomas and their management  
class4	1015	a retrospective clinical review of 100 consecutive patients with extremity sarcomas managed by limb salvage operations was performed to evaluate local tumor control and morbidity  
class4	1015	the mean follow up period was 45 1 months  
class4	1015	overall survival was 86   
class4	1015	there were local recurrences in 3  of patients  and 26 complications in 22 patients  
class4	1015	wound necrosis was the most frequent complication  
class4	1015	failure of allogeneic bone graft operations occurred in 25 patients  
class4	1015	most of the complications were salvageable without loss of limb  
class4	1015	limb salvage is an acceptable surgical treatment of extremity sarcomas based on adequate local control and minimal morbidity  
class4	1016	leiomyoma of a digital artery  
class4	1016	benign  soft tissue masses of the hand are common  
class4	1016	a vascular leiomyoma is an unusual tumor of smooth muscle origin  
class4	1016	in a 62 year old man  the tumor arose from within a digital artery  
class4	1016	persistent symptoms prompted an excisional biopsy  requiring resection of a portion of the artery  
class4	1016	adequate collateral circulation preempted the need for a vascular graft  
class4	1016	vascular repair or grafting may be necessary if collateral circulation is not adequate  
class4	1017	posterior nuchal cystic hygroma  published erratum appears in clin perinatol 1990 dec 17 4  viii  
class4	1017	when cystic hygroma is detected antenatally  the prognosis is usually poor  and intrauterine or neonatal death are common  
class4	1017	this seems especially true for turner syndrome  the largest etiologic group associated with cystic hygroma  and the lethal multiple pterygium syndromes  
class4	1017	however  some fetuses with turner syndrome  and also with certain other diagnoses  had a good outcome  and further study of these conditions is required before more definite prognostic indicators and risk figures will be available  
class4	1017	increasing numbers of syndromes are being reported in association with fetal cystic hygroma  and lymphedema may be a common element in their pathogenesis  
class4	1017	mild  short lived  or otherwise uncomplicated jugular lymphatic obstruction may be a cause of the neck webbing seen in the noonan  familial pterygium colli  and distichiasis lymphedema syndromes  
class4	1017	with earlier and more widespread fetal ultrasonography  and more sensitive techniques  a greater number of resolving fetal cases may be reported  
class4	1017	this may clarify the natural history and provide prospective criteria for the conditions that have better prognoses  
class4	1017	the associated conditions include autosomal dominant and recessive genetic traits  
class4	1017	careful ultrasound study for other malformations  polyhydramnios and fetal growth parameters  a fetal karyotype  and  if appropriate  pathologic examination are required to determine the etiology and recurrence risk  
class4	1017	the parents should be asked about exposure to alcohol or other agents and should be examined for signs of pterygium colli or noonan syndrome  
class4	1017	if the decision is made to continue the pregnancy  and there is doubt about the natural history and prognosis  multi disciplinary supervision should include social services  neonatology  pediatric surgery  cardiology  and genetics specialties when indicated  
class4	1018	subpleural mononuclear cell infiltration  significance in the differential diagnosis of pleuritis showing nonspecific histologic findings  
class4	1018	to determine if patients who had lymphocyte rich pleural effusion and a pleural biopsy without any specific findings could be histopathologically differentiated between those with tuberculous and nontuberculous pleuritis  we histologically re evaluated the pleural biopsies of all patients whose pleural effusion was predominant with lymphocytes and contained no malignant cells  
class4	1018	a total of 40 patients with a nonspecific histologic findings of pleural biopsy specimen were categorized based on their ultimate diagnosis as having tuberculous  n   15   carcinomatous  n   10  or nontuberculous  benign pleuritis  n   15   
class4	1018	the pleural biopsy specimen of patients with nontuberculous  benign pleuritis frequently showed a band like infiltration of mononuclear cells in the subpleural adipose tissue with minimal pleural inflammatory infiltrate  10 out of 15 patients   while the same finding was infrequent in those with tuberculous pleuritis  0 out of 15  p   0 0001  and pleuritis associated with carcinoma  three out of 10  p   0 082   
class4	1018	based on these results  the presence of band like infiltration of mononuclear cells in the subpleural adipose tissue with minimal pleural inflammatory infiltrate in pleural biopsy specimens of patients with lymphocyte rich pleural effusion suggests that the pleuritis is nontuberculous in its nature  
class4	1019	feasibility of intraoperative cytodiagnosis of lung cancer  
class4	1019	of 354 thoracotomies  114 cases involved intraoperative cytopathologic evaluation  
class4	1019	the study included 86 men and 28 women  and 184 specimens were examined  
class4	1019	smears were taken from the lung lesion or lymph node and the chest wall or bronchial stump by imprint or needle aspiration  
class4	1019	intraoperative evaluations were compared with histologic findings  
class4	1019	in 85 cases not diagnosed as malignant preoperatively  malignancy was confirmed in 97 6 percent of cases and histologic type in 71 8 percent  
class4	1019	in the 28 cases diagnosed as malignant preoperatively  there was only one false negative  
class4	1019	the most important finding during thoracotomy is whether a lesion is malignant or not  
class4	1019	the time required to obtain a pathologic diagnosis also is important  
class4	1019	we are able to obtain the results of a cytologic diagnosis within 10 min  
class4	1019	cytologic diagnosis of malignancy during thoractomy may be a feasible and convenient method of diagnosis  especially where malignancy is suspected  
class4	1020	concentration of tumor associated trypsin inhibitor  tati  in pleural effusions  
class4	1020	we measured the concentration of tumor associated trypsin inhibitor  tati  in plasma and pleural fluid of 84 patients with pleural effusions of various causes  
class4	1020	we observed elevated  greater than 30 micrograms l  tati levels in pleural fluid in 45 percent of patients with pleural effusion associated with malignant disease and in 15 percent of patients with benign disease  
class4	1020	similar results were obtained for tati in plasma  
class4	1020	the concentration of tati in pleural fluid closely parallelled that in plasma  
class4	1020	in patients with renal insufficiency and in patients with biliary obstruction  the tati levels were elevated both in plasma and pleural fluid  
class4	1020	a positive correlation was seen between the concentration of tati and the activity of alkaline phosphatase in plasma  
class4	1020	the results show that simultaneous determination of tati in plasma and pleural fluid improves the diagnosis of cancer only marginally  
class4	1020	our results also support the hypothesis that elevated tati levels may reflect an acute phase reaction caused by inflammatory disease or tissue destruction associated with cancer not only in inflammatory conditions  but also in malignant disease where the tumor itself is not producing tati  
class4	1021	determinants of cell type in patients with cancer of the lungs  
class4	1021	in order to evaluate the determinants of cell type in patients with primary lung cancer  we compared smoking characteristics in 1 939 patients  1 474 men and 465 women   
class4	1021	patients with squamous cell carcinomas  adenocarcinomas  or small cell carcinomas were eligible  
class4	1021	this study did not consider smoking as a risk factor for lung cancer  as all subjects had a confirmed diagnosis  
class4	1021	we were interested in smoking history and the pattern of smoking among those whose risk was 100 percent  
class4	1021	among these patients  we confirmed that a larger subset of nonsmoking individuals developed adenocarcinomas than squamous cell or small cell carcinomas  however  the duration and intensity of cigarette smoking  as measured by pack years  were not determinants of tumor cell type in male patients  
class4	1021	small cell carcinomas in women were more strongly associated with cigarette smoking than either squamous cell carcinomas or adenocarcinomas  
class4	1021	more than 3 500 different substances have been measured in tobacco smoke  including tumor initiators  promoters  and those involved in tumor progression  
class4	1021	these data confirm the hypothesis that factors other than cigarette smoking are more likely to be involved in the initiation of adenocarcinomas than other cell types  
class4	1021	endogenous and exogenous factors related to gender may be more important than the duration or intensity of cigarette smoking  
class4	1022	pulmonary malignant angioendotheliomatosis  presentation with fever and syndrome of inappropriate antidiuretic hormone  
class4	1022	a 64 year old man presented with protracted fever  hyponatremia  and mononeuritis multiplex  
class4	1022	inappropriate antidiuretic hormone secretion was established  
class4	1022	the absence of pulmonary infiltrates precluded any lung biopsy  
class4	1022	autopsy revealed malignant angioendotheliomatosis involving multiple organs including the alveolar septa and pulmonary vasculature  
class4	1022	an early diagnosis of mae in the setting of fever and siadh may be possible via transbronchial biopsy  
class4	1023	a case of massive true thymic hyperplasia with non hodgkin s lymphoma  
class4	1023	a case of massive true thymic hyperplasia with non hodgkin s lymphoma of the mediastinum is reported in a 14 year old boy  
class4	1023	computed tomographic scan of the chest showed a mass of the anterior mediastinum and conspicuous swelling of the lymph nodes in the upper and lower mediastinum  
class4	1023	they were grossly resected  
class4	1023	the tumor of the anterior mediastinum was histologically diagnosed as true thymic hyperplasia  
class4	1023	all of the mediastinal lymph nodes were diagnosed as non hodgkin s lymphoma  diffuse  mixed small and large cell type  
class4	1024	urogenital dysfunction after abdominoperineal resection for carcinoma of the rectum  
class4	1024	the long term urogenital dysfunctions in 46 of 104 surviving patients submitted to abdominoperineal resection for rectal carcinoma between 1972 and 1986 were collected and assessed  
class4	1024	urinary retention was present in 41 percent of the men and 35 percent of women  while incontinence was present in 10 percent of men and 29 percent of women  
class4	1024	impotence was reported by 59 percent of the males  all sexually active before surgery  
class4	1024	dyspareunia was present in 50 percent of the women in the study  
class4	1024	the possibility of treating prostatic hypertrophy concurrently with abdominoperineal resection in selected cases to avoid urinary retention is discussed  
class4	1024	the limited number of responders to the survey may interfere with the global statistical significance  
class4	1025	a critical review of chemical lymph node clearance and staging of colon and rectal cancer at ferguson hospital  1977 to 1982 
class4	1025	a unique opportunity to evaluate the method of chemical lymph node clearance for colorectal cancer exists at ferguson hospital  
class4	1025	lymph node clearance has been used at the institution since 1977  and this retrospective analysis was undertaken to ascertain its validity there  
class4	1025	furthermore  the node positive group was evaluated to ascertain if the current staging system  turnbull  1967  is prognostically accurate for the dukes  c group  
class4	1025	specifically evaluated for possible prognostic variance was the survival of those patients whose tumors demonstrated partial bowel wall penetration and only one to four positive nodes  a  c1 subset   previously reported to have favorable prognosis  
class4	1025	eight hundred sixty four cases of colon and rectal cancer treated surgically from 1977 to 1982 were analyzed  
class4	1025	there was a mean of 27 lymph nodes retrieved per specimen and a mean of 4 5 positive nodes per dukes  c specimen  
class4	1025	there were 43 c1 and 201 c2 cases with five year survival rates of 73 and 38 percent  respectively  
class4	1025	the results of chemical clearance at ferguson hospital were found to be comparable with that of other centers using chemical clearance and superior to hand dissection  
class4	1025	the c1 subset clearly is noted to have prognostic advantage and should occupy a separate designation in any staging system  
class4	1026	colonoscopic screening of asymptomatic patients with a family history of colon cancer  
class4	1026	the records of 201 asymptomatic patients who underwent colonoscopy based solely on a family history of colon cancer were reviewed  
class4	1026	eighty five patients  42 percent  had a total of 166 lesions  
class4	1026	fifty four  27 percent  patients of the screened population had neoplastic lesions  while 31  15 percent  patients had nonneoplastic polyps  
class4	1026	four carcinomas were found  
class4	1026	twenty five of the patients with polyps  29 percent  had no polyps distal to the splenic flexure  these proximal polyps  and two carcinomas  would have been missed on screening with fiberoptic sigmoidoscopy  
class4	1026	nineteen of these 25 patients had polyps smaller than 0 5 cm  which likely would have been missed with contrast enemas  
class4	1026	almost one half  47 percent  of all polyps discovered at screening colonoscopy were proximal to the descending colon  
class4	1026	only one patient younger than 40 years old had adenomas  
class4	1026	the yield of polyps and cancer in patients with familial risk indicates screening colonoscopy should be considered after age 40  
class4	1027	survival in patients with large bowel cancer  a population based investigation from the melbourne colorectal cancer study  
class4	1027	five year survival data were obtained in 97 percent or 1105 of 1140 new patients with histologically confirmed colorectal adenocarcinoma during a 12 month period in 1981 and 1982  as part of a large comprehensive population based study of colorectal cancer incidence  etiology  and survival  the melbourne colorectal cancer study  
class4	1027	fifteen percent of patients were dukes  a stage  32 percent were dukes  b  25 percent were dukes  c  and 29 percent were dukes  d  
class4	1027	at five years after diagnosis  the observed survival rate was 36 percent and the adjusted rate was 42 percent  
class4	1027	dukes  staging was a highly discriminating factor in survival  p less than 0 001   
class4	1027	survival rates were better in women than in men and better for patients with colon cancer than for patients with rectal cancer  
class4	1027	survival by dukes  staging was not affected by colon subsite or by the tumor being the first and single tumor  metachronous tumor  or synchronous tumor  
class4	1027	the survival of younger patients was better for dukes  stages a  b  and c  and worse for dukes  d  
class4	1027	survival was worse in the presence of bowel perforation in dukes  c and d stages  
class4	1027	within dukes  d  incurable cases   survival was best in the absence of hepatic metastases  slightly worse when only hepatic metastases were present  and poorest in the presence of both hepatic and extrahepatic metastases  
class4	1027	statistical modeling of survival determinants other than staging indicated that cell differentiation had the largest effect  survival decreasing with poor cell differentiation   followed by site  survival worse for rectal cancer than colon cancer   then age  survival better for younger patients   while bowel perforation had the smallest effect on survival  
class4	1028	endometrioma  an intra abdominal troublemaker  
class4	1028	a ten year review of intestinal and abdominal wall endometriomas is reported  
class4	1028	seven cases of intestinal and two cases of abdominal wall endometriomas are presented  
class4	1028	symptoms were varied but a majority had some gynecologic complaint  
class4	1028	in this select group of patients  preoperative investigations did not assist in establishing the diagnosis  
class4	1028	all patients underwent surgery and coexisting inflammatory bowel disease was present in two patients  
class4	1028	this review suggests that endometrioma of the intestine requires a high index of suspicion for diagnosis and that danazol does not appear to be effective treatment for these patients  
class4	1029	colonic lipoma as a source of massive hemorrhage  report of a case  
class4	1029	colonic lipomas are a rare source of massive lower gastrointestinal bleeding requiring operative intervention  
class4	1029	a case of massive hemorrhage from cecal lipomatosis is presented  
class4	1029	the methods of preoperative diagnosis and treatment are discussed  
class4	1030	malignant potential of juvenile polyposis coli  report of a case and review of the literature  
class4	1030	juvenile polyps of the colon and rectum traditionally have been viewed as being benign inflammatory or harmartomatous lesions without potential for malignant change  
class4	1030	the authors report a case of adenocarcinoma developing in a patient with sporadic juvenile polyposis  
class4	1030	juvenile polyposis was diagnosed in the patient at age 4 years  
class4	1030	he underwent subtotal colectomy at age 6 years  
class4	1030	at age 12  he underwent a proctectomy and a swenson pull through because of adenomatous changes in the rectal stump  
class4	1030	at age 19 surveillance endoscopy revealed invasive cancer in a juvenile polyp  
class4	1031	early gastric cancer  endoscopic diagnosis of depth of invasion  
class4	1031	in order to decide on a treatment strategy against gastric cancers  an accurate preoperative evaluation of the depth of cancer invasion is essential  
class4	1031	preoperative endoscopic diagnosis of the depth of invasion was compared with pathological results of the resected specimen in 206 early gastric cancers and 32 early like advanced gastric cancers  
class4	1031	the endoscopic distinction between early and early like advanced cancers was correctly made in 83 6  of the cases  
class4	1031	among the early gastric cancers  mucosal and submucosal invasion was correctly presumed in 71 9  of the cases  
class4	1031	when the tumor was an elevated type  or located in the antrum  the endoscopic diagnosis tended to be deeper than the true depth  
class4	1031	the size of tumor contributed little to the depth diagnosis  
class4	1031	pathomorphological changes on the tips of converging folds were the important clue for diagnosing depth  
class4	1032	cholecystokinin stimulates growth of human pancreatic adenocarcinoma sw 1990  
class4	1032	the effect of a synthetic analogue of cck  thr4 nle7cck 9  on growth of sw 1990 human pancreatic cancer was examined in two experimental models  
class4	1032	nude mice bearing sw 1990 pancreatic cancer xenografts were injected with cck  5  15  or 25 micrograms kg  or vehicle twice daily for 20 days  
class4	1032	animals were then sacrificed and tumor volume  weight  protein  and deoxyribonucleic acid  dna  content were evaluated  
class4	1032	sw 1990 cells were grown in vitro and the effects of cck  secretin  vasoactive intestinal peptide  vip   and proglumide  a cck receptor antagonist  on cell number and dna synthesis were determined  
class4	1032	the highest dose of cck  25 micrograms kg  significantly increased tumor weight  protein content  and dna content  p less than 0 005   
class4	1032	in vitro  cck caused significant increases in cell counts of up to 47  at six days and 66  at 12 days compared to control  
class4	1032	graded concentrations of cck had a biphasic effect on dna synthesis with significant increases of up to 65   p less than 0 005   
class4	1032	cck induced cell proliferation was inhibited by proglumide  
class4	1032	secretin slightly increased cancer cell growth  although not as potently as cck  vip or secretin in combination with cck did not show potentiation  
class4	1032	these results indicate that growth of some human pancreatic cancers may be influenced by gastrointestinal peptides  of which cck is the most potent  
class4	1033	improved scintigraphic assessment of severe cholestasis with the hepatic extraction fraction  
class4	1033	in previous studies  we found that biliary scintigraphy with technetium 99m labeled iminodiacetic acid   99mtc ida  provided excellent discrimination between intrahepatic and extrahepatic cholestasis  except in patients with profound cholestasis who had poor visualization of the biliary tree  
class4	1033	in this study  we have used deconvolution analysis to determine the hepatic extraction fraction  hef  of a hypothetical single circulatory pass of  99mtc ida  
class4	1033	our hypothesis was that extraction of radionuclide from the blood would be normal in patients with extrahepatic obstruction alone  but would be impaired in patients with intrahepatic disease  ihd   
class4	1033	the purpose of this study was to compare the hef in patients with profound cholestasis  bilirubin greater than or equal to 3 0 mg dl  due to either ihd or common bile duct obstruction  cbdo   
class4	1033	normal subjects  n   13  had an hef of 100   
class4	1033	patients with cbdo  n   13  had slightly reduced hef values  92 8     3 2   despite profound hyperbilirubinemia  6 1     1 0 mg dl   
class4	1033	patients with ihd  n   23  had a markedly reduced hef  43 1     4 1   which was significantly lower than patients with cbdo and normal subjects  p less than 0 001   
class4	1033	we conclude that the determination of the hef during biliary scintigraphy is helpful in distinguishing between intrahepatic and extrahepatic disease in patients with hyperbilirubinemia  bilirubin greater than or equal to 3 0 mg dl   
class4	1034	prospective study of alcohol intake and large bowel cancer  
class4	1034	the alcohol intake of a cohort of japanese men in hawaii is directly and significantly related to the risk of developing rectal cancer  whether assessed on the basis of amount consumed or as a percent of total calories  
class4	1034	wine and whiskey are directly related to rectal cancer  but beer is the only alcoholic beverage that displays a statistically significant dose response  p   0 008   
class4	1034	colon cancer risk also is related directly to alcohol intake  but the association is statistically significant only when measured as a percent of energy intake  
class4	1034	this suggests that alcohol might displace cancer inhibitors from the diet  
class4	1034	calcium  vitamin c  and dietary fiber are inversely related to colon cancer risk in this cohort  and each of these micronutrients displays statistically significant negative correlation with alcohol intake  
class4	1034	a possible positive association between alcohol and lung cancer was ruled out after adjusting for cigarette smoking  
class4	1034	cancers of the prostate and stomach were unrelated to alcohol intake  but the risk of acquiring cancer at all other sites combined was strongly related to alcohol intake  
class4	1035	diagnosis of metastatic lesions to the stomach by salvage cytology  a report of three cases  
class4	1035	secondary neoplasms of the stomach are rare and are often clinical and diagnostic problems  
class4	1035	three patients with bleeding  volcano like  ulcers were diagnosed by combined endoscopic  salvage  cytology and surgical biopsy as having metastatic submucosal lesions from hematologic spread  
class4	1035	the combination of endoscopic appearance  clinical findings  and tissue and cytologic examination can lead to the correct diagnosis  
class4	1035	the results from these cases support the utility of this cytologic technique in combination with biopsy in this clinical setting  
class4	1036	primary non hodgkin s t cell lymphoma of the esophagus  a case with peculiar endoscopic ultrasonographic pattern  
class4	1036	we report a case of primary esophageal non hodgkin s t cell lymphoma in a young white female  
class4	1036	at admission  endoscopy revealed large  irregularly shaped  esophageal ulcerations with super imposed candidiasis  
class4	1036	endoscopic ultrasonography to assess submucosal alterations and periesophageal involvement revealed a diffuse hypoechogenic thickening  up to 5 mm  of the esophageal wall  a pattern consistent with lymphomatous infiltration  
class4	1036	definitive diagnosis was made with the aid of histology and immunohistochemistry  
class4	1037	anionic complex carbohydrate units of human thyroglobulin  
class4	1037	human thyroglobulin  htg  contains sulfate in chondroitin 6 sulfate chains and in complex carbohydrates  
class4	1037	in this study the sulfate containing complex carbohydrates were characterized by the number of sulfate and sialic acid residues that they contain  
class4	1037	samples of normal and nodular thyroid tissue were incubated for 16 h in  35s sulfate containing medium  and htg was purified from the tissues and the media  
class4	1037	complex carbohydrates were enzymatically removed from htg  
class4	1037	subsequent analysis on an hplc anion exchange column at ph 2 2 separated the carbohydrate units according to their number of negative charges  
class4	1037	sulfate containing peaks were monitored by radioactivity  and sialic acid containing peaks were identified by their shift to lower charge after treatment with neuraminidase  
class4	1037	peaks corresponding to sialic acid free carbohydrate units with one to four sulfates were identified  
class4	1037	also  carbohydrate units with two and three negative charges containing both sulfate and sialic acid were present  
class4	1037	in the nodular tissue of one patient there were more sulfated units with higher charge  especially units containing sialic acid  
class4	1037	in this patient the proportion of sulfated polyvalent units with sialic acid was 22 4  for normal and 64 6  for nodular tissue  
class4	1037	no difference in the composition of the charged units between the tissues and their corresponding media was seen  making it unlikely that the sulfate containing carbohydrates play a role in htg release  
class4	1037	it is concluded that htg contains complex carbohydrate units with up to four sulfate groups and units with both sulfate and sialic acid  
class4	1037	in some patients  the sulfate containing anionic carbohydrate units of htg from normal and nodular thyroid tissue are different  
class4	1038	hormonal treatment of functional ovarian cysts  a randomized  prospective study  
class4	1038	estrogen  e  progestin therapy for functional ovarian cysts is widely used in clinical practice  but the efficacy of this treatment has not been determined in controlled trials  
class4	1038	in this study  we examined the effect of e progestin administration in a group of infertility patients enrolled in a program of ovulation induction who had cysts identified by transvaginal sonography  
class4	1038	patients were randomized to receive either norethindrone 1 mg mestranol 0 05 mg d  group a  n   24  or no treatment  group b  n   24  for up to 6 weeks  
class4	1038	patients were re evaluated by sonography at 3  6  and 9 weeks after entry into the protocol  
class4	1038	the ages  mean cyst diameters  and proportions of patients having received gonadotropins in the previous menstrual cycle were not significantly different among the two groups  
class4	1038	all patients who had a sonographic abnormality persisting for 9 weeks were surgically explored and found to have pathological cysts  
class4	1038	the rate of disappearance of functional ovarian cysts was not affected by e progestin treatment  
class4	1039	multiple hormone elevations in zollinger ellison syndrome  prospective study of clinical significance and of the development of a second symptomatic pancreatic endocrine tumor syndrome  
class4	1039	in the present study of 45 patients with zollinger ellison syndrome  the frequency and clinical importance of the release of multiple gastrointestinal peptides were assessed prospectively  
class4	1039	during an initial evaluation  extent of gastrinoma  clinical symptoms  disease duration  and presence or absence of multiple endocrine neoplasia  type i  men i  were assessed  
class4	1039	all patients had determinations of fasting plasma gastrin  human pancreatic polypeptide  motilin  neurotensin  and somatostatin  35 had determinations of insulin and gastrin releasing peptide and 21 had determinations of glucagon  
class4	1039	a plasma elevation of additional peptides besides gastrin was detected in 62   with 44  having one  18  having two  and 0  having three additional peptides elevated  
class4	1039	motilin was elevated in 29   human pancreatic polypeptide in 27   neurotensin in 20   and gastrin releasing peptide in 10   whereas insulin  glucagon  and somatostatin were not elevated in any patient  
class4	1039	the presence or absence of elevation of any peptide did not differ in patients with or without men i  with gastrinoma size  with the presence or absence of metastatic disease  or with various clinical symptoms  
class4	1039	patients were assessed yearly for clinical evidence of a secondary symptomatic pancreatic endocrine tumor syndrome with a median follow up of 146 and 84 months from onset or diagnosis  respectively  
class4	1039	only one patient  2  of patients  developed a second syndrome  rate  2 patients per 100 patients observed for 10 years   
class4	1039	these results demonstrate that the plasma elevation of multiple gastrointestinal peptides is common in patients with zollinger ellison syndrome  however  the rate of developing a second symptomatic pancreatic endocrine tumor syndrome is much lower than generally believed  
class4	1039	furthermore  no evidence is found to support the conclusions that the detection of the plasma elevation of these peptides is clinically important in assessing men i status  disease extent  or presence of metastatic disease or that elevated levels of motilin  neurotensin  gastrin releasing peptide  or human pancreatic peptide are associated with any distinct clinical symptoms  
class4	1039	therefore  we recommend that plasma concentrations of these additional gastrointestinal peptides should not be assessed routinely but rather only if new symptoms develop  
class4	1040	detection of duodenal gastrinomas by operative endoscopic transillumination  a prospective study  
class4	1040	the ability of operative endoscopic transillumination of the bowel wall to detect duodenal gastrinoma was evaluated prospectively in 26 patients with the zollinger ellison syndrome  
class4	1040	the results were assessed by exploratory laparotomy and compared with the results of other localization techniques  
class4	1040	twelve duodenal gastrinomas were resected from 10 patients  
class4	1040	operative endoscopic transillumination detected 10 of the 12 gastrinomas  a sensitivity of 83   which was significantly greater  p less than 0 05  than that for either preoperative imaging  25   or intraoperative ultrasonography and palpation  42    
class4	1040	the sensitivity of operative endoscopic transillumination was a result of the ability to detect focal areas that did not transilluminate on the serosal side of the duodenum  and not the mucosal appearances seen through the endoscope  which were not helpful  
class4	1040	operative endoscopic transillumination detected gastrinomas less than 1 cm in diameter throughout the duodenum  
class4	1040	of the patients in this study  39  had duodenal gastrinomas  a greater frequency than previously reported  
class4	1040	these results indicate that operative endoscopic transillumination is the most sensitive technique yet described for detecting duodenal gastrinomas and should be performed routinely in all patients with the zollinger ellison syndrome who undergo exploratory laparotomy for cure  
class4	1041	liver fatty acid binding protein  a marker for studying cellular differentiation in gut epithelial neoplasms  
class4	1041	human liver fatty acid binding protein is a 127 residue cytoplasmic protein synthesized in liver and in the intestinal epithelium  
class4	1041	previous studies of normal and transgenic mice indicated that the liver fatty acid binding protein gene is a sensitive marker of enterocytic differentiation  
class4	1041	this study shows the use of immunohistochemical methods to examine liver fatty acid binding protein gene expression in normal human colonic epithelium  colonic villoglandular adenomas  nonmucinous and mucinous adenocarcinomas  and several types of noncolonic epithelial neoplasms  
class4	1041	cells containing liver fatty acid binding protein were found in normal colonic epithelium  in two thirds of colorectal villoglandular adenomas and nonmucinous adenocarcinomas  and in one third of mucinous adenocarcinomas but not in noncolonic  nonhepatic carcinomas  
class4	1041	all liver fatty acid binding protein positive colonic adenomas and adenocarcinomas contained patches of immunoreactive cells distributed among histologically identical patches of cells without liver fatty acid binding protein immunoreactivity  
class4	1041	this  mosaicism  was also found in metastases from liver fatty acid binding protein positive colonic adenocarcinomas  
class4	1041	immunostaining of these liver fatty acid binding protein positive tissues for carcinoembryonic antigen did not show a mosaic cellular pattern in its expression  
class4	1041	these data suggest that within a given neoplasm  differences exist in the differentiation programs of monoclonally derived  malignant colonic epithelial cells and that liver fatty acid binding protein is a useful marker for operationally defining these subpopulations  
class4	1041	liver fatty acid binding protein is also a potentially useful diagnostic marker for colorectal and hepatic carcinomas  
class4	1042	caseating hepatic granulomas in hodgkin s lymphoma  
class4	1042	a 68 year old man presented with recurrent hodgkin s lymphoma after a 9 year disease free interval induced by chemotherapy  
class4	1042	in addition to histological evidence of recurrent hodgkin s disease  the liver biopsy specimen showed extensive caseating granulomas  
class4	1042	cultures of bone marrow and liver tissue tested negative for mycobacterium tuberculosis  
class4	1042	no antituberculous treatment was administered  and the patient had an excellent clinical response to additional chemotherapy for lymphoma  
class4	1042	hodgkin s lymphoma should be added to the list of disease entities associated with caseating granulomas in the liver  
class4	1043	colonic lipomas  outcome of endoscopic removal  
class4	1043	colonic lipomas are benign adipose tumors which are usually submucosal  
class4	1043	with the increase in the number of endoscopic procedures being performed  these tumors are often detected incidentally at colonoscopy  
class4	1043	although the risks of removing these tumors have been recognized  numerous reports have documented safe removal by snare electrocautery  
class4	1043	we have reviewed the clinical outcome and the endoscopic and histopathologic features of seven lipomas that were endoscopically removed over a 5 year period  
class4	1043	four patients recovered uneventfully  while three patients  42 8   developed colonic perforation after the polypectomy  
class4	1043	in the latter group  the lipomas were significantly larger than they were in the patients who did not develop colonic perforation  1 9     0 4 and 4 2     0 7 cm  respectively  p   0 048   
class4	1043	furthermore  the polypectomy specimens from those patients who developed perforation all contained significant muscularis propria  
class4	1043	lipomatous polyps that are identified at endoscopy to be greater than or equal to 2 cm in diameter and to have a limited pedicle are at the greatest risk for endoscopic perforation  
class4	1044	expandable biliary metal stents for malignancies  endoscopic insertion and diathermic cleaning for tumor ingrowth  
class4	1044	seventeen patients with malignant biliary strictures have been treated by endoscopic insertion of self expandable metallic prostheses  
class4	1044	two patients received two prostheses inserted simultaneously in both the left and right hepatic ducts for klatskin tumor type iii  
class4	1044	immediate results were satisfactory despite an operative mortality of 18   and neither early nor late clogging was observed even in patients who presented previously with sludge above plastic stents that were removed  
class4	1044	however  among five patients followed for more than 4 months  two presented with obstruction due to tumor ingrowth into the stent through the metallic mesh  
class4	1044	accordingly  initial enthusiasm concerning long term patency of these stents has decreased  
class4	1044	however  we describe a technique of  diathermic cleaning  of tumor ingrowth which can easily restore the stent patency  
class4	1044	the advantages of these wire mesh 30 f stents are their easier insertion  better immediate drainage  and absence of dislocation or perforation  
class4	1045	performing screening flexible sigmoidoscopy using colonoscopes  experience in 500 subjects  
class4	1045	there is still controversy regarding the optimal length of flexible sigmoidoscopes  
class4	1045	we performed screening distal colon examinations using 168 cm colonoscopes in 500 asymptomatic subjects who were unsedated and had sigmoidoscopy cleansing preparation  
class4	1045	the mean depth of penetration was 66 cm and was similar in persons in whom the examination was discontinued because of poor preparation versus those with discomfort  
class4	1045	polyps were detected in 87 patients  but only 5 subjects had polyps detected above 60 cm  
class4	1045	we conclude that in a group of unsedated subjects scheduled for flexible sigmoidoscopy after a sigmoidoscopy prep  the use of instruments longer than 60 cm gives very little additional yield  
class4	1046	hormonal and enzymatic parameters of hepatic regeneration in patients undergoing major liver resections  
class4	1046	thirteen patients who underwent 40  to 80  removal of their livers had blood samples drawn initially and daily on postoperative days 1 to 7  
class4	1046	the enzyme marker of heightened polyamine metabolism  ornithine decarboxylase  and the indicator of dna synthesis  thymidine kinase  were measured  
class4	1046	in addition  the hormones  insulin  glucagon  estradiol and androgen   which in animals are known to reflect and possibly modulate regeneration  were measured  
class4	1046	changes in all these indices followed the same pattern as in rats  dogs and swine but at a slower rate  
class4	1046	ornithine decarboxylase and estradiol increased within 24 hr  but thymidine kinase and insulin rises did not become statistically significant until 3 to 5 days  
class4	1046	using these plasma or serum indices as surrogate measures of biochemical events in the liver itself  regeneration reached a maximum after 4 or 5 days  
class4	1046	by computed tomography scan analysis  restoration of hepatic cell mass was not complete until 3 wk  
class4	1047	pathological observations of intrahepatic peribiliary glands in 1 000 consecutive autopsy livers  iii  survey of necroinflammation and cystic dilatation  
class4	1047	pathological changes and significance of intrahepatic peribiliary glands  hitherto poorly recognized intrahepatic elements  have been evaluated in our laboratory  
class4	1047	in this report  we surveyed necroinflammatory and cystic changes of the peribiliary glands in 1 000 consecutive autopsy livers because these two changes coexisted frequently in the same liver  
class4	1047	the necroinflammatory change was found in 228 livers  22 8   and the cystic change in 202 livers  20 2    and 103 cases showed both changes in the same liver  
class4	1047	the necroinflammatory change was frequently found in intrahepatic cholangitis and extrahepatic biliary obstruction with bacterial infection  suggesting that biliary bacterial inflammation extends into these peribilary glands  
class4	1047	this change was also frequent in systemic infection or septicemia without biliary bacterial infection  implying that the peribiliary glands were also damaged in such conditions without direct infection  
class4	1047	the cystic change was frequent in livers with portal hypertension or obstruction  adult polycystic disease and necroinflammation of the glands  suggesting that the cystic change of the glands could occur as the result of the disturbance of intrahepatic circulation or as the result of inflammatory destruction of the glandular conduits  
class4	1047	some of peribiliary cysts may be of congenital origin  
class4	1047	dysfunction related to these pathological changes in the glands may diminish seromucous secretion and cause alterations in hepatic bile composition  
class4	1047	the cystic change of the glands may retard bile flow by compressing bile duct lumina  
class4	1048	efficacy of transesophageal echocardiography as a perioperative monitor in patients undergoing cardiovascular surgery  analysis of 149 consecutive studies  
class4	1048	to evaluate the usefulness of transesophageal echocardiography as a perioperative monitor in patients undergoing cardiovascular surgery  149 consecutive patients were studied since 1985  
class4	1048	left ventricular function was assessed by measurement of left ventricular dimension and ejection fraction in patients with valvular disease  
class4	1048	this monitoring was useful in detecting the changes in left ventricular performance in patients with volume overload and in managing patients in the early postoperative period  
class4	1048	cardiac tamponade was clearly demonstrated before changes in electrocardiogram and hemodynamic data  
class4	1048	in 27 patients  transesophageal color doppler echocardiography was used to confirm that there was no residual regurgitation immediately after valvular reconstructive surgery  
class4	1048	transesophageal color doppler echocardiography was also useful in detecting the entry of false lumen before surgery in 7 patients with dissecting aortic aneurysm  
class4	1048	there were no unsuccessful introductions  no traumatic or thermal injuries  18 patients  12 1   with hoarseness and 5 patients  3 4   with transient arrhythmia  
class4	1048	in conclusion  transesophageal echocardiography provides a good imaging window to the heart and great vessels perioperatively  
class4	1048	this expedient  safe informative imaging method can be used more routinely in patients during surgery  
class4	1049	three staged approach to the surgical management of renal cell carcinoma extending into the right atrium  case report  
class4	1049	left renal cell carcinoma extending into the right atrium was treated by angioinfarction  removal of right atrial tumour using cardiopulmonary bypass and ten days later abdominal radical nephrectomy and inferior vena cava thrombectomy  
class4	1049	twenty four months later the patient remains well with no evidence of tumour recurrence  
class4	1050	substance p is present in a subset of thyrotrophs in the human pituitary  
class4	1050	substance p immunoreactivity and tachykinin like peptides are present in the pituitary gland of several mammalian species  
class4	1050	in humans  however  the biochemical nature and cellular localization of pituitary substance p has not been defined  
class4	1050	we report here that substance p immunoreactive material is present in low concentrations in both the anterior and posterior lobes of the human pituitary gland  
class4	1050	gel chromatography and reverse phase high performance liquid chromatography indicate that the majority of the substance p immunoreactivity in human pituitaries elutes as authentic substance p and its oxidized derivative  
class4	1050	immunohistochemical studies showed substance p immunoreactive fibers and terminals in the posterior pituitary gland and occasional substance p immunoreactive cell bodies in the anterior lobe  
class4	1050	the substance p immunoreactive cells were found to colocalize with a small subpopulation of tsh beta immunoreactive cells  thyrotrophs   
class4	1050	substance p immunoreactivity was also found in a pituitary microadenoma that contained numerous tsh beta immunoreactive cells  
class4	1050	these studies indicate that substance p is present in the human pituitary gland  and they suggest a relationship between substance p and thyroid function  
class4	1051	parathyroid hormone like peptide in normal and neoplastic human endocrine tissues  
class4	1051	pth like peptide  plp  is produced by tumors commonly associated with hypercalcemia as well as nonneoplastic tissues and several endocrine glands and tumors  
class4	1051	to characterize the distribution of plp in human endocrine tissues and tumors  we localized plp in formalin fixed paraffin embedded material using the avidin biotin peroxidase technique with polyclonal antisera  
class4	1051	among peptide hormone producing tissues  plp was identified in nontumorous adenohypophysis and pituitary adenomas  medullary thyroid carcinomas  normal  hyperplastic  and adenomatous parathyroids  adrenal medulla and pheochromocytomas  normal pancreatic islets  and endocrine tumors of pancreas  gut  and lung  including small cell carcinomas  
class4	1051	in other endocrine tissues plp was identified in nontumorous thyroid follicular epithelium  colloid nodules  and follicular neoplasms  normal adrenal cortex  adrenocortical adenomas  and carcinomas  nontumorous testicular leydig cells  normal ovarian granulosa and thecal cells  an ovarian thecoma and a granulosa cell tumor  placental trophoblast  and decidua  
class4	1051	these results demonstrate that plp is localized in many normal and neoplastic endocrine cells  including those not known to influence extracellular calcium homeostasis  
class4	1051	the presence of plp in a variety of endocrine tissues suggests that it may play a local physiological role in the growth or function of endocrine cells  
class4	1052	insulin like growth factor ii  possible local growth factor in pheochromocytoma  
class4	1052	pheochromocytomas  neural crest tumors  express an abundance of insulin like growth factor ii  igf ii   
class4	1052	to assess further the potential for igf ii to play an autocrine role for these tumors  we measured 1  igf ii content by rra in 7 pheochromocytomas and peripheral blood in these patients  2  igf ii receptors by western analysis  and 3  characterized the tumor binding proteins by ligand blot studies  
class4	1052	igf ii levels in the tumors varied from 2 8 41 micrograms g  
class4	1052	chromatography revealed that 60  of the peptide eluted as a large mol wt form of igf ii  8 7 10 kda   the remainder coeluted with mature peptide  7 5 kda   
class4	1052	this was in contrast to igf ii levels in normal adrenal tissue  0 225     0 005 micrograms g  or another neural crest derived tumor  medullary carcinoma of the thyroid  0 63     0 02 micrograms g   
class4	1052	serum igf ii levels in the 7 patients with pheochromocytoma  720     71 ng ml  were similar to those in 35 normal controls  762     69 ng ml   
class4	1052	radiolabeled igf ii  9     1   and igf i  20     2   bound specifically to pheochromocytoma membranes  
class4	1052	western analysis of these membranes using a specific antiserum directed against the type ii receptor demonstrated a band at 210 kda  
class4	1052	affinity cross linking studies with  125i igf i demonstrated a specific band at 140 kda  
class4	1052	ligand blot analysis was performed on the void volume pools from the sephadex g 75 column and demonstrated bands at about 30 and 25 kda  
class4	1052	in conclusion  these data 1  confirm that pheochromocytomas have increased levels of igf ii  2  demonstrate that despite high igf ii concentrations in the tumors  peripheral levels are not elevated  suggesting that very little tumoral igf ii is released into the circulation  unlike catecholamines  3  demonstrate the presence of igf ii and igf i receptors  4  describe binding protein species similar to those present in other tissues  
class4	1052	thus  the presence of high levels of igf ii and both type i and type ii receptors suggests that igf ii may act through both receptors to alter tumor growth  
class4	1053	insulin like growth factor i receptors in nonfunctioning thyroid nodules  
class4	1053	we have recently demonstrated the production of insulin like growth factor i  igf i  as well as the presence of type i igf receptors in human thyroid cells in primary culture  
class4	1053	the role of igf i in the control of thyroid cell growth has been well established  
class4	1053	in order to investigate the involvement of igf i in abnormal thyroid growth  the density of igf i receptors in solitary  cold  micro  and macro follicular thyroid adenomas  and in extranodular histological normal tissue was studied  
class4	1053	forty three euthyroid patients with isolated cold nodules were selected for the study  
class4	1053	in 30 patients the presence of igf i receptors was evaluated by using quantitative immunohistochemistry  in 10 patients by using radioligand binding studies  and in 3 patients by using affinity labeling  
class4	1053	cross linking and binding studies clearly demonstrated the presence of a homogeneous class of binding sites for type i igf receptors  
class4	1053	furthermore  radioligand studies did not show any significant differences in receptor density between the 2 types of thyroidal tissues  
class4	1053	conversely  the computerized analysis of 900 fields of nodular and normal thyroid tissues immunostained with the monoclonal antibody alpha ir3  strongly indicated that higher concentrations of igf i receptors were present in the epithelial cells of non functioning thyroid nodules than in the adjacent extranodular thyroid tissues  
class4	1053	these studies strongly suggest that the same type i igf receptor is present in thyroid follicular adenomas as in histological normal thyroid tissue removed from the same patient  
class4	1053	the higher concentration of igf i receptors as documented by immunostaining in the adenomas suggests that igf i may contribute to the abnormal growth of the neoplasms  
class4	1054	transthyretin receptors on human astrocytoma cells  
class4	1054	transthyretin  ttr   a transport protein for t4 and retinol binding protein  is the principal t4 binding protein of cerebrospinal fluid  
class4	1054	its function in regard to the delivery of its ligands and in other respects is unclear  
class4	1054	the binding of  125i  ttr to cultured human astrocytoma cells was studied to determine whether these cells carry receptors for ttr  
class4	1054	scatchard analysis was consistent with a single class of binding sites with a kd of 3 nm  
class4	1054	no significant cross reactivity with transferrin or serum albumin was observed  
class4	1054	internalization of ttr was temperature dependent and proportional to receptor occupancy  
class4	1054	dilutions of cerebrospinal fluid displaced  125i ttr in proportion to their content of radioimmunoassayable ttr and in parallel with purified ttr  
class4	1054	the uptake and internalization of ttr increased in the presence of high t4 or t3 concentrations  
class4	1054	these results demonstrate that ttr binds to specific high affinity receptors on human astrocytoma cells  
class4	1054	receptor binding of ttr provides a potential mechanism for the delivery of its ligands within the central nervous system  
class4	1055	clinical review 16  parathyroid hormone related proteins  coming of age in the 1990s  
class4	1055	the last 3 yr have yielded a fertile harvest of new information on the hhm clinical syndrome and on the novel peptide hormone family responsible for the syndrome  
class4	1055	whereas the clinical riddle enshrouding the hhm syndrome first posed in the early 1940s appears to have been largely solved  a whole new field  concerning the physiological role s  of pthrp has opened  
class4	1055	the field has evolved rapidly and provides an example of fruitful clinical investigation  the original problem was a clinical one  the hhm syndrome   understanding the clinical disorder led to pursuit of the problem in the laboratory  adenylate cyclase assays  protein purification  molecular cloning  pthrp synthesis   and observations made in the laboratory have rapidly yielded clinical fruits  pthrp immunoassays  and opened a new window on normal physiology  
class4	1056	clonal origin of pituitary adenomas  
class4	1056	as the pathogenesis of pituitary adenomas remains unclear  the tumor clonal composition of these common neoplasms was studied  
class4	1056	clonality was determined in female patients by analysis of restriction fragment length polymorphisms of the x chromosome genes hypoxanthine phosphoribosyl transferase and phosphoglycerate kinase in conjunction with their respective methylation patterns  
class4	1056	peripheral lymphocyte dna was screened from 62 female patients undergoing transsphenoidal surgery for pituitary adenoma  
class4	1056	eleven patients were heterozygous for the bgli site on pgk  4 for the bamhi site on hprt  and 1 patient for both sites  
class4	1056	of these 16 patients  3 had acromegaly  4 had cushing s disease  7 had hyperprolactinemia  and 2 were clinically nonfunctional  
class4	1056	after surgery  morphological study  including immunohistochemistry and electron microscopy of the pathological specimens  allowed a direct comparison between clonality and tumor cell type  
class4	1056	control fresh normal pituitary tissue was found to be polyclonal  
class4	1056	the following tumors were monoclonal  all 3 somatotroph adenomas  4 of 4 lactotroph tumors  3 of 4 corticotroph cell adenomas  a gonadotroph adenoma  and a nonsecretory adenoma  
class4	1056	a mixed plurihormonal adenoma was polyclonal  as were 2 tumors consisting of adenomatous lactotrophs interspersed with nontumorous adenohypophyseal pituitary tissue and one corticotroph adenoma mixed with normal pituitary tissue  
class4	1056	functional pituitary adenomas derived from somatotrophs  corticotrophs  or lactotrophs and nonsecretory tumors are monoclonal in nature  suggesting that somatic cell mutations precede clonal expansion of these cells and play a major role in pituitary tumorigenesis  
class4	1057	androgen response to endogenous insulin secretion during the frequently sampled intravenous glucose tolerance test in normal and hyperandrogenic women  
class4	1057	women with ovarian hyperandrogenism frequently have insulin resistance  whose underlying mechanism remains to be determined  
class4	1057	in the present study we have investigated the relationship between insulin sensitivity and the acute effect of endogenous insulin secretion on circulating androgen levels  
class4	1057	insulin sensitivity  glucose mediated insulin release  and glucose insulin stimulated androgen responses were determined during a frequently sampled iv glucose tolerance test in a group of 19 women with clinical evidence of polycystic ovary syndrome  pcos  and 9 age  and weight matched controls  
class4	1057	insulin  i   glucose  androstenedione  testosterone  t   free t  and dehydroepiandrosterone  dhea  levels were measured before and during the 3 h following iv administration of glucose  300 mg kg   
class4	1057	intravenous tolbutamide  300 500 mg  was injected 20 min after the glucose injection  
class4	1057	insulin sensitivity  si  was calculated by application of the minimal model of glucose kinetics  
class4	1057	fasting androstenedione  t  free t  and i concentrations were significantly higher in the women with pcos than in controls  p less than 0 02   
class4	1057	in pcos subjects  fasting i was correlated with both t  r   0 51  p less than 0 05  and dhea  r   0 706  p less than 0 01   
class4	1057	si was significantly lower in pcos subjects  si  68 35     8 34 min 1  nmol ml  than in control subjects  si  133 36     21 7 min 1  nmol ml    
class4	1057	a significant decline in dhea levels was observed in control subjects 3 h after glucose administration  from 28 4     3 0  final  16 2     2 4  p less than 0 02   
class4	1057	pcos women with normal insulin sensitivity  si  greater than 75 0 min 1  nmol ml   showed a similar fall in dhea  from 20 3     2 5 to 12 8     1 8 nmol l  p less than 0 02   
class4	1057	no significant change occurred in insulin resistant pcos subjects  si  less than 75 0 min 1  nmol ml    
class4	1057	other androgen levels showed a modest nonsignificant decline during the study in pcos and control groups  
class4	1057	these findings confirm the weight independent insulin resistance of some hyperandrogenic women  
class4	1057	the failure of glucose stimulated endogenous insulin secretion to significantly depress dhea levels in insulin resistant women with pcos may account in part for their androgen excess  
class4	1058	growth of cultured human cerebral meningiomas is inhibited by dopaminergic agents  presence of high affinity dopamine d1 receptors  
class4	1058	we have found that microm concentrations of the dopamine agonist bromocriptine significantly decrease the proliferation rate of human meningioma cells in culture  25 56  inhibition   
class4	1058	this effect was also seen with direct application of dopamine  as well as the dopamine d1 agonist     skf 38393  both applied in microm concentrations  to meningioma cell cultures  
class4	1058	receptor studies with the dopamine d1 ligand  125i sch 23982  dopamine d1 antagonist  indicated that dopamine d1 binding sites were present in the membranes of meningioma tissue  
class4	1058	the mean dissociation constant  kd  was 325       74 5 sem  pm and the receptor density  bmax  was 25 4       1 5 sem  fmol mg pellet protein in 5 human meningiomas  
class4	1058	the pharmacological specificity was proven by     skf 38393       skf 83566 or     butaclamol and their inactive isomers     skf 38393 and     butaclamol in a 1000 fold excess  
class4	1058	these results provide evidence that human meningiomas possess high affinity dopamine d1 receptors and that dopamine agonists have an antiproliferative effect on these tumors in culture  
class4	1058	we conclude that the proliferation of cerebral meningiomas may be under dopaminergic control and that dopamine agonists may have a role in the medical treatment of patients with meningiomas  
class4	1059	endothelin like immunoreactivity in human breast cyst fluid  
class4	1059	immunoreactive endothelin has been detected in 21 of 43 samples of breast cyst fluid  21 cases  3 5     0 6 pmol l  mean     sem  
class4	1059	other 22 cases  not detectable  less than 0 5 pmol l   
class4	1059	fast protein liquid chromatographic analysis of the immunoreactive endothelin of pooled breast cyst fluid showed two immunoreactive peaks  one in the void volume and the other in the position of endothelin 1  
class4	1059	it is probable that endothelin 1 is produced by the epithelial cells lining breast cysts  but significance of the presence of endothelin 1 in breast cyst fluid remains to be elucidated  
class4	1060	sensitivity of digoxigenin and biotin labelled probes for detection of human papillomavirus by in situ hybridisation  
class4	1060	the sensitivity of digoxigenin and biotin labelled dna probes for the detection of human papillomavirus  hpv  by dot blotting and in situ hybridisation was compared in tissues from cervical  laryngeal  and anogenital neoplasia  
class4	1060	probes were either labelled with digoxigenin by the random primer technique and detected with anti digoxigenin antibody  or labelled with biotin by nick translation and detected with streptavidin  both methods having a common final visualisation procedure using alkaline phosphatase  
class4	1060	digoxigenin labelled probes proved two to 10 fold more sensitive by quantitative dot blotting and four fold more sensitive in detecting hpv 16 dna in a series of 31 anal carcinomas  compared with biotinylated probes  
class4	1060	the digoxigenin method also produced less non specific background staining of tissue sections than biotin labelled probes  
class4	1060	it is concluded that digoxigenin dna labelling and detection provides a simple  reliable  and efficient alternative to the use of biotin or radioactive isotopes for the detection of hpv dna by in situ hybridisation  
class4	1060	digoxigenin labelled probes also offer the possibility of double labelling in situ hybridisation procedures when used with biotin labelled probes to provide simultaneous identification of different dna sequences  
class4	1061	application of 1 nm gold probes on paraffin wax sections for in situ hybridisation histochemistry  
class4	1061	an in situ hybridisation technique that uses 1 nm immunogold reagents and silver enhancement was devised to detect biotinylated dna viral probes in formalin fixed  paraffin wax sections of human cervix  
class4	1061	dna probes labelled with biotin 11 deoxyuridine triphosphate were detected after hybridisation to nucleic acid sequences by an antibiotin antibody  followed by a gold labelled secondary antibody  
class4	1061	silver enhancement then permitted visualisation of the signal at the light microscopic level  
class4	1061	the method was reliable and produced less background staining than previously described methods  
class4	1061	the signal could be enhanced by epi polarisation microscopy  
class4	1061	furthermore  biotinylated dna probes may be detected directly by a 1 nm gold labelled goat antibiotin antibody without loss of labelling intensity  and this may be preferable to the longer two layer technique  previously described  
class4	1062	importance of sampling method in dna analysis of lung cancer  
class4	1062	lung carcinomas are characterised by considerable histological variation within the tumour  
class4	1062	the possible effects of this morphological heterogeneity on the estimation of tumour ploidy were investigated  
class4	1062	multiple tissue blocks were systematically taken from 20 lung tumours and analysed by flow cytometry  
class4	1062	the routine  archival paraffin wax embedded diagnostic blocks from these cases were also analysed  
class4	1062	nineteen  95   of the tumours were shown to contain aneuploid stemlines by systematic sampling  but if only one of these systematic tissue blocks had been taken from each case the incidence of dna aneuploidy could have been as low as 45   
class4	1062	only 15  75   tumours were aneuploid when all the routine archival blocks were analysed  but by specifically selecting tumour areas from the archival material the accuracy of this method was increased to 90   
class4	1062	it is concluded that tumour sampling methods are of primary importance in assessing the dna content of lung tumours  
class4	1062	routine paraffin wax embedded archival tissue provides a suitable source of material for this purpose  provided that  turnover  selection is carried out  
class4	1063	cells immunoreactive for neuropeptide in human thymomas  
class4	1063	the presence of opioid peptides  bombesin  and substance p was investigated by immunohistochemistry in tissue sections from six human thymomas  
class4	1063	the number of immunoreactive cells seemed to vary from one case to another  
class4	1063	ultrastructural investigation  showing the presence of desmosomes in labelled cells  allowed these cells to be classified as epithelial lineage cells  
class4	1063	the occurrence of cells containing neuropeptide in thymomas suggest that peptide molecules could have modulated the behaviour of this tumour  given the reported influence of these molecules on immune functions and their growth promoting activity on several cell types  including mesenchymal and epithelial cells  
class4	1064	tissue preparation for simultaneous flow cytometric quantitation of tumour associated antigens and dna in solid tumours  
class4	1064	a multiparameter flow cytometric assay for the simultaneous study of tumour associated antigens  taa  and dna in fresh solid tumours was devised  
class4	1064	cell suspensions were prepared by disaggregating unfixed solid tumour samples mechanically over a stainless steel mesh  
class4	1064	indirect immunofluorescence was used to identify the taa  and dna was stained with propidium iodide  
class4	1064	cell morphology was well preserved  cell clumping was negligible  and high quality indirect immunofluorescence quality indirect immunofluorescence and dna staining were obtained  
class4	1064	the technique is simple  rapid  and reproducible  
class4	1064	multiparameter assays can be developed to study prognostic indicators such as membrane oncoproteins  receptors  and multidrug resistance in solid tumours  
class4	1064	with a suitable panel of antibodies the technique might become an aid in the differential diagnosis and biochemical diagnosis of some solid tumours  
class4	1065	value of monoclonal anti myeloperoxidase  mpo7  for diagnosing acute leukaemia  
class4	1065	the expression of myeloperoxidase  mpo  was studied in 100 cases of acute leukaemia  83 with acute myeloid leukaemia  aml  and 17 acute lymphoblastic leukaemia  all  by both a conventional cytochemical method and the immunocytochemical antiperoxidase  apaap  technique using the monoclonal antibody mpo7  
class4	1065	in each case the staining was evaluated by light microscopical examination  percentage of positive cells   
class4	1065	of the 83 cases of aml  78  93 9   were positive for mpo7 compared with 70  84 3   by cytochemistry  
class4	1065	antibodies against the myeloid markers cd13 and cd33 were positive in 71  85 5   and 70  84 3   cases  respectively  
class4	1065	importantly  all cases of all were negative for both mpo7 and cytochemical mpo staining even when they were positive for cd13 and cd33  
class4	1065	these results indicate that the anti myeloperoxidase antibody mpo7 is the most sensitive and specific reagent for the diagnosis of aml and should therefore be included in routine immunophenotyping panels  
class4	1066	cutaneous manifestations of postthymic t cell malignancies  description of five clinicopathologic subtypes  
class4	1066	this study was undertaken to identify the cutaneous manifestations among different prognostic subgroups of postthymic t cell malignancies  
class4	1066	cutaneous involvement was demonstrated in 43 of 88 cases  
class4	1066	we recognized five clinicopathologic subtypes  type i  classical cutaneous t cell lymphoma  ctcl  or mycosis fungoides  six cases  type ii  primary large cell type ctcl  ki 1 antigen  ki 1  or ki 1    seven cases  type iii  primary angioinvasive t cell lymphoma  three cases  type iv  human t lymphotropic virus type i  htlv i   adult t cell leukemia lymphoma  atl   eight cases  type v  secondary cutaneous involvement by peripheral t cell lymphoma  ptl   19 cases  
class4	1066	primary ctcl and atl tend to involve papillary dermis with or without epidermotropism  whereas ptl and angioinvasive t cell lymphoma predominantly affect skin adnexae  vessels  and subcutis  
class4	1066	cutaneous lesions in type v ptl are heterogeneous and may be confused with panniculitis  vasculitis  or an eczematous eruption  
class4	1066	classic ctcl  ki 1  lymphoma  and angioinvasive t cell lymphoma have a chronic course  whereas atl  ki 1  large cell lymphoma  and ptl are clinically aggressive  
class4	1067	giant eccrine acrospiroma  
class4	1067	four cases of large eccrine acrospiroma  three benign  one malignant  are reported  
class4	1067	the benign tumors involved the lower extremities of two women and one man  73 to 89 years of age   
class4	1067	the duration of the lesions ranged from 10 to 20 years  
class4	1067	the malignant tumor involved the left side of the chest of a 60 year old man  
class4	1067	its occurrence in a lesion that had been present for 40 years suggested malignant transformation of a pre existing benign eccrine acrospiroma  
class4	1067	each tumor showed little to no cellular atypia  
class4	1067	mitotic rates  mitotic figures per 10 high power fields  varied both between and within lesions  
class4	1067	average mitotic rates did not differentiate the benign from the malignant tumors  
class4	1067	the most important distinguishing features of large benign eccrine acrospiromas are the relative circumscription  the lack of cellular atypia  and the absence of stromal  perineurial  and angiolymphatic invasion  
class4	1068	intralesional interferon therapy for basal cell carcinoma  
class4	1068	in a clinical trial of 172 patients at four medical centers  interferon alfa 2b  1 5 x 10 6  iu  or a placebo was injected directly into biopsy proved noduloulcerative or superficial basal cell carcinomas three times weekly for 3 weeks  for a cumulative dose of 13 5 million iu  
class4	1068	efficacy of treatment was determined at 16 to 20 weeks by examination of biopsy specimens that demonstrated cure of lesions in 86  of interferon treated patients and in only 29  of placebo treated patients  
class4	1068	during the treatment course and follow up  an initial inflammatory response was observed at the treatment sites  followed by diminished erythema  improvement in overall appearance  and a decrease in size of lesions  
class4	1068	side effects of treatment  mainly flu like symptoms  were usually mild and transient and occurred more commonly in the interferon treated group  
class4	1068	only three patients  all in the interferon treated group  discontinued therapy because of side effects  
class4	1068	one year after initiation of therapy  81  of interferon recipients and 20  of those given the placebo remained tumor free  
class4	1068	noduloulcerative and superficial lesions were equally responsive to treatment with interferon  
class4	1068	for some patients with noduloulcerative or superficial basal cell carcinomas  intralesional interferon alfa 2b may be an alternative  effective treatment  
class4	1069	autoimmunity and malignancy  
class4	1069	in patients with autoimmune diseases malignancy is observed more frequently than in an age matched control group  
class4	1069	in strains of mice susceptible to autoimmune diseases  the incidence of lymphoreticular malignancies is increased  
class4	1069	although viruses have not been directly implicated in their pathogenesis or etiology  there are suggestions that slow viruses may be involved  
class4	1069	viruses have been found to be important in the development of lymphomas  
class4	1069	hence in genetically susceptible animals  viruses can initiate the autoimmune process  
class4	1069	prolonged stimulation of the autoimmune process or a prolonged state of immunodeficiency could trigger or activate genes or their products  which could result in the development of malignancy  
class4	1070	buschke loewenstein tumor  verrucous carcinoma of the penis  
class4	1070	the buschke loewenstein tumor is an anogenital tumor of characteristic clinical and histologic pattern best considered as a low grade  well differentiated squamous cell carcinoma  
class4	1070	this remarkable neoplasm and its features are reviewed in detail  stressing salient advances in our understanding of it  
class4	1071	cutaneous melanoma and bilateral retinoblastoma  
class4	1071	we report the case of an otherwise healthy 37 year old man who had had bilateral enucleation during early childhood for bilateral retinoblastomas  in addition to two cutaneous melanomas  the first appearing at age 27 years   
class4	1071	he also had dysplastic melanocytic nevi and a history of cutaneous melanoma in his mother  
class4	1071	retinoblastoma may aggregate in families and is associated with dna abnormalities of chromosome 13  
class4	1071	recent reports have emphasized the appearance of second malignancies in retinoblastoma survivors  
class4	1071	the second malignancies include osteosarcoma  soft tissue sarcoma  and cutaneous melanoma  
class4	1071	cutaneous melanoma also may aggregate in families  usually in the setting of dysplastic melanocytic nevi  
class4	1071	the features of this case and of similar reported cases suggest that there may be a greater than expected association between retinoblastoma and cutaneous melanoma  
class4	1072	multicentric cloacogenic carcinoma  report of a case with anogenital pruritus at presentation  
class4	1072	a case of multicentric cloacogenic carcinoma of the perianal skin and vulva in a 79 year old woman is presented  and the embryologic basis for the multicentricity is discussed  
class4	1072	histologically  cloacogenic carcinoma can be differentiated from other small cell neoplasms that affect the area  
class4	1072	cloacogenic carcinoma should be considered a rare cause of anogenital pruritus  
class4	1072	it is important to perform an early biopsy of anogenital lesions that do not respond to conventional therapy  
class4	1073	severe lidocaine intoxication by cutaneous absorption  
class4	1073	a severe lidocaine intoxication by cutaneous absorption is described  
class4	1073	data are presented to show a significant absorption of lidocaine through diseased skin when lidocaine cream is used as a local anesthetic  
class4	1073	awareness of this route of intoxication might be important in patients in whom neurologic or psychiatric symptoms develop while large amounts of lidocaine cream are being used  
class4	1074	disseminated kaposi s sarcoma not associated with hiv infection in a bisexual man  
class4	1074	we report a 42 year old white bisexual man with disseminated kaposi s sarcoma limited to the skin and gastrointestinal tract  
class4	1074	results of several serum tests for human immunodeficiency virus  hiv  antibodies have been negative  
class4	1074	the cd4 cd8 ratio has remained normal  and his kaposi s sarcoma has had a benign clinical course during 30 months of follow up  
class4	1074	similar reports of disseminated kaposi s sarcoma with a benign clinical course in homosexual or bisexual men without demonstrable hiv infection are reviewed  
class4	1074	some cellular immune impairment that might be more prevalent in the homosexual population may be implicated in the pathogenesis of this type of kaposi s sarcoma  
class4	1075	cutaneous horn of the penis  its association with squamous cell carcinoma and hpv 16 infection  
class4	1075	cutaneous horns of the penis are rare  
class4	1075	including this case  only 19 cases have been reported in the english language literature  
class4	1075	in 37  of the reported cases a malignant tumor was found beneath the cutaneous horn  
class4	1075	our case is remarkable because a stage i squamous cell carcinoma developed on the shaft of the penis of a neonatally circumcised man  
class4	1075	human genital carcinoma resulting from a multifactorial process in which  promoting  papillomavirus is an integral element is being increasingly reported  
class4	1075	we review the relationship of circumcision to genital human papillomavirus infection and their synergism in the development of squamous cell carcinoma  
class4	1076	lip paresthesia associated with a jaw mass  
class4	1076	a case is reported in which mandibular swelling and lower lip numbness were the first signs of a metastatic adenocarcinoma of the lung  
class4	1076	the development of paresthesia  with or without other oral symptoms  requires that a diagnosis of malignancy be considered until confirmed or ruled out by tissue biopsy  
class4	1076	a thorough head and neck examination in all patients  especially in those whose history or habits may indicate increased risk of malignancy is necessary  
class4	1077	oncogenes and suppressor genes  their involvement in colon cancer  editorial  
class4	1077	abnormalities in oncogenes  which are broadly classified into viral and cellular oncogenes  and suppressor genes appear critical for the development of colon cancer  
class4	1077	cellular oncogenes contribute to malignant transformation when they become activated by point mutation  translocation  amplification  or loss of regulator sequences  
class4	1077	the properties of the oncoproteins  the proteins encoded by oncogenes which are essential for carcinogenesis  are unclear  
class4	1077	suppressor genes normally suppress the tumorigenic phenotype by keeping the growth of cells in check  it is their inactivation that contributes to malignant transformation  
class4	1077	development of colon cancer appears to take place by stepwise accumulation of multiple genetic alterations during the progression from normal colon to adenoma and carcinoma  
class4	1077	activation of ras  an early event in this sequence  is found in 50  of colon cancers  overexpression of c myc is found in approximately 80   
class4	1077	inactivation of suppressor genes  which occurs during later stages  is noted in greater than 70  of tumors  
class4	1077	a current model of colonic tumorigenesis is presented  
class4	1078	liver transplant for metastatic neuroendocrine tumor  
class4	1078	generally  the results of liver transplantation for metastatic liver disease have not been favorable  
class4	1078	one exception has been the unique group of neuroendocrine tumors  the slow growth of which allows liver transplantation to effectively palliate and control symptoms  
class4	1078	we report two cases   a  a 51 year old man who underwent orthotopic liver transplantation and resection of the pancreatic primary tumor for a nonfunctioning malignant neuroendocrine tumor with features of both carcinoid and islet cell glucagonoma remains symptom free and without evidence of tumor recurrence at 13 months follow up  
class4	1078	 b  a 47 year old man who underwent orthotopic liver transplantation and whipple resection for a metastatic islet cell tumor in the head of the pancreas is fully recovered at 5 months follow up  
class4	1079	a nongastrin malignant ampullary tumor causing gastric acid and pepsin hypersecretion  a case report  
class4	1079	we report a case of multiple duodenal ulcers with gastric hypersecretion due to a nongastrin secretagogue produced by a malignant tumor of the pancreas in a 78 year old man  
class4	1079	the case resembled a zollinger ellison syndrome  zes  with high acid output  basal acid output 27  sham meal stimulated 37  maximum acid output 47 meq h   but with fasting gastrin 43 pg ml  nonresponsive to secretin  
class4	1079	as in zes  pepsin output was comparatively low  and secretion was inhibitable by atropine  50  inhibited by 1 microm   
class4	1079	the tumor removed at surgery contained less than 1 ng gastrin per gram  but was many times more potent than pentagastrin in stimulating acid from a lumen perfused rat stomach  
class4	1079	the tumor also contained cholecystokinin  cck 8 and cck 33   motilin  insulin  and somatostatin  which were also present in adjacent normal pancreas  in addition  the tumor contained pancreatic polypeptide and pancreatic cancer associated antigen  
class4	1079	this case represents a rare syndrome due to an as yet undefined peptide secreted by a  frequently malignant  pancreatic endocrine tumor and masquerading as zes  
class4	1079	this is the first report of studies of pepsin secretion and of the effect of atropine  suggesting that the physiologic effects of the secretagogue resemble that of gastrin  
class4	1080	insulinoma after streptozotocin therapy for metastatic gastrinoma  natural history or iatrogenic complication  
class4	1080	islet cell carcinoma frequently produces more than one chemical product  although its clinical expression is usually restricted to a single hormone  
class4	1080	we describe an unusual patient who presented with full blown metastasizing gastrinoma  
class4	1080	he was treated with cimetidine for five years and then streptozotocin therapy  which resulted in a regression in hepatomegaly and a fall in serum gastrin levels  
class4	1080	following one year s therapy with streptozotocin  he was admitted in hyperinsulinemic hypoglycemic stupor  
class4	1080	this appears to be the first reported case of a  shift  from clinical gastrinoma to insulinoma possibly related to prolonged streptozotocin therapy  
class4	1081	insulin like growth factor i supports proliferation of autocrine thymic lymphoma cells with a pre t cell phenotype  
class4	1081	we have studied the phenotypic characteristics and growth properties of murine t lymphoma cell lines derived from primary x ray induced thymic lymphomas at the earliest stage at which they can be detected  and well before spreading to other organs has occurred  
class4	1081	these cell lines serve as model systems for the earliest events in t cell lymphoma induction  before tumor cell progression and spreading to other organs  
class4	1081	we find that primary x ray induced t cell lymphoma lines have phenotypic characteristics of thymic pre t cells and show no proliferative response to any of the il tested nor to other hematopoietic growth factors  
class4	1081	however  they do proliferate in response to insulin like growth factor i  igf i  and to a small autocrine peptide distinct from igf i  which we term lymphoma growth factor  
class4	1081	one of the earliest lesions in t cell lymphoma induction may therefore be an inhibition of differentiation at one of several specific points  
class4	1081	in its early stages  t lymphoma cell growth may be restricted to an environment where local concentrations of specific growth factors such as igf i or lymphoma growth factor are sufficiently high  
class4	1082	regional and systemic distribution of anti tumor x anti cd3 heteroaggregate antibodies and cultured human peripheral blood lymphocytes in a human colon cancer xenograft  
class4	1082	anti tumor antibody  317g5  covalently coupled to an anti cd3 antibody  okt3  produces a heteroaggregate  ha  antibody that can target pbl to lyse tumor cells expressing the appropriate tumor ag  
class4	1082	the i v  
class4	1082	and i p  
class4	1082	distribution of radiolabeled ha antibody 317g5 x okt3 and of radiolabeled cultured human pbl were studied in athymic nude mice bearing solid intraperitoneal tumor established from the human colon tumor line  ls174t  
class4	1082	mice were injected with 125i labeled ha antibody  125i labeled anti tumor mab  or 111in labeled pbl  and at designated timepoints tissues were harvested and measured for radioactivity  
class4	1082	125i 317g5 x okt3 localized specifically to tumor sites  
class4	1082	tumor radioactivity levels  percent injected dose gram  were lower with 125i 317g5 x okt3 ha antibody than with 125i 317g5 anti tumor mab  but were similar to levels reported for other anti tumor mab  
class4	1082	the major difference in radioactivity levels observed between i v  
class4	1082	and i p  
class4	1082	administration of 125i 317g5 x okt3 was an increase in hepatic radioactivity after i v  
class4	1082	ha antibody administration  
class4	1082	ha antibodies produced from f ab  2 fragments  which exhibit decreased m  
class4	1082	w  
class4	1082	and decreased fc receptor mediated binding  demonstrated improved tumor tissue ratios as compared to intact antibody ha  
class4	1082	125i 317g5 f ab  2 x okt3 f ab  2 antibody levels were equivalent to intact ha antibody levels in tumor  but were lower than intact ha antibody levels in the blood  bowel  and liver  
class4	1082	tumor bowel ratios  20 1 at 48 h  were highest when 317g5 f ab  2 x okt3 f ab  2 was injected i p  
class4	1082	autoradiography confirmed that anti tumor x anti cd3 ha antibodies localized specifically to intraperitoneal tumor  that i p  
class4	1082	administered ha antibodies penetrated tumor directly  and that i v  
class4	1082	administered ha antibodies distributed along tumor vasculature  
class4	1082	cultured human pbl distributed in moderate concentrations to intraperitoneal tumor when administered i p   but not when administered i v  
class4	1082	the poor localization of i v  
class4	1082	injected pbl to tumor may reflect species disparity in homing receptors and or endothelial ligands  a problem which may be overcome with a syngeneic model  
class4	1082	these results suggest that regional therapy with ha antibodies and pbl may offer advantages over systemic therapy for initial clinical trials  
class4	1083	lymphokine activated killer  lak  cells  v  8 mercaptoguanosine as an il 2 sparing agent in lak generation  
class4	1083	guanine ribonucleosides  substituted at the c8 position with either a bromine or a thiol group  have recently been shown to regulate several immunologic responses  
class4	1083	we have previously shown that 8 mercaptoguanosine  8mg  can replace the requirement for cytokines in the generation of mhc restricted ctl  
class4	1083	in this paper  we examined the ability of 8mg to induce mhc nonrestricted killer cells  
class4	1083	we found that 8mg did not induce significant lytic activity from normal resting lymphocytes  
class4	1083	however  8mg was able to synergize with minimal amounts of il 2 in inducing lytic activity similar to lymphokine activated killers  lak  in that both nk sensitive and nk resistant tumor cells were killed  
class4	1083	both the precursors and effectors of 8mg lak activity were similar to nk cells and were cd4  cd8  asialo gm1  nk1 1   
class4	1083	similar to il 2 induced lak  8mg lak were b220   
class4	1083	8mg appeared to  stage  these precursor lymphocytes to become more responsive to il 2 because optimal induction of 8mg lak required preincubation with 8mg before the addition of il 2  
class4	1083	this  staging  appeared to be due to the release of a  second signal  since it was readily inhibited by cyclosporine a  
class4	1083	anti ifn alpha beta was as efficient as cyclosporine a in inhibiting 8mg lak generation  whereas anti ifn gamma and anti il 1 did not exhibit significant inhibition  
class4	1083	these findings suggest that 8mg can be of possible utility as an il 2 sparing agent in lak generation from nk cells  
class4	1084	excision repair of pyrimidine dimers induced by simulated solar radiation in the skin of patients with basal cell carcinoma  
class4	1084	one prominent lesion induced in dna by ultraviolet  uv  radiation is the cyclobutyl pyrimidine dimer formed between adjacent pyrimidines on the same dna strand  
class4	1084	we investigated whether people who have developed basal cell carcinoma on sun exposed skin have an altered ability to repair uv induced pyrimidine dimers in dna  
class4	1084	twenty two patients with at least one basal cell carcinoma  aged 31 84 years  and 19 healthy volunteers  aged 25 61 years  took part in the study  
class4	1084	both groups were given one minimal erythema dose  med  of simulated solar radiation on the lower back  
class4	1084	dna was extracted from the irradiated skin 0 to 6 h later  and the number of uv induced pyrimidine dimers was determined using a dimer specific endonuclease  
class4	1084	at time 0  the average number of dimers per unit of dna was similar in the two groups  
class4	1084	after 6 h  an average of 22     4  of the dimers were removed in the group with basal cell carcinoma compared to 33     4  in the cancer free group  
class4	1084	in the basal cell carcinoma group  only 23  of the patients repaired more than 30  of the dimers after 6 h  compared with 53  of the cancer free subjects  p less than 0 05   
class4	1084	we conclude that patients who develop basal cell carcinoma on sun exposed skin may have a decreased ability to repair pyrimidine dimers induced in skin exposed to simulated solar radiation  
class4	1085	susceptibility to effects of uvb radiation on induction of contact hypersensitivity as a risk factor for skin cancer in humans  
class4	1085	normal  healthy human volunteers and patients with proved history of non melanoma skin cancer have been tested for their capacity to develop contact hypersensitivity to dinitrochlorobenzene  dncb  following exposure of buttock skin to acute  low dose ultraviolet b  uvb  radiation  
class4	1085	using a radiation protocol that achieves virtually complete depletion of normal appearing langerhans cells from irradiated skin  it was learned that approximately 60  of healthy volunteers developed vigorous contact hypersensitivity  ch  when 2000 micrograms dncb was painted on the irradiated site  
class4	1085	these individuals were designated uvb resistant  and were distinguished from other individuals  designated uvb susceptible  who failed to develop contact hypersensitivity following an identical treatment protocol  
class4	1085	it was then discovered that virtually all  92   skin cancer patients exposed to uvb and dncb failed to develop ch  i e   were uvb susceptible  
class4	1085	in subsequent experiments  epicutaneous application of 2000 micrograms dncb to unirradiated skin of uvb susceptible individuals revealed a further distinction between normal persons and skin cancer patients  
class4	1085	approximately 45  of the latter  and none of the former  remained unresponsive  failed to develop contact hypersensitivity following this second attempt at sensitization   implying that they had been rendered immunologically tolerant  
class4	1085	these tolerant individuals responded normally to the unrelated hapten  diphencyprone  
class4	1085	we conclude that human beings resemble inbred strains of laboratory mice in that some individuals are uvb susceptible  whereas others are uvb resistant  
class4	1085	because the incidence of uvb susceptibility was significantly higher in skin cancer patients  and as specific unresponsiveness could be demonstrated only in these patients  we propose that uvb susceptibility  as we define it in this hapten system  may be a risk factor for the development of skin cancer  
class4	1086	premalignant lesions and cancers of the skin in the general population  evaluation of the role of human papillomaviruses  
class4	1086	to evaluate the role of human papillomaviruses  hpv  in the development of premalignant lesions and cancers of the skin in the general population  314 biopsies obtained from 227 patients with benign neoplasms  premalignant lesions  and cancers of the skin and from 25 patients with squamous cell carcinoma of the lip were analyzed by southern blot hybridization  
class4	1086	dna probes specific for various cutaneous and genital hpv types were used in hybridizations conducted under nonstringent or stringent conditions  
class4	1086	hpv dna sequences were only detected in eight specimens obtained from six patients  hpv 34 in one case of periungual bowen s disease  hpv 36 and an as yet uncharacterized hpv in two cases of actinic keratosis  hpv 20 in one case of basal cell carcinoma  an as yet unrecognized hpv in one case of squamous cell carcinoma  and hpv 16 in one case of squamous cell carcinoma of the lip  
class4	1086	none of the specimens of cutaneous horn and keratoacanthoma contained detectable hpv dna  
class4	1086	in contrast  hpv dna sequences  mostly hpv 16  were detected in 13 of 23 cases of anogenital bowen s disease and invasive bowen s carcinoma  
class4	1086	hpv dna sequences were not detected in 90 cutaneous samples further analyzed by the polymerase chain reaction technique  using amplification primers that contain conserved sequences among the genomes of hpv  
class4	1086	these results strongly suggest that the known hpv types play only a minor role  if any  in skin carcinogenesis in the general population  
class4	1087	cytomegalovirus in the brain  in vitro infection of human brain derived cells  
class4	1087	models for human cytomegalovirus  hcmv  brain infection have been developed in a variety of brain derived cells in which the factors governing virus infectivity might be studied in vitro  
class4	1087	studies were initiated with brain endothelial cells  the likely portal of entry for virus into the central nervous system  
class4	1087	primary explant cultures of brain endothelial cells  derived from homogenates of healthy human brain  supported complete viral gene expression and cytopathic effect  cpe   
class4	1087	endothelial cells do not appear to be a barrier for hcmv passage into the central nervous system  
class4	1087	astroglial lines  primary explant or tumor derived  varied in their ability to support hcmv replication  
class4	1087	some  t98g  supported incomplete  immediate early  gene expression while others  a 172  did not support any detectable gene expression  
class4	1087	some astroglial lines  hs 683  supported extensive virus replication with minimal viral cpe  
class4	1087	neuronal cell lines  sk n mc  were fully permissive  
class4	1087	the more differentiated glial lines  astrocytoma  were fully permissive to hcmv infection  however  the less differentiated glial lines  glioblastoma  were partly or nonpermissive  
class4	1088	distribution and specific identification of papillomavirus major capsid protein epitopes by immunocytochemistry and epitope scanning of synthetic peptides  
class4	1088	monoclonal  mabs  and polyclonal antibodies were produced against the major capsid protein of detergent disrupted  purified bovine papillomavirus type 1  bpv 1   
class4	1088	the precise locations of the corresponding epitopes were identified by the reactivity of mabs and selected polyclonal antibodies with synthetic  overlapping  hexameric peptides corresponding with 95  of the bpv 1 major capsid protein  
class4	1088	the topography of these epitopes was determined by reactivity of antibodies with intact  conformational and nonconformational surface epitopes  and disrupted  external or internal nonconformational epitopes  bpv 1 virions  
class4	1088	the distribution of epitopes in various papillomaviruses of 13 different species was determined by reactivity of the mabs and polyclonal sera with productively infected  formalin fixed papillomas  fibropapillomas  and fibromas  
class4	1088	epitope scanning  using mabs and polyclonal antisera  resulted in the precise location of bpv 1 hexameric epitopes that could be correlated with their topography on the capsid and distribution in papillomatous lesions of various species  
class4	1089	second primary tumours of the larynx following bronchial carcinoma  
class4	1089	the occurrence of multiple primary malignancies in patients with laryngeal cancer is well known  
class4	1089	the possibility that lung cancer patients may be at risk of subsequent laryngeal cancer is less well recognized  
class4	1089	the possibility of laryngeal cancer developing later has implications for the follow up of lung cancer patients  
class4	1089	three cases of subsequent laryngeal primary cancer occurring in survivors of bronchial cancer are presented and the implications are discussed  
class4	1090	alternating cisplatinum and vac ineffective in end stage squamous cell carcinoma of the head and neck  
class4	1090	sixteen patients with end stage squamous cell carcinoma of the head and neck were admitted to a phase ii study of alternating courses of cisplatinum  100 mg m2  and vac  vincristine 1 4 mg m2  adriamycin 50 mg m2  cyclophosphamide 750 mg m2  given at three weekly intervals  
class4	1090	only two patients achieved a response  12 per cent   
class4	1090	the median survival time was 62 days which is much the same as that of a similar group of patients who received no chemotherapy in a previous trial  70 days   
class4	1091	head and neck cancer and ageing  a retrospective study in 438 patients  
class4	1091	to evaluate whether age over 70 years represents a prognostic factor in head and neck cancer  we reviewed all cases observed between 1981 and 1984  
class4	1091	four hundred and thirty eight  438  patients were considered in relation to three age groups  less than or equal to 59  60 69  and greater than or equal to 70 years  defined as non elderly  mid elderly and elderly respectively   
class4	1091	the main parameters analyzed included histological diagnosis  no difference emerged among the three age groups   anatomical site  hypopharyngeal carcinoma was most frequent in non elderly patients   tnm stage  an higher incidence of early stages was seen in the elderly   performance status  better in the non elderly   previous illnesses  life style related diseases were more frequent in the non elderly   contraindications to surgery  more frequent in the elderly   surgical treatment   en bloc  resections were more often employed in the non elderly   post operative complications and local control  no difference between the three groups   multiple primary malignancies  head and neck  oesophagus and lung were more frequent in non elderly patients  and survival  no difference   
class4	1091	although age affects several features of head and neck cancer patients  it does not appear from the present study to be an independent prognostic factor for local control and survival  
class4	1091	with regard to survival  stage appeared to be the most important prognostic factor  
class4	1092	rhinosporidiosis associated with squamous cell carcinoma in the tongue  
class4	1092	the peritumoural region of a squamous cell carcinoma of the tongue when examined with light and electron microscope showed nodular bodies in the submucosa with all the distinctive features of  sporangium and  spores  of rhinosporidiosis  
class4	1092	the occurrence of rhinosporidiosis in the tongue along with malignancy has not been reported hitherto  
class4	1092	some interesting observations and causal relationships are discussed  
class4	1093	malignant adenolymphoma of the parotid gland  report of carcinomatous transformation  
class4	1093	malignant transformation of an adenolymphoma  warthin s tumour  is a rare event  
class4	1093	this paper presents a case of carcinoma arising in an adenolymphoma of the parotid gland  
class4	1094	multiple primary malignancies in patients with malignant tumours of the nasal cavities and paranasal sinuses  
class4	1094	the incidence of multiple primary malignancies  mpm  was analysed in 1297 patients with malignant tumours of the nasal cavities and paranasal sinuses  
class4	1094	the patients were followed for a minimum of six years or until death  
class4	1094	the incidence of mpm was 3 4 per cent  44 1297  which is lower in patients with malignant tumours of other regions in the upper aerodigestive tract  
class4	1094	five of the 44 patients had second malignancies within previously irradiated areas  
class4	1094	there was a difference between the proportion of histologies occurring in irradiated tissues compared with the overall 1297 patients  
class4	1094	this finding suggests that radiotherapy may induce a second cancer  
class4	1095	radiation therapy of laryngeal cancer  a twenty year experience  
class4	1095	this paper reviews a 20 year experience of radiation treatment of 286 laryngeal cancers and presents results with a minimum five year follow up  
class4	1095	all cases presented had glottic or supraglottic squamous cell carcinomas with no clinical evidence of nodal metastasis  
class4	1095	a policy of primary radiotherapy with surgery for salvage of treatment failures  produced control of primary disease and prevention of metastases superior to most other regimes documented in the literature  
class4	1096	effect of microwave and ionizing radiation in patients with recurrent laryngeal carcinoma  
class4	1096	this study describes the treatment and survival of 54 patients with gross recurrent laryngeal carcinoma after radiotherapy  
class4	1096	twenty six patients were treated with local ultra high frequency hyperthermia in combination with radiotherapy and chemotherapy  hrch   
class4	1096	twenty eight control patients were treated with radiotherapy and chemotherapy  rch   
class4	1096	eight patients  33 per cent  in hrch showed a three year survival but no patient in the rch group  
class4	1096	at two years 18 patients  75 per cent  in hrch and two  7 per cent  in rch survived  
class4	1097	benign parotid tumour enucleation  a reliable operation in selected cases  
class4	1097	the method of surgical treatment for benign tumours of the parotid gland had not yet been rationalized  but many authors recommend parotidectomy as the most appropriate procedure  
class4	1097	a series of 289 operations for parotid swelling is reported  the majority of mixed and warthin s tumours underwent enucleation without either complications or recurrence  
class4	1097	the rationale of parotidectomy versus enucleation is discussed but in fast growing  deeply infiltrating and recurrent tumours  parotidectomy appears to be the best choice  
class4	1097	in the other group of more commonly occurring tumours  enucleation represents a reliable time saving option  
class4	1098	hoarseness as the sole presenting symptom of foramen magnum meningioma  
class4	1098	foramen magnum tumours are rare  
class4	1098	they may present with bizarre symptoms and mimic many conditions  
class4	1098	we report a presentation with the sole complaint of hoarseness  never previously described in the literature  
class4	1098	voice returned to normal after surgical removal of the foramen magnum meningioma  
class4	1099	laryngeal metastasis from colonic adenocarcinoma  
class4	1099	metastases to the larynx from distant primaries are very rare  
class4	1099	usually the secondary lesion comes from an hypernephroma or malignant melanoma  
class4	1099	a case of metastatic laryngeal tumour from a colonic adenocarcinoma  occurring in a 59 year old woman  is presented and the routes for laryngeal spread are discussed  
class4	1099	the poor survival rate of these patients justified only conservative surgery  
class4	1100	intralaryngotracheal thyroid  
class4	1100	a case of intralaryngotracheal thyroid in a 57 year old man is presented  
class4	1100	the treatment modalities are considered and the previous literature is reviewed  
class4	1101	mid line presentation of cervical lymphomata  
class4	1101	three cases of lymphoma are reported  all of which presented as a mid line cervical swelling and appeared to be localised disease  
class4	1101	the importance of early removal of such lesions is emphasized  
class4	1102	causes of death in hospitalized intravenous drug abusers  
class4	1102	the authors reviewed at autopsy the causes of death of 274 patients with evidence of intravenous drug abuse who had been admitted to a large public hospital  
class4	1102	there were 127 who died from diseases unrelated to intravenous drug abuse  and in 41  of these  chronic alcoholism was implicated  
class4	1102	deaths from overdose syndromes and drug related organ pathology comprised only 11  of all cases  
class4	1102	the mean age at death was 39 years  
class4	1102	there was a male female ratio of 3 6 1  
class4	1102	half of all patients died from infection  72 from acquired immunodeficiency syndrome  aids  alone  
class4	1102	these findings indicate that persons hospitalized with a history of intravenous drug abuse usually die from causes other than overdose and that aids and chronic alcoholism are significant problems  
class4	1102	emphasis should be placed upon detecting  hidden  intravenous drug deaths to provide more accurate statistical information  
class4	1103	lambert eaton syndrome  autonomic neuropathy and inappropriate antidiuretic hormone secretion in a patient with small cell carcinoma of the lung  
class4	1103	a patient with small cell carcinoma of the lung developed asymptomatic autonomic neuropathy  inappropriate antidiuretic hormone  adh  secretion and lambert eaton myasthenic syndrome  
class4	1103	the autonomic neuropathy and inappropriate adh secretion were present at the time of diagnosis of the tumour  
class4	1103	following chemotherapy these resolved  but 5 months later the patient developed lambert eaton syndrome which responded to 3 4 diaminopyridine  
class4	1103	this sequence of changes appears to be unique  
class4	1104	prognostic value of c myc proto oncogene overexpression in early invasive carcinoma of the cervix  
class4	1104	the prognostic effect of c myc oncogene overexpression was assessed in a multivariate analysis of 93 patients with invasive carcinoma of the cervix  stage ib  iia  and iib proximal  
class4	1104	the treatment was based on the association of brachytherapy colpohysterectomy and lymphadenectomy  
class4	1104	analysis of c myc gene expression was done using northern and slot blot hybridization techniques  
class4	1104	overexpression of c myc  ie  levels at least three times the mean observed in normal tissues  was present in 33  of the tumors  
class4	1104	the proportion of carcinomas with c myc overexpression significantly increased with the size of the primary tumor  p    04   
class4	1104	no relationship was found between c myc overexpression and the other clinical and histologic parameters  including the nodal status  
class4	1104	the relative risk of relapse  overall  pelvic failure  distant metastases  was analyzed in a cox s proportional hazards model  
class4	1104	three factors were significantly related to the risk of overall relapse when the multivariate analysis was performed  namely  the tumor size  the nodal status  and c myc expression  
class4	1104	a combination of c myc expression and the nodal status provided a very accurate indication of the risk of relapse  
class4	1104	indeed  patients with negative nodes had a 3 year disease free survival rate of 93   95  confidence interval  cl   79  to 98   when c myc was expressed at a normal level  whereas this rate was only 51   95  cl  26  to 63   when c myc was overexpressed  log rank test  p    02   
class4	1104	in addition  in the subgroup of patients with positive nodes  this rate was 44   95  cl  25  to 77   and 15   95  cl  4  to 49   when c myc gene was expressed at normal level  or overexpressed  respectively  
class4	1104	finally  c myc gene overexpression was  in the multivariate analysis  the first factor selected by the model regarding the risk of distant metastases  
class4	1105	high  versus standard dose megestrol acetate in women with advanced breast cancer  a phase iii trial of the piedmont oncology association  
class4	1105	one hundred seventy two patients with advanced breast cancer were randomized to receive oral standard dose megestrol acetate  ma   160 mg d or high dose ma  800 mg d  
class4	1105	all but two patients had one prior trial of tamoxifen therapy for either metastatic disease  74   or as adjuvant treatment  26    
class4	1105	pretreatment characteristics were similar for both arms  
class4	1105	high dose ma resulted in a superior complete plus partial response rate  27  v 10   p    005   time to treatment failure  median  8 0 v 3 2 months  p    019   and survival  median  22 4 v 16 5 months  p    04  when compared with standard dose therapy  
class4	1105	these differences remained significant after adjustment for other covariates  
class4	1105	thirty four patients were given high dose ma after failure of standard dose ma treatment  and none responded  
class4	1105	weight gain was the most distressing side effect  with 13  of standard dose and 43  of high dose patients gaining more than 20 lbs  
class4	1105	four major cardiovascular events occurred in patients receiving high dose treatment and one in patients given standard doses  
class4	1105	other toxicity was modest  
class4	1105	high dose ma may represent a significant improvement in secondary endocrine therapy for advanced breast cancer patients refractory to initial endocrine treatment  but its use on a regular basis should be reserved until these results are confirmed by other clinical trials  
class4	1106	epirubicin cardiotoxicity  a study of 135 patients with advanced breast cancer  
class4	1106	the cardiotoxicity of epirubicin  epi  was evaluated clinically  radiologically  with ecg  and with multiple ecg gated radionuclide determination of the left ventricular ejection fraction  lvef  during rest in 135 patients with advanced breast cancer  
class4	1106	the epi doses were 60 mg m2 on days 1 and 8 every 4 weeks or 45 mg m2 plus vindesine 3 mg m2 on the same schedule  
class4	1106	the median cumulative dose of epi was 500 mg m2  range  47 to 1 563   
class4	1106	eight of the 135 patients developed congestive heart failure  chf   
class4	1106	of 67 patients treated with epi less than 500 mg m2  none developed chf  
class4	1106	among 48 patients treated with doses between 500 and 1 000 mg m2  one had chf  2   95  confidence limits  0 1 to 11 1   
class4	1106	among 20 patients who received epi from 1 000 to 1 563 mg m2  seven developed chf  35   95  confidence limits  15 4 to 59 2   
class4	1106	four patients died due to cardiotoxicity  
class4	1106	the risk of epi cardiotoxicity at the present schedule is considerable at doses above 1 000 mg m2  
class4	1106	at doses between 500 and 1 000 mg m2 the risk of chf decreases  and at doses below 500 mg m2  it is negligible  
class4	1106	for all patients  the prevalence of chf was 6  and the sensitivity of lvef high  95    mainly due to the low incidence of chf  
class4	1106	among the 20 patients who received epi at more than 1 000 mg m2  the prevalence of chf was 35  and the sensitivity only 64   
class4	1106	the specificity was maximally 62   
class4	1106	our results suggest that lvef is of no value as a predictor for chf  
class4	1107	acute renal dysfunction during interleukin 2 treatment  suggestion of an intrinsic renal lesion  
class4	1107	adoptive immunotherapy with interleukin 2  il 2  and lymphokine activated killer  lak  cells has been effective in treating some advanced malignancies in animals and humans  
class4	1107	one complication of this treatment is a reversible  oliguric  acute renal failure  which has been ascribed to renal hypoperfusion and resultant prerenal azotemia  
class4	1107	we serially studied renal function in 10 patients receiving high dose regimens of recombinant interleukin 2  ril 2  to attempt to delineate further the nature of the renal dysfunction caused by il 2 treatment  
class4	1107	renal plasma flow was computed from iodine 131  i 131 hippuran  mediphysics  paramus  nj  orthoiodohippurate  excretion curves  and glomerular filtration rate  gfr  was determined by creatinine clearance  
class4	1107	studies done prior to and on day 4 of treatment showed that gfr fell in nine of 10 patients  with a mean decrease of 43      8   and renal plasma flow fell in five of the 10 patients with a mean decrease of 5      10   
class4	1107	the average pretherapy filtration fraction was calculated to be 23      1  and after 4 days of treatment  decreased to a mean value of 15     2   
class4	1107	the bun to creatinine ratio also declined in all patients  
class4	1107	these findings collectively suggest that il 2 nephrotoxicity may result from an intrarenal defect in addition to the previously described prerenal azotemia  
class4	1107	additionally  radionuclide studies of renal function are a reliable and reproducible noninvasive method of assessing these changes in renal function  
class4	1108	long term sequelae of conservative treatment by surgery  brachytherapy  and chemotherapy for vulval and vaginal rhabdomyosarcoma in children  
class4	1108	between 1970 and 1978  17 girls with rhabdomyosarcoma  rms  of the vulva or vagina were treated at the institut gustave roussy  igr  by conservative treatment including surgery  brachytherapy  and chemotherapy  
class4	1108	twelve pubescent or postpubescent girls were studied for long term sequelae  
class4	1108	eleven of 12 patients have had a normal puberty  two have a total of three healthy children  11 have normal menses  and 10 normal menarche  one after hormonal replacement   
class4	1108	only one patient underwent hysterectomy following low dose brachytherapy  
class4	1108	five girls have no vaginal complications  and three are sexually active  
class4	1108	three have had minimal vaginal sequelae  which required surgical correction to permit sexual intercourse  
class4	1108	four girls sustained serious sequelae  colorectal  vaginal  urethral  and ureteral stenosis   
class4	1108	these sequelae  secondary to irradiation  are potentially avoidable in the future given the current advances in brachytherapy and improvements in dosimetry  
class4	1108	this conservative treatment is useful and appropriate for girls with rms of vulvar or vaginal origin when complete remission cannot be obtained with chemotherapy and partial colpectomy  
class4	1109	questionable role of cns radioprophylaxis in the therapeutic management of childhood rhabdomyosarcoma with meningeal extension  
class4	1109	a series of 15 consecutive children with head and neck nonorbital rhabdomyosarcoma  rmsa  with meningeal extension were prospectively treated with chemotherapy consisting of adriamycin  doxorubicin  adria laboratory  columbus  oh   adm   vincristine  vcr   cyclophosphamide  cpm   and dactinomycin  dact  followed by radiotherapy  60 gy  to the primary tumor volume  along with intrathecal methotrexate  it mtx   
class4	1109	thirteen of 15 responded to preradiation chemotherapy  
class4	1109	four of 13 relapsed  
class4	1109	relapse occurred at the level of the primary tumor in three of four  
class4	1109	the 3 year progression free survival  pfs  was 59   similar to that achieved in a previous series treated with a comparable therapeutic approach that also included whole brain radiotherapy as a prophylaxis of possible occult meningeal seeding  
class4	1109	it is concluded that cns prophylaxis with radiotherapy is questionable in the management of childhood rmsa with meningeal extension  
class4	1110	treatment of metastatic melanoma with an autologous tumor cell vaccine  clinical and immunologic results in 64 patients  
class4	1110	we treated 64 patients with metastatic melanoma using a melanoma vaccine preceded by low dose cyclophosphamide  cy   and monitored immunologic effects and antitumor activity  
class4	1110	on day 0  the patients were given cy 300 mg m2 intravenously  
class4	1110	three days later  they were injected intradermally with vaccine consisting of 10 to 25 x 10 6  autologous  enzymatically dissociated  cryopreserved  irradiated  25 gy  tumor cells mixed with bacillus calmette guerin  bcg   
class4	1110	this treatment sequence was repeated every 28 days  
class4	1110	of 40 assessable patients with measurable metastases  five had responses  four complete and one partial  with a median duration of 10 months  7 to 84  months   
class4	1110	in six additional patients  we observed an antitumor response that seems to be peculiar to this vaccine therapy  the regression of metastatic lesions that appeared after the immunotherapy was begun  
class4	1110	delayed type hypersensitivity  dth  to autologous  mechanically dissociated melanoma cells that had not been exposed to extraneous antigens  such as enzymes or fetal calf serum  increased significantly following immunotherapy  day 0 v day 49  p less than  001  day 0 v day 161  p less than  001  day 0 v day 217  p    021   
class4	1110	antitumor responses to the vaccine were strongly associated with dth  as indicated by three observations   1  eight of 10 patients who exhibited tumor regression had positive dth   2  in postsurgical adjuvant patients  there was a highly significant linear relationship  p less than  001  between the intensity of dth to autologous melanoma cells and the time to recurrence of tumor  and  3  nine patients who developed dth to the autologous melanoma cells in their original vaccine developed new metastases that failed to elicit dth or elicited a much smaller response  
class4	1110	in three cases  we were able to excise regressing tumors for histologic examination  such tumors were characterized by an intense infiltration of lymphocytes  
class4	1110	this demonstration that an immune response to melanoma associated antigens can be elicited in cancer bearing patients provides some basis for optimism about the prospects for developing active immunotherapy that has practical therapeutic value  
class4	1111	human tumor fluorouracil trapping  clinical correlations of in vivo 19f nuclear magnetic resonance spectroscopy pharmacokinetics  
class4	1111	we previously reported that fluorouracil  5fu  accumulation and metabolism in human livers and tumors can be studied by in vivo nuclear magnetic resonance spectroscopy  nmrs   
class4	1111	we have extended these observations by evaluating the pharmacokinetics of 5fu in the tumors of 11 patients with carcinoma of the breast  colon  endometrium  cervix  and kidney  using 19f nmrs in a 1 5 magnetom  siemens medical systems  cerrito  ca  magnetic resonance imaging unit  mri   
class4	1111	these nmrs measurements detected a long lived tumor pool of 5fu in six of 11 tumors in our patients including carcinomas in the pelvis  breast  lung  and liver  
class4	1111	the half life  t1 2  of this tumor pool of  trapped  5fu was 0 33 to 1 3 hours  20 to 78 minutes   much longer than the t1 2 of 5fu in blood  5 to 15 minutes   
class4	1111	neither the anabolites of 5fu  fluorinated nucleosides  nucleotides  5fu rna  or 5fu thymidylate synthase  nor the catabolites  eg  fluorobetaalanine  fbal   were detectable by 19f nmrs  
class4	1111	patient response to chemotherapy appeared to correlate with the extent of trapping of free 5fu in the human tumors  in the seven patients receiving 5fu  or 5fu or fudr plus leucovorin  four of four patients whose tumors trapped 5fu responded to fluorinated pyrimidine chemotherapy  whereas three patients in whom there was a failure to detect tumor trapping were resistant to 5fu  
class4	1111	we conclude that nmrs is clinically feasible  and enables investigators to study 5fu pharmacokinetics and metabolism in tumors in vivo  
class4	1111	19f nmrs of 5fu allows for in vivo evaluation of 5fu metabolic modulation and might be able to guide therapeutic decisions  
class4	1112	changes in the clearance of total and unbound etoposide in patients with liver dysfunction  
class4	1112	the disposition of total and non protein bound etoposide was investigated in 21 cancer patients receiving etoposide and cisplatin combination chemotherapy  
class4	1112	etoposide plasma concentrations were determined using a specific high performance liquid chromatography  hplc  method  and etoposide plasma protein binding was determined by equilibrium dialysis  
class4	1112	the patients had a wide range of renal function  creatinine clearance  32 to 159 ml min m2  and hepatic function  total bilirubin range  0 3 to 21 5 mg dl  aspartate aminotransferase  ast  range  14 to 415 iu l  serum albumin range  2 7 to 4 1 g dl   
class4	1112	the mean etoposide total systemic clearance was not different in 15 patients with total bilirubin less than 1 0 mg dl versus six patients with total bilirubin 1 1 to 21 5 mg dl  18 7     5 9 ml min m2 v 26 4     10 7 ml min m2  t test p    06   with a trend toward higher total clearance in the patients with abnormal bilirubin values  
class4	1112	however  the mean clearance of unbound etoposide was significantly lower in patients with increased total bilirubin  220     90 ml min m2 v 135     61 ml min m2  t test p    027   
class4	1112	the fraction of etoposide unbound  fu  in plasma was significantly higher in patients with increased bilirubin  9      3  v 27      15   t test p    002   explaining the trend toward higher total clearance in these patients  
class4	1112	etoposide clearance  total or unbound  in the 14 patients with measurable hepatic metastases was not different from the clearance in the seven patients without hepatic metastases  
class4	1112	this study provides an explanation for why patients with increased bilirubin do not have lower total systemic clearance of etoposide  and indicates that such patients have a higher exposure to unbound etoposide  
class4	1112	the results of ongoing pharmacodynamic studies of total and unbound etoposide in patients with increased bilirubin will determine the clinical relevance of altered etoposide protein binding  
class4	1113	clinical evaluation of a side entry access port  a novel dual lumen venous access device  
class4	1113	the initial clinical experience with a low profile side entry access  sea  dual lumen implantable venous access port for cancer chemotherapy administration is summarized in this report  
class4	1113	the catheter material is polyurethane  
class4	1113	the overall experience in 35 patients in this study was a total of 6 224 patient days  with a mean of 178 days per patient  
class4	1113	a variety of chemotherapeutic agents  biologic response modifiers  and antibiotics were administered  
class4	1113	in 26  of the patients  the device chambers were in simultaneous use during the treatment period  
class4	1113	a 6  incidence of clinical subclavian vein thrombosis was noted  
class4	1113	there was no infectious complications  
class4	1113	inconsistencies in blood withdrawal and temporary catheter dysfunction were comparable to other access ports in clinical use  
class4	1113	the novel design of this side entry port and the catheter material of low thrombogenicity make this device a good option in patients requiring a low profile system and dual access  
class4	1113	nursing staff should be made aware of the side entry design and that in service training for accessing the septum is required in centers where such devices are not routinely used  
class4	1114	a prospective  randomized evaluation of the treatment of colorectal cancer metastatic to the liver  
class4	1114	over a 4 year period  1982 to 1986   91 patients with solitary or multiple metastases from colorectal cancer were stratified  based on findings at laparotomy  to one of three groups and then prospectively randomized to one of two treatment arms within each group  
class4	1114	group a patients had solitary resectable metastases  group b patients had multiple  resectable metastases  and group c patients had multiple  unresectable metastases  
class4	1114	patients were randomized to one of two treatment arms within a group  group a arm a1  resection only  arm a2  resection and continuous hepatic artery infusion  chai  of fluorodeoxyuridine  fudr   group b arm b1  resection and chai  arm b2  chai only  group c arm c1  chai  arm c2  systemic fluorouracil followed by chai  
class4	1114	median time to failure  ttf  was 31 8  11 1  and 8 8 months for groups a  b  and c  respectively  
class4	1114	arm a2 had an improved ttf when compared with arm a1  p    03   
class4	1114	median survival correlated with extent of disease and was 37 3  22 4  and 13 8 months for groups a  b  and c  respectively  
class4	1114	survival was not changed by treatment variation  arms  within each group  
class4	1114	two  and 5 year cumulative survivals for groups a  b  and c were 72 7  and 45 4   45 8  and 16 7   and 31 7  and 3 2   respectively  
class4	1114	in patients with multiple metastases  groups b and c   those patients whose original tumor was a dukes  b had a significantly improved ttf and survival over those patients whose tumor was a dukes  c  p less than or equal to  02   
class4	1115	quantitative analysis of antibody localization in human metastatic colon cancer  a phase i study of monoclonal antibody a33  
class4	1115	a33 is a mouse immunoglobulin g2a  igg2a  monoclonal antibody  mab  that detects a heat stable  protease  and neuraminidase resistant epitope  
class4	1115	the antigen is homogeneously expressed by virtually all colon cancers and in the colon mucosa but not other epithelial tissues  
class4	1115	the biodistribution and imaging characteristics of iodine 131  131i  maba33 were studied in colorectal carcinoma patients with hepatic metastases  
class4	1115	antibody labeled with 2 to 5 mci of 131i was administered intravenously  iv  7 to 8 days before surgery at five dose levels  ranging from 0 2 mg to 50 mg  with three or more patients entered at each dose level  
class4	1115	in addition  three patients received 2 mg 131i mabta99  an isotype matched control mab  together with 125i maba33  
class4	1115	evaluation included whole body imaging with a gamma camera  technetium 99  99mtc  human serum albumin blood pool scans  liver spleen scans  abdominal computed tomographic  ct  scans  hepatic arteriograms  antibody pharmacokinetics  and assessment of antibody distribution in biopsied malignant and normal tissues  
class4	1115	selective maba33 localization to tumor tissue was demonstrated in 19 of 20 patients  and external imaging correlated with surgical inspection  pathologic examination  and tissue radioactivity  
class4	1115	one week after antibody administration  tumor liver ratios ranged from 6 9 1 to 100 1 and tumor serum ratios from 4 1 1 to 25 2 1  
class4	1115	99mtc albumin blood pool studies showed that liver metastases were hypovascular  emphasizing the selective localization of maba33 despite poor tumor blood flow  
class4	1115	control mabta99 studies showed maba33 localization was antigen specific  tumor liver ratios were 2 3  to 45 fold higher for specific antibody  
class4	1115	in metastatic lesions  radioisotope was localized primarily in the viable periphery  however  even the necrotic tumor core concentrated specific antibody  
class4	1115	external imaging showed isotope visualization in some patients  large bowel  whether this represents specific antibody uptake or gastric iodine secretion is unclear  
class4	1116	an early phase ii study of cpt 11  a new derivative of camptothecin  for the treatment of leukemia and lymphoma  
class4	1116	an early phase ii study of a new camptothecin analog and an inhibitor of topoisomerase i  cpt 11  was conducted in 62 patients with refractory leukemia and lymphoma by four different treatment schedules in a multiinstitutional cooperative study  
class4	1116	cpt 11 therapy resulted in four complete remissions  crs  and three partial remissions  prs  in 29 assessable non hodgkin s lymphoma  nhl  patients  one pr in three hodgkin s disease  hd   one cr and one pr in 11 acute lymphoblastic leukemia  all   and one pr in 15 acute myelogenous leukemia  aml  patients  
class4	1116	single infusion of 200 mg m2 every 3 to 4 weeks produced no response in both leukemia and lymphoma patients  
class4	1116	sixty minute infusions of 40 mg m2 d for 5 days every 3 to 4 weeks or for 3 days weekly produced four crs  17   and four prs  17   in 24 patients with malignant lymphoma  
class4	1116	sixty minute infusions of 20 mg m2 twice a day for 7 days every 3 to 4 weeks resulted in one cr and two prs in 12 patients with acute leukemia  
class4	1116	no response was seen in an acute leukemia patient by another treatment schedule  
class4	1116	cpt 11 was effective in two  15   of 13 primarily refractory leukemia and lymphoma cases  in two of four relapsed cases  and in seven  17   of 41 relapsed and refractory cases  
class4	1116	major side effects were leukopenia  91   and gastrointestinal  gi   76    
class4	1116	cpt 11 was shown to be effective against refractory leukemia and lymphoma  and thus deserves further clinical study  the novel antitumor activity mode of this drug predicts no cross resistance to presently available antitumor drugs  
class4	1117	the unique aspects of acute promyelocytic leukemia  
class4	1117	acute promyelocytic leukemia  apl  accounts for approximately 10  of cases of acute myeloid leukemia  aml   
class4	1117	distinctive features of this disorder at the time of diagnosis include leukopenia coexisting with a marrow replaced with granulated dysplastic promyelocytes  disseminated intravascular coagulopathy  lack of ia  hla dr  antigen expression  and translocation between the long arms of chromosomes 15 and 17  t 15 17    
class4	1117	heparin is widely but not universally used to interfere with the coagulopathy during the initial phases of treatment  
class4	1117	serial bone marrow examinations during the induction period demonstrate the achievement of remission despite the persistence of malignant appearing promyelocytes  
class4	1117	patients with apl are generally younger than those with other subtypes of aml  have a 70  to 80  likelihood of entering remission  and are thought to have a more favorable prognosis than other individuals with aml  
class4	1117	remission may be achieved with a conventional anthracycline cytarabine combination  anthracycline alone  or  apparently  all trans retinoic acid  
class4	1117	genes potentially important in myeloid differentiation such as granulocyte colony stimulating factor  g csf  and myeloperoxidase are located close to the breakpoint in the t 15 17  but have not been conclusively shown to be rearranged in the translocation  
class4	1117	a better understanding of the unique aspects of apl may well shed light on the pathogenetic processes of aml  
class4	1118	intraperitoneal yttrium 90 labeled monoclonal antibody in ovarian cancer 
class4	1118	from march 1987 to march 1988  a phase i to ii study was carried out in 25 patients with ovarian cancer  
class4	1118	they received escalating doses of intraperitoneally  ip  administered yttrium 90  y 90  labeled monoclonal antibody  hmfg1  against a tumor cell surface antigen  
class4	1118	myelosuppression prevented an escalation of the administered y 90 activity above 25 mci  
class4	1118	y 90 labeled antibody was absorbed from the peritoneal cavity into the circulation  
class4	1118	maximum blood y 90 activity was observed 40 hours after the ip injection with a mean of 21  of the injected activity  range  14 2  to 26 4   in the circulation  
class4	1118	the radiation dose the bone marrow received from circulating y 90 labeled antibody  the blood radiation dose  was calculated by applying the medical internal radiation dose  mird  formulation to the measured y 90 activity in patients blood  
class4	1118	myelosuppression occurred following calculated blood radiation doses to bone marrow of only 10 to 30 cgy  
class4	1118	the excessive myelosuppression following such modest radiation doses from circulating y 90 labeled antibody could be explained by the uptake of y 90 by bone  
class4	1118	in an attempt to reduce bone absorption of y 90  seven patients received an intravenous  iv  infusion of edta  sinclair pharmaceuticals ltd  godalming  united kingdom   
class4	1118	this increased the urinary excretion of y 90 from a mean of 11 1  to 32 3  of the injected activity  p    0001   
class4	1118	fourteen patients had assessable tumor at laparoscopy  
class4	1118	tumor regression was observed in one patient  and palliation of ascites in a further patient  
class4	1119	pediatric osteosarcoma  therapeutic strategies  results  and prognostic factors derived from a 10 year experience  
class4	1119	ninety eight pediatric patients were treated with three separate protocols  treatment and investigation of osteosarcoma  tios  i  ii  and iii  and 47 developed recurrent disease  metastases and or local recurrence   
class4	1119	actuarial overall disease free survival  hereafter designated survival  was 43   
class4	1119	over 90  of the patients were treated initially with preoperative intraarterial cisplatin  cdp   
class4	1119	postoperative chemotherapeutic regimens comprised high dose methotrexate with leucovorin rescue  mtx cf   adriamycin    adr  doxorubicin  adria laboratories  columbus  oh   and cyclophosphamide  
class4	1119	primary definitive treatment comprised amputation or limb salvage  tios i and tios iii   
class4	1119	patients treated with preoperative cdp and surgery  tios i and iii  had a 62  survival  
class4	1119	patients in tios ii refused surgical extirpation  they were treated exclusively with chemotherapy and had a 23  survival  
class4	1119	survival in patients treated with amputation was 55  and limb salvage 58   
class4	1119	prognostic factors considered significant in relation to development of pulmonary metastases comprised tumor burden  p    04  and the percentage of tumor necrosis induced by preoperative chemotherapy  p    01   
class4	1119	histopathologic subtype was marginally significant  chondroblastic was more favorable as opposed to osteoblastic  p    05   
class4	1119	these findings are compared with results and prognostic factors published in the literature  
class4	1120	current urinary mass screening for catecholamine metabolites at 6 months of age may be detecting only a small portion of high risk neuroblastomas  a chromosome and n myc amplification study  
class4	1120	we studied 96 infants and children with untreated neuroblastomas  
class4	1120	chromosomes of tumor cells were analyzed in 68  and n myc copy numbers were determined in 67 patients  
class4	1120	patients found by a mass screening program for 6 month old infants  group a1  39 patients  or those less than 12 months of age found clinically  group a2  13 patients  were rarely in the disseminated stage  a1  three of 39  a2 one of 13   their tumors usually had near triploid  3n  or hypertetraploid  greater than 4n  karyotypes  a1  28 of 37  a2  nine of 11   and never had n myc amplification  a1  zero of 34  a2  zero of 11   
class4	1120	in contrast  children 12 months or over  group b  27 patients  were usually in the disseminated stage  19 of 27   p less than  0001   their tumors usually had near diploid  2n  or near tetraploid  4n  karyotypes  16 of 20   p    0027   and often had n myc amplification  nine of 22   p less than  0001   
class4	1120	of the 40 clinically found patients  a2 and b   six had undergone the screening with a negative result at the age of 6 months  
class4	1120	two of the six patients had n myc amplification in the tumors  
class4	1120	most tumors found by the screening showed known characteristics predicting a good prognosis  and the majority of tumors showing characteristics predicting a poor prognosis were found in patients aged between 12 and 36 months  
class4	1120	our chromosome and n myc amplification studies suggest that a low risk tumor does not usually evolve to a high risk tumor  
class4	1120	thus  the current mass screening program may be detecting only a small portion of highly malignant neuroblastomas at the earliest stage  
class4	1120	infants should be screened twice  at 6 months as well as at 12 months of age  for the early detection of high risk neuroblastomas  
class4	1121	mechlorethamine  vincristine  and procarbazine chemotherapy for recurrent high grade glioma in adults  a phase ii study  
class4	1121	we undertook a phase ii study of combination chemotherapy with mechlorethamine  nitrogen mustard  6 mg m2 intravenously day 1 and day 8  vincristine 2 mg intravenously day 1 and day 8  and procarbazine 100 mg m2 orally days 1 through 14  mop  in adults with recurrent high grade glioma  
class4	1121	there were 31 patients entered and 27 patients assessable for response  
class4	1121	the median age was 49 years old  
class4	1121	all patients had prior maximal radiotherapy  and eight had previous chemotherapy  
class4	1121	responses were determined based on clinical and computed tomographic  ct  scan magnetic resonance imaging  mri  criteria  
class4	1121	the response rate  partial response  pr  plus objective qualitative response  oqr  plus complete response  cr   was 52  with one cr  
class4	1121	the response rate was higher in patients with anaplastic astrocytoma as compared with glioblastoma multiforme  p less than  05   
class4	1121	the median duration of response was 42 weeks  
class4	1121	median survival for all assessable patients was 30 weeks  and for responders  it was 60 weeks  
class4	1121	response was correlated with ability to decrease dexamethasone doses and improved performance status  
class4	1121	toxicity was mainly hematologic with leukopenia being common  
class4	1121	there was one treatment related death from listeria meningitis  and two patients developed pneumocystis carinii pneumonia  
class4	1121	there were three episodes of neutropenic fever  
class4	1121	we conclude that mop is active and merits further investigation in adult high grade glioma  
class4	1122	phase ii study of fluorouracil and recombinant interferon alfa 2a in previously untreated advanced colorectal carcinoma  
class4	1122	we conducted a phase ii clinical trial of fluorouracil  5fu  and recombinant interferon alfa 2a  rifn alpha 2a  in 52 previously untreated patients with bidimensionally measurable metastatic colorectal cancer  
class4	1122	during week 1  5fu was administered as a continuous intravenous infusion  750 mg m2 d for 5 consecutive days  
class4	1122	intravenous bolus administration of 5fu 750 mg m2 was given weekly for 7 weeks starting on day 12  
class4	1122	rifn alpha 2a  roferon  hoffman laroche  nutley  nj   9 x 10 6  u  was administered subcutaneously three times weekly during weeks 1 to 8  
class4	1122	patients were evaluated for response on week 9  
class4	1122	of 52 patients enrolled in the study  51 were assessable for toxicity  and 45 were assessable for response  
class4	1122	fifteen patients experienced partial response  and one patient achieved a clinical complete response for an overall response rate of 35   95  confidence interval  ci   22   50    
class4	1122	median duration of response is 7 5 months  range  4 to 11 months   
class4	1122	seventy percent of patients entered on the study are alive with a median follow up duration of 7 months  
class4	1122	twenty five percent of patients developed grade 4 toxicity  and 82  developed grade 3 toxicity  
class4	1122	one drug related death in the presence of sepsis was reported  and two treatment related seizures occurred  
class4	1122	our experience with this schedule produced a lower response rate with greater toxicity than previously reported  
class4	1122	current randomized trials comparing this schedule of 5fu with rifn alpha 2a to 5fu plus folinic acid  leucovorin  or single agent 5fu may determine its role in the treatment of advanced colorectal carcinomas  
class4	1123	adjuvant cyclophosphamide  methotrexate  and fluorouracil in patients with axillary node positive breast cancer  an update of the guy s manchester trial  
class4	1123	between 1976 and 1985  391 patients  202 premenopausal  189 postmenopausal  with operable breast cancer and positive axillary lymph nodes were randomized after total mastectomy and axillary clearance to receive cyclophosphamide  methotrexate  and fluorouracil  cmf   n   193  or no adjuvant therapy  n   198   
class4	1123	after a median follow up of 8 years  both relapse free survival  rfs  and survival  s  were significantly prolonged in premenopausal patients receiving cmf  rfs  p less than  001  s  p    003   
class4	1123	treatment with cmf resulted in a significant improvement in rfs in premenopausal patients both with steroid receptor positive and steroid receptor negative tumors and also in subgroups of premenopausal patients defined by the number of axillary nodes involved  
class4	1123	premenopausal patients who developed permanent amenorrhea following cmf had a significantly better rfs than those who continued to menstruate  
class4	1123	induction of amenorrhea following cmf was related to age  with almost all patients over 40 years becoming amenorrheic  
class4	1123	for patients less than or equal to 40 years  development of amenorrhea following cmf did not influence outcome  
class4	1123	no difference was detected between control and cmf groups  rfs  p    9  s  p    9  in postmenopausal patients nor in any subgroup of these patients  
class4	1123	the results of this trial of the efficacy of cmf for improving rfs and s have strengthened with longer follow up  
class4	1124	node negative breast cancer  prognostic subgroups defined by tumor size and flow cytometry 
class4	1124	adjuvant systemic therapy for women with node negative breast cancer is most easily justified for those patients at highest risk of relapse  
class4	1124	we have examined the impact of tumor size  histologic grade  estrogen receptor  er  status  tumor ploidy  and s phase fraction  spf  on relapse free survival  rfs  for 169 patients with node negative breast cancer in order to identify groups of patients at high and low risk of relapse  
class4	1124	patients with small tumors  less than or equal to 1 0 cm  had a significantly better rfs than those with larger tumors  p    005   with 96  remaining relapse free at 5 years  
class4	1124	patients with tumors less than or equal to 1 0 cm were thus excluded from analysis when attempting to define a group with a poor prognosis  
class4	1124	within the group of patients with tumors greater than 1 0 cm  tumor ploidy  p    63   er status  p    3   or progesterone receptor  pgr  status  p    24  did not predict for rfs  
class4	1124	patients with grade 1 or 2 infiltrating ductal tumors had a significantly better prognosis than those with grade 3 tumors  p    04   
class4	1124	the prognostic factor that gave the widest separation between subgroups  however  was spf  
class4	1124	patients whose tumors were greater than 1 0 cm with an spf less than or equal to 10  had a 5 year rfs of 78  compared with a 5 year rfs of 52  for those with an spf greater than 10   p    006   
class4	1124	we have combined tumor size and spf to identify three prognostic groups   1  tumor less than or equal to 1 0 cm  5 year rfs 96    2  tumor greater than 1 0 cm plus spf less than or equal to 10   5 year rfs 78   3  tumor greater than 1 0 cm plus spf greater than 10   5 year rfs 52   
class4	1124	these prognostic groupings may help identify patients most suitable for adjuvant therapy  
class4	1125	drug induced dna damage and tumor chemosensitivity  
class4	1125	cytotoxic drugs act principally by damaging tumor cell dna  
class4	1125	quantitative analysis of this interaction provides a basis for understanding the biology of therapeutic cell kill as well as a rational strategy for optimizing and predicting tumor response  
class4	1125	recent advances have made it possible to correlate assayed dna lesions with cytotoxicity in tumor cell lines  in animal models  and in patients with malignant disease  
class4	1125	in addition  many of the complex interrelationships between dna damage  dna repair  and alterations of gene expression in response to dna damage have been defined  
class4	1125	techniques for modulating dna damage and cytotoxicity using schedule specific cytotoxic combinations  dna repair inhibitors  cell cycle manipulations  and adjunctive noncytotoxic drug therapy are being developed  and critical therapeutic targets have been identified within tumor cell subpopulations and genomic dna alike  
class4	1125	most importantly  methods for predicting clinical response to cytotoxic therapy using both in vitro markers of tumor cell sensitivity and in vivo measurements of drug induced dna damage are now becoming a reality  
class4	1125	these advances can be expected to provide a strong foundation for the development of innovative cytotoxic drug strategies over the next decade  
class4	1126	magnetic resonance imaging contrast agents  theory and application to the central nervous system  
class4	1126	the theoretical aspects of magnetic resonance  mr  imaging contrast agents are reviewed  and their current applications to the central nervous system  cns  and their future applications are discussed  
class4	1126	profound differences exist between contrast agents used for mr imaging and computerized tomography  ct   
class4	1126	in mr imaging  the contrast agents are not imaged directly but rather act on adjacent protons to shorten t1 and t2 relaxation times  
class4	1126	this in turn results in signal intensity changes  
class4	1126	the lanthanide metal  gadolinium  in the form of gadopentetate dimeglumine  has been found to be both safe and efficacious as the only currently approved contrast agent for mr imaging  
class4	1126	magnetic resonance imaging revolutionized the detection and treatment of disease affecting the brain and spine  
class4	1126	initially  it was thought that signal characteristics on mr imaging would allow differentiation of specific pathology  
class4	1126	it was soon found that mr studies were able to detect more abnormalities but were less able to characterize them  
class4	1126	the recent development of contrast agents for mr imaging has allowed this modality to surpass ct for the evaluation of most cns lesions  
class4	1126	at present  contrast enhanced mr imaging is generally accepted as the study of choice for evaluating acoustic neurinomas  pituitary lesions  meningeal disease  primary and secondary brain tumors  active multiple sclerosis  intradural spinal neoplasms  intramedullary spinal disease  and postoperative states in both the spine and brain  
class4	1126	even when contrast enhanced ct can detect the same abnormalities  evaluation of the lesions in multiple planes on mr imaging can sometimes yield invaluable information  especially prior to surgery  
class4	1126	future developments of contrast material for mr imaging include non gadolinium compounds  intrathecal contrast media  cerebral blood flow and volume evaluation  and  possibly  antibody labeled contrast agents  
class4	1127	clinoidal meningiomas  
class4	1127	anterior clinoidal meningiomas are frequently grouped with suprasellar or sphenoid ridge meningiomas  masking their notorious association with a high mortality and morbidity rate  failure of total removal  and recurrence  
class4	1127	to avoid injury to encased cerebral vessels  most surgeons are content with subtotal removal  
class4	1127	without total removal  however  recurrence is expected  
class4	1127	recent advances in cranial base exposure and cavernous sinus surgery have facilitated radical total removal  
class4	1127	the author reports 24 cases operated on with vigorous attempts at total removal of the tumor with involved dura and bone  
class4	1127	this experience has distinguished three groups  i  ii  and iii  which influence surgical difficulties  the success of total removal  and outcome  
class4	1127	these subgroups relate to the presence of interfacing arachnoid membranes between the tumor and cerebral vessels  
class4	1127	the presence or absence of arachnoid membranes depends on the origin of the tumor and its relation to the naked segment of carotid artery lying outside the carotid cistern  
class4	1127	total removal was impossible in the three patients in group i  with postoperative death occurring in one patient and hemiplegia in another  
class4	1127	total removal was achieved in 18 of the 19 patients in group ii  with one death from pulmonary embolism  
class4	1127	in the two patients in group iii  total removal without complications was easily achieved  
class4	1128	motility factor produced by malignant glioma cells  role in tumor invasion  
class4	1128	to better understand the cellular mechanism of tumor invasion  the production of a cell motility stimulating factor by malignant glioma cells was studied in vitro  
class4	1128	serum free conditioned media from cultures of rat c6 and human t98g cell lines contained a factor that stimulated the locomotion of the producer cells  
class4	1128	this factor was termed the  glioma derived motility factor   the glioma derived motility factor is a heat labile protein with a molecular weight greater than 10 kd and has relative stability to acid  
class4	1128	the factor showed not only chemotactic activity but also chemokinetic  stimulated random locomotion  activity in the two types of glioma cells studied  
class4	1128	although glioma derived motility factors in conditioned media obtained from two different cell origins are likely to be the same  chemokinetic migration of t98g cells to their conditioned medium was much stronger than that of c6 cells to theirs  
class4	1128	coincubation of cells with cytochalasin b  which disrupts the assembly of cellular actin microfilaments  almost completely inhibited the cell migration stimulated by glioma derived motility factor  
class4	1128	cytochalasin b also induced marked alterations in cell morphology  including cell retraction and arborization  while the drug did not affect cell attachment to culture dishes  
class4	1128	these results indicate that glioma cells produce a motility factor which may play a role particularly when tumor cells are detached and migrate away from the original tumor mass  thus promoting tumor invasion  
class4	1128	also  glioma cell migration stimulated by the motility factor requires the normal organization of cytoskeletons such as actin microfilaments  
class4	1129	antigen related to cell proliferation in malignant gliomas recognized by a human monoclonal antibody  
class4	1129	a human monoclonal antibody  cln igg  was produced from a human human hybridoma derived from lymphocytes of a patient with cervical carcinoma  
class4	1129	the reactivities of this antibody with various human glioma tissues and cultured glioma cells and the characterization of the antigen recognized by cln igg on malignant glioma cells were analyzed and reported  
class4	1129	cln igg reacted with various human glioma cells and glioma tissues  especially glioblastoma  but did not react with normal brain tissues or fetal brain tissues  
class4	1129	a large amount of antigen recognized by cln igg was expressed on cell membranes of undifferentiated glioma cells and of glioma cells at the g2 m tumor growth phase in cycling cells  
class4	1129	antigen recognized by cln igg was detected in only one of seven samples of cyst fluid  and was not detected in 27 serum samples or 18 samples of cerebrospinal fluid from glioma patients  
class4	1129	cln igg exhibited antibody dependent cell cytotoxicity against u 25 1 mg glioma cells and primary cultured cells of glioblastomas and anaplastic astrocytomas  
class4	1129	these data suggest that the antigen recognized by cln igg might be related to cell proliferation in malignant gliomas  
class4	1129	thus  cln igg might be useful for immunotherapy or immunoimaging of malignant gliomas  
class4	1130	evidence of a local immune activation in cystic brain tumors  
class4	1130	the fluid of cystic brain tumors was characterized with regard to the protein content  
class4	1130	in most malignant tumors  the concentrations of immunoglobulins g and m  igg and igm  were higher relative to other proteins in the cyst fluid than in the serum of the same patient  
class4	1130	a markedly elevated ratio of monomeric to pentameric igm was detected in the cyst fluid of two patients with glioblastomas  
class4	1130	the results indicate a local immunoglobulin synthesis in malignant cystic brain tumors  
class4	1130	it is hypothesized that higher than expected concentrations of igg and igm in cyst fluid as compared to plasma are a sign of an ongoing immune response triggered by the tumor  
class4	1131	epithelial cyst of the fourth ventricle  case report  
class4	1131	a case of epithelial cyst in the fourth ventricle of a 4 year old child is described  
class4	1131	a single epithelial layer with a clear basement membrane lining the cyst wall was observed  
class4	1131	there were no prominent histological findings to suggest a pathogenesis for this cyst based on immunohistochemical or ultrastructural studies  however  the cyst fluid contained significant amounts of carcinoembryonic antigen  
class4	1131	it is considered that the epithelial layer lining the cyst wall was possibly of endodermal origin  
class4	1132	recurrence of acoustic neurilemoma as a malignant spindle cell neoplasm  case report  
class4	1132	a 75 year old man presented with a right cerebellopontine angle tumor 11 months after complete macroscopic resection of a right acoustic neurilemoma  
class4	1132	histological examination of the recurrent tumor showed a malignant spindle cell neoplasm with positive staining for s 100 protein  
class4	1132	the patient had no stigmata of von recklinghausen s disease  
class4	1132	it is proposed that this recurrence represents progression from a benign to a malignant acoustic nerve sheath tumor  an event that is extremely rare outside the clinicopathological context of neurofibromatosis  
class4	1133	administered dose and tumor dose of bleomycin labeled with cobalt 57 in mice and men  
class4	1133	tumor concentrations of the chemotherapeutic drug  bleomycin  labeled with cobalt 57  co bleo  were compared in mouse tumor models and in human lung tumors using quantitative single photon emission computed tomography  
class4	1133	drug concentrations in histologically similar human tumors showed marked variability for the same injected dose  id   
class4	1133	small cell carcinomas showed concentrations between 1 09 and 8 85  id cc x 10  3  while non small cell lung tumors showed a concentration variation between 0 36 and 6 75  id cc x 10  3   
class4	1133	in contrast to the situation in human tumors  uptake in mouse tumors showed only slight variability in animals with the same tumor model  
class4	1133	emt 6 tumors in mice showed at 6 hr significantly higher uptake of co bleo  p less than 0 001  and significantly higher tumor to lung ratio  p less than 0 001  when compared to murine fibrosarcomas  
class4	1133	the emt 6 tumors in contrast to the fibrosarcomas responded to bleomycin treatment in a dose dependent manner  
class4	1133	the results indicate that while in mice the tumor dose closely follows the administered dose  in humans  the tumor dose and the tumor to lung ratio in the individual patient cannot be predicted from the administered dose  
class4	1134	imaging of tumor in patients with indium 111 labeled biotin and streptavidin conjugated antibodies  preliminary communication 
class4	1134	tumor localization in patients has been achieved through the in vivo use of streptavidin and biotin  
class4	1134	in these preliminary studies  the monoclonal antibody hmfg1 was conjugated with streptavidin and 1 mg was administered intravenously to each of 10 patients with documented squamous cell carcinoma of the lung  
class4	1134	two to 3 days later  111in labeled biotin was also administered intravenously  
class4	1134	no evidence of toxicity was observed  
class4	1134	background radioactivity levels were reduced in liver  1  id at 24 hr  and kidneys  2   and in all other normal tissues and blood  
class4	1134	images of lung tumor were obtained in as little as 2 hr following administration of labeled biotin  
class4	1134	in eight patients  tumor was detected with labeled biotin alone without the previous administration of streptavidin conjugated antibody but in three of these patients  the images were improved with the prior administration of conjugated antibody  
class4	1134	these results suggest that this approach may improve the tumor to normal tissue radioactivity ratios in radioimmunotargeting  
class4	1135	immunoscintigraphy of ovarian cancer with indium 111 labeled ov tl 3 f ab  2 monoclonal antibody  
class4	1135	the safety and diagnostic accuracy of immunoscintigraphy with the indium 111 labeled monoclonal antibody ov tl 3 f ab  2 111in ov tl 3 f ab  2  for diagnosis and follow up of ovarian cancer was prospectively studied in 31 patients  
class4	1135	planar and spect scintigraphy were performed up to 4 days after i v  
class4	1135	injection of 140 mbq 111in ov tl 3 f ab  2  
class4	1135	surgical evaluation was possible in 22 out of 31 patients  
class4	1135	imaging results were compared with x ray computed tomography  ultrasound  and ca 125 serum level using the histologically confirmed surgical findings as a  gold standard   apart from a transient rash observed in two patients  no other immediate or delayed adverse reactions were observed  
class4	1135	within the surgically evaluated group  ovarian cancer lesions were detected in 16 out of 17 patients  94    
class4	1135	of 45 distinct tumor deposits found at operation  67  were detected and localized with immunoscintigraphy while x ray computed tomography and ultrasound visualized 53  and 23   respectively  
class4	1136	the potential of 2 deoxy 2 18f fluoro d glucose  fdg  for the detection of tumor involvement in lymph nodes  
class4	1136	to assess the potential of fdg for pet imaging of nodal tumor metastases  we evaluated its uptake into normal lymph nodes  tumor involved lymph nodes  and subcutaneous tumor xenografts in rodents  
class4	1136	normal lymph nodes in mice and rats accumulate fdg moderately  developing node blood ratios of 1 3 11 9 1 at 2 hr following i v  
class4	1136	injection  
class4	1136	by contrast  fdg given subcutaneously to healthy sprague dawley rats developed very high normal draining lymph node blood ratios  272 1  versus 7 7 1 by i v  
class4	1136	injection  
class4	1136	in nude mice  subcutaneous human ovarian cancer xenografts had 1 27 fold more uptake relative to blood than did normal popliteal lymph nodes  
class4	1136	subcutaneous tumor xenografts of rat breast cancer developed tumor normal node uptake ratios of 4 91     0 43 1 and tumor blood ratios of 6 6     0 9 at 2 hr postinjection  
class4	1136	mouse nodes involved with 38c13 murine b cell lymphoma had mean node blood ratios of 42 9     6 7 1 and tumored node normal lymph node uptake of 6 3 1  
class4	1136	thus  fdg given intravenously but not subcutaneusly  due to high normal nodal uptake  has potential as an agent for the detection of metastatic tumors in regional lymph nodes using pet scanning  
class4	1137	radioimmunoscintigraphy using iodine 131 anti cea monoclonal antibodies and thallium 201 scintigraphy in medullary thyroid carcinoma  a case report  
class4	1137	this case report demonstrates the use of thallium 201  201tl  scans versus iodine 131   131l  anti cea f ab  2 scans in a patient with high serum cea levels due to metastases of medullary thyroid carcinoma in the suprarenal region and sacroiliacal region  
class4	1137	scintigraphy using monoclonal antibodies directed against cea showed a higher tumor uptake  0 26  dose and 0 64  dose  respectively  than a thallium scan and is believed to be promising for future radiotherapeutic applications  
class4	1138	treatment planning for internal radionuclide therapy  three dimensional dosimetry for nonuniformly distributed radionuclides  
class4	1138	a calculational approach is described that provides the spatially varying radiation absorbed dose  presented as isodose contours superimposed on ct images  from nonuniform and or irregular cumulated activity distributions  
class4	1138	ct images are read from magnetic tape and are displayed on a high resolution color graphics display monitor  
class4	1138	source tissue geometries are defined on a series of contiguous ct images automatically  by an edge detection algorithm  or manually  using a trackball   thereby obtaining a three dimensional representation of the various source volumes of activity  
class4	1138	dose calculations are performed using a radionuclide specific absorbed dose point kernel in the form of a lookup table  
class4	1138	the method described yields the spatially varying dose delivered to tumor and normal tissue volumes from a patient specific cumulated activity distribution in a clinically implementable manner  
class4	1138	this level of accuracy in determining normal tissue and tumor doses may prove valuable in the evaluation and implementation of radionuclides and radiolabeled compounds for therapeutic purposes  
class4	1139	effects of energy restriction on mouse mammary tumor virus mrna levels in mammary glands and uterus and on uterine endometrial hyperplasia and pituitary histology in c3h shn f1 mice  
class4	1139	we investigated the effects of energy restriction on the pituitary ovarian axis and on a hormone responsive gene  the mouse mammary tumor virus  mmtv   
class4	1139	female c3h shn f1 hybrid mice  known to display a high incidence of mammary tumors  ate an energy restricted diet  48 kcal wk  or a control diet  95 kcal wk  beginning at the time of weaning  
class4	1139	by 67 wk of age  12 of 32 mice in the control group  but none of the 33 mice in the energy restricted group  had developed mammary tumors  
class4	1139	six tumor free mice from each group were studied in detail at 67 wk of age  
class4	1139	all six tumor free control mice  but none of the six energy restricted mice  showed uterine endometrial hyperplasia at autopsy  
class4	1139	mice subjected to energy restriction did not display an estrous cycle  
class4	1139	the average levels of mmtv mrna in mammary glands and uteri were strongly reduced by energy restriction  
class4	1139	mmtv mrna levels in mammary glands from control mice were two orders of magnitude lower than those in mammary tumors  
class4	1139	energy restriction lowered the percentage of pituitary mammatropes and suppressed proliferation of mammatropes with advancing age  
class4	1139	energy restriction thus appeared to inhibit endometrial hyperplasia and to decrease mmtv production at the mrna level in the mammary glands and in the uterus  
class4	1139	these effects may be a consequence of hormonal changes originating at the pituitary ovarian axis  
class4	1140	implementation of cancer prevention guidelines in clinical practice  
class4	1140	data from several sources  including consumer surveys  physician surveys  and medical record audits  indicate that consumers do not receive cancer screening tests as recommended by the national cancer institute  the american cancer society  and the u s  
class4	1140	preventive services task force  
class4	1140	performance rates are consistently below published standards for all tests except pap tests  
class4	1140	major reasons physicians do not perform the recommended tests include physician forgetfulness  disagreement with recommendations  lack of time  and patient refusal  
class4	1140	physicians also tend to overestimate their own performance rates  
class4	1140	barriers to screening test performance can be categorized into patient factors  physician factors  test factors  and health care delivery system factors  
class4	1140	interventions  such as computerized reminder systems  physician audits with feedback  and patient education and reminders  can be effective in promoting performance of such screening  
class4	1140	interventions that target both physician and patient may be particularly effective  
class4	1141	implementation of preventive services in an hmo practice  
class4	1141	practice does not conform to guidelines unless the guidelines are specifically implemented and performance is monitored  
class4	1141	several examples of implementation in one health maintenance organization  hmo  are given  
class4	1141	these include immunization for influenza and follow up of positive screening tests for colorectal and cervical cancer  
class4	1141	each implementation effort has required the development of systems  which in this hmo are automated  
class4	1141	several issues influencing implementation are discussed  including resource constraints and priorities for the allocation of new resources  
class4	1141	developers cannot expect that their guidelines will be incorporated into clinical practice  
class4	1141	they must foster specific implementation plans  
class4	1142	breast cancer screening  who should be included  
class4	1142	the recommendations of the u s  
class4	1142	preventive services task force are reviewed in regard to screening for breast cancer  
class4	1142	in contradistinction to those issued by some other national organizations  screening for breast cancer using mammography at ages 40 49 is not recommended  
class4	1142	it is concluded that the scientific evidence is insufficient at present to recommend mammography screening for women aged 40 49  
class4	1142	the recommendations of the task force are  all women over age 40 should receive an annual breast examination  all women should have mammography every one or two years beginning at age 50 and concluding at approximately age 75 unless disease has been detected  and it may be prudent to begin mammography at an earlier age for women at high risk of breast cancer  
class4	1142	these recommendations are appropriate in light of the available evidence  though at present there is no evidence that clinical examination of the breasts at any age reduces breast cancer mortality  the upper age beyond which breast cancer screening no longer has a significant effect in reducing breast cancer mortality is unknown  and there is no evidence that women at high risk for breast cancer benefit to a different degree from screening than women not at high risk  
class4	1143	colorectal cancer  have we identified an effective screening strategy  
class4	1143	three currently used screening methods are aimed at detecting colorectal cancer when it is asymptomatic and curable  and at detecting polyps so that they can be removed before they can progress to cancer  
class4	1143	digital rectal examinations are relatively cheap and easy but can detect only a small fraction of large bowel cancers  
class4	1143	sigmoidoscopy is more sensitive  but its low acceptability to patients has been only partially mitigated by the introduction of the 35 cm flexible instrument  
class4	1143	fecal occult blood testing has limited sensitivity because blood from cancers and polyps is neither continuously shed nor uniformly distributed in feces  specificity and positive predictive value are also low because of other sources of blood in the stool  
class4	1143	prudent judgment suggests that all of these screening tests may prevent death from colorectal cancer in some patients  
class4	1143	however  none has been proven effective in general use by well controlled studies  
class4	1143	case control studies can provide timely and valuable new evidence in this regard  the authors  investigations in progress are described  
class4	1143	the current lack of strong evidence in support of these screening tests should not be interpreted as evidence against their use  
class4	1144	the impact of the u s  preventive services task force guidelines on cancer screening  perspective from the national cancer institute  
class4	1144	the u s  
class4	1144	preventive services task force evaluated the medical literature  utilizing strict criteria to judge the merits of experimental trials designed to show benefit in screening for cancer  
class4	1144	for individuals at normal risk  the task force was not able to make recommendations for or against screening for colorectal  prostate  skin  oral  or testicular cancers  
class4	1144	only one physical examination cancer screening procedure has ever been tested in a randomized trial  
class4	1144	during the past 27 years  the national cancer institute  nci  has funded six randomized screening trials  
class4	1144	thus far  only one has shown a decrease in mortality  
class4	1144	recognizing the limitations of such trials  the nci published  working guidelines for early cancer detection   designed for the practicing physician  these guidelines were based upon the best available evidence and on the judgment of representatives of medical professional organizations  
class4	1145	squamous cell carcinoma antigen for detection of squamous cell and mucoepidermoid carcinoma after primary treatment  a preliminary report  
class4	1145	this study evaluated the efficacy of using the periodic measurement of the serum level of squamous cell carcinoma antigen  scc antigen  for determining the local recurrence and or metastasis of squamous cell and mucoepidermoid carcinomas after primary treatment  
class4	1145	it was found that at the time of clinical recognition of recurrence  the scc antigen level was normal  but metastasis to regional lymph nodes or to remote organs generally was accompanied by an increase of scc antigen  
class4	1145	changes in the scc antigen level with mucoepidermoid carcinoma seemed to be less sensitive than with squamous cell carcinoma  
class4	1146	pedunculated soft tissue mass on the alveolar gingiva  clinical conference  
class4	1146	a case of peripheral ameloblastoma  a rare intraoral neoplasm  has been presented  
class4	1146	the lesion appears most commonly as a mass on the mandibular lingual gingiva of patients in their fifth and sixth decades of life  
class4	1146	the peripheral ameloblastoma does not share the aggressive nature of the intraosseous variant  
class4	1146	the lesion has been overtreated in the past and warrants only a local supraperiosteal excision  
class4	1147	mucous cell hyperplasia in an odontogenic cyst from a patient with muir torre syndrome  
class4	1147	mucous cell proliferation in a periapical radicular cyst from a patient with a family history of colonic malignancies and multiple sebaceous neoplasms of the skin  so called muir torre syndrome  is reported  
class4	1147	such goblet cell hyperplasia has not been previously reported to be associated with any known syndrome  
class4	1147	we believe the finding of mucous cell hyperplasia in an odontogenic cyst may not simply be coincidental  but should raise suspicion of paraneoplastic potential and warrant further evaluation for possible occult neoplastic disease  
class4	1148	serial magnetic resonance imaging in neonatal hypoxic ischemic encephalopathy  
class4	1148	we prospectively performed magnetic resonance imaging  mri  studies during the neonatal period  and at 4 and 8 months of age  on 15 term infants with hypoxic ischemic encephalopathy  and compared the results with their neurodevelopmental outcome at 18 months of age  
class4	1148	cerebral palsy developed in nine infants  two infants were classified as having abnormalities of tone and delayed motor milestones that were suggestive of cerebral palsy  and four infants were normal  
class4	1148	structural abnormalities  delayed myelination  or a combination of the two were detected with mri at 8 months of age in all nine infants with later development of cerebral palsy  
class4	1148	three of the four normal infants and one infant with suggestive abnormalities had normal serial mri findings  
class4	1148	each of the remaining two infants  one normal  one with suggestive abnormalities  had isolated persistent ventricular dilation on all three mri studies  
class4	1148	our results suggest that 8 months appears to be the earliest time at which mri findings correlate well with later adverse neurodevelopmental outcome in this population  
class4	1149	interaction between trimethoprim sulfamethoxazole and methotrexate in children with leukemia  
class4	1149	because trimethoprim sulfamethoxazole  tmp smx  causes neutropenia in children with leukemia  we investigated the possibility that pharmacokinetic interaction between methotrexate  mtx  and tmp smx causes accumulation of the antileukemia agent  
class4	1149	we studied the pharmacokinetics of mtx given intravenously or orally to nine children with acute lymphoblastic leukemia  once with and once without tmp smx  
class4	1149	there was an increase in free mtx fraction during tmp smx therapy in all patients  from  mean     sd  37 4     11  without tmp smx to 52 2     6 4  with tmp smx  p less than 0 01   
class4	1149	plasma clearance of total mtx did not change significantly  whereas clearance of free mtx decreased significantly  from 12 5     4 to 7 6     1 5 ml kg min  p less than 0 05   
class4	1149	there was a consistent decrease in the renal clearance of free mtx  from 12 1     6 8 to 5 6     2 4 ml kg min  p less than 0 05   
class4	1149	elimination half life of mtx was not affected significantly by tmp smx  
class4	1149	there was a significant correlation between serum concentrations of tmp smx and the percentage of decrease in the renal clearance of free mtx  r   0 91  p less than 0 05   
class4	1149	these changes in protein binding and tubular clearance of mtx  caused by competition with tmp smx  result in a mean 66  increase in systemic exposure to mtx and may explain the myelotoxicity often observed with the coadministration of the two drugs  
class4	1150	laparoscopic management of ovarian cysts  
class4	1150	one hundred two women with ovarian cysts were managed laparoscopically over a 13 year period  
class4	1150	thirteen were treated with laparoscopic inspection followed by laparotomy  6 with laparoscopic fine needle aspiration followed by laparotomy and 83 with laparoscopic fenestration and biopsy  with or without coagulation or removal of the cyst lining  
class4	1150	satisfactory results were noted in patients treated completely with laparoscopy  
class4	1150	only 1 of 56 functional  simple or paraovarian cysts recurred during the study period  
class4	1150	two of the 18 ovarian endometriomas treated with fenestration and coagulation or removal of the lining recurred  whereas 8 of 9 such lesions recurred when treated with fenestration alone  
class4	1150	there were no surgical complications  
class4	1151	expression of the mdr1 gene in human gastric and colorectal carcinomas  
class4	1151	we measured expression of the mdr1 gene  also known as the pgy1 gene  in the human gastrointestinal tract  
class4	1151	mdr1 messenger rna  mrna  levels were elevated in 13 of 15 colorectal carcinoma specimens and in six of 13 gastric carcinoma specimens  
class4	1151	well differentiated colorectal carcinomas contained significantly higher concentrations of mdr1 mrna than moderately differentiated colorectal carcinomas  
class4	1151	similarly  moderately differentiated gastric carcinomas contained higher concentrations of mdr1 mrna than poorly differentiated gastric carcinomas  
class4	1151	mdr1 gene expression in normal colorectal and gastric tissues adjacent to carcinomas was similar to that in the carcinomas  
class4	1151	mdr1 gene expression in xenografts of colorectal and gastric carcinomas in nude mice was also investigated  
class4	1151	elevated expression of the mdr1 gene was seen in only four of 18 xenografts of colorectal carcinoma and was not seen in any xenografts of gastric carcinoma  
class4	1151	p glycoprotein was distributed over the luminal surface of the colorectal carcinoma  
class4	1151	these results imply that the higher levels of mdr1 mrna found in well differentiated carcinomas derived from colorectal tissues are the results of increased expression of the mdr1 gene in the luminal surface cells  
class4	1151	the level of expression of the mdr1 gene in colorectal and gastric carcinomas appears to correlate with the degree of differentiation and also appears to be affected by transplantation into nude mice  
class4	1152	race  nutritional status  and survival from breast cancer  
class4	1152	the effects of nutritional status on differences in the survival of black and white women with breast cancer were studied in a cohort of 1 960 georgia women diagnosed during 1975 1979  
class4	1152	after data were adjusted for stage of disease  socioeconomic status  and other prognostic factors  poorer survival rates were shown in black women  
class4	1152	within each stage classification  lower levels of serum albumin and hemoglobin and higher relative body weight were more common among blacks and were independently associated with poorer survival  
class4	1152	among women with stage 3 disease  adjustment for these variables substantially reduced the excess mortality rate among blacks  suggesting that racial differences in survival may be partly explained by differences in nutritional status or extent of disease within stage  
class4	1153	effect of tamoxifen on serum insulinlike growth factor i levels in stage i breast cancer patients  
class4	1153	insulinlike growth factor i  igf i  has been shown to be a potent mitogen for breast cancer cells in vitro  and igf i receptors have been demonstrated on human primary breast neoplasms  
class4	1153	in a randomized  placebo controlled study  we document that administration of the antiestrogen tamoxifen to patients with breast cancer was associated with a statistically significant  p    002  reduction in the serum level of igf i  
class4	1153	the mean igf i level was 1 4 u ml in the placebo treated group and 0 9 u ml in the tamoxifen treated group  
class4	1153	because serum igf i level is growth hormone  gh  dependent and because data suggest that the pubertal surge in gh and igf i levels is sex steroid dependent  we speculate that the mechanism underlying our observation may involve blockade by tamoxifen of estrogen action in the hypothalamic pituitary axis  
class4	1153	we conclude that tamoxifen treatment reduces igf i levels and that this reduction may contribute to the therapeutic effect of the drug  
class4	1154	reduction of the membrane fluidity of human breast cancer cells by tamoxifen and 17 beta estradiol  
class4	1154	the intracellular steady state levels of methotrexate were previously shown to be reduced in estrogen receptor  er  negative human breast cancer mda mb 436 cells and er positive human breast cancer mcf7 cells following treatment with pharmacologically relevant concentrations of 17 beta estradiol  e2   
class4	1154	we now report that both e2 and tamoxifen  tmx  significantly decreased the fluidity of mcf7 and mda mb 436 cellular membranes  
class4	1154	with e2 or tmx at concentrations greater than 1 microm  perturbations in membrane fluidity were accompanied by apparently non er mediated cytotoxicity  
class4	1154	alterations in membrane structure may have contributed to the cytotoxicity of high dose endocrine therapy and to the ability of e2 to inhibit methotrexate transport and cytotoxicity in some human breast cancer cells  
class4	1155	antitumor activity of liposome encapsulated doxorubicin in advanced breast cancer  phase ii study  
class4	1155	previous studies in animals have demonstrated liposome encapsulated doxorubicin  led  has substantially less cardiac toxicity than free doxorubicin but retains antitumor activity  
class4	1155	in a phase i clinical study of led  the maximum tolerated dose was 90 mg m2 and dose limiting toxicity was considered to have been reached when granulocytopenia was produced  
class4	1155	we used led to treat 20 patients with advanced  measurable breast cancer  
class4	1155	led was given at doses of 60 75 mg m2 every 3 weeks as an intravenous infusion  
class4	1155	regression of disease was objectively measured in nine patients  in five of these patients  complete regression of the index lesion occurred  
class4	1155	the mean duration of the responses was 7 months  
class4	1155	hematologic toxicity consisted of grade 1 2 leukopenia in some patients  
class4	1155	gastrointestinal toxicity and mucositis were generally mild and tolerable  
class4	1155	alopecia occurred in all patients and usually was complete  
class4	1155	twelve patients received cumulative doses of led of greater than 400 mg m2 and were evaluated with radionuclide ventriculograms  
class4	1155	in eight patients  the cumulative dose was greater than 500 mg m2  and five had endomyocardial biopsies  
class4	1155	four of these biopsy results were billingham grade 0  while one  cumulative led dose  750 mg m2  showed grade 1 changes with mild myofibrillar loss and dilatation of the sarcoplasmic reticulum involving less than 5  of cardiac myocytes  
class4	1155	two patients had decreases in left ventricular ejection fraction  
class4	1155	one of these patients had received a total dose of led of 630 mg m2 and had a decline of 13  in left ventricular ejection fraction  but had no clinical evidence of congestive heart failure and had a billingham grade 0 endomyocardial biopsy  
class4	1156	oral zidovudine  continuous infusion fluorouracil  and oral leucovorin calcium  a phase i study  
class4	1156	a phase i clinical  pharmacologic  and biochemical evaluation of escalating oral zidovudine  azt  given over 2 days with a fixed dose of continuous infusion fluorouracil  800 mg m2 per day x 3 days  and oral leucovorin calcium was performed  
class4	1156	eighteen patients were treated with doses of azt ranging from 1 0 to 9 0 g m2 per day  
class4	1156	nausea and vomiting were dose limiting  with a maximally tolerated dose of 7 5 g m2 per day  
class4	1156	rash and mucositis occurred but were not dose limiting  
class4	1156	a dose related increase in peak plasma levels of azt was observed  and the alpha half life of azt in plasma  75 min  was unaffected by these high doses  
class4	1156	at doses above 4 0 g m2 per day  trough levels significantly increased  perhaps reflecting prolonged absorption from the gut  
class4	1156	no responses were observed  however  a significant increase in dna single strand breaks was observed in peripheral blood cells after a threshold dose of 4 0 g m2 per day  confirming a biological effect of azt in this regimen  
class4	1156	further trials with an intravenous formulation capable of maintaining plasma levels and circumventing dose limiting toxicity are warranted  
class4	1157	validation of intermediate end points in cancer research  
class4	1157	investigations using intermediate end points as cancer surrogates are quicker  smaller  and less expensive than studies that use malignancy as the end point  
class4	1157	we present a strategy for determining whether a given biomarker is a valid intermediate end point between an exposure and incidence of cancer  
class4	1157	candidate intermediate end points may be selected from case series  ecologic studies  and animal experiments  
class4	1157	prospective cohort and sometimes case control studies may be used to quantify the intermediate end point cancer association  
class4	1157	the most appropriate measure of this association is the attributable proportion  
class4	1157	the intermediate end point is a valid cancer surrogate if the attributable proportion is close to 1 0  but not if it is close to 0  
class4	1157	usually  the attributable proportion is close to neither 1 0 nor 0  in this case  valid surrogacy requires that the intermediate end point mediate an established exposure cancer relation  
class4	1157	this would in turn imply that the exposure effect would vanish if adjusted for the intermediate end point  
class4	1157	we discuss the relative advantages of intervention and observational studies for the validation of intermediate end points  
class4	1157	this validation strategy also may be applied to intermediate end points for adverse reproductive outcomes and chronic diseases other than cancer  
class4	1158	inhibition of invasion of invasive human bladder carcinoma cells by protein kinase c inhibitor staurosporine  
class4	1158	to study the effect of the protein kinase c  pkc  inhibitor staurosporine on invasion  we selected the invasive human bladder carcinoma cell line ej  
class4	1158	total pkc activity was more than twofold higher in the ej cells than in rt4 cells  superficial human bladder carcinoma cells   which do not pass through an artificial basement membrane  
class4	1158	there was more pkc activity in the cytosol than in the membrane of ej cells  
class4	1158	staurosporine  at nontoxic concentrations  inhibited the invasion of ej cells through an artificial basement membrane in a dose dependent manner  
class4	1158	staurosporine caused a dose dependent inhibition of cell motility but did not inhibit cell attachment  
class4	1158	staurosporine represents a new agent for the inhibition of tumor cell invasion and may prove useful in studying the mechanisms responsible for this phenomenon  
class4	1159	anti idiotype monoclonal antibody carrying the internal image of ganglioside gm3  
class4	1159	murine anti idiotype monoclonal antibodies were generated against a human igm monoclonal antibody  l612  that recognizes ganglioside gm3 on human melanoma  
class4	1159	hybridomas secreting antibodies that bound specifically to l612 were selected by enzyme linked immunosorbent assay using l612 and three negative control human igms  including monoclonal anti gm2 and anti gd2 antibodies  as well as purified serum igm  as antigen sources  
class4	1159	gm3 binding inhibition and cell binding inhibition assays were used to identify seven anti idiotype monoclonal antibodies that recognized determinants located within the antigen combining sites of l612  
class4	1159	to determine whether these anti idiotype monoclonal antibodies possessed the internal image of the original antigen  we immunized syngeneic balb c mice with one of the anti idiotype monoclonal antibodies  4c10  coupled with keyhole limpet hemocyanin  
class4	1159	sera from the immunized mice reacted strongly with an antigen positive m12 melanoma cell line and with purified gm3  
class4	1159	because l612 detects and kills melanoma tumor cells in vitro and in vivo in the presence of complement without affecting normal tissues  anti idiotype monoclonal antibodies carrying the internal image of gm3 may be an effective tool for active specific immunotherapy in patients with melanoma  
class4	1160	nonrandom chromosomal abnormalities in primary uveal melanoma  
class4	1160	we report on 14 cases of clonal chromosomal anomalies in patients with primary uveal melanoma  
class4	1160	an increased dosage of chromosome 8 or of parts of the long arm of chromosome 8  8q  were detected in eight patients  57    
class4	1160	the smallest multiplied area of 8q appeared to be the region 8q2 1    qter  
class4	1160	monosomy of chromosome 3 was seen in six patients  43    five of which were associated with anomalies of chromosome 8  
class4	1160	increased dosage of parts of chromosome 8q and loss of heterozygosity of chromosome 3  or the combination of both  seemed to be nonrandom for uveal melanoma and may distinguish it genetically from cutaneous malignant melanoma  
class4	1160	anomalies of chromosome 6  mostly resulting in additional material of 6p or a deletion of 6q  were found in six patients  43    
class4	1160	these anomalies  which seem to be common features of cutaneous malignant melanoma  were considered secondary rather than primary changes in uveal melanoma  since they were present only in subclones in most cases  
class4	1160	loss of the y chromosome  restricted to tumor cells  was detected in four male patients  and loss of one x chromosome was detected in a female patient  
class4	1161	prospective study of the frequency and size distribution of polyps missed by colonoscopy  
class4	1161	an important determinant in interpreting the results of colorectal polyp chemoprevention trials is the rate of polyps missed during colonscopic examination  
class4	1161	we prospectively examined 90 patients by tandem colonoscopy performed by two alternating examiners  
class4	1161	in 69  76 7   patients  221 neoplastic lesions were documented histologically  
class4	1161	of a total of 58 lesions detected in 31 patients  no neoplastic lesion greater than or equal to 10 mm in size was missed  16  of diminutive  less than or equal to 5 mm  neoplastic polyps and 12 3  of medium sized  6 9 mm  neoplastic polyps were missed by the first examiner  
class4	1161	we conclude that an experienced colonoscopist will miss about 15  of colorectal neoplastic polyps less than 10 mm in size in the setting of adequate bowel preparation  
class4	1161	large  greater than or equal to 10 mm  polyps were rarely missed  however  with the  miss  rate in our study equal to 0  with a 95  confidence limit of 4 64   
class4	1162	mutagen sensitivity in patients with head and neck cancers  a biologic marker for risk of multiple primary malignancies  
class4	1162	eighty four patients with head and neck cancers were evaluated for in vitro sensitivity to mutagens and then followed longitudinally for development of multiple primary malignancies  
class4	1162	we assessed mutagen sensitivity by exposing lymphocytes to bleomycin in vitro and quantitating the bleomycin induced chromosomal breaks per cell  
class4	1162	the mutagen hypersensitive patients  ie  those who expressed greater than 1 0 break per cell  were significantly more likely to develop multiple primary cancers than were patients who were less sensitive  less than or equal to 1 0 break per cell   relative risk   4 4  95  confidence limits   1 2  15 8   
class4	1162	this relationship was independent of age  sex  site  and treatment of first primary cancer and tobacco or alcohol exposures  
class4	1162	sensitivity to bleomycin induced chromosomal damage serves as an indicator of genetic susceptibility to multiple primary malignancies in patients with head and neck cancers  
class4	1163	parotid gland and facial nerve trauma  a retrospective review  
class4	1163	included in this study are all patients with trauma to the parotid region seen at our center from 1979 to 1989  
class4	1163	there was a total of five patients with injury to the parotid area  two patients with isolated facial nerve injury  one with isolated parotid duct injury  two with combined duct and nerve injury  
class4	1163	there were four males and one female  with a mean age of 34 years  range  16 to 62 years   
class4	1163	the three patients with parotid duct injury required other procedures for associated trauma  
class4	1163	a total of eight nerve branches were severed in four patients  
class4	1163	seven of the eight nerve branches  82 5   were primarily repaired  with excellent functional results  
class4	1163	two of the three ductal injuries were repaired primarily over a stent  and one was ligated  
class4	1163	no complications resulted from either treatment  
class4	1163	based on our clinical experience and review of the literature  we suggest that the treatment of parotid region injuries should include  1  a complete initial assessment  2  primary repair of parotid duct transection within 24 hours when possible  3  primary repair of all facial nerve injuries  although delayed nerve repair remains a viable alternative  and 4  nonsurgical treatment of sialoceles and fistulae  
class4	1164	neoadjuvant chemotherapy in invasive bladder cancer  the evolving role of surgery  
class4	1164	the role of an operation in patients receiving neoadjuvant chemotherapy for clinically localized but invasive transitional cell carcinoma of the bladder currently is evolving  
class4	1164	an operation is essential for case selection and evaluation of local response but it also contributes to bladder preservation and survival  
class4	1164	the procedure that is necessary to select for and assess response to chemotherapy may itself alter the actual or proceed to evolution of invasive bladder cancer  
class4	1164	neoadjuvant chemotherapy is a reasonable therapeutic strategy in selected patients but it remains to be seen whether the results will prove to be superior to those achieved with standard endoscopic and open operations  
class4	1165	incidence and properties of renal masses and asymptomatic renal cell carcinoma detected by abdominal ultrasonography  
class4	1165	renal ultrasonography was performed in 45 905 adults  including 41 364 without any signs suggesting urinary tract malignancies  1 667 with microscopic hematuria only and 2 874 with some signs of malignancy  
class4	1165	renal lesions were found in 355 adults  0 858   in the asymptomatic  39  2 3   in the microscopic hematuria and 75  2 6   in the symptomatic groups  respectively  
class4	1165	renal cell carcinoma was found in 35  7 5   lesions  19  5 4   in the asymptomatic  none in the microscopic hematuria and 16  21 3   in the symptomatic groups  
class4	1165	a total of 47 patients  including 12 other renal cell carcinoma patients transferred from related hospitals  was grouped into 28 without and 19 with symptoms  
class4	1165	primary tumor size and clinical stages were significantly smaller and lower  respectively  in the asymptomatic group than in the symptomatic group  
class4	1165	radical nephrectomy was performed in all but 2 asymptomatic patients  
class4	1165	the 5 year survival rates after nephrectomy were 94 7 and 60 9  for the asymptomatic and symptomatic groups  respectively  p less than 0 01   
class4	1165	the results indicate that ultrasonography is a useful tool to detect low stage asymptomatic renal cell carcinoma at low cost  
class4	1166	magnetic resonance imaging for assessment of vena caval tumor thrombi  a comparative study with venacavography and computerized tomography scanning  
class4	1166	we assessed the accuracy of magnetic resonance imaging in demonstrating the presence and extent of vena caval tumor thrombi  
class4	1166	the study group included 20 patients with vena caval thrombi from renal cell carcinoma  18   renal pelvic transitional cell carcinoma  1  and adrenal pheochromocytoma  1   
class4	1166	preoperative diagnostic studies included magnetic resonance imaging in all patients  inferior venacavography in 16 and computerized tomography scanning in 15  
class4	1166	all patients underwent an operation in which the presence and extent of the vena caval thrombus were confirmed  
class4	1166	magnetic resonance imaging accurately delineated the presence and extent of the thrombus in all 20 patients  100    
class4	1166	venacavography was accurate in 15 patients  94   but 8  50   required a retrograde and antegrade study  
class4	1166	computerized tomography scanning demonstrated the presence of a tumor thrombus in all 15 patients but accurately delineated the cephalad extent of the thrombus in only 5  33    
class4	1166	in patients with vena caval tumor thrombi magnetic resonance imaging can provide accurate information regarding the extent of vena caval involvement while avoiding the need for an invasive contrast imaging study  
class4	1167	ureterosigmoidostomy  long term results  risk of carcinoma and etiological factors for carcinogenesis  
class4	1167	we followed postoperatively 75 patients who underwent ureterosigmoidostomy between 1942 and 1987  
class4	1167	of the patients 30 were asked to undergo routine examination  including fiberoptic sigmoidoscopy with biopsy and analysis of a urine feces slurry for nitrate  nitrite and nitrosamines in comparison to 20 control volunteers  
class4	1167	after a mean observation of 14 years 7 months  1 to 46 years  64 5  of the patients had bilaterally normal kidneys without any previous complications  77 5  of the renal units being normal  
class4	1167	sigmoidoscopic biopsy revealed 3 carcinomas at the ureterocolonic junction resulting in an 8 5 to 10 5 fold increased risk of colon carcinoma compared to the general population  
class4	1167	the excretion of nitrite and n nitrosamines was increased  and nitrate excretion was decreased compared to healthy control volunteers  suggesting endogenous formation of nitrosamines by bacterially reduced nitrate and endogenous amines  
class4	1167	the urological long term results of ureterosigmoidostomy are similar to those of conduits  
class4	1167	however  the increased incidence of colon carcinoma is not yet proved to be higher than in conduits  
class4	1168	primary adenocarcinoma of the bladder  favorable prognostic significance of deoxyribonucleic acid diploidy measured by flow cytometry  
class4	1168	flow cytometric nuclear deoxyribonucleic acid ploidy analysis was done successfully on 38 specimens of primary bladder adenocarcinoma treated between 1954 and 1985  
class4	1168	of the specimens 10  26   were deoxyribonucleic acid diploid  8  21   were tetraploid and 20  53   were aneuploid  
class4	1168	distribution of ploidy patterns between the 14 histological low grade and 24 high grade tumors was similar  
class4	1168	of 38 tumors 35  92   showed muscle invasion  
class4	1168	one tumor arose in a previously exstrophied bladder  10 were of urachal origin and 27 arose in an anatomically normal bladder  
class4	1168	of the urachal origin tumors 80  were deoxyribonucleic acid aneuploid  
class4	1168	at 5 and 10 years after diagnosis 80 and 70   respectively  of the patients with diploid tumors were free of disease  
class4	1168	by contrast  at 5 and 10 years after treatment only 20 and 12   respectively  of the patients with nondiploid tumors have not had disease progression  p less than 0 001 log rank test   
class4	1168	none of the 6 patients with diploid  high grade  high stage  muscle invasive tumors had subsequent progression  
class4	1168	in contrast  16 of 17 patients  94   with high grade  high stage  nondiploid tumors had either local or distant tumor recurrence  p less than 0 0005   
class4	1168	nuclear deoxyribonucleic acid ploidy pattern appears to be the most significant prognostic information currently available to stratify expected prognosis for patients with muscle invasive adenocarcinoma of the bladder  
class4	1168	this test probably should be a standard tool in the clinical management of patients with this rare bladder malignancy  
class4	1169	randomized phase ii evaluation of carboplatin and chip in advanced transitional cell carcinoma of the urothelium  the eastern cooperative oncology group  
class4	1169	a total of 83 patients with metastatic transitional cell carcinoma who had previously received no systemic therapy entered a randomized phase ii evaluation of carboplatin and cis dichloro transdihydroxy bis isopropylamine platinum iv  chip   administered respectively at 400 and 270 mg  m 2 every 28 days  
class4	1169	among evaluable patients with measurable disease response rates were 3 of 22  14   95  confidence interval 5 to 35   for carboplatin and 4 of 25  16   95  confidence interval 5 to 36   for chip  
class4	1169	among 17 patients with evaluable but not measurable metastases  10 carboplatin and 7 chip recipients  there were no responses  
class4	1169	median survival for 64 evaluable patients was 4 8 months  5 0 months for carboplatin and 4 3 months for chip recipients   
class4	1169	independent factors prognostic for survival  p less than 0 01  were performance status  0 or 1 versus 2 or 3   liver metastases  prior radiation therapy and recent weight loss  p   0 02   
class4	1169	multivariate analysis confirmed that a performance status of 2 or 3 and liver metastases were predictive of shorter survival  
class4	1169	a total of 31  of the patients treated with carboplatin and 34  of those who received chip experienced severe or life threatening myelosuppression  
class4	1169	while the response rates with carboplatin and chip are modest  we believe that the characteristics of these agents indicate that they should be evaluated further  
class4	1170	perioperative methotrexate  vinblastine  doxorubicin and cisplatin  m vac  for poor risk transitional cell carcinoma of the bladder  an eastern cooperative oncology group pilot study  
class4	1170	a total of 18 patients with locally advanced transitional cell carcinoma of the bladder underwent 2 preoperative cycles of chemotherapy with methotrexate  vinblastine  doxorubicin and cisplatin followed by radical cystectomy and 2 postoperative cycles of chemotherapy  
class4	1170	radical cystectomy was performed in 17 of 18 patients  94   with a pathological partial response in 3  17   and a pathological complete response in 2  11    for an over all response rate of 28   95  confidence limits 10 to 53    
class4	1170	at 23 month median followup 9 patients  50   remained without evidence of recurrent disease  while 9  50   died of metastatic bladder cancer  
class4	1170	average relative dose intensity of all therapy given was 78   
class4	1170	hematological toxicity was moderate  with no septic deaths or bleeding complications  
class4	1170	however  4 thromboembolic events occurred  
class4	1170	while downstaging of the primary bladder tumor can occur with this perioperative schedule our results were not as impressive as some previously reported findings  
class4	1170	the incidence of thromboembolic events is worrisome  
class4	1171	local recurrence and survival following nerve sparing radical cystoprostatectomy  
class4	1171	from march 1982 through july 1988  76 men underwent nerve sparing radical cystoprostatectomy for carcinoma of the bladder at our hospital  
class4	1171	of the 76 patients 2  2 6   had positive surgical margins  dome of the bladder and left ureter  and neither had positive margins at the site of nerve sparing modifications  
class4	1171	of 3 patients  3 9   who had local recurrence none had positive surgical margins  
class4	1171	the 5 year actuarial local recurrence rate is 7 5   
class4	1171	thirteen of 76 patients  17   died of transitional cell carcinoma and 7  9   died of other causes  while 53  70   are alive without evidence of disease with a mean followup of 38 4 months  
class4	1171	the 5 year actuarial survival rates are 64  over all  68  without disease and 78  disease specific  
class4	1171	of the 42 evaluable men who underwent cystoprostatectomy alone 27  64   are potent  compared to 2 of the 12 men  17   who also underwent urethrectomy  
class4	1171	we conclude that the nerve sparing modifications do not compromise cancer control  that local recurrence and survival rates are at least comparable to those achieved with standard radical cystoprostatectomy  and that it is possible to preserve potency in most men undergoing this procedure  
class4	1172	testicular carcinoma in patients positive and at risk for human immunodeficiency virus  
class4	1172	patients with the acquired immunodeficiency syndrome are at increased risk for certain malignancies  
class4	1172	because acquired immunodeficiency syndrome and testicular cancer affect primarily young men  the potential complications that acquired immunodeficiency syndrome might impose raise significant concern  
class4	1172	to address this question we performed a retrospective review of all cases of testicular cancer during an 11 year period  
class4	1172	of 140 patients 6 had human immunodeficiency virus infection and 7 were from human immunodeficiency virus risk groups  
class4	1172	all cases were either stage i or ii disease with seminoma in 8  teratocarcinoma in 3  embryonal cell carcinoma in 1 and teratoma in 1  
class4	1172	the clinical presentations of these patients were comparable to those of patients without human immunodeficiency virus risk factors  
class4	1172	the majority of the patients received standard therapy  including orchiectomy followed by lymphadenectomy  radiation therapy or chemotherapy depending on stage and pathological subtype  
class4	1172	patients tolerated therapy well with only 1 course of radiation therapy complicated by pneumocystis carinii pneumonia  
class4	1172	all patients achieved complete remission and none died of testicular cancer  
class4	1172	since treatment of these patients may worsen the immunosuppression  surveillance is recommended after orchiectomy for acquired immunodeficiency syndrome patients with stage i disease  
class4	1172	however  the majority of patients with human immunodeficiency virus infection should receive standard therapy  
class4	1173	clinical stage 1 testicular cancer  the role of modified retroperitoneal lymphadenectomy  
class4	1173	a total of 85 patients underwent modified retroperitoneal lymphadenectomy for clinical stage i nonseminomatous germ cell tumor of the testis from 1982 to 1989  
class4	1173	the technique was a modified bilateral dissection via a thoracoabdominal approach  
class4	1173	a full bilateral dissection was done above the level of the inferior mesenteric artery but unilateral dissection was performed below the inferior mesenteric artery using a template method  
class4	1173	of the 85 patients 64 had pathological stage a and 21 had stage b1 disease  
class4	1173	relapses have occurred in 4 of 64 stage a cancer patients  6   and 3 of 21 stage b1 cancer patients  15    
class4	1173	antegrade ejaculation was preserved without pharmacological therapy in 75 of 85 patients  88   and 5 others were converted to antegrade ejaculation with imipramine  
class4	1173	therefore  80 of 85 patients  94   have recovered antegrade ejaculation  
class4	1173	with a median followup of 38 months 7 relapses have been noted  
class4	1173	we conclude that modified retroperitoneal lymph node dissection allows for preservation of ejaculation  decreases concern about retroperitoneal understaging and represents the preferred alternative to surveillance protocols for patients with low stage testicular cancer  
class4	1174	erythrocyte polyamine levels in human prostatic carcinoma  
class4	1174	abnormally high red blood cell polyamine levels were found in benign prostatic hyperplasia and in prostatic adenocarcinoma patients  
class4	1174	in prostatic adenocarcinoma patients a relationship was noted between the importance of red blood cell spermidine and spermine concentrations  and the clinical stage of the disease  whitmore classification   
class4	1174	considering prostatic adenocarcinoma patient populations  patients with metastases  groups 3 and 4  statistically differed from those without metastases  group 2   
class4	1174	furthermore  red blood cell polyamine level determination discriminated patients in the hormonal escape group  group 4  from those usually considered as hormone responsive  groups 2 and 3   
class4	1174	no statistically significant correlation was observed between red blood cell polyamine levels and usual tumor markers  prostatic acid phosphatase and prostate specific antigen   
class4	1174	these results confirmed that red blood cell polyamine levels must be considered as a circulating index of cell proliferation that might be of clinical importance during the long term followup and treatment of prostatic adenocarcinoma patients  
class4	1175	the relationship of prostate specific antigen levels and residual tumor volume in stage a prostate cancer  
class4	1175	preoperative serum prostate specific antigen correlates well with morphometrically determined prostate tumor volume in prostatectomy specimens  
class4	1175	however  since prostate specific antigen is produced by hyperplastic as well as malignant prostatic epithelium  the contribution of hyperplastic epithelium  benign prostatic hyperplasia  to serum prostate specific antigen interferes with the ability of serum prostate specific antigen to predict tumor volume in individual patients  
class4	1175	we wondered if the removal of benign prostatic hyperplasia tissue would increase the correlation between prostate specific antigen and tumor volume  and  thus  make prostate specific antigen a more accurate predictor of residual cancer volume after transurethral resection of the prostate  
class4	1175	a total of 67 patients with clinical stage a cancer underwent radical retropubic prostatectomy  22  or 33   with stage a1 and 45  or 67   with stage a2 disease   and had pre radical prostatectomy measurement of serum prostate specific antigen and morphometric determination of residual cancer volume in the radical prostatectomy specimen  
class4	1175	the correlation between serum prostate specific antigen and residual cancer volume for all 67 patients was 0 66  and for stages a1 and a2 disease it was 0 64 and 0 70  respectively  
class4	1175	all stage a1 cancer patients with a serum prostate specific antigen value of 1 ng  ml  
class4	1175	or less had residual tumor volumes of less than 0 5 cc and all stage a cancer patients with a serum prostate specific antigen value of more than 10 ng  ml  
class4	1175	had residual tumor volumes of greater than 0 5 cc  
class4	1175	of the patients 51  had levels of 1 to 10 ng  ml  
class4	1175	and serum prostate specific antigen was not useful to predict residual tumor volume in this group  
class4	1175	serum prostate specific antigen measurements may be helpful in stage a1 cancer patients with levels of 1 ng  ml  
class4	1175	or less  or greater than 10 ng  ml  
class4	1175	in choosing the most appropriate therapy  
class4	1176	prostate specific antigen for assessing response to ketoconazole and prednisone in patients with hormone refractory metastatic prostate cancer  
class4	1176	serial prostate specific antigen levels were assessed in 15 patients with hormone refractory metastatic prostate cancer treated with ketoconazole and prednisone  
class4	1176	of the men 12  80   with continually increasing prostate specific antigen levels before treatment had a decrease in prostate specific antigen with a median duration of response of 3 months  
class4	1176	three patients  20   had a prolonged response  greater than or equal to 8 months  as seen by a persistently decreasing prostate specific antigen and improvement in bone pain  
class4	1176	there appears to be a small subgroup of patients with progressive prostate cancer despite androgen ablation who will benefit from ketoconazole and glucocorticoid treatment  
class4	1176	the use of serial prostate specific antigen levels appears to help define this subgroup and avoid the need for multiple radiological procedures to assess response  
class4	1177	radical prostatectomy for clinical stage t1 2n0m0 prostatic adenocarcinoma  long term results  
class4	1177	a total of 441 stage t1 2n0m0 and 11 stage t1 2n0m0 cancer patients with an elevated acid phosphatase level only  and 18 stage t1 2n m0 cancer patients underwent radical prostatectomy  
class4	1177	analysis of the 441 stage t1 2n0m0 cancer patients demonstrated that failure and survival were a function of the disease being organ confined  specimen confined or margin positive  with 10 year failure rates of 12  30 and 60   respectively  
class4	1177	of the patients with positive margins 44 were and 79 were not irradiated postoperatively  
class4	1177	postoperative radiation produced no survival advantage  
class4	1177	no difference in interval to failure or of survival could be identified between 105 patients whose disease was diagnosed by transurethral resection and 328 who had a palpable abnormality  
class4	1177	eleven patients had negative bone and node findings but they had an elevated acid phosphatase level  
class4	1177	all 8 patients not treated with immediate androgen deprivation failed within 36 months  
class4	1178	pheochromocytoma in the pediatric age group  the prostate  an unusual location  
class4	1178	pheochromocytomas of the prostate are rare  with only 3 cases in adults reported in the literature  
class4	1178	we present the case of an 8 year old boy with a pheochromocytoma of the prostate and a second tumor in the region of the left internal iliac artery  
class4	1179	nuclear morphometry as a prognostic indicator for genitourinary rhabdomyosarcoma  a preliminary investigation  
class4	1179	rhabdomyosarcoma of the urogenital tract is a malignant mesenchymal tumor seen primarily in childhood  
class4	1179	multimodal therapy  encompassing surgery  radiotherapy and chemotherapy  has dramatically improved the survival of patients with this disease  
class4	1179	however  the quest for markers of tumor aggression is important to decrease the morbidity of treatment given to patients with good prognosis tumors  while at the same time intensifying treatment of tumors with poor prognosis  
class4	1179	using archival tumor specimens from 13 patients with genitourinary rhabdomyosarcoma  a multivariate analysis of multiple nuclear shape descriptors was done with the hopkins morphometry system  
class4	1179	three nuclear shape descriptors clearly separated patients with no evidence of disease recurrence or progression from those with recurrent disease  progressive disease or death of disease  
class4	1179	these nuclear shape descriptors were standard error of the chain code standard deviation analysis  p   0 010   range of the feret ellipticity distribution  p   0 016  and standard error of the chain code range analysis  p   0 037   
class4	1179	with multivariate analysis these shape descriptors taken together separated patients with good and poor prognoses to a level of significance of p   0 007  
class4	1179	thus  nuclear morphometric analysis may prove to be useful as an individual prognostic indicator in childhood genitourinary rhabdomyosarcoma and warrants further analysis in a much larger  blinded  controlled study  
class4	1180	de novo carcinoma of the lower urinary tract in renal allograft recipients  
class4	1180	immunocompetence has been postulated as an important defense against the progression of urothelial carcinoma  
class4	1180	three cases of de novo lower urinary tract carcinoma in renal transplant recipients demonstrated the potential for unusually rapid urothelial extension and invasion in chronically immunosuppressed patients  
class4	1180	two patients had a history of perineal condyloma acuminata  tumors from 1 of these harbored the genetic sequences of human papillomavirus type 6  
class4	1180	one patient had multiple manifestations of cyclophosphamide related urothelial injury  including bladder carcinoma  
class4	1180	treatment of 2 patients culminated in a radical operation during which the remaining native urinary system was resected completely  with sacrifice of the allograft kidney in 1 and diversion into an ileal conduit in 1  
class4	1180	the remaining patient underwent urethrectomy and partial cystectomy with a sigmoid conduit  
class4	1181	retroperitoneal lymph node dissection in malignant mesothelioma of tunica vaginalis testis  
class4	1181	a case of metastatic mesothelioma of the tunica vaginalis testis in a 57 year old man is reported  
class4	1181	clinicopathological findings and treatment options are reviewed  
class4	1182	long term effects of gastrocystoplasty in rats  
class4	1182	twenty prepubescent rats underwent microsurgical gastrocystoplasty by a technique which is described  
class4	1182	an equal number of control rats had their bladders opened and closed  
class4	1182	rats were sacrificed at 16 to 18 months postoperatively  
class4	1182	there were no differences in final weight  serum electrolytes  or renal function between the two groups  
class4	1182	prominent histopathologic changes of the bladder occurred in the gastrocystoplasty group  
class4	1182	these changes included papillomas present in five of the 15 rats surviving long term  
class4	1182	no significant changes occurred in the bladders of the control group of rats  
class4	1182	possible etiologies and the significance of the rats  
class4	1182	possible etiologies and the significance of the gastrocystoplasty related lesions are discussed  
class4	1183	fatal sepsis following intravesical bacillus calmette guerin administration for bladder cancer  
class4	1183	intravesical administration of bacillus calmette guerin has been shown to be highly effective treatment of superficial bladder cancer  
class4	1183	complications from bacillus calmette guerin therapy are usually minor but serious and even fatal reactions can occur  
class4	1183	five recent cases illustrate the gravity of bacillus calmette guerin sepsis  
class4	1183	one man with severe debility and the organic brain syndrome died acutely with a fever of 40 c  
class4	1183	two men had frank sepsis that progressed to multiorgan failure and death  
class4	1183	sepsis progressed despite the use of isoniazid  rifampin and streptomycin  
class4	1183	two men who had equally progressive sepsis with intravesical bacillus calmette guerin survived with the use of cycloserine for the first 72 hours of treatment  
class4	1183	triple antituberculous antibiotics  including cycloserine  may be lifesaving  
class4	1183	sepsis resulted from intravenous absorption through inflamed or disrupted urothelium  
class4	1183	bacillus calmette guerin treatment should not be administered in the presence of severe cystitis or after grossly traumatic catheterization  
class4	1184	fatal disseminated mycobacterial infection following intravesical bacillus calmette guerin  
class4	1184	we describe a fatal case of disseminated mycobacteriosis after intravesical bacillus calmette guerin immunotherapy  
class4	1184	we summarize the prior safety record of this therapeutic modality  discuss local and systemic pathophysiological mechanisms by which dissemination might have occurred  and review the reported clinical experience with antituberculous chemotherapy for significant bacillus calmette guerin infection  
class4	1184	finally  we offer suggestions for prophylaxis of certain patients with a history of exposure to intravesical bacillus calmette guerin  
class4	1185	nephron sparing surgery for renal cell carcinoma with venous involvement  
class4	1185	a nephron sparing operation recently has been shown to provide extended survival free of disease in selected patients with localized renal cell carcinoma  particularly for tumors of lower stage  
class4	1185	to define better the role of conservative surgical treatment in more locally advanced renal cell carcinoma we reviewed 9 patients with venous tumor involvement in solitary functioning kidneys who underwent a nephron sparing operation  
class4	1185	complete tumor resection with adequate preservation of renal function was accomplished in all cases  
class4	1185	of the 9 patients 5 had no evidence of disease 7 to 93 months  mean 33 2 months  postoperatively  
class4	1185	the remaining 4 patients died of metastatic renal cell carcinoma 17 to 47 months  mean 35 5 months  postoperatively  2 of whom had concomitant local recurrences in the renal remnant  
class4	1185	based on previously reported results of total nephrectomy for renal cell carcinoma with venous involvement and the morbidity associated with renal replacement therapy  we believe that a nephron sparing operation is a viable option in the management of these patients  
class4	1186	adverse impact of fibrin clot inhibitors on intravesical bacillus calmette guerin therapy for superficial bladder tumors  
class4	1186	although intravesical bacillus calmette guerin therapy has proved to be efficacious in the treatment and prophylaxis against tumor recurrence of superficial bladder tumors  its mechanism of action has not been fully elucidated  
class4	1186	previous work has suggested that bacillus calmette guerin organisms attach to the matrix protein  fibronectin  during fibrin clot formation at sites of urothelial disruption and that this attachment was required for the antitumor effect of bacillus calmette guerin to be expressed  
class4	1186	furthermore  drugs inhibiting clot formation were found to abrogate the antitumor effect of intravesical bacillus calmette guerin therapy in a murine bladder tumor model  
class4	1186	to examine the effect of inhibitors of fibrin clot formation on the results of intravesical bacillus calmette guerin therapy  a retrospective analysis of 149 evaluable patients receiving intravesical bacillus calmette guerin for superficial bladder tumors was performed  
class4	1186	the over all response rate free of tumor for 29 patients who concomitantly received inhibitors of fibrin clot formation with bacillus calmette guerin therapy was 48   as compared with 67  for 120 patients who were not receiving these medications  p   0 0655  chi square   
class4	1186	the most striking difference was noted for patients who failed with recurrent superficial disease  
class4	1186	of the patients who received fibrin clot inhibitors during intravesical bacillus calmette guerin therapy 35  had recurrent superficial tumors compared to only 8  of those who did not receive these drugs during a mean followup of 29 8 plus or minus 11 months  p   0 005  chi square   
class4	1186	our study suggests that inhibitors of fibrin clot formation may have an adverse influence on the results of intravesical bacillus calmette guerin therapy for superficial bladder tumors  
class4	1187	outpatient flexible cystoscopy and fulguration of recurrent superficial bladder tumors  
class4	1187	flexible cystoendoscopy and fulguration were used in the outpatient management of 185 patients with superficial bladder tumors followed for 24 months  
class4	1187	this method provided optimal surveillance for recurrence and successful tumor control in selected cases  
class4	1188	primary malignant lymphoma of the bladder  
class4	1188	we treated 11 patients with primary malignant lymphoma of the bladder  
class4	1188	the typical patient is a woman more than 50 years old who presents with urgency and frequency of micturition  and occasionally gross hematuria  
class4	1188	hydronephrosis is present in half of the patients and cystoscopy usually reveals a solid tumor  
class4	1188	partial cystectomy  when feasible  with or without radiotherapy and chemotherapy is the usual treatment modality  
class4	1188	when localized to the bladder  malignant lymphoma has an over all favorable prognosis  
class4	1189	clinical and pathological findings in prostates following intravesical bacillus calmette guerin instillations  
class4	1189	the prostates of 36 patients who were treated with intravesical bacillus calmette guerin were evaluated by digital rectal examination and transrectal ultrasonography  
class4	1189	when abnormal palpatory and or ultrasonographic findings were detected  core needle biopsies from the suspicious areas were performed  
class4	1189	of the 36 patients 20 underwent biopsies of the prostate  
class4	1189	pathological findings revealed typical granulomas in 8 patients  3 caseating and 5 noncaseating multifocal granulomas   
class4	1189	nonspecific chronic prostatitis was noted in 4 patients and benign prostatic hyperplasia was noted in 8  
class4	1189	the number of bacillus calmette guerin instillations ranged from 6 to 19  
class4	1189	the interval from initiation of therapy to biopsy ranged from 1 5 to 14 5 months  
class4	1189	caseating granulomas were found during the early course of bacillus calmette guerin instillations  1 5 to 3 0 months   whereas noncaseating granulomas were detected at later stages  4 to 14 5 months   
class4	1189	these findings present a high incidence of granuloma formation in patients treated with intravesical bacillus calmette guerin  
class4	1189	the duration of therapy is a determinant factor in the induction of granuloma type  
class4	1190	the prognostic value of modal deoxyribonucleic acid in low grade  low stage untreated prostate cancer  
class4	1190	we selected for a prospective surveillance study 167 patients with untreated grades 1 and 2 prostate cancer  
class4	1190	the tumors were classified regarding modal deoxyribonucleic acid value  ploidy  by flow cytometry  cytological grade by transrectal fine needle aspiration biopsy and local tumor stage  
class4	1190	of the patients 146 could be evaluated  
class4	1190	mean followup was 50 months  
class4	1190	the initial ploidy was statistically correlated to cytological grade but not to initial local tumor stage  prostatic acid phosphatase activity or patient age  
class4	1190	initial ploidy and cytological grade had a prognostic value regarding local tumor progression when considered as single predictors and in combination  
class4	1190	two patients with diploid and 8 with nondiploid tumors initially had metastases during the surveillance  
class4	1190	five patients  1 with diploid and 4 with nondiploid disease  died of prostatic cancer  
class4	1190	modal deoxyribonucleic acid value and cytological grade were of prognostic value in untreated prostate cancer  
class4	1191	evaluation of tumor progression by repeated fine needle biopsies in prostate adenocarcinoma  modal deoxyribonucleic acid value and cytological differentiation  
class4	1191	repeated fine needle aspiration biopsies of the prostate were taken during a period of 24 months or more from 84 patients with untreated prostate cancer  
class4	1191	serial followup regarding modal deoxyribonucleic acid values and cytological differentiation of the tumor cells was possible in 72 and 78 patients  respectively  
class4	1191	during followup the modal deoxyribonucleic acid values in the tumor cells changed towards an increased aneuploidy in 17 patients and the cytological differentiation decreased in 18  
class4	1191	these findings of a change in modal deoxyribonucleic acid values and cytological differentiation of prostate cancer cells during the course of untreated patients support the concept of a gradual dedifferentiation of prostate cancer  
class4	1192	management of stage d1 adenocarcinoma of the prostate  the johns hopkins experience 1974 to 1987  
class4	1192	there is no consensus on the proper management of men with stage d1 adenocarcinoma of the prostate  
class4	1192	although cure is unlikely  many men survive for long intervals apparently free of metastatic disease  
class4	1192	thus  effective palliation of the local lesion with low morbidity is desirable  
class4	1192	from 1974 to 1987  120 consecutive men with stage d1 prostate cancer were treated with 3 primary modes of therapy  mean followup 48 months   1  expectant therapy  35   2  external beam radiotherapy  21  and 3  radical prostatectomy  64   
class4	1192	these patients were statistically homogeneous as determined by gleason grade but not by extent of metastatic disease  
class4	1192	the over all 5 and 10 year projected actuarial survival rates for the radical prostatectomy patients were 97 and 62   respectively  and the apparent clinical survival free of disease at 5 years and 80 months  respectively  was 83 and 68   
class4	1192	the direct disease specific 10 year survival free of disease was 46   
class4	1192	however  only 3 of 27 patients followed for 3 years or longer had undetectable levels of prostate specific antigen  
class4	1192	using a cox univariate proportional hazards model several factors appeared to have significant prognostic value including volume of lymph node metastases  macroscopic greater than 2 mm    percentage of positive lymph nodes sampled and frozen section diagnosis  
class4	1192	gleason grade  clinical stage and the number of positive nodes did not have significant prognostic value  
class4	1192	local recurrence requiring an operation was noted in 8 of 35 patients  23   treated expectantly  5 of 21  24   treated with radiotherapy and 2 of 64  3   treated with radical prostatectomy  
class4	1192	significant gastrointestinal or genitourinary complications occurred in 33  of the men treated with radiotherapy and 1 5  of those undergoing radical prostatectomy  
class4	1192	since the introduction of nerve sparing radical prostatectomy in 1982  potency resumed in 55  of the 33 patients who were potent preoperatively and have been followed 1 year or longer  
class4	1192	these data suggest that in properly selected patients radical prostatectomy  although not curative  can provide excellent palliation of the local lesion with acceptable morbidity and that symptomatic local recurrence of prostatic cancer achieved with radiation therapy is identical to the results in men who were managed expectantly  
class4	1193	total pelvic exenteration with simultaneous bowel and urinary reconstruction  
class4	1193	the technique of total pelvic exenteration with simultaneous bowel and urinary reconstruction is described as a surgical option for the management of pelvic sarcoma in adults and for highly selected patients with other types of advanced pelvic malignancy  
class4	1193	the surgical technique is presented in detail as performed in a 43 year old man who presented with extensive primitive pelvic sarcoma  
class4	1193	we believe that this approach may provide the benefits of an exenterative operation without the undesirable psychosocial sequelae of a permanent colostomy and external urinary diversion  
class4	1194	isolated primary aldosteronism in a patient with adrenal carcinoma and xy xxy mosaic klinefelter s syndrome  
class4	1194	although breast cancer  germ cell tumors and other neoplasms are known to occur in patients with klinefelter s syndrome  adrenal carcinoma has not yet been reported in such patients  
class4	1194	we describe a rare case of severe primary aldosteronism as the unique manifestation of a large adrenocortical carcinoma in a patient with klinefelter s syndrome  
class4	1194	complete biological and hormonal evaluation was performed  
class4	1194	surgical treatment was successful and the patient remained asymptomatic with normal biological and hormonal values after 1 year of followup  
class4	1195	transrectal ultrasonography in the evaluation of the infertile man  a report of 3 cases  
class4	1195	the traditional evaluation of the infertile man with azoospermia or low ejaculate volume includes determination of serum testosterone and follicle stimulating hormone levels  a seminal fructose test  post ejaculate urinalysis and  sometimes  vasography  
class4	1195	transrectal ultrasonography  a technique currently familiar to most urologists  recently has been added to our diagnostic armamentarium  
class4	1195	this office based imaging procedure provides an accurate assessment of the prostate  ejaculatory ducts and seminal vesicles  which can be helpful in the evaluation of certain infertile patients  
class4	1195	we describe 3 patients who presented with either azoospermia or decreased ejaculate volume in whom transrectal ultrasonography had a critical role in the fertility evaluation  
class4	1195	the clinical indications for and interpretation of transrectal ultrasonography in the infertile population are described  
class4	1195	transrectal ultrasonography currently is the most accurate  inexpensive and readily available noninvasive imaging technique used to diagnose obstruction of the ejaculatory ducts in the infertile patient with either azoospermia or low ejaculate volume  
class4	1196	gonadoblastoma in an anatomically normal man  a case report and literature review  
class4	1196	gonadoblastoma  a rare gonadal neoplasm  presents most frequently in phenotypic female or phenotypically male patients with dysgenetic gonads or undescended testes  
class4	1196	to date  only 2 cases of gonadoblastoma have been reported in anatomically normal male patients with scrotal testes  
class4	1196	both of these patients presented with testicular masses and germ cell tumors  
class4	1196	we report a case of a genotypically and phenotypically normal  fertile man with descended testes who on evaluation for chronic orchialgia had a gonadoblastoma unaccompanied by a germ cell neoplasm  
class4	1196	the tumor was nonpalpable and was initially discovered on scrotal ultrasound  
class4	1197	in situ hybridization of prostate specific antigen mrna in human prostate  
class4	1197	prostate specific antigen  psa  mrna was detected by in situ hybridization utilizing a 428 base pair  35s  labelled cdna probe from the 3  noncoding region of the psa gene  
class4	1197	thirty six fresh surgical specimens were collected from patients undergoing radical retropubic prostatectomy for carcinoma of the prostate  
class4	1197	quantitative analysis of the levels of psa mrna in both the benign and malignant tissues was performed using an ibas 2000 image analysis system  
class4	1197	the results of this study demonstrated that there is a significant decrease in the expression of psa mrna in the carcinoma tissue when compared to the benign epithelium  
class4	1197	the average binding  number of silver grains 1 x 10 4  microns  
class4	1197	2  for 20 specimens of malignant epithelium was 475     161 and 586     140 for 16 specimens of benign epithelium  p less than 0 05   
class4	1197	eleven patients had both benign and malignant tissue from the same surgical specimen available for study  
class4	1197	from these paired specimens  the psa mrna expression was also significantly reduced in the malignant epithelium when compared to the benign epithelium  445     162 and 588     135 respectively  p less than 0 005   
class4	1197	the psa protein was detected using a monoclonal antibody to psa with an immunohistochemical staining technique  
class4	1197	the psa protein expression paralleled the expression of the psa mrna in the majority of the tissue sections  
class4	1197	many of the tumor specimens showed a heterogeneous expression of psa  whereas all of the benign epithelium had a uniform high level of psa expression  
class4	1197	in conclusion  psa mrna and protein are located only within the glandular epithelial tissue  the expression of psa protein parallels that of the psa mrna  and both the psa protein and psa mrna are significantly decreased in the malignant epithelium when compared to benign prostatic epithelium  
class4	1198	popliteal artery occlusion caused by cystic adventitial disease  successful treatment by urokinase followed by nonresectional cystotomy  
class4	1198	preoperative diagnosis of an occluded popliteal artery caused by cystic adventitial disease allowed use of urokinase to successfully dissolve secondary thrombosis  
class4	1198	subsequent non resectional adventitial cystotomy and evacuation of cyst contents allowed lasting restoration of a patent arterial lumen and return of normal distal pulses  
class4	1198	this nongrafting technique may serve as a model for future patients with occluded arteries caused by this condition  
class4	1199	prospective study of estrogen replacement therapy and risk of breast cancer in postmenopausal women  published erratum appears in jama 1991 apr 10 265 14  1828  
class4	1199	we prospectively examined the use of estrogen replacement therapy in relation to breast cancer incidence in a cohort of women 30 to 55 years of age in 1976  
class4	1199	during 367 187 person years of follow up among postmenopausal women  722 incident cases of breast cancer were documented  
class4	1199	overall  past users of replacement estrogen were not at increased risk  relative risk  0 98  95  confidence interval  0 81 to 1 18   including even those with more than 10 years since last  corrected  use  relative risk after adjustment for established risk factors  0 70  95  confidence interval  0 45 to 1 10   
class4	1199	however  the risk of breast cancer was significantly elevated among current users  relative risk  1 36  95  confidence interval  1 11 to 1 67   
class4	1199	among current users  a stronger relationship was observed with increasing age but not with increasing duration of use  
class4	1199	these data suggest that long term past use of estrogen replacement therapy is not related to risk of breast cancer but that current use may modestly increase risk  
class4	1200	preoperative cell mediated immune function and the prognosis of patients with gastric carcinoma  
class4	1200	the cell mediated immune function of 83 patients with gastric carcinoma was assessed preoperatively and the results were compared to that of 52 patients with benign lesions  
class4	1200	the data were subjected to an analysis in order to evaluate their prognostic significance  
class4	1200	the abilities to induce allogeneic cytotoxicity and to produce interleukin 2  il2  in patients with stage iv carcinoma were significantly depressed  as compared to those in patients with benign lesions  whereas natural killer  nk  cell activity was not significantly impaired  
class4	1200	there was no significant correlation among these immune functions  
class4	1200	when the patients were stratified into two groups  those who had high  greater than the mean value in patients with benign lesions  and low  less than the same value  values of these immune reactivities  the survival of patients with high nk activity  greater than or equal to 43   was significantly better  as compared to that of patients with low cytotoxicity  less than 43    
class4	1200	however  there was no correlation between the survival and allogeneic cytotoxicity in these patients  
class4	1200	the high ability to produce il2  greater than or equal to 1 3 u ml  correlated with the better survival in the patients  but not in the group of patients who underwent curative resection  
class4	1201	adenocarcinoma arising in barrett s esophagus  
class4	1201	a review of nine adenocarcinomas of the esophagus arising in barrett s epithelium was undertaken  
class4	1201	we found the disease among white males disproportionately  
class4	1201	risk factors and incidence rate remain to be clarified  
class4	1201	only one patient was in a surveillance program and only he had carcinoma discovered  early   he still survives while only one of the eight whose diagnosis followed investigation of symptoms remains alive  
class4	1202	small cell carcinoma of the pancreas and biliary tract  
class4	1202	four cases of anaplastic carcinoma of the pancreas or biliary tract were studied clinicopathologically and immunohistochemically  
class4	1202	all four cases were intermediate cell type and contained a minimum amount of microscopic foci of differentiated glandular adenocarcinoma  
class4	1202	argyrophilic tumor cells were not seen in any of the four tumors  
class4	1202	immunohistochemically  no tumor was positive for hormonal products  but all tumors were positive for epithelial markers  
class4	1202	these findings suggest that the anaplastic carcinoma are not derived from argyrophilic cells  but rather from adenocarcinomas which have the potential for anaplastic metaplasia  
class4	1202	the long term survival of one patient emphasized the importance of chemotherapy in the treatment of small cell carcinoma of the pancreas and biliary tract  
class4	1203	neoadjuvant cis ddp in esophageal cancers  an experience at a regional cancer centre  india  
class4	1203	we are analysing the results of 80 patients who underwent surgery during 1983 84 for esophageal cancer  
class4	1203	forty patients who received pre operative single agent cis ddp were grouped under  a  and 40 patients who went for surgery directly were grouped under  b   
class4	1203	twenty two patients  55   of group a showed tumor necrosis  
class4	1203	both groups underwent resection and hand sewn anastamosis of the esophagus  
class4	1203	there were 10 post operative deaths among 80 resected cases  9 of them being from anastomatic leak  
class4	1203	cis ddp has induced negligible side effects  
class4	1203	a comparatively high survival rate during early years in patients who responded to cis ddp suggests that neoadjuvant chemotherapy might be of value  
class4	1204	obstructing carcinoma of the cecum  
class4	1204	carcinoma of the cecum  the third most common location for malignancy of the large bowel  was examined with attention centered upon cecal cancers producing obstruction  
class4	1204	reviewing 136 patients revealed 11 obstructing lesions  8 1   presenting as distal small bowel obstructions  
class4	1204	the mean age of the patients was 74 years  
class4	1204	all but one patient had resection for cure which consisted of a right hemicolectomy with ileotransverse colostomy  
class4	1204	there was no operative mortality or significant morbidity  
class4	1204	bowel obstruction due to cecal carcinoma is an infrequent occurrence arising in elderly patients and carries a poor survival rate due to advanced disease at the time of diagnosis and treatment  
class4	1205	complications of stapled anastomoses in anterior resection for rectal carcinoma  colorectal anastomosis versus coloanal anastomosis  
class4	1205	postoperative results of 48 patients who underwent anterior resection using the eea stapler were evaluated  
class4	1205	in all but 2 cases the indication for surgery was colorectal carcinoma  
class4	1205	in 24 patients an anastomosis was created above the 5 cm level  above the anal verge  colorectal anastomosis  and in 24 at the 0 5 cm level  coloanal anastomosis   
class4	1205	there was no perioperative mortality  
class4	1205	the only complication observed in the colorectal anastomosis group was one case of late anastomotic stenosis  
class4	1205	in the coloanal anastomosis group there were 4 cases with early anastomosis leaks  3 cases with late stenosis and 5 cases with various degrees of late fecal incontinence  ultimately resulting in a permanent diverting stoma in 5  10 4   patients  
class4	1205	we conclude that for rectal tumors the eea stapled anterior resection provides excellent functional results in most cases  
class4	1205	stapled coloanal anastomoses more often demonstrate various  early and late  complications  
class4	1205	nevertheless in spite of chronic discomfort  many patients still prefer their complaints to a permanent stoma  
class4	1206	carcinoma of the pancreas  a retrospective review  
class4	1206	eighty five patients with adenocarcinoma of the pancreas were reviewed in order to evaluate the efficacy of our methods of diagnosis and treatment  
class4	1206	the most useful diagnostic test was percutaneous transhepatic cholangiography  ptc  with a diagnostic rate of 96   
class4	1206	pancreaticoduodenectomy  whipple procedure  and total pancreatic resection were performed in 13 and 2 patients  respectively  
class4	1206	the remaining 50 patients underwent various palliative drainage procedures  
class4	1206	twenty patients did not undergo operation for various reasons  
class4	1206	the primary tumor was found in the head of the pancreas in 50 patients  59    the body in 6 patients  7    and in the tail in 8 patients  9    
class4	1206	postoperative complications  including sepsis  bleeding  intra abdominal abscesses  and anastomotic leaks  occurred in 37  of the patients  
class4	1206	there were one operative and 9 postoperative deaths  
class4	1206	the average survival for those patients undergoing surgical intervention was 6 months  
class4	1206	there were no 5 year survivors  
class4	1207	in vivo selection and characterization of a murine mammary tumor subline with high potential for spontaneous lymph node metastasis  
class4	1207	a transplantable mammary adenocarcinoma  grown in balb c mice  with a marked enhancement in its draining lymph node metastatic ability  mm3ln   was obtained through an in vivo procedure from a variant tumor moderately metastatic to lymph nodes  mm3   
class4	1207	both mm3 and mm3ln presented a similar latency and tumor growth rate and reached the same tumor mean diameter at death  
class4	1207	mm3ln tumor bearing mice exhibited a larger mean survival time  
class4	1207	the new variant showed a 2 5 fold higher incidence of tumor draining lymph node metastases than mm3 line  with no differences in the incidence of lung metastases  
class4	1207	morphology as well as cytogenetic and in vitro adhesion properties were studied in order to characterize the new subline  
class4	1207	this murine tumor model has potential application in the study of the metastatic process in lymphoid tissue  
class4	1208	ampullary carcinoma in patients under 50 years of age with a poor prognosis  
class4	1208	clinicopathologic features of 145 japanese patients with ampullary carcinoma were compared among three age groups  
class4	1208	the 145 patients were divided into three groups by the patient s age at the time of operation  there were 24 patients in group i  younger  aged less than or equal to 50 years  99 in group ii  ordinary  aged 51 69  and 22 in group iii  elderly  aged greater than or equal to 70  
class4	1208	the three groups showed no significant difference in sex  icterus  duration of icterus  size of the tumor  year of operation  macroscopic type  histopathologic type  tumor margin  lymphatic permeation  venous invasion  or pancreatic invasion  
class4	1208	the survival curve of group i was worse than those of groups ii and iii  
class4	1208	multivariate regression analysis using 11 prognostic variables failed to reveal that the age of the patient at the time of operation was an independent factor  
class4	1208	the younger patients aged less than or equal to 50 fared worse than the elderly patients aged greater than or equal to 70  because the group i tumors included a significantly greater number of advanced ampullary carcinoma with more frequent perineural invasion than did the group iii tumors  
class4	1209	colon carcinoma associated with ureterosigmoidostomy  
class4	1209	a patient developing a colonic adenoma 38 years following ureterosigmoidostomy is presented  
class4	1209	the mechanisms of neoplastic transformation associated with ureterosigmoidostomy is now better understood  
class4	1209	this knowledge is being applied to develop modifications both of the surgical technique and the management of patients with this form of urinary diversion  and is a subject of discussion  
class4	1210	metastatic tumors of the umbilicus  a review 1830 1989  
class4	1210	umbilical metastases from known and unknown primary cancers are rare  
class4	1210	the eponym  sister mary joseph s nodule  has been used by generations of physicians  
class4	1210	the first reports of this clinical sign were from walshe in 1846  
class4	1210	a review of the literature revealed 265 cases from then until 1989  
class4	1210	only 85 cases of umbilical metastasis from unknown primary tumors were found  
class4	1210	this review should help us to focus on the common and uncommon primary sites in the diagnosis of patients with this finding  
class4	1210	a single case report and the work up for the hidden primary tumor are described  
class4	1211	parathyroid hormone related peptide in plasma of patients with hypercalcemia and malignant lesions 
class4	1211	we developed and validated a radioimmunoassay for circulating human parathyroid hormone related peptide  pthrp   based on a commercial antiserum to the synthetic 1 34 fragment of pthrp  125i tyr degrees pthrp 1 34  as radioligand  and prior extraction of the native peptide from plasma with c 2 cartridges  
class4	1211	we determined immunoreactive pthrp concentrations in plasma samples from 48 healthy persons  mean     sd  3 1     1 0 pmol liter  range  less than 2 to 5 pmol liter   8 patients with primary hyperparathyroidism  36 patients with hypercalcemia and a concurrent malignant lesion  and 9 normocalcemic patients with cancer and increased serum levels of carcinoembryonic antigen or prostate specific antigen  
class4	1211	pthrp was normal in samples from patients with primary hyperparathyroidism  3 2     1 1 pmol liter   secondary hyperparathyroidism  2 5     1 3 pmol liter   and cancer without hypercalcemia  2 4     1 0 pmol liter   
class4	1211	in contrast  plasma immunoreactive pthrp levels were increased  6 0 to 85 0 pmol liter  in 47  of patients with hypercalcemia and cancer of various types  with or without bone metastatic lesions  
class4	1211	large amounts of pthrp were also found in conditioned medium from cultured human prostatic carcinoma cells  
class4	1211	thus  pthrp may be a causative factor for hypercalcemia associated with a malignant lesion in at least half of the cases  
class4	1211	measurement of circulating pthrp may be of differential diagnostic help in hypercalcemic states  
class4	1212	diagnosis of malignant cardiac disease by endomyocardial biopsy 
class4	1212	among oncology patients  endomyocardial biopsy has been used primarily for the evaluation of anthracycline cardiotoxicity  
class4	1212	in addition  however  endomyocardial biopsy may be useful for the detection of malignant cardiac neoplasms  
class4	1212	between 1982 and 1989  metastatic involvement of the heart was diagnosed by endomyocardial biopsy in seven patients at our institution  
class4	1212	all except one of these patients were older than 50 years of age and had dyspnea as an initial symptom  and all had a known malignant lesion  
class4	1212	results of endomyocardial biopsy confirmed cardiac involvement by a hematologic malignant lesion in four patients and metastatic melanoma in two patients  
class4	1212	in one patient  who had a history of breast cancer and lymphoma  a metastatic neoplasm of uncertain differentiation was observed  
class4	1212	myocyte damage was evident in endomyocardial biopsy specimens from two of the four patients with hematologic malignant disease  
class4	1212	endomyocardial biopsy was performed to confirm the possibility of metastatic involvement in five patients  in the other two  endomyocardial biopsy was performed to determine whether anthracycline cardiotoxicity was present  and metastatic involvement was unanticipated  
class4	1213	paraneoplastic cerebellar degeneration  a clinical comparison of patients with and without purkinje cell cytoplasmic antibodies  
class4	1213	in a review of 32 patients with paraneoplastic cerebellar degeneration  pcd   16  all of whom were women  had purkinje cell cytoplasmic antibodies  pcab  and 16  8 women  did not  
class4	1213	most patients  15 of 16 seropositive and 12 of 16 seronegative patients  had active cancer at the time of neurologic diagnosis  
class4	1213	gynecologic or breast cancers were found in 14 of 16 seropositive and in 2 of 8 seronegative female patients  lung cancer was diagnosed in 7 of 16 seronegative patients but in no seropositive patient  
class4	1213	in seropositive patients  the onset of the syndrome was more often abrupt and abnormalities of affect  mentation  ocular motility  and cerebrospinal fluid igg index were more common than in seronegative patients  
class4	1213	additional paraneoplastic neurologic syndromes were present in five seronegative patients but in no seropositive patient  
class4	1213	clinical impairment was equivalent in both groups  approximately 75  of patients were confined to a wheelchair or bed at last follow up  
class4	1213	four of 16 seropositive patients died  4 to 18 months after onset of pcd   and 7 of 16 seronegative patients died  7 to 120 months after onset of pcd   
class4	1213	thus  pcab seem to be a marker for a clinical subset of female patients with gynecologic or breast cancer  
class4	1213	the high frequency of other autoimmune paraneoplastic syndromes in patients with seronegative pcd suggests that pcd in both seropositive and seronegative patients may have a common pathogenic basis that involves an as yet unidentified antineuronal autoimmune mechanism  
class4	1214	renal cell carcinoma associated with sarcoidlike tissue reaction  
class4	1214	a 60 year old man was referred to our institution with the diagnosis of sarcoidosis  
class4	1214	because of several months  complaint of right flank pain and weight loss  the patient had consulted his local physician  
class4	1214	after an extensive workup revealed only cholelithiasis  he underwent a cholecystectomy for presumed chronic cholecystitis  
class4	1214	at the time of operation  biopsy of several liver nodules and peripancreatic nodes revealed noncaseating granulomas  consistent with sarcoidosis  
class4	1214	on initial examination at our institution  the patient had microhematuria  
class4	1214	a chest roentgenogram demonstrated multiple pulmonary nodules  an abdominal computed tomographic scan showed an indeterminate left renal mass  and magnetic resonance imaging of the spine revealed abnormal signals in the body of t 12  
class4	1214	open lung biopsy showed an adenocarcinoma with clear cell features  likely of renal origin  
class4	1214	the patient was diagnosed as having a metastatic renal carcinoma associated with a sarcoidlike tissue reaction  
class4	1214	although noncaseating granulomas have been reported in association with other malignant lesions  to our knowledge this is the first report of such an association with renal carcinoma  
class4	1214	in addition  this case illustrates several points  
class4	1214	first  sarcoidosis is a multisystem disorder with protean extrapulmonary manifestations  
class4	1214	in fact  all our patient s findings could have been attributed to sarcoidosis  
class4	1214	second  noncaseating granulomas occur with many types of processes  including infections  chemical exposures  and  as in this case  neoplasms  
class4	1214	thus  noncaseating granulomas are not pathognomonic for sarcoidosis  
class4	1214	third  sarcoidosis is a clinical diagnosis that cannot be based on histologic findings alone  
class4	1215	malignant transformation of adenomatous hyperplasia to hepatocellular carcinoma  
class4	1215	to clarify the course of adenomatous hyperplasia  ah  of the liver  17 patients with 20 biopsy proven ah nodules were followed clinically for 1 5 years  
class4	1215	at the initial biopsy the mean nodular diameter was 10  sd 4  mm and the relative cellularity    mean cellularity of ah divided by mean parenchymal cellularity  x 100  141  27   
class4	1215	the criteria for diagnosis of malignant transformation of ah were both a doubling of nodular volume and changes on imaging  
class4	1215	between 6 and 50 months after biopsy  9 of the 18 nodules which could still be accurately identified met the criteria for transformation  histological proof of hepatocellular carcinoma  hcc  was obtained later for 7 of these 9 nodules  
class4	1215	the product of diameter and cellularity  transformation index  was the strongest predictor of the time to transformation  
class4	1215	9 ah nodules did not undergo transformation  7 did not meet one or both criteria and 2 became undetectable by imaging  
class4	1215	because of the high risk of malignant transformation  it can be concluded that ah is an absolute precursor of hcc  
class4	1215	it should therefore be treated as a potential malignant disorder  
class4	1216	efficacy and morbidity of partial laryngectomy and postoperative radiation therapy  
class4	1216	in recent years  we have seen increasing use of partial laryngectomies for larger lesions that were previously treated by total laryngectomy  
class4	1216	the resultant closer margins have made postoperative radiation therapy an important adjuvant treatment to conservation laryngeal surgery  
class4	1216	we review the university of california  los angeles  experience with combination partial laryngectomy and postoperative radiation therapy between 1973 and 1987 for treatment of carcinoma of the larynx  
class4	1216	twenty four such patients who underwent partial laryngectomies and postoperative radiation therapy are examined  
class4	1216	techniques of treatment  complications  and the functional ability of the remaining larynx are discussed  
class4	1216	the locoregional control rate at 5 years was 80   
class4	1216	risk factors associated with an increased risk of recurrence were positive margins  vascular invasion  and extranodal spread  
class4	1216	there were no major problems with postoperative wound healing or airway management during the radiation treatment  
class4	1216	vocal and swallowing function were well preserved in most cases  
class4	1216	we conclude that combination partial laryngectomy and radiation therapy permits preservation of laryngeal function without serious complications  and therefore is an effective treatment for selected patients with carcinoma of the larynx  
class4	1217	1990 ogura memorial lecture  moral dilemmas in head and neck cancer  
class4	1217	neither morality nor dilemma can be defined meaningfully in the concept of the practical management of head and neck cancer  
class4	1217	although both have important implications  particularly with regard to ethnic and social factors  they play a relatively minor role in determining management policy  
class4	1217	with little knowledge of the intrinsic causes of cancer and with a treatment strategy limited to radiotherapy and surgery  our desire for cure must be tempered by concern to avoid any increase in patient privations  
class4	1217	my philosophy  based upon the care of more than 3500 patients over almost 30 years  reflects some of the difficulties of applying the concept  do nothing that may cause harm   while offering each patient the opportunity for long term cure  
class4	1218	the efficacy of comprehensive neck dissection with or without postoperative radiotherapy in nodal metastases of squamous cell carcinoma of the upper respiratory and digestive tracts  
class4	1218	neck recurrence free curves corrected for local recurrence were compared for 494 patients who underwent 565 comprehensive neck dissections  
class4	1218	in 42 dissections  no radicality could be obtained  
class4	1218	of the 523 histologically radical dissections  examination revealed tumor in 352 cases  
class4	1218	patients in whom three or more positive nodes or extranodal spread in one or more nodes were found received postoperative radiotherapy  
class4	1218	in the histologically n0 group  the incidence of neck recurrence after 5 years was 3   in the n  group as a whole  it was 10   
class4	1218	analysis of the influence of extranodal spread and the number of positive nodes showed that the group with one or two positive nodes without extranodal spread  that did not receive postoperative radiotherapy  did not statistically differ from the other groups  
class4	1218	this suggests that the results of the group with one or two positive nodes without extranodal spread can be improved by postoperative radiotherapy  
class4	1219	flexible nd yag laser palliation of obstructive tracheal metastatic malignancies  
class4	1219	flexible nd yag endoscopic laser surgery may become an effective new modality for palliation in patients with obstructive endotracheal metastatic malignancies  
class4	1219	we report the results of the treatment of two patients with severely obstructing intraluminal tracheal metastatic melanoma and medullary thyroid carcinoma  using the neodymium yag laser via the flexible fiberoptic bronchoscope  
class4	1219	both patients complained of significant dyspnea  orthopnea  cough  and hemoptysis and were not candidates for rigid bronchoscopy because of underlying medical contraindications and anatomical problems  
class4	1219	multiple treatment sessions were used with treatment intervals of 1 to 2 weeks  
class4	1219	all treatments were performed in the operating room under sedation  without intubation  with topical lidocaine and standard superior laryngeal nerve block  
class4	1219	successful relief of airway obstruction with complete regression of the endotracheal masses was achieved and no recurrences were seen after 9 months  follow up  
class4	1219	flexible nd yag laser bronchoscopy offered an alternative for the relief of obstructing endotracheal or bronchial malignancies in patients in whom the rigid bronchoscope could not be passed  
class4	1219	it seemed to prolong survival in selected cases  and provided definite improvement in quality of life  
class4	1220	carcinoma of the external auditory canal  an update  
class4	1220	this review is a continuation of the series of 35 cases of carcinoma of the external auditory canal originally reported by the senior author and colleagues  
class4	1220	eighteen additional cases have been evaluated and treated since 1976  
class4	1220	preoperative high resolution computed tomographic scanning has replaced polytomography  and improved surgical skull base approaches have allowed for extended resections of advanced lesions  
class4	1220	a revised classification for local and extensive lesions is presented  
class4	1220	the prognosis for localized tumors treated by en bloc resection remains excellent  whereas prognosis for extensive lesions might be more dependent on histologic type and grade of tumor  
class4	1221	variations on the temporoparietal fascial flap  
class4	1221	an improved understanding of the vascular supply of the layers of the temporal fossa has increased the potential of this region for new and ingenious reconstructive techniques  
class4	1221	separate and independently vascularized layers of this region include hair bearing scalp  glabrous skin  tempororoparietal fascia  and galea aponeurotica   temporalis muscle and fascia  and pericranium  
class4	1221	island flaps of glabrous skin and scalp provided esthetically appropriate tissue to cover a variety of defects  
class4	1221	the malleable bulk of the subcutaneous fascial layers were combined with skin grafts to restore thin lining  and used as a vascularized bed for cartilage grafts in otherwise unsatisfactory recipient sites  
class4	1221	illustrative cases from our 5 year clinical experience are presented to demonstrate various combinations of the temporoparietal fascial pedicle with tissues from the temporal region to reconstruct the eyebrows  eyelids  orbits  cheeks  and lips  
class4	1222	primary central nervous system lymphoma in patients with and without the acquired immune deficiency syndrome  a retrospective analysis and review of the literature  
class4	1222	twenty two cases of pcl were reviewed  in which 9 patients had aids and 13 did not  
class4	1222	a review of the literature identified 247 cases of aids related pcl  
class4	1222	differences between patients with aids and immunocompetent pcl were noted in our series  
class4	1222	aids related pcl when compared to non aids pcl in our series has the following notable clinical features  1  significantly younger age at presentation  median age 34 versus 59 years  2  significantly higher incidence of b symptoms  44  versus 8   3  worse median performance status at presentation  3 versus 1  and  4  shorter median survival  3 versus 10 months  
class4	1222	differences in performance status and survival  however  were not significant  
class4	1222	aids related pcl is further characterized by frequent  44   ring enhancing mass lesions on head ct scan  a finding that makes it clinically difficult to distinguish from toxoplasmosis  
class4	1222	median survival appears to be improved in the absence of opportunistic infection at time of diagnosis of pcl  6 versus 2 months  
class4	1222	the therapeutic approach to patients with pcl  with and without aids  is variable  
class4	1222	combined modality therapy may improve the survival in patients with non aids pcl  
class4	1222	therapy for patients with aids related pcl is tailored to the status of the individual and it is  therefore  difficult to make comparisons to non aids pcl patients  
class4	1222	aids patients are often too ill to tolerate aggressive surgery or systemic treatment and in this instance  radiotherapy alone may be an acceptable alternative  
class4	1222	nonetheless  overall survival for patients with aids related and non aids pcl remains poor  
class4	1223	altered expression of the retinoblastoma gene product in human sarcomas  
class4	1223	background  
class4	1223	the retinoblastoma susceptibility  rb  gene is a prototype tumor suppressor gene originally isolated from patients with heritable retinoblastoma  
class4	1223	this gene encodes a nuclear phosphoprotein whose expression is altered in several types of human tumors  
class4	1223	methods  
class4	1223	we studied the expression of the rb protein in 44 primary and 12 metastatic high grade human sarcomas by means of immunohistochemical methods and western blotting  
class4	1223	computerized image analysis was used to quantify the level of rb gene product in individual tumor cells  
class4	1223	the expression of the rb gene was then correlated with clinical outcome in the patients with primary tumors  
class4	1223	results  
class4	1223	of the 44 patients with primary sarcomas  13  30 percent  had tumors with normal  homogeneous expression of the rb protein in essentially all tumor cells  
class4	1223	thirty one patients with primary tumors  70 percent  had altered rb expression  in 18  40 percent  the rb protein was heterogeneously expressed  and in 13  30 percent  it was detected in fewer than 20 percent of the tumor cells  
class4	1223	all 12 of the patients with metastatic sarcomas had altered expression of the rb protein  
class4	1223	when the findings in the patients with primary tumors were correlated with clinical outcome  survival was found to be significantly increased in the patients whose tumors had homogeneous rb expression  as compared with those with either heterogeneous expression  p   0 026  or no expression  p   0 012   
class4	1223	conclusions  
class4	1223	tumors in which the expression of rb gene product was decreased were more aggressive than tumors in which this protein was expressed by nearly all cells  
class4	1223	the rb gene product may be an important prognostic variable in patients with these tumors  
class4	1224	relation of meat  fat  and fiber intake to the risk of colon cancer in a prospective study among women  
class4	1224	background  
class4	1224	the rates of colon cancer in various countries are strongly correlated with the per capita consumption of red meat and animal fat and  to a lesser degree  inversely associated with the consumption of fiber  
class4	1224	methods  
class4	1224	we conducted a prospective study among 88 751 women 34 to 59 years old and without a history of cancer  inflammatory bowel disease  or familial polyposis who completed a dietary questionnaire in 1980  
class4	1224	by 1986  during 512 488 person years of follow up  150 incident cases of colon cancer had been documented  
class4	1224	results  
class4	1224	after adjustment for total energy intake  animal fat was positively associated with the risk of colon cancer  p for trend   0 01   the relative risk for the highest as compared with the lowest quintile was 1 89  95 percent confidence interval  1 13 to 3 15   
class4	1224	no association was found for vegetable fat  
class4	1224	the relative risk of colon cancer in women who ate beef  pork  or lamb as a main dish every day was 2 49  95 percent confidence interval  1 24 to 5 03   as compared with those reporting consumption less than once a month  
class4	1224	processed meats and liver were also significantly associated with increased risk  whereas fish and chicken without skin were related to decreased risk  
class4	1224	the ratio of the intake of red meat to the intake of chicken and fish was particularly strongly associated with an increased incidence of colon cancer  p for trend   0 0005   the relative risk for women in the highest quintile of this ratio as compared with those in the lowest quintile was 2 49  95 percent confidence interval  1 50 to 4 13   
class4	1224	a low intake of fiber from fruits appeared to contribute to the risk of colon cancer  but this relation was not statistically independent of meat intake  
class4	1224	conclusions  
class4	1224	these prospective data provide evidence for the hypothesis that a high intake of animal fat increases the risk of colon cancer  and they support existing recommendations to substitute fish and chicken for meats high in fat  
class4	1225	overall mortality and cancer mortality around french nuclear sites 
class4	1225	higher than expected mortality from leukaemia has been observed in the population under age 25 living around sellafield and dounreay  nuclear reprocessing plants in the united kingdom  
class4	1225	we report the results of a similar study for the population residing around nuclear sites in france  
class4	1225	the number of leukaemia deaths was 58  comparable to the 62 in control areas  and slightly less than the 67 expected from national mortality statistics  
class4	1225	twelve deaths due to hodgkin s disease were observed around nuclear sites  this is about twice the number of hodgkin s deaths observed in control areas and twice the number expected from national mortality statistics  
class4	1225	this observation must  however  be interpreted in light of the fact that several causes of deaths were studied  increasing the play of chance  
class4	1226	a downstream initiation element required for efficient tata box binding and in vitro function of tfiid  
class4	1226	the gfa gene encodes glial fibrillary acidic protein  an intermediate filament protein expressed in glial cells  
class4	1226	in vitro transcription analysis has shown that the human gfa promoter contains two initiation elements that can independently specify the transcription startpoint  
class4	1226	one of the elements is a tata box 25 base pairs  bp  upstream from the transcription startpoint  the other is located between 10 and 50 bp downstream from the transcription initiation site  
class4	1226	we have now shown by transfection that both elements are required for efficient transcription in cultured cells  
class4	1226	a partially purified natural human tata box binding factor  tfiid  from hela cells gave footprints that extended from upstream of the tata box through the downstream initiator  
class4	1226	deletion of the downstream initiator inhibited both tfiid binding to the tata box and transcription in vitro  
class4	1226	in contrast to natural human tfiid  clone human and yeast tfiids expressed in bacteria gave footprints covering only the tata box region  although hypersensitive sites were observed in the downstream region  
class4	1226	the cloned tfiids also showed less dependence than natural human tfiid on the downstream initiator for both tata box binding and in vitro transcription  
class4	1226	these results suggest that natural human tfiid contains an additional component s  that contribute s  to stable tfiid binding and effective transcription by interacting with the downstream initiator  
class4	1227	circulating cd8  cytotoxic t lymphocytes specific for htlv i px in patients with htlv i associated neurological disease  
class4	1227	the human t lymphotropic virus type i  htlv i   the first human retrovirus to be characterized  is associated with adult t cell leukaemia and a chronic progressive disease of the central nervous system termed tropical spastic paraparesis  or htlv i associated myelopathy  
class4	1227	only 1  of individuals infected with htlv i develop clinical disease however  
class4	1227	the various manifestations of an htlv i infection may be related to differences in the genetic backgrounds of individuals  infection with variant strains of htlv i  differences in viral tropism or host immune response to the virus  
class4	1227	whereas the humoral response to htlv i is well characterized  little is known about the human cellular immune response  such as the production of cytotoxic t lymphocytes  
class4	1227	here we report the presence of high levels of circulating htlv i specific cytotoxic t lymphocytes in patients with htlv i associated neurological disease but not in htlv i seropositive individuals without neurological involvement  
class4	1227	these cytotoxic t lymphocytes are cd8   hla class i  restricted and predominantly recognize the htlv i gene products encoded in the regulatory region px  
class4	1227	these findings suggest that htlv i specific cytotoxic t lymphocytes may contribute to the pathogenesis of associated neurological disorders associated with htlv i  
class4	1228	inhibition of tumor growth in a glioma model treated with boron neutron capture therapy  
class4	1228	this investigation attempts to determine whether increased survival time seen when the f98 glioma model is treated with boron neutron capture therapy  bnct  is a result of inhibition of tumor growth caused by radiation induced alterations in endothelial cells and normal tissue components  
class4	1228	this indirect effect of radiation has been called the tumor bed effect  
class4	1228	a series of tumor bearing rats was studied  using a standardized investigational bnct protocol consisting of 50 mg kg of na2b12h11sh injected intravenously 14 to 17 hours before neutron irradiation at 4 x 10 12  n cm2  
class4	1228	ten rats  serving as controls  received no treatment either before or after tumor implantation  
class4	1228	a second group of 10 rats was treated with bnct 4 days before tumor implantation  these animals received no further treatment  
class4	1228	the remaining group of 10 rats received no pretreatment but was treated with bnct 10 days after implantation  
class4	1228	histological and ultrastructural analyses were performed in 2 animals from each group 17 days after implantation  
class4	1228	survival times of the untreated control animals  mean  25 8 days  did not differ statistically from the survival times of the rats in the pretreated group  mean  25 5 days   
class4	1228	the rats treated with bnct after implantation survived significantly longer  p less than 0 02  mean  33 2 days  than the controls and the preirradiated animals  
class4	1228	tumor size indices calculated from measurements taken at the time of death were similar in all groups  
class4	1228	these results indicate that  with this tumor model  bnct does not cause a tumor bed effect in cerebral tissue  
class4	1228	the therapeutic gains observed with bnct result from direct effects on tumor cells or on the peritumoral neovascularity  
class4	1229	characterization of a newly established malignant meningioma cell line of the human brain  iomm lee  
class4	1229	a permanent malignant meningioma  mm  cell line of the human brain designated  iomm lee  is reported  
class4	1229	this cell line was successfully established from the tumor of a 61 year old chinese man with repeated recurrent primary intraosseous malignant meningioma of the skull  
class4	1229	it has been subcultured for more than 60 passages during the past 30 months  
class4	1229	the doubling time of cultured cells is approximately 62 hours  
class4	1229	tumorigenicity in athymic nude mice  balb c nu nu  who develop multiple pulmonary metastases was observed  the doubling time of tumor volume in vivo is approximately 5 days  
class4	1229	karyotypic analysis revealed this cell line to be of human origin and near diploid  with a modal chromosome number of 49  
class4	1229	the mesenchymal tumor marker vimentin and intracytoplasmic microfilaments were identified in the cytoplasm of tumor cells by indirect immunohistochemical peroxidase anti peroxidase assays and immunogold ultrastructural localization by transmission electron microscopy  respectively  
class4	1229	scanning electron microscopy of cultured cells and xenografted tumors revealed ellipsoidal or carrot shaped tumor cells presenting a wrinkled surface with short sparse microvilli  
class4	1229	potential proliferating activity was determined by ki 67 monoclonal antibody  the ki 67 labeling index of cultured cells and xenografted tumors was approximately 36  and 30   respectively  
class4	1229	this newly established malignant meningioma cell line of the human brain may prove useful as a research model  
class4	1230	functional results of facial nerve suture after removal of acoustic neurinoma  analysis of 25 cases  
class4	1230	the facial nerve is sometimes severed during the removal of acoustic neurinomas  either intentionally to ensure complete removal  or unintentionally because of difficulties in identification  
class4	1230	in such cases we have  if possible  sutured the nerve stumps microsurgically  either end to end or by use of an intervening nerve graft  
class4	1230	we analyzed the outcome of 25 instances of facial nerve suturing in a series of 219 patients operated on for acoustic neurinoma from 1979 to 1987  
class4	1230	the first signs of recovery appeared at an average of 12 months  and there was continued improvement for several years  
class4	1230	recovery was graded from 1 to 6  
class4	1230	the anastomosis was successful in 24 of the 25 sutured nerves  in that at least some facial movement and tone were restored  grade 5 or higher   
class4	1230	in 11 of the 25 cases  facial appearance at rest and with movement was moderately good  grade 2 or 3   
class4	1230	a grade 1 result  with no perceivable facial dysfunction  was never achieved  
class4	1230	typically  oral muscles showed the most improvement and frontal muscles the least  
class4	1230	facial appearance was better at rest than with movement  which was always complicated by some degree of synkinesis  
class4	1230	closure of the eye was so good in 13 of the 25 cases that neither tarsorrhaphy nor an eyelid spring was necessary  
class4	1230	when the facial nerve is severed  intraoperative suture is recommended  because it provides a chance for moderately good restoration of facial appearance  
class4	1231	extracranial repair of cerebrospinal fluid fistulas  technique and results in 37 patients  
class4	1231	although neurosurgeons have traditionally preferred intracranial repair for the management of cerebrospinal fluid  csf  fistulas  this approach is associated with the complications of a craniotomy  anosmia  and a high incidence of recurrent fistulas  
class4	1231	extracranial repair  on the other hand  produces no central nervous system morbidity  preserves olfaction  and is associated with a low incidence of recurrence  
class4	1231	although there have been several reports of extracranial repair of csf fistulas by otorhinolaryngologists  this approach has received scant mention in the neurosurgical literature  
class4	1231	we report here our experience with 37 patients with csf rhinorrhea or otorrhea who underwent extracranial repair  
class4	1231	the etiology of the fistula was postoperative in 22  traumatic in 6  and spontaneous in 9  
class4	1231	the fistulas were repaired using one of four techniques  external ethmoid sphenoid in 18 patients  transmastoid in 9  transseptosphenoid in 7  and osteoplastic frontal sinusotomy in 3  
class4	1231	in 32 of the 37 patients  86   the fistulas were successfully repaired with the initial procedure  
class4	1231	of the 5 patients requiring a second operation  the fistula was successfully closed in 4 for an overall success rate of 97   
class4	1231	complications were few and consisted of a transient facial paresis in a patient undergoing transmastoid repair and one death from meningitis  
class4	1231	the authors conclude that because of low morbidity and mortality and a high success rate in closing fistulas  extracranial repair is the preferred technique for the operative management of csf rhinorrhea and otorrhea  
class4	1232	symptomatic pineal cyst  case report  
class4	1232	pineal cysts are being described with increasing frequency since the advent of magnetic resonance imaging  
class4	1232	although pineal cysts are incidental findings in as many as 4  of magnetic resonance imaging studies  symptomatic pineal cysts are quite rare  
class4	1232	we present a case of pineal cyst causing aqueductal obstruction with symptomatic hydrocephalus and resultant headache and syncope  which was treated by surgical resection  
class4	1232	a review of the relevant literature and discussion follow  
class4	1233	clinical study of intracranial nongerminomatous germ cell tumors producing alpha fetoprotein  
class4	1233	we present six patients with intracranial nongerminomatous germ cell tumors that produced alpha fetoprotein  afp   
class4	1233	their ages ranged from 8 to 20 years  average  11 5 years old   two were male and four were female  
class4	1233	four of the tumors originated in the pineal region and two in the suprachiasmatic region  
class4	1233	one patient treated with only radiation therapy died within 3 months of admission as a result of intraperitoneal metastasis via a ventriculoperitoneal shunt  
class4	1233	another patient  treated with radiation therapy and intrathecal administration of neocarzinostatin  died after 12 months because of tumor progression and subarachnoid dissemination  
class4	1233	two patients who received radiation and combination therapy with cisplatin  vinblastine  and bleomycin died after 13 and 25 months  
class4	1233	the remaining two patients treated with radiation therapy and adjuvant chemotherapy  cisplatin and etoposide  are now alive without recurrence after 16 and 19 months from admission  
class4	1233	adjuvant chemotherapy with cisplatin and etoposide appears to be efficacious in the treatment of intracranial nongerminomatous germ cell tumor  
class4	1234	vagal schwannoma associated with syncopal attacks and postural hypotension  a case report  
class4	1234	a case of vagal schwannoma in the cerebellomedullary angle is reported  
class4	1234	preoperatively  the patient had paroxysmal episodes of postural hypotension with syncope  
class4	1234	after total removal of the vagal tumor  her systemic blood pressure returned to normal  
class4	1235	multiple intracranial tumors of different cell types  
class4	1235	multiple intracranial tumors of different cell types are rare  
class4	1235	we report nine patients with multiple intracranial tumors  who did not have a history of trauma  irradiation  or phacomatosis  
class4	1235	the clinical  radiological  and histopathological findings as well as indications for operations in patients with asymptomatic second tumors are discussed  
class4	1236	occult vascular malformations of the optic chiasm  magnetic resonance imaging diagnosis and surgical laser resection  
class4	1236	angiographically occult vascular malformations of the optic nerve and chiasm are extremely rare  
class4	1236	before the advent of magnetic resonance imaging  mri   it was difficult to diagnose these lesions preoperatively  
class4	1236	we report mri scan findings of optic chiasm cavernous angiomas in two patients with chiasmal syndrome  
class4	1236	mri was useful in localizing the vascular malformation and delineating its characteristics  especially chronic hemorrhage  
class4	1236	one patient underwent biopsy of the lesion  
class4	1236	the other patient underwent complete microsurgical resection of the malformation with the carbon dioxide laser with preservation of vision  
class4	1236	occult vascular malformations of the optic nerve and chiasm may be a more common cause of visual deterioration than previously recognized  
class4	1236	the mri scan is the imaging modality of choice for diagnosing and following these lesions  
class4	1236	in certain patients  these vascular malformations may be amenable to complete surgical removal with stabilization or improvement of visual function  
class4	1237	a case of dyschondroplasia associated with brain stem glioma  diagnosis by stereotactic biopsy  
class4	1237	we present a 24 year old patient with multiple chondromas of both hands  the pelvis  the left leg  and an associated brain stem glioma  
class4	1237	there was no evidence of hemangioma or dyschromia  and the condition was diagnosed as ollier s disease  a special type of dyschondroplasia like maffucci s syndrome and kast s disease  
class4	1237	an increased overall risk for development of malignant skeletal and nonskeletal tumors is associated with maffucci s syndrome  
class4	1237	the risk of malignant degeneration is lower in ollier s disease  
class4	1237	a glioma in the pons and the right lobe of the cerebellum was found in this patient  
class4	1237	the literature describes an association with gliomas in only 12 cases of dyschondroplasia and an infratentorial localization in just one case  
class4	1237	signs of malignancy were histologically confirmed in 7 cases without significant preponderance of any one type  
class4	1237	our patient had a low grade brain stem astrocytoma with fibrillar and gemistocytic components  
class4	1237	a stereotactic serial biopsy made it possible to rule out malignant degeneration  
class4	1237	stereotactic brain tumor biopsy as a routine neurosurgical procedure is particularly valuable for deep space occupying processes and forms the basis for therapy  
class4	1237	in the present case  irradiation was not recommended  
class4	1238	an unusual complication of silastic dural substitute  case report  
class4	1238	a case is presented in which a patient developed an unusual complication after the use of silastic dural substitute  
class4	1238	in 1983  the patient underwent removal of a meningioma with the involved dura  
class4	1238	five years later  he developed around the graft material a very thick connective tissue capsule  which simulated a recurrent meningioma clinically and radiologically  
class4	1239	brain stem and spinal metastases of supratentorial glioblastoma multiforme  a clinical series  
class4	1239	although the spread of supratentorial glioblastoma multiforme to the brain stem and spine has been extensively described in published autopsy series  information on the diagnosis  treatment  and subsequent clinical course of patients manifesting symptoms of glioblastomatous dissemination ante mortem remains scant  
class4	1239	we report a series of 11 patients having the signs and symptoms of neuraxis dissemination of supratentorial glioblastoma multiforme  
class4	1239	all patients had radiographic documentation of metastases by either contrast enhanced myelograms or enhanced magnetic resonance imaging scans  
class4	1239	ten presented with spinal involvement  whereas one presented with lower cranial neuropathies secondary to diffuse involvement of the basal cisterns  
class4	1239	the mean age of the patients was 38 5 years  and the mean time interval between diagnosis of intracranial disease and diagnosis of metastases was 14 1 months  
class4	1239	after diagnosis of tumor spread  subsequent mean survival time was 2 8 months  
class4	1239	all patients received additional radiotherapy to the areas of metastasis  but the clinical response to radiotherapy was quite poor  
class4	1239	this study confirms previous reports in the literature suggesting that metastases occur in younger patients and in patients with extended survival  
class4	1239	the findings suggest that the relatively infrequent clinical incidence of the symptomatic spread of glioblastoma multiforme  as compared with the frequent incidental discovery of such spread at autopsy  may be the result of the limited survival of the affected patients  and not due to the biology of the tumor  
class4	1240	ultrastructural evidence for differentiation in a human glioblastoma cell line treated with inhibitors of eicosanoid metabolism  
class4	1240	human glioblastoma cells incubated in the presence of inhibitors of eicosanoid biosynthesis show decreased cellular proliferation without cytotoxicity  
class4	1240	we studied the ultrastructural morphology of a human glioblastoma cell line cultured with nordihydroguaiaretic acid  ndga   a lipoxygenase inhibitor  or 5 8 11 14 eicosatetraynoic acid  a cyclooxygenase and lipoxygenase inhibitor  
class4	1240	when glioblastoma cells were treated for 3 days with antiproliferative concentrations of either agent  they shared many morphological characteristics  including evidence for increased astrocytic differentiation with only limited signs of toxicity  
class4	1240	the inhibited glioma cells demonstrated an increase in the number and length of astrocytic processes containing greater numbers of glial filaments  and the ndga treated cells also demonstrated extensive lateral pseudopod formation along the processes  
class4	1240	the glioblastoma cell shape also became more elongated  losing the usual nuclear lobularity and nuclear inclusions  especially in ndga treated cells  
class4	1240	many cytoplasmic organelles packed the cytosol of the inhibited glioma cells  including prominent golgi apparatus  dilated smooth endoplasmic reticulum evolving into dilated vesicles  cytoplasmic vacuoles  and numerous concentric laminations  
class4	1240	there was limited evidence for toxicity  however  as the mitochondria were more pleomorphic with some mitochondrial distention and disruption of the cristae along with an increase in cytoplasmic vacuolization  
class4	1240	we conclude that the inhibitors of eicosanoid biosynthesis  ndga and 5 8 11 14 eicosatetraynoic acid  not only suppress glioblastoma cell proliferation  but also induce increased astrocytic differentiation  
class4	1241	epidermoid tumors of the 4th ventricle  report of seven cases  
class4	1241	epidermoid tumors occur very rarely in the 4th ventricle  
class4	1241	we discuss the history  clinical course  and the surgical results for seven patients  
class4	1241	one patient had a remittal of symptoms  probably due to the emergence of the tumor from the 4th ventricle into the cisterna magna  
class4	1241	total removal of the capsule was possible only in the youngest patient  
class4	1241	at present  four patients  mean follow up  6 years  enjoy good general and neurological health  
class4	1242	changes in intracochlear and intracanalicular nerves after acoustic neurinoma excision confirmed by magnetic resonance imaging  
class4	1242	postoperative magnetic resonance imaging findings related to the vestibulocochlear and facial nerves within the internal auditory canal were analyzed in acoustic neurinomas  
class4	1242	t1  and proton weighted magnetic resonance images showed that the vestibulocochlear nerves distal to the internal auditory meatus increased in signal intensity after surgical intervention  
class4	1242	these nerves were conspicuously enhanced after intravenous administration of gadolinium diethylene triamine pentaacetic acid  
class4	1242	the preserved facial nerves were also markedly enhanced postoperatively  
class4	1242	as a possible cause of these findings  we suggest operative disruption of the blood nerve barrier with ensuing nerve edema  although the operative procedures were carefully carried out using a surgical microscope  
class4	1242	the clinical significance of traumatic disruption of the blood nerve barrier and subsequent nerve edema are discussed from the standpoint of preservation of cochlear nerve function  
class4	1243	clinicopathological experience with pineocytomas  report of five surgically treated cases  
class4	1243	the clinicopathological experience associated with five cases of pineocytoma is presented  
class4	1243	all patients were treated by surgical removal without postoperative radiotherapy  
class4	1243	in three individuals  2000 cgy was administered to the tumor as a presurgical diagnostic test  with no evidence of response  
class4	1243	all cases demonstrated histological features of pineocytoma  according to the criteria of borit et al   and of the so called  pineocytoma with neuronal differentiation   according to the criteria of rubinstein  
class4	1243	the experience obtained from the present series reveals that these tumors can occur in the initial decades of life  that a cystic appearance and the presence of calcifications are distinctive features of their radiological evaluation  and that they have a good prognosis after surgical removal  even when the histological data indicate local invasion  
class4	1243	the convenience of reserving the term  pineocytoma  for these tumors  and of including the so called  pineocytomas without further differentiation  within the group of pineoblastomas  is suggested in order to achieve a practical clinicopathological assessment of parenchymatous pineal tumors  
class4	1244	subdural hematoma associated with metastatic neoplasms  
class4	1244	two cases of subdural hematoma  one acute and the other chronic  associated with cancer metastatic to the dura are reported  
class4	1244	various mechanisms of the association of hematomas with cancer are reviewed  
class4	1245	maffucci s syndrome with bilateral cartilaginous tumors of the cerebellopontine angle  
class4	1245	maffucci s syndrome is characterized by the combination of multiple enchondromas  ollier s disease  and hemangiomatosis  
class4	1245	these hemangiomas develop in the subcutaneous tissue and form red blue tumors dispersed over the whole body  
class4	1245	intracranial involvement is rare  making a preoperative radiological diagnosis and differentiation from other tumors rather difficult  
class4	1245	the radiological characteristics and successful removal of the intracranial part of a chondrosarcoma of the cerebellopontine angle in a case of maffucci s syndrome are reported in this paper  
class4	1246	concurrent intradural and extradural meningiomas of the cervical spine  
class4	1246	a case of an extradural spinal meningioma presenting with a separate intradural meningioma at the same cord level is reported  
class4	1246	review of the english literature on spinal epidural meningiomas reveals a high incidence of concurrent intradural tumors in patients with epidural meningiomas  
class4	1246	this leads to the conclusion that the intradural space should be evaluated carefully when an epidural meningioma is encountered  
class4	1247	intradural spinal cord tumor presenting as a subarachnoid hemorrhage  magnetic resonance imaging diagnosis  
class4	1247	negative findings on four vessel angiography after a subarachnoid hemorrhage are seen in 5 to 30  of patients  
class4	1247	a previously silent lesion in the spinal canal may be responsible for the ictus in a small percentage of this group  
class4	1247	the etiological factors include tumors and arteriovenous malformations  however  investigations of such lesions have been limited to patients with signs and symptoms of spinal cord or nerve root pathological processes  
class4	1247	this report describes the management of a 56 year old woman with clinical findings typical of an aneurysmal subarachnoid hemorrhage and negative findings on cerebral angiography  in whom magnetic resonance imaging with gadolinium enhancement revealed an intradural extramedullary cervical schwannoma  
class4	1247	for this reason  cervicothoracic magnetic resonance imaging with gadolinium enhancement should be considered as an adjunctive scanning examination in all patients with a subarachnoid hemorrhage and negative findings on angiography  
class4	1248	radiation necrosis of the optic chiasm  optic tract  hypothalamus  and upper pons after radiotherapy for pituitary adenoma  detected by gadolinium enhanced  t1 weighted magnetic resonance imaging  case report  
class4	1248	a 26 year old woman was treated for a prolactin secreting pituitary adenoma by surgery and radiotherapy  5860 rads   
class4	1248	fourteen months later  she developed right hemiparesis and dysarthria  
class4	1248	a t1 weighted magnetic resonance imaging scan using gadolinium contrast showed a small  enhanced lesion in the upper pons  
class4	1248	seven months later  she had a sudden onset of loss of vision  and radiation optic neuropathy was diagnosed  
class4	1248	a t1 weighted magnetic resonance imaging scan showed widespread gadolinium enhanced lesions in the optic chiasm  optic tract  and hypothalamus  
class4	1248	magnetic resonance imaging is indispensable for the early diagnosis of radiation necrosis  which is not visualized by radiography or computed tomography  
class4	1249	pituitary hemorrhage into a rathke s cleft cyst 
class4	1249	this report describes a case of symptomatic pituitary hemorrhage into a rathke s cleft cyst in a 25 year old woman  
class4	1249	the literature on pituitary hemorrhage in nonadenomatous sellar tumors is reviewed  
class4	1250	suprasellar pituitary adenoma arising from the pars tuberalis  case report  
class4	1250	a rare case of suprasellar pituitary adenoma arising from the pars tuberalis in a 53 year old woman is presented  
class4	1250	the tumor was located exclusively above the diaphragma sellae  and no invasion into the sella turcica was noted  
class4	1251	central neurogenic hyperventilation  pharmacologic intervention with morphine sulfate and correlative analysis of respiratory  sleep  and ocular motor dysfunction  
class4	1251	central neurogenic hyperventilation  cnh   for which there is no effective therapy  can eventually result in respiratory fatigue and death  
class4	1251	this report describes a patient with cnh due to a brainstem anaplastic astrocytoma who also exhibited disturbances of sleep and ocular motor function  
class4	1251	the cnh responded clinically to morphine sulfate and methadone  
class4	1251	analysis of ventilatory response to co2 before and after morphine demonstrated a depression of ventilatory response  49 to 53  of baseline  and occlusion pressure response  35 to 50  of baseline  to co2  with a requirement for high doses of naloxone  10 mg iv  to reverse the effect  
class4	1251	polysomnography revealed sustained hyperventilation  elevated o2 saturation  and low end tidal co2 throughout all stages of non rapid eye movement  nrem  sleep  and absence of rapid eye movement  rem  sleep  
class4	1251	ocular motor evaluation disclosed absence of horizontal and reflexive saccades with compensatory head thrusts  
class4	1251	correlation of the clinical and physiologic data with the mri abnormalities suggested that the lesion responsible for cnh in this patient might reside in the medial tegmental parapontine reticular formation  
class4	1251	since recurrent episodes of hyperventilation responded in a sustained fashion to iv and oral opiates  this treatment may warrant consideration in other patients with cnh  
class4	1252	procarbazine chemotherapy in the treatment of recurrent malignant astrocytomas after radiation and nitrosourea failure  
class4	1252	the brain tumor study group has shown procarbazine  pcb  to be as effective an adjuvant treatment as 1 3 bis 2 chloroethyl  1 nitrosourea  bcnu   
class4	1252	we treated 35 patients with recurrent malignant astrocytomas after radiation and nitrosourea failure with successive courses of pcb 150 mg m2 d for 28 days every 8 weeks  
class4	1252	after 2 courses  2 patients had complete responses  7 had partial responses  11 had stable disease  and 15 had progression  
class4	1252	significantly more patients receiving pcb had complete or partial responses or stable disease than a similar group of patients in a previous trial who received intra arterial  ia  cisplatin  ddp   
class4	1252	there is a significant advantage in time to disease progression for those receiving pcb compared with those receiving ia diaziquone  azq   
class4	1252	our results suggest that pcb is a more effective 2nd agent than ia ddp or azq following radiation and nitrosourea failure  
class4	1253	antibodies to synthetic peptide  125 148  of the alpha subunit of human nicotinic acetylcholine receptor in sera from patients with myasthenia gravis  
class4	1253	we measured the amount of antibodies to a synthetic peptide that corresponds to the alpha subunit residues lys125 thr148 of human acetylcholine receptor  achr  in myasthenic sera  
class4	1253	we detected anti peptide antibodies in 52   89 171  of the patients with myasthenia gravis  mg   but none in any of the healthy controls  
class4	1253	anti peptide antibodies should provide a valuable immunologic parameter for the clinical evaluation of mg  but no apparent correlation was observed between the titers of anti peptide and anti achr antibodies  
class4	1254	cavernous hemangioma of the spinal cord  report of 2 unusual cases  
class4	1254	we present 2 cases of spinal cord intramedullary cavernous hemangioma  1 patient is the 1st reported case of multiple spinal cord lesions  
class4	1254	diagnosis is greatly enhanced by the use of mri  
class4	1255	classification of endometrial cells on cervical cytology  
class4	1255	one hundred eighty eight women who had endometrial cells on cervical cytologic specimens during the secretory phase or in the postmenopausal period were studied retrospectively  
class4	1255	each had undergone hysterectomy or endometrial biopsy within 12 months of the original smear  
class4	1255	the endometrial cells were classified as typical  atypical  or suspicious for carcinoma  
class4	1255	among premenopausal subjects  three of 57 with typical cells had endometrial hyperplasia  one of two with atypical cells had endometrial polyps  and both with cells suspicious for carcinoma had endometrial carcinoma  
class4	1255	in the postmenopausal group  ten  13 5   of 74 with typical endometrial cells had either hyperplasia or carcinoma  and five  22 7   of 22 with atypical cells and 24 77 4   of 31 patients with suspicious cells had either hyperplasia or carcinoma  
class4	1255	the present findings and a review of the pertinent literature demonstrate that the classification system used is helpful in predicting the risk for endometrial disease in patients with endometrial cells seen on cervical cytologic smears during the secretory phase or in the postmenopausal period  
class4	1256	a randomized trial comparing two methods of cold knife conization with laser conization  
class4	1256	in a randomized study  62 women were submitted to cold knife conization with application of sturmdorf sutures  60 to cold knife conization without sutures  and 61 to laser conization  
class4	1256	early hemorrhage occurred in 1 6  13 3  and 6 6  of women  respectively  p less than  05   and late hemorrhage in 15 3  3 6  and 11 7   respectively  
class4	1256	considering early and late hemorrhage together  there was no significant difference among the three treatment groups  
class4	1256	dysmenorrhea tended to be more common after application of sturmdorf sutures  as it was reported by 27 8  13 2  and 14 3  of patients  respectively  but the difference was not statistically significant  
class4	1256	dysmenorrhea occurred in 13  of the cases with a cone height of 20 mm or less and in 26  of the cases with a cone height greater than 20 mm  p less than  05   
class4	1256	endocervical cells were present significantly more often after sampling with a cytobrush than with a cotton swab  p less than  0001   whereas the method of conization had no influence  
class4	1256	in smears obtained with a cytobrush  endocervical cells were present in 88 0  84 9  and 82 5  of the cases  in smears obtained with a cotton swab  endocervical cells were present in 46 6  57 7  and 54 5   respectively  
class4	1256	we conclude that cold knife conization without sturmdorf sutures is about equal to laser conization in overall complications  but the laser is preferable for outpatient treatment because of a lower frequency of early hemorrhage  
class4	1256	sturmdorf sutures should be avoided  
class4	1256	smears at follow up should be taken with a cytobrush and a wooden spatula  
class4	1257	basement membrane of cervical adenocarcinoma  an immunoperoxidase study of laminin and type iv collagen  
class4	1257	the basement membrane components type iv collagen and laminin were examined immunohistochemically in 14 cases of adenocarcinoma of the cervix  
class4	1257	the patterns of staining in adenocarcinoma in situ  invasive adenocarcinoma  and early invasive adenocarcinoma were compared to see whether characteristic patterns could be delineated  
class4	1257	adenocarcinoma in situ had a uniform intact basement membrane  whereas the basement membrane of invasive adenocarcinoma was fragmented and irregular  
class4	1257	cases of early stromal invasion showed early gland buds and outpouchings with defective basement membrane staining  
class4	1257	the degree of histologic differentiation of the tumor was not clearly related to the amount of basement membrane component staining  
class4	1257	the concept of early stromal invasion in cervical adenocarcinoma  as supported by our immunohistochemical studies  is discussed as it relates to a possible pathogenic mechanism in early invasion and infiltration of adenocarcinoma of the cervix  
class4	1258	treatment of fallopian tube carcinoma with cisplatin  doxorubicin  and cyclophosphamide  
class4	1258	primary carcinoma of the fallopian tube is uncommon and is often treated using regimens active in ovarian carcinoma  
class4	1258	evidence is scant that such therapies benefit patients with fallopian tube carcinoma  
class4	1258	between december 1979 and july 1988  we treated 18 patients who had adenocarcinoma of the fallopian tube with the combination of cisplatin  50 mg m2   doxorubicin  50 mg m2   and cyclophosphamide  500 mg m2  administered intravenously on 1 day every 28 days  
class4	1258	histologic confirmation of fallopian tube carcinoma was obtained before entry in the study  
class4	1258	three patients had stage i disease  five had stage ii  nine had stage iii  and one had stage iv  
class4	1258	sixteen patients received the combination therapy as first line treatment after cytoreductive surgery  and two patients received it for recurrent carcinoma  
class4	1258	seven patients had clinically measurable disease at the start of therapy  
class4	1258	two of these patients had a complete clinical response  two had stable disease  and three had progressive disease  
class4	1258	eight of the 15 patients with stages ii iv disease underwent second look laparotomy  four had a complete response to therapy and four had a partial response  making the overall response rate 53   
class4	1258	the toxicity of the regimen was moderate  
class4	1258	the median survival was 81 months  
class4	1258	patients with stages ii iv disease had a median survival of 43 9 months and a progression free survival of 22 5 months  
class4	1258	this regimen appears to be active in fallopian tube carcinoma and can result in response rates comparable to those reported for epithelial ovarian cancer  
class4	1259	debulking of pelvic and para aortic lymph node metastases in ovarian cancer with the cavitron ultrasonic surgical aspirator  
class4	1259	six patients with metastatic ovarian cancer with extensive involvement of the pelvic and or para aortic lymph nodes underwent surgical debulking with the cavitron ultrasonic surgical aspirator  
class4	1259	intraoperative and postoperative morbidity was minimal  
class4	1259	it is suggested that this technique may be used for cytoreductive surgery in combination with standard surgical techniques  
class4	1260	the significance of moderate and severe inflammation on class i papanicolaou smear 
class4	1260	the significance of a cytologic diagnosis of moderate and severe inflammation with a normal  class i  papanicolaou smear has not been addressed  
class4	1260	a retrospective review of 596 consecutive cervical smears performed over 13 months revealed 85 women who had a class i cytologic smear with moderate to severe inflammation  
class4	1260	seventy eight patients had colposcopic examinations and were considered for this study  
class4	1260	fifty nine  75 6   had cervical punch biopsies and or endocervical biopsies  
class4	1260	of the 78  19  24 4   had cervical condylomata and nine  11 5   had cervical intraepithelial neoplasia  
class4	1260	we conclude that class i cytologic smears with moderate to severe inflammation may be associated with findings of condylomata and cervical dysplasia  
class4	1261	vitreous changes and macular edema in central retinal vein occlusion  
class4	1261	the condition of the posterior vitreous was determined in 56 eyes with central retinal vein occlusion  crvo   
class4	1261	using a life table analysis  it was studied in 56 eyes  
class4	1261	the incidence of posterior vitreous detachment  pvd  in the crvo eyes at the first vitreous examination did not differ significantly from that in 64 age matched control eyes  
class4	1261	however  the incidence of pvd in crvo eyes increased from 39 3  at the first vitreous examination to 58 5  after 6 months  and to 69 6  1 year from the examination  
class4	1261	the incidence of pvd in crvo eyes during follow up was statistically higher than that of the controls  p    009   
class4	1261	the incidence of pvd after the first vitreous examination was significantly higher in eyes with hemorrhagic retinopathy than in eyes with venous stasis retinopathy  p    04   
class4	1261	in the 34 eyes with macular edema  the edema lasted significantly longer in those with vitreomacular attachment  vma  at the first examination than in those without vma at this time  p    02   
class4	1261	vma may play an important role in the pathogenesis and chronicity of macular edema in crvo  
class4	1262	management of macular puckers associated with retinal angiomas  
class4	1262	monocular visual loss in four patients was caused by epiretinal macular membranes associated with peripheral retinal capillary angiomas or angioma like lesions  
class4	1262	three patients had solitary vascular lesions and one had two discrete vascular lesions  
class4	1262	all patients were in good health  with no evidence of the von hippel lindau syndrome  
class4	1262	in three patients  spontaneous peeling of the macular membranes and visual improvement occurred 2 to 6 months after obliteration of the angioma like lesions with cryotherapy  two patients   or cryotherapy combined with argon laser  one patient   
class4	1262	the fourth patient underwent a vitrectomy 8 months after the macular pucker had failed to respond to treatment of the vascular lesion  
class4	1263	experience with photocoagulation in behcet s disease  
class4	1263	between 1973 and 1987 we examined both eyes of 300 patients with the uveoretinitis type lesions characteristic of behcet s disease  
class4	1263	of the 556 eyes whose fundus could be examined  38 eyes  6 8   in 33 patients  11   had developed retinal capillary nonperfusion  branch retinal vein occlusion  or retinal or disc neovascularization  
class4	1263	these eyes were treated by photocoagulation  primarily to forestall vitreous hemorrhage and the development of neovascular glaucoma  as well as to decrease the macular edema resulting from vein occlusion  
class4	1263	the treatment  which was well tolerated  was successful in closing retinal capillary nonperfusion areas and eliminating retinal neovascularization  
class4	1263	disc neovascularization was resolved completely in some cases  and partially in others  
class4	1264	fluorescein angiography in ciliary body melanomas  
class4	1264	we retrospectively studied the value of iris fluorescein angiography in predicitng benignity or malignancy in 10 cases of ciliary body melanoma with iris extension  
class4	1264	no correlation between fluorescein angiographic appearance and histopathologic features was observed  
class4	1264	fluorescein angiography adds little to the management of ciliary body melanomas with iris extension  
class4	1265	visual disturbance in patients with melanocytoma of the optic disk  
class4	1265	visual disturbance in 11 patients with melanocytoma of the optic disk was analyzed  
class4	1265	goldmann visual field examination showed enlargement of mariotte s blind spot in 7 of 10 patients  70   and visual field defect or depression in 7 patients  70    
class4	1265	in 6 of the 7 patients with visual field defect of depression  86    the portion of visual field damage corresponded with the location of the tumor and retinal nerve fiber bundle defect  
class4	1265	in 1 patient  sudden loss of visual acuity occurred  presumably due to anterior ischemic optic neuropathy induced by melanocytoma  
class4	1266	argon green  514 nm  versus krypton red  647 nm  modified grid laser photocoagulation for diffuse diabetic macular edema  
class4	1266	between 1984 and 1988  225 eyes of 132 patients were entered in a prospective  randomized clinical trial to determine if any significant differences exist between treatment with argon green  514 nm  and krypton red  647 nm  modified grid laser photocoagulation for patients with diffuse diabetic maculopathy with or without cystoid macular edema  
class4	1266	at the 12  and 24 month follow up visits  no statistically significant difference was found between the two groups with respect to all of the following  reduction or elimination of macular edema  improvement in visual acuity  worsening of visual acuity  number of treatments per eye  and effect on the visual field  
class4	1266	at the 12 month follow up visit  none of the following factors statistically affected the visual outcome in either of the two groups  a history of systemic hypertension  systemic vascular disease  cystoid macular edema  or initial poor visual acuity  
class4	1267	the epidemiology of ophthalmic malignancies in new york state  
class4	1267	the epidemiologic characteristics of more than 1400 primary eye cancers  icd 9  site 190  diagnosed among new york state  nys  residents between 1975 and 1986 are described  
class4	1267	among nys male residents  the average annual age adjusted incidence rate was 7 5 per 1 000 000  and among nys female residents  the rate was 5 4 per 1 000 000  male female rate ratio  1 39   
class4	1267	the majority of ophthalmic malignancies were included within three histologic groupings  melanomas  70 4    retinoblastomas  9 8    and squamous cell carcinomas  9 2    
class4	1267	the average annual incidence of retinoblastoma among persons in nys who were less than 5 years of age was 9 5 per 1 000 000 for boys and 8 7 per 1 000 000 for girls  male female rate ratio  1 09   
class4	1267	the average annual incidence  age adjusted  of ocular melanomas was 4 9 per 1 000 000 among men and 3 7 per 1 000 000 among women in nys  male female rate ratio  1 32   
class4	1267	expanded knowledge of the epidemiology of ophthalmic cancers can help to develop a foundation on which to monitor disease patterns and can serve to stimulate further etiologic research involving these rare malignancies  
class4	1268	introducing the  walk up  flap  
class4	1268	reconstructive oral and maxillofacial surgeons often find the need for additional soft tissue even when a myocutaneous flap has been previously placed  
class4	1268	this article introduces the principles  technique  and results of 32  walk up  muscle flaps derived from existing myocutaneous flaps  
class4	1268	the anastomotic vascular ingrowth at the original myocutaneous flap s distal end permits its proximal detachment and axial vessel ligation to rotate the proximal two thirds to a tissue deficient site  
class4	1268	in our experience at the university of miami  these flaps have been predictable  97  viable transfer rate   have provided vascular soft tissue in deficient areas  and have been skin grafted at their surface to increase oral lining or skin cover  among several other uses  
class4	1269	multiple myeloma and bullous lichenoid lesions  an unusual association  
class4	1269	many associations of lichenoid reactions have been described but this case appears to be a previously unreported association  with multiple myeloma  
class4	1269	this case also demonstrates the necessity of a mucosal biopsy with adequate hematologic and serologic investigations to obtain a definitive diagnosis  
class4	1270	thermally induced  nicotine  stomatitis  a case report  
class4	1270	a palatal lesion resembling  nicotine  stomatitis was found in a woman who did not smoke  
class4	1270	however  the patient frequently drank extremely hot beverages  
class4	1270	after she was instructed to reduce the temperature of the beverages  the lesion almost completely resolved  
class4	1270	this suggests that heat was the primary cause of this lesion and also implicates heat as the major cause of nicotine stomatitis  
class4	1271	diagnosis of oral hairy leukoplakia by ultrastructural examination of exfoliative cytologic specimens  
class4	1271	lingual exfoliative cytologic specimens  scrapings  were obtained from 18 patients positive for human immunodeficiency virus with clinical oral hairy leukoplakia  
class4	1271	buccal mucosal scrapings were obtained from 12 of these patients  
class4	1271	the specimens were processed for examination by transmission electron microscopy  tem   
class4	1271	sixteen  89   of the lingual specimens revealed infection of keratinocytes by herpes type virus  
class4	1271	there was no evidence of virus infection in the 12 buccal mucosal scrapings  
class4	1271	fungal hyphae were seen by tem in 14  78   of the lingual scrapings and two  17   of the buccal scrapings  
class4	1271	one exfoliative specimen and two biopsy specimens were stained for epstein barr virus dna with a dna probe  
class4	1271	the demonstration of herpes type virions by tem in keratinocytes from a lesion clinically suspected to be hairy leukoplakia provides direct  objective diagnosis  
class4	1271	furthermore  use of exfoliative cytologic specimens provides a clinically simple  noninvasive technique  
class4	1272	the cellular composition of basal cell adenoma of the parotid gland  an immunohistochemical analysis  
class4	1272	four cases of basal cell adenoma of the parotid gland were examined immunohistochemically to characterize their cellular composition  
class4	1272	in all cases epithelial membrane antigen and keratin were detected in the inner luminal cells  some cells also showed positive staining for secretory functional markers  indicating their differentiation toward secretory epithelium  
class4	1272	in tubular and trabecular types the outer cells consistently displayed an intense staining for vimentin and some were also positive for actin  indicating their myoepithelial nature  
class4	1272	in the solid type  most tumor cells resembled the ductal cells or basal cells of larger ducts in normal gland with regard to their immunoreactivity  
class4	1272	our results may suggest that the proportion and arrangement of heterogeneous tumor cells are responsible for different histologic patterns of the salivary basal cell adenoma  
class4	1273	primary malignant melanoma in the parotid gland  
class4	1273	reports of primary malignant melanoma arising from the parotid salivary gland are extremely rare and  to date  have been sporadic  
class4	1273	we report a pertinent case  and tabulate and correlate the clinical findings of the 13 cases reported thus far in the literature  
class4	1273	the most common symptom is a progressively enlarging  asymptomatic  firm  and fixed mass  
class4	1273	total excision has been the established treatment of choice  
class4	1273	the contribution of radiotherapy  chemotherapy  and immunotherapy remains unclear  and it is not possible at present to predict the outcome of treatment in individual patients  
class4	1273	although rare  primary malignant melanoma should be considered in the differential diagnosis of parotid tumors  
class4	1273	the clinical significance of establishing the diagnosis of primary malignant melanoma of the parotid gland is emphasized  
class4	1274	clinical and instrumental evaluation of sensory function before and after percutaneous anterolateral cordotomy at cervical level in man  
class4	1274	sensory perception thresholds were assessed by clinical testing and by quantitative instrumental testing before and after operation in 16 subjects for whom unilateral percutaneous cervical cordotomy was performed for the relief of pain due to malignant disease  and compared with clinical assessments of sensory function  
class4	1274	we were able to confirm the association between deficit in pin prick sensation and pain relief in the majority of instances  though the completeness or otherwise of pain relief does not correspond to absence of pin prick sensation  
class4	1274	there is no objective interference with low threshold mechanical sensation as measured instrumentally  although cordotomised subjects do not experience startle  tickle  or cutaneous erotic sensation when subjected to appropriate low intensity tactile sensation  
class4	1274	quantitative instrumental testing shows that the greatest deficits produced by cordotomy are in the sensations of skinfold pinch      tissue damage pain  and skin cooling  
class4	1274	the latter is transduced in the periphery by a delta fibres  sensations of warmth and hot pain  transduced by primary afferent c fibres  are much less significantly affected  
class4	1274	our findings thus fail to resolve the question as to whether chronic clinical pain is mainly an a delta  or a c fibre mediated phenomenon  
class4	1275	screening for neuroblastoma at 3 weeks of age  methods and preliminary results from the quebec neuroblastoma screening project  
class4	1275	a large neuroblastoma screening study was recently started in the province of quebec  canada  
class4	1275	this project  a collaboration between the quebec network for genetic medicine and the university of minnesota  is studying the impact of screening infants for the preclinical detection of neuroblastoma on the population based mortality caused by this tumor  
class4	1275	all infants born in quebec during a 5 year period will be screened twice  at 3 weeks and at 6 months  
class4	1275	urinary homovanillic acid and vanillylmandelic acid determination from dried filter paper samples is used for screening  
class4	1275	initial qualitative screening is done by means of thin layer chromatography with confirmatory quantitative screening by gas chromatography mass spectrometry  gc ms   
class4	1275	during the initial 6 months of 3 week screening  41 673 neonates  92  compliance rate  were screened and 10 6  of them were tested also by gc ms  
class4	1275	nine of these neonates had positive results on two gc ms tests and were referred for evaluation to rule out the presence of neuroblastoma  
class4	1275	four had the tumor  1 had a calcified adrenal gland  and 4 had no tumor detected  
class4	1275	three additional neonates had clinical diagnosis of neuroblastoma before they reached the screening age of 3 weeks  
class4	1275	a neuroblastoma that did not secrete homovanillic acid or vanillylmandelic acid was diagnosed clinically in 1 additional patient who tested negative by screening  
class4	1276	when epilepsy masquerades as heart disease  awareness is key to avoiding misdiagnosis  
class4	1276	autonomic neural impulses that accompany discharges during a seizure can cause a variety of cardiac manifestations  including cardiac arrhythmias  sudden death  anginal chest pain  neurogenic pulmonary edema  and symptoms of pheochromocytoma  
class4	1276	either generalized or focal seizures may generate such signs and symptoms  
class4	1276	a better appreciation of cardiac problems caused by epilepsy is helpful in preventing misdiagnosis  because the clinical picture in such a patient may be confusing  
class4	1277	expression of murine renin genes in subcutaneous connective tissue  
class4	1277	a renin promoter large tumor antigen  t antigen  fusion gene was constructed to provide a reporter function for renin expression in transgenic mice  
class4	1277	these transgenic mice gave rise to tumors in subcutaneous soft tissue  which was attributed to transgene expression at this site  
class4	1277	an immunohistochemical analysis of transgenic fetuses from several independent lines revealed scattered t antigen containing mesenchymal cells and fibroblasts in the subcutaneous layer of the skin between the panniculus carnosus muscle of the skin and the skeletal muscle of the body wall  
class4	1277	this localization is consistent with the location of overt tumorigenesis in adult mice  
class4	1277	this pattern was specific for the renin t antigen fusion gene as no immunohistochemical staining was observed in transgenic fetuses containing a heterologous promoter t antigen fusion gene  
class4	1277	northern blot analysis of tumor rna indicated that most of the tumors expressed both t antigen and the endogenous renin gene ren 1c  
class4	1277	in addition  when multiple renin genes were introduced by crossing transgenic mice with nontransgenic dba 2j mice  which contain another allele of the ren 1 locus as well as the duplicated locus ren 2  the resultant tumors expressed the ren 2 gene  
class4	1277	northern blots were then used to analyze renin expression in the subcutaneous tissue of normal mice  
class4	1277	fully processed renin mrna was detected in eviscerated 15 5 day postcoitus fetal and newborn carcasses and in newborn skin  
class4	1277	our data indicate that there is a renin expressing cell population in fetal and newborn subcutaneous tissue  
class4	1278	e1a dependent expression of adenovirus genes in otf963 embryonal carcinoma cells  role of e1a induced differentiation  
class4	1278	some undifferentiated f9 embryonal carcinoma cells allow adenovirus genes to be expressed independently of the e1a oncogene normally required for their activation  this has been attributed to a cellular equivalent of e1a in f9 cells  
class4	1278	however  transcription of all early genes was low in undifferentiated otf963 embryonic carcinoma cells during the first 48 hr after infection with adenovirus type 5  ad5   
class4	1278	transcription then increased to about the level seen 16 hr after infection of cells induced to differentiate by retinoic acid  ra   referred to as ra df9 cells   but this increase did not occur in cells infected by the e1a deletion mutant dl312  
class4	1278	addition of e1a in trans  or of ra  had no immediate effect on viral transcription in otf963 cells  but viral transcription increased about 48 hr after these additions  
class4	1278	ad5 induced transcription of several differentiation specific genes in otf963 cells with about the same kinetics as their induction by ra  
class4	1278	these genes were superinduced in ra df9 cells by camp or infection by adenovirus  
class4	1278	we suggest the small amount of e1a produced early in infection of otf963 cells activates cellular genes  some of which are differentiation specific and required for efficient transcription of viral genes  so that e1a both induces and is induced by differentiation  
class4	1278	the simple hypothesis of a cellular equivalent to e1a does not adequately explain the complex interactions between viral and cellular genes in otf963 embryonic carcinoma cells  
class4	1279	the human immunodeficiency virus type 2 vpr gene is essential for productive infection of human macrophages  
class4	1279	the human immunodeficiency virus  hiv  genetic determinant s  responsible for tropism in human t cells or macrophages are not well defined  
class4	1279	we studied the role of the hiv type 2  hiv 2  nef and vpr genes in viral tropism  
class4	1279	hiv 2 mutants  lacking either vpr or nef genes  or both vpr and nef  were obtained by site specific mutagenesis of a biologically active hiv 2 proviral clone  hiv 2sbl isy   which is infectious in both human t cells and macrophages  
class4	1279	viral progeny carrying mutations of nef  vpr  or of both nef and vpr genes replicated more efficiently than the parental virus in primary human peripheral blood cells and in the human hut 78 t cell line  
class4	1279	in contrast  the hiv 2 nef  mutant infected human macrophages as efficiently as the parental virus  whereas viruses lacking the vpr gene either alone or in conjunction with the lack of the nef gene did not replicate in macrophages  
class4	1279	thus  some lack of nef in hiv 2 enhances viral replication in t cells and does not interfere with viral replication in primary macrophages  whereas vpr is essential for replication of hiv 2 in human macrophages  
class4	1279	because the parental hiv 2sbl isy cloned virus also infects rhesus macaques  the use in animal studies of these hiv 2 mutants with differences in cell tropism and rates of replication will be highly useful in understanding the mechanism of viral infectivity and possibly pathogenicity in vivo  
class4	1280	human colorectal cancers display abnormal fourier transform infrared spectra  
class4	1280	fourier transform infrared spectroscopy  ft ir  was applied to the study of tissue sections of human colorectal cancer  
class4	1280	pairs of tissue samples from colorectal cancer and histologically normal mucosa 5 10 cm away from the tumor were obtained from 11 patients who underwent partial colectomy  
class4	1280	all cancer specimens displayed abnormal spectra compared with the corresponding normal tissues  
class4	1280	these changes involved the phosphate and c o stretching bands  the ch stretch region  and the pressure dependence of the ch2 bending and c   o stretching modes  
class4	1280	our findings indicate that in colonic malignant tissue  there are changes in the degree of hydrogen bonding of  i  oxygen atoms of the backbone of nucleic acids  increased    ii  oh groups of serine  tyrosine  and threonine residues  any or all of them  of cell proteins  decreased   and  iii  the c   o groups of the acyl chains of membrane lipids  increased   
class4	1280	in addition  they indicate changes in the structure of proteins and membrane lipids  as judged by the changes in their ratio of methyl to methylene groups  and in the packing and the conformational structure of the methylene chains of membrane lipids  
class4	1280	the cell s  of the malignant colon tissues responsible for these spectral abnormalities is unknown  
class4	1280	cultured colon adenocarcinoma cell lines displayed similarly abnormal ft ir spectra  
class4	1280	the diagnostic potential of the observed changes is discussed  
class4	1281	a rhesus monkey model for sexual transmission of a papillomavirus isolated from a squamous cell carcinoma  
class4	1281	recently we molecularly cloned and characterized a papillomavirus from a lymph node metastasis of a primary penile carcinoma found in a rhesus monkey  this virus species  rhesus papillomavirus type 1  rhpv 1   is similar to oncogenic human papillomaviruses  hpvs   such as hpv 16 or hpv 18  in that the rhpv 1 dna was found to be integrated in the tumor cell dna  
class4	1281	to compare the sexual transmission and oncogenic nature of rhpv 1 with these hpvs  we undertook an extensive retrospective study of a group of rhesus monkeys whose sexual mating and offspring histories were known  
class4	1281	these animals had mated directly with the index male mentioned above or were secondarily exposed to this virus through intermediate sexual partners  
class4	1281	this study combines cytological  histopathological  and several complementary hybridization and dna amplification techniques on multiple tissue samples to demonstrate the sexually transmitted nature of rhpv 1  
class4	1281	the oncogenic potential of rhpv 1 is suggested in several of the infected animals by the presence of various degrees of neoplasia including squamous cell cancer of the cervix  
class4	1282	transfer of secretory proteins from the endoplasmic reticulum to the golgi apparatus  discrimination between homologous and heterologous transfer in intact heterokaryons  
class4	1282	to examine aspects of the transfer of secretory proteins from the endoplasmic reticulum to the golgi apparatus in situ  heterokaryons were formed between hep g2 human hepatoma cells and wi 38 human fibroblasts  
class4	1282	the cells were appropriately treated with cycloheximide before fusion  which emptied them of their respective secretory proteins  serum albumin for the hep g2 cells and procollagen i for the wi 38 cells  
class4	1282	after fusion was complete  the cycloheximide was washed out  protein synthesis was resumed  and the rates of reappearance of serum albumin and procollagen i in the two separated golgi apparatuses within each heterokaryon were followed by immunofluorescence microscopy  
class4	1282	serum albumin was found to always reappear first in the golgi apparatus contributed by the hep g2 half of the heterokaryon  and procollagen i in the golgi apparatus of the wi 38 half  
class4	1282	these results suggest that the endoplasmic reticulum to golgi apparatus transfer in situ is not simply a stochastic process but is either spatially restricted or exhibits cell type specificity or both  
class4	1283	adult t cell leukemia derived factor thioredoxin  produced by both human t lymphotropic virus type i  and epstein barr virus transformed lymphocytes  acts as an autocrine growth factor and synergizes with interleukin 1 and interleukin 2  
class4	1283	interleukin 1  il 1  has been obtained from the epstein barr virus infected b lymphoblastoid cell line 3b6 and shown to be involved in autocrine growth of 3b6 b cells  
class4	1283	independently  adult t cell leukemia derived factor  adf  was purified from human t lymphotropic virus i infected leukemic t cell line  atl 2  and reported as an interleukin 2  il 2  receptor inducing factor  
class4	1283	we have previously reported the same molecular mass  pi  and nh2 terminal amino acid sequence for both 3b6 derived il 1 and adf  
class4	1283	cdna cloning of adf demonstrated high homology with the prokaryotic disulfide reducing enzyme thioredoxin  
class4	1283	we show here that adf and 3b6 derived il 1 are identical  
class4	1283	by rna blot  3b6 and atl 2 cells were shown to contain high levels of 0 6 kilobase mrna corresponding to adf  
class4	1283	such message was not detected in resting peripheral blood lymphocytes but could be weakly induced by lymphocyte activation  
class4	1283	antibodies have been raised against synthetic peptides corresponding to the nh2 terminus and the cooh terminus of adf  
class4	1283	immunoblotting and sequential immunoprecipitation with these antibodies revealed the same 13 kda protein in 3b6 and atl 2 cells  
class4	1283	recombinant adf could sustain growth of 3b6 and atl 2 cells at low cellular concentration without fetal calf serum  adf  thus  appears involved in their autocrine growth  
class4	1283	similarly  recombinant adf could enhance growth of other b cell lines  including the epstein barr virus negative burkitt lymphoma line bl41 and the lymphoblastoid cell lines crag8  crb95  and 1g8  
class4	1283	finally  recombinant adf exhibits marked synergism with other cytokines  such as il 1 and il 2  allowing virally infected lymphocytes to respond to suboptimal amounts of a variety of growth factors  
class4	1284	the recombinant immunotoxin anti tac fv  pseudomonas exotoxin 40 is cytotoxic toward peripheral blood malignant cells from patients with adult t cell leukemia  
class4	1284	anti tac fv  pe40 is a recombinant single chain immunotoxin containing the heavy and light variable regions of the anti tac monoclonal antibody fused to a mutant form of pseudomonas exotoxin  pe   
class4	1284	anti tac binds to the p55 subunit of the human interleukin 2  il 2  receptor  and anti tac fv  pe40 kills human or monkey cell lines that contain either the intact il 2 receptor or its p55 subunit alone  
class4	1284	to assess the usefulness of anti tac fv  pe40 in treatment of il 2 receptor positive leukemia  we tested peripheral blood mononuclear cells from six patients with adult t cell leukemia  
class4	1284	in each of the six patients  anti tac fv  pe40 was extremely cytotoxic to the malignant cells  
class4	1284	metabolic activity and sensitivity of the fresh cells improved when a small amount of il 2  10 units per ml  was present during incubation  
class4	1284	the toxin concentration necessary to inhibit protein synthesis by 50  after 16 hr incubation of cells with immunotoxin varied from 1 6 to 16 ng ml  2 5 25 x 10  11  m   
class4	1284	in every case  binding was by means of the tac antigen because anti tac fv  pe40 cytotoxicity was prevented by adding excess anti tac antibody  
class4	1284	moreover  anti tac alone or an inactive mutant of anti tac fv  pe40 without adp ribosylation activity had very little cytotoxic activity  
class4	1284	peripheral blood mononuclear cells from normal controls  from a patient with tac negative leukemia  and from adult t cell leukemia patients without significant peripheral blood involvement were not sensitive to anti tac fv  pe40  
class4	1284	these results indicate that anti tac fv  pe40 is a potent cytotoxin against adult t cell leukemia cells in vitro and warrants clinical testing  
class4	1285	a 170 kda membrane bound protease is associated with the expression of invasiveness by human malignant melanoma cells  
class4	1285	malignant spreading of cancer cells requires cell surface proteases that cleave the crosslinked collagenous matrix of connective tissues  
class4	1285	from correlating the morphologically defined invasiveness of tumor cells with the presence of specific membrane associated proteases  we have identified a malignant human melanoma cell line  lox  that invades crosslinked gelatin films in vitro and contains uniquely a neutral 170 kda gelatinase in the cell membrane  
class4	1285	a similar gelatinase was found in membranes recovered from culture media conditioned with lox  
class4	1285	the 170 kda gelatinase is a wheat germ agglutinin binding protein  
class4	1285	the proteolytic activity is maximal at neutral ph  enhanced by edta and dithiothreitol  inhibited by the cysteine protease inhibitors n ethylmaleimide  hgcl2  and phenylmethylsulfonyl fluoride  and can bind to an organomercurial adsorbent  suggesting that it is a neutral sulfhydryl sensitive protease  
class4	1285	this 170 kda gelatinase of lox cells was not found in a control melanoma cell line  sk mel28  or in 32 other tumor cell lines that did not show extracellular gelatin degradation  
class4	1285	thus  we have identified a large membrane bound protease that may be a specific marker molecule for melanoma cell invasiveness  
class4	1286	homeobox gene expression plus autocrine growth factor production elicits myeloid leukemia  
class4	1286	in the murine myelomonocytic leukemia wehi 3b  proviral insertions have induced expression of the hox 2 4 homeobox gene and the gene for the myeloid growth factor interleukin 3  il 3   
class4	1286	to assess their potential oncogenic role  normal bone marrow cells were infected with retroviruses bearing the genes for il 3 or il 3 plus hox 2 4  
class4	1286	unlike the il 3 virus  the il 3 hox 2 4 virus was highly leukemogenic  
class4	1286	infected cells expressing both genes exhibited retarded differentiation in vitro  generated myelomonocytic cell lines  and provoked a rapid  transplantable myeloid leukemia in vivo  
class4	1286	the oncogenic action of hox 2 4 appears to derive from its ability to impede the il 3 driven terminal differentiation of myeloid cells  
class4	1286	the results suggest that homeobox genes can regulate key differentiation processes such as self renewal capacity and that their inappropriate expression can be oncogenic  
class4	1287	introduction of nerve growth factor  ngf  receptors into a medulloblastoma cell line results in expression of high  and low affinity ngf receptors but not ngf mediated differentiation  
class4	1287	expression of the cloned human nerve growth factor receptor  ngfr  cdna in cell lines can generate both high  and low affinity binding sites  
class4	1287	since the inability to respond appropriately to differentiation factors such as ngf may contribute to determining the malignant phenotype of neuroblastomas  we sought to determine whether the same is true of medulloblastomas  
class4	1287	to generate a human central nervous system neuronal cell line that would respond to ngf  we infected the medulloblastoma cell line d283 med with a defective retrovirus carrying the cdna coding for the human ngfr  
class4	1287	the resultant cells  med ngfr  expressed abundant low  and high affinity ngfrs  and ngf treatment induced a rapid transient increase of c fos mrna in the ngfr expressing cells but not in the parent line or in cells infected with virus lacking the cdna insert  
class4	1287	however  the med ngfr cells did not internalize the ngfr at high efficiency  nor did they differentiate in response to ngf  
class4	1287	three important conclusions emerge from this study   i  internalization of ngfrs is not necessary for some early rapid transcriptional effects of ngf   ii  an unknown factor s  that cooperates with the cloned ngfr in allowing high affinity ngf binding is found in a primitive central nervous system cell line  and  iii  ngfrs introduced into and expressed by d283 med  i e   med ngfr  cells are partially functional but are unable to induce differentiation in these primitive neuron like tumor cells  implying that high efficiency receptor mediated endocytosis of ngf and its receptor may be a necessary step in the cascade of events leading to ngf mediated differentiation  
class4	1288	rapid  nonradioactive detection of clonal t cell receptor gene rearrangements in lymphoid neoplasms  
class4	1288	southern blot hybridization analysis of clonal antigen receptor gene rearrangements has proved to be a valuable adjunct to conventional methods for diagnosing lymphoid neoplasia  
class4	1288	however  southern blot analysis suffers from a number of technical disadvantages  including the time necessary to obtain results  the use of radioactivity  and the susceptibility of the method to various artifacts  
class4	1288	we have investigated an alternative approach for assessing the clonality of antigen receptor gene rearrangements in lymphoid tissue biopsy specimens  
class4	1288	this approach involves the amplification of rearranged gamma t cell receptor genes by the polymerase chain reaction and analysis of the polymerase chain reaction products by denaturing gradient gel electrophoresis  
class4	1288	by use of this approach  clonal rearrangements from neoplastic lymphocytes constituting as little as 0 1 1  of the total cells in the tissue are detected as discrete bands in the denaturing gel after the gel is stained with ethidium bromide and viewed under ultraviolet light  
class4	1288	in contrast  polyclonal rearrangements from reactive lymphocytes appear as a diffuse smear along the length of the gel  
class4	1288	our findings suggest that polymerase chain reaction combined with denaturing gradient gel electrophoresis may offer a rapid  nonradioactive  and sensitive alternative to southern blot analysis for the diagnostic evaluation of lymphoid tissue biopsy specimens  
class4	1289	dioxin inducible  ah receptor dependent transcription in vitro  
class4	1289	we have developed a homologous in vitro transcription system that requires  i  2 3 7 8 tetrachlorodibenzo p dioxin  called tcdd or dioxin    ii  the ah receptor  and  iii  a dioxin responsive enhancer for activity  
class4	1289	unfractionated nuclear extracts from mouse hepatoma cells contain an inhibitor and fail to direct transcription in vitro  
class4	1289	however  following phosphocellulose chromatography and reconstitution  the fractionated nuclear extract directs accurate transcription in vitro  using as a template the promoter enhancer region from the mouse cytochrome p1 450 gene  cyp1a1  linked to a  g free cassette   which generates a transcript with no guanosine residues   
class4	1289	extracts from tcdd treated cells exhibit higher activity than extracts from untreated cells when transcribing a template containing both the promoter and enhancer but not when transcribing a template containing the promoter alone  
class4	1289	extracts from ah receptor defective cells fail to direct in vitro transcription in a tcdd inducible fashion  
class4	1289	a regulatory element that contains two binding sites for the liganded ah receptor plus a truncated cyp1a1 promoter suffices to direct tcdd inducible  ah receptor dependent transcription in vitro  
class4	1289	the inducible  receptor dependent  enhancer dependent properties of this system make it appropriate for analyzing in vitro the mechanism of dioxin action and the function of the ah receptor  
class4	1290	molecular structure of a major insulin mitogen activated 70 kda s6 protein kinase  
class4	1290	the molecular structure of a rat hepatoma 70 kda insulin mitogen stimulated s6 protein kinase  obtained by molecular cloning  is compared to that of a rat homolog of the 85 kda xenopus s6 protein kinase alpha  both kinases were cloned from h4 hepatoma cdna libraries  
class4	1290	the 70 kda s6 kinase  calculated molecular mass of 59 186 da  exhibits a single catalytic domain that is most closely related in amino acid sequence  56  identity  to the amino terminal  kinase c like domain of the rat p85 s6 kinase  calculated molecular mass of 82 695 da   strong similarity extends through a further 67 residues carboxyl terminal to the catalytic domain  40  identity   corresponding to a region also conserved among the kinase c family  
class4	1290	outside of this segment of approximately 330 amino acids  the structures of the p70 and p85 s6 kinases diverge substantially  
class4	1290	the p70 s6 kinase is known to be activated through serine threonine phosphorylation by unidentified insulin mitogen activated protein kinases  
class4	1290	a model for the regulation of p70 s6 protein kinase activity is proposed wherein the low activity of the unphosphorylated enzyme results from the binding of a basic  inhibitory pseudosubstrate site  located carboxyl terminal to the extended catalytic domain  to an acidic substrate binding region  located amino terminal to the catalytic domain   substrate binding is thereby prevented  
class4	1290	s6 kinase activation requires displacement of this inhibitory segment  which is proposed to occur consequent to its multiple phosphorylation  
class4	1290	the putative autoinhibitory segment contains several serine and threonine residues  each followed directly by a proline residue  
class4	1290	this motif may prevent autophosphorylation but permit transphosphorylation  two of these serine residues reside in a maturation promoting factor  mpf  cdc 2 consensus motif  
class4	1290	thus  hormonal regulation of s6 kinase may involve the action of mpf cdc 2 or protein kinases with related substrate specificity  
class4	1291	identical splicing of aberrant epidermal growth factor receptor transcripts from amplified rearranged genes in human glioblastomas  
class4	1291	the epidermal growth factor receptor gene has been found to be amplified and rearranged in human glioblastomas in vivo  
class4	1291	here we present the sequence across a splice junction of aberrant epidermal growth factor receptor transcripts derived from corresponding and uniquely rearranged genes that are coamplified and coexpressed with non rearranged epidermal growth factor receptor genes in six primary human glioblastomas  
class4	1291	each of these six tumors contains aberrant transcripts derived from identical splicing of exon 1 to exon 8 as a consequence of a deletion rearrangement of the amplified gene  the extent of which is variable among these tumors  
class4	1291	in spite of this intertumoral variability  each intragenic rearrangement results in loss of the same 801 coding bases  exons 2 7  and creation of a new codon at the novel splice site in their corresponding transcripts  
class4	1291	these rearrangements do not  however  affect the mrna sequence for the signal peptide  the first five codons  or the reading frame downstream of the rearrangement  
class4	1292	correlation of the structure of the transmembrane domain of the neu oncogene encoded p185 protein with its function  
class4	1292	the human homologue of the neu oncogene is frequently found in human tumors  
class4	1292	certain amino acid substitutions at position 664 in the transmembrane domain of the neu oncogene encoded p185 protein product are known to cause malignant transformation of cells  
class4	1292	using conformational energy analysis based on ecepp  empirical conformational energies for polypeptides program   we have previously determined the preferred three dimensional structures for the transmembrane domain of the p185 protein with a transforming  glutamic acid  and a nontransforming  valine  substitution at the critical position 664 and found that the global minimum energy conformation of this region in the nontransforming protein contains a sharp bend  whereas the global minimum energy conformation for this region from the transforming protein is entirely alpha helical  
class4	1292	we now demonstrate that this result holds for other known nontransforming  glycine  histidine  tyrosine  and lysine  and transforming  glutamine  substitutions at position 664  
class4	1292	furthermore  a simple statistical thermodynamic analysis of the results indicates that approximately 85  of each of the nontransforming sequences exist with the bend at positions 664 and 665  while approximately 90  of each of the transforming sequences exist as an alpha helix  
class4	1292	about 9  of the nontransforming sequences exist as the alpha helix  
class4	1292	these results suggest that if the intracellular concentration of the normal protein is increased at least 10 fold  thereby increasing the alpha helical form by this factor  cell transformation should result  
class4	1292	this conclusion is directly supported by genetic experiments in which this level of overexpression of the normal protein was achieved with attendant cell transformation  
class4	1293	sixty consecutive breast reconstructions with the inflatable expander  a critical appraisal  
class4	1293	breast reconstruction using inflatable expanders has become an established and preferred technique  
class4	1293	although our knowledge of the biomechanical changes occurring in expanded skin has increased greatly  little information is available regarding average aesthetic results achieved with this technique  
class4	1293	in order to eliminate the bias of best case selection reports  this study of 60 consecutive patients undergoing skin expansion breast reconstruction was undertaken  
class4	1293	results of the study demonstrated a significant frequency and diversity of complications  
class4	1293	in particular  immediate breast reconstruction with skin expanders was identified as a high risk procedure because of its association with skin necrosis and delayed wound healing  
class4	1293	although two procedures  insertion and replacement  had been anticipated  patients from both the boston and new york groups required approximately three operations to complete the expansion process  
class4	1293	average aesthetic results  often characterized by problems of symmetry  ptosis  and contour  need to be recognized and improved  
class4	1294	a prospective clinical evaluation of autogenous vein grafts used as a nerve conduit for distal sensory nerve defects of 3 cm or less  
class4	1294	the purpose of this study was to determine the efficacy of autogenous vein grafts as nerve grafts  avnc  for bridging of small peripheral sensory nerve gaps as compared with direct repair and with conventional nerve grafting techniques  ang   
class4	1294	patients with painful neuroma or segmental nerve injury of 3 cm were chosen as the test group  
class4	1294	those amenable to direct repair were classified as controls  
class4	1294	between 1982 to 1988  a total of 22 patients were enrolled in this study  
class4	1294	a total of 34 nerves were repaired  15 with a venous nerve conduit  4 with a sural nerve graft  and 15 with direct repair  
class4	1294	significant symptom relief and satisfactory sensory function return were uniformly observed  
class4	1294	the two point discrimination measurements indicated superiority of direct repair and probably of conventional nerve grafting  
class4	1294	however  the universally favorable patient acceptance and the return of measurable two point discrimination indicates the effectiveness of autogenous vein grafts as nerve conduits when selectively applied to bridge a small nerve gap  less than or equal to 3 cm  on nonessential peripheral sensory nerves  
class4	1295	dacron fabric enveloped hydroxyapatite prosthesis for sternal tumor defect  an autopsy report  
class4	1295	a 38 year old housewife with solitary plasmacytoma of the manubrium who underwent a subtotal sternectomy treated by resection of the lesion is reported  
class4	1295	this was followed by replacement with a dacron fabric enveloped hydroxyapatite prosthesis  
class4	1295	the dacron fabric was sutured to the surrounding tissues  and then the clavicle was passed through the cylindrical shaped dacron fabric to form a sternoclavicular joint capsule  
class4	1295	the patient returned to her daily life 3 months after the operation  
class4	1295	she had no trouble in her daily living  without any dislocation of the sternoclavicular joints or any displacement of the artificial sternum  
class4	1295	the autopsy examination about 1 year after the operation showed that the dacron fabric enveloping the artificial sternum became stronger with time  
class4	1295	the sternoclavicular joint also was stably fixed  and the dacron fabric fulfilled its function as an artificial articular capsule and biologic fixation of the surrounding supporting tissues  
class4	1296	interventional radiology of the biliary tract  intraductal radiation  
class4	1296	one palliative method of treating patients with a high duct cholangiocarcinoma is the use of 192ir wire  
class4	1296	this is placed through the tumor  which has been previously intubated  and delivers a high local dose of radiation  
class4	1296	the mean survival time in 30 patients treated with intraductal radiation was 16 8 months  an improvement compared to surgical bypass or endoscopic and radiologic drainage procedures  
class4	1297	pneumonia due to legionella micdadei in bone marrow transplant recipients  
class4	1297	legionella micdadei has previously been described as a cause of nosocomial pneumonia  particularly in kidney transplant recipients  
class4	1297	cell mediated immunity is the principal host defense against this pathogen  
class4	1297	a common clinical scenario in the immunocompromised host is that of septic pulmonary embolus  but asymptomatic infections have also been reported  
class4	1297	the organism is weakly acid fast in clinical specimens but loses this property when grown on solid media  
class4	1297	we report two cases of l  
class4	1297	micdadei pneumonia  differing markedly in clinical severity and outcome  in bone marrow transplant recipients  
class4	1297	additionally  we note the growth of the organism in liquid culture media with preservation of its acid fast property  
class4	1298	current advances in the diagnosis and treatment of aids  an introduction  
class4	1298	significant progress has been made in the diagnosis and treatment of aids  
class4	1298	laboratory tests available for assessment of human immunodeficiency virus  hiv  infection include the detection of antibodies to hiv type 1  the direct detection of the virus  the identification of surrogate markers  and the phenotypic analysis of peripheral blood mononuclear cells  
class4	1298	clinicians have made great strides in the treatment of tumors  opportunistic infections  and complications associated with aids as well as in the treatment of the infection itself  
class4	1298	in selected patients  treatment with interferon alpha has been successful against aids related kaposi s sarcoma  
class4	1298	attempts to treat the leukopenia and anemia of patients with aids by the administration of hematopoietic growth factors have resulted in increased white blood cell counts and a decrease in erythrocyte transfusion requirements  
class4	1298	in addition to zidovudine  several antiretroviral agents are undergoing testing  including the nucleoside analogues dideoxycytidine and dideoxyinosine  soluble cd4  and the glycosidase inhibitor n butyldeoxynojirimycin  
class4	1299	cytomegalovirus infections in bone marrow transplant recipients given intensive cytoreductive therapy  
class4	1299	cytomegalovirus  cmv  infections were studied in 785 bone marrow transplant recipients given intensive cytoreductive therapy  
class4	1299	cmv excretion occurred in 24   viremia in 9   seroconversion in 40   and overall active infection in 47   
class4	1299	cmv disease was much less common  
class4	1299	retinitis  enteritis  and pneumonitis occurred in only one  five  less than 1    and 55  7   of the patients  respectively  
class4	1299	allograft recipients were more likely to develop cmv disease than were autograft patients  p    0001  despite comparable rates of active cmv infection  
class4	1299	cmv disease was rare after primary infection in both autograft and allograft recipients  0 and 1   respectively   
class4	1299	in contrast  cmv disease occurred in 16  of seropositive allograft recipients  
class4	1299	among allograft recipients  risk factors for cmv pneumonitis were seropositivity  age greater than 10 years  and acute graft vs  host disease  while the use of cyclosporine as prophylaxis against graft vs  host disease was protective  
class4	1299	although active infection rates did not decrease  the rates of cmv pneumonitis in allograft recipients during successive years declined significantly  p less than  001   
class4	1300	detection of bcr abl fusion in chronic myelogeneous leukemia by in situ hybridization  
class4	1300	chronic myelogeneous leukemia  cml  is genetically characterized by fusion of the bcr and abl genes on chromosomes 22 and 9  respectively  
class4	1300	in most cases  the fusion involves a reciprocal translocation t 9 22  q34 q11   which produces the cytogenetically distinctive philadelphia chromosome  ph1   
class4	1300	fusion can be detected by southern  dna  analysis or by in vitro amplification of the messenger rna from the fusion gene with polymerase chain reaction  pcr   
class4	1300	these techniques are sensitive but cannot be applied to single cells  
class4	1300	two color fluorescence in situ hybridization  fish  was used with probes from portions of the bcr and abl genes to detect the bcr abl fusion in individual blood and bone marrow cells from six patients  
class4	1300	the fusion event was detected in all samples analyzed  of which three were cytogenetically ph1 negative  
class4	1300	one of the ph1 negative samples was also pcr negative  
class4	1300	this approach is fast and sensitive  and provides potential for determining the frequency of the abnormality in different cell lineages  
class4	1301	regulation of gene expression with double stranded phosphorothioate oligonucleotides  
class4	1301	alteration of gene transcription by inhibition of specific transcriptional regulatory proteins is necessary for determining how these factors participate in cellular differentiation  
class4	1301	the functions of these proteins can be antagonized by several methods  each with specific limitations  
class4	1301	inhibition of sequence specific dna binding proteins was achieved with double stranded  ds  phosphorothioate oligonucleotides that contained octamer or kappa b consensus sequences  
class4	1301	the phosphorothioate oligonucleotides specifically bound either octamer transcription factor or nuclear factor  nf  kappa b  
class4	1301	the modified oligonucleotides accumulated in cells more effectively than standard ds oligonucleotides and modulated gene expression in a specific manner  
class4	1301	octamer dependent activation of a reporter plasmid or nf kappa b dependent activation of the human immunodeficiency virus  hiv  enhancer was inhibited when the appropriate phosphorothioate oligonucleotide was added to a transiently transfected b cell line  
class4	1301	addition of phosphorothioate oligonucleotides that contained the octamer consensus to jurkat t leukemia cells inhibited interleukin 2  il 2  secretion to a degree similar to that observed with a mutated octamer site in the il 2 enhancer  
class4	1301	the ds phosphorothioate oligonucleotides probably compete for binding of specific transcription factors and may provide anti viral  immunosuppressive  or other therapeutic effects  
class4	1302	survey of alabama physicians  use of mammography  1989  
class4	1302	in early 1989 we surveyed by questionnaire alabama primary care physicians  n   1800  concerning their attitudes toward and use of mammography  
class4	1302	there were 681 respondents  37 8    
class4	1302	the majority  83   recommend mammograms for their patients according to the american cancer society guidelines and obtain baseline studies in asymptomatic women between the ages of 35 and 40 years  
class4	1302	it appears that the cost of mammograms is decreasing in alabama  a screening study was available for  50 or less to 34  of responding physicians  
class4	1302	almost one half  48   of the physician respondents believe that more than 50  of their patients have had at least one mammogram  
class4	1303	preventing colorectal cancer  
class4	1303	knowledgeable patients should not die of colorectal cancer  
class4	1303	increasing the intake of dietary fiber  decreasing fat consumption  and increasing the use of modern technology to detect adenomatous polyps and early cancer can greatly decrease the mortality associated with colorectal cancer  
class4	1304	synchronous hodgkin s disease and myelofibrosis terminating with granulocytic sarcoma and acute megakaryocytic leukemia  
class4	1304	our patient had stage iiiai hodgkin s disease with synchronous myelofibrosis and myeloid metaplasia  
class4	1304	a slowly progressive myeloproliferative disease developed over 9 1 2 years and terminated in a painful osteolytic bone disease  spinal extradural granulocytic sarcoma and acute megakaryocytic leukemia  
class4	1304	it is likely that this was a result of the myeloproliferative disease rather than a late complication from combination chemotherapy  
class4	1304	our case demonstrates the importance of a curative approach to hodgkin s disease even in the face of a coexistent disease with a long or unknown natural history  
class4	1305	adenocarcinoma of the appendiceal stump  
class4	1305	we have reported the case of a 58 year old woman with nonspecific abdominal complaints in whom barium enema and subsequent colonoscopy showed a 3 cm lobulated adenocarcinoma within a villous adenoma arising from the appendiceal stump  
class4	1305	because such appendiceal malignancies have no specific clinical signs  symptoms  or radiologic features  preoperative diagnosis is extremely difficult  and colonoscopy may be required to clarify radiologically demonstrated irregularities  
class4	1306	trabecular or merkel s cell carcinoma  
class4	1306	two cases of trabecular cell carcinoma of the skin are presented  
class4	1306	the clinical presentation and behavior  and the histologic findings  of the tumor are described  
class4	1306	surgical excision of the primary lesion with regional lymph node dissection  if indicated  is the treatment of choice  
class4	1306	distant metastasis is treated by local irradiation  
class4	1307	adenocarcinoma of the colon occurring with intussusception in an adolescent  
class4	1307	hydrostatic reduction of intussusception is definitive therapy in most infants with this abnormality  
class4	1307	in the older child  adolescent  and adult  a polyp or tumor is often present  
class4	1307	operative intervention should be considered earlier in the clinical course both to relieve the intussusception and to define the nature of the lead point  
class4	1308	the predictive value of needle localization mammographically assisted biopsy of the breast  
class4	1308	this study was done to review critically the experience at the university of california at san diego in needle localization mammographic biopsy of the breast with regard to use and accuracy in identifying early carcinoma of the breast  
class4	1308	ninety seven patients underwent needle localization mammographic biopsy of the breast between 1985 and 1987  
class4	1308	indications for this procedure included the presence of microcalcifications or a mass shown on mammographic examination  or both  in conjunction with physical examination which did not define a discrete abnormality in the area  
class4	1308	mammographic  demographic  pathologic  hormone receptor data and staging information were recorded and processed on the microvax ii computer  digital equipment corporation   
class4	1308	twenty four per cent of lesions with needle localization mammographic assisted biopsy proved to be malignant  
class4	1308	sixteen lesions were diagnosed as an infiltrating ductal carcinoma and ten of these had an accompanying intraductal carcinoma  
class4	1308	over all  intraductal carcinoma was present in 16 of the 23 specimens diagnosed as malignant  
class4	1308	at biopsy  the margins were clear in 17 of 23  and vascular invasion was present in only one patient with an infiltrating lobular carcinoma  
class4	1308	five were tumor in situ  12 were stage 1 and five were stage 2  staging information was not available in one instance   
class4	1308	hormone receptor data were available in 17 of 23 specimens  
class4	1308	estrogen receptors were positive in 13 and progesterone receptors were positive in six  
class4	1308	the smallest preinvasive malignant lesion was 4 millimeters  as seen on the mammogram  and the smallest free standing invasive lesion was 8 millimeters  
class4	1308	preinvasive lesions  intraductal  presented as microcalcifications in 80 per cent  
class4	1308	invasive lesions presented as either a mass  n   9  or as a mass and microcalcifications  n   5  in 81 per cent  
class4	1308	all five lesions presenting as both a mass and microcalcifications on mammogram proved to be malignant  
class4	1308	multifocal lesions on mammographic examination which proved to be malignant were multifocal pathologically in only 50 per cent  
class4	1308	needle localization mammographic biopsy is useful in detecting early carcinoma of the breast  
class4	1308	biopsy should be done on lesions presenting on mammogram as both a mass and microcalcifications and not observed  
class4	1308	focality of lesions on mammogram does not correlate with focality on biopsy and may be misleading as criteria for operative planning  
class4	1309	focal nodular hyperplasia of the liver  
class4	1309	twenty four patients underwent biopsy or resection of the liver for focal nodular hyperplasia  fnh  at memorial sloan kettering cancer center from 1978 to 1988  
class4	1309	twenty two of the patients were women  
class4	1309	the mean age was 35 years  
class4	1309	a history of antecedent oral contraceptive or conjugated estrogen  premarin  use was obtained in 18 of 21 women  
class4	1309	there were two men  aged 26 and 37 years  neither gave a history of hormone use  
class4	1309	most of the tumors were solitary  22 of 24  and located in the left lobe of the liver  17 of 22   
class4	1309	fifteen of the patients had a prior or simultaneous malignant lesion and six had other benign tumors  
class4	1309	most of the tumors were resected with a wedge or subsegment of liver  13 of 24   
class4	1309	four patients underwent segmentectomy and five required lobectomy for removal of the tumors  
class4	1309	two patients had an intraoperative biopsy only  
class4	1309	the patients in whom the tumor was diagnosed preoperatively underwent computed tomography and arteriography routinely  
class4	1309	scintigraphy of the liver with sulfur colloid was obtained in only three patients  despite its distinct potential for nonoperative diagnosis of fnh  
class4	1310	time to recurrence varies inversely with thickness in clinical stage 1 cutaneous melanoma  
class4	1310	the thickness of a tumor has been identified as the principal prognostic factor in cutaneous malignant melanoma  
class4	1310	however  time to recurrence has not conclusively been related to thickness  
class4	1310	a retrospective study of 216 patients with a primary cutaneous malignant melanoma that recurred was conducted to clarify this relationship and investigate possible independent relationships between age at diagnosis and sex of patients to time to recurrence  
class4	1310	the results of analysis of linear regression revealed an inverse linear relationship between thickness and time to recurrence  p less than 0 001   
class4	1310	patients more than 50 years of age at the time of diagnosis were shown to relapse sooner than those less than 50 years of age  p   0 014   
class4	1310	sex was not a significant factor in predicting time to recurrence  p greater than 0 10   
class4	1310	these results suggest that thickness of tumor provides an indication of time to recurrence in those patients destined to recur and stress the need for long term surveillance in patients with a history of malignant melanoma because of the possibility of late relapse even with thin lesions  
class4	1311	repeat hepatic resection for primary and metastatic carcinoma of the liver  
class4	1311	during the last 15 years  19 patients underwent repeated hepatic resections for malignant lesions of the liver  
class4	1311	the first hepatic resection had been performed four to 40 months earlier for treatment of hepatocellular carcinoma  nine patients  or hepatic metastases  ten patients   eight of which were of colorectal origin  
class4	1311	repeat resection was an extensive hepatectomy in six  a segmentectomy in six and a local excision in seven  
class4	1311	in one patient  three wedge resections and  finally  hepatic transplantation were subsequently performed after an initial extended right lobectomy  
class4	1311	the operative mortality rate was 5 2 per cent  
class4	1311	the three year actuarial survival rate was 64 per cent after the second resection  
class4	1312	mediastinal tracheostomy using a pectoralis major myocutaneous flap after resection of carcinoma of the esophagus involving the proximal part of the trachea  
class4	1312	an operative procedure of mediastinal tracheostomy using a pectoralis major myocutaneous flap is presented  
class4	1312	in this procedure  the terminal portion of the trachea penetrates through the center of a pectoralis major myocutaneous flap and the tracheal wall is completely wrapped with the muscular portion of the flap  
class4	1312	between 1981 and 1988  eight patients with carcinoma in the cervicothoracic segment of the esophagus underwent mediastinal tracheostomy after laryngoesophagectomy and extended resection of the proximal part of the trachea through sternal manubrectomy  because of invasion into the trachea  
class4	1312	in five of eight patients  a pectoralis major myocutaneous flap was used to construct a tracheal stoma  
class4	1312	a skin flap only  or both a skin flap and a muscle flap  was used in the other three  
class4	1312	in four of eight patients  tracheal necrosis occurred  and rupture of the brachiocephalic artery occurred in one patient when the tracheal stoma had been constructed using both a skin flap and a muscle flap  
class4	1312	however  neither skin breakdown nor bleeding from the major vessels occurred when using the myocutaneous flap  
class4	1312	therefore  it is concluded that the construction of the tracheal stoma using a pectoralis major myocutaneous flap is recommended for mediastinal tracheostomy after laryngoesophagectomy with extended resection of the proximal part of the trachea  
class4	1313	the justification for surgical treatment of metastatic melanoma of the gastrointestinal tract  
class4	1313	fifty six patients with symptomatic metastatic melanoma of the gastrointestinal tract  git  treated surgically at the sydney melanoma unit between 1974 and 1989 were reviewed  
class4	1313	the majority of these patients presented with abdominal pain or symptoms of anemia  
class4	1313	the small intestine was the site of metastasis in more than 80 per cent  
class4	1313	the mean over all survival time was 11 7 months  range of one to 60 months  after surgical treatment of a first metastasis to the git and 3 6 months  range of zero to 12 months  postoperatively for a second git metastasis  
class4	1313	forty four of the patients reported complete relief of their symptoms postoperatively  
class4	1313	the results suggest that an aggressive approach to symptomatic git metastases from malignant melanoma is justified both to relieve distressing symptoms and to prolong life  
class4	1314	hepatic resection for advanced hepatocellular carcinoma with removal of portal vein tumor thrombi  
class4	1314	in 13 of 398 patients who underwent hepatectomy  tumor thrombi of the remnant portal vein was concomitantly removed by the balloon catheter method in 8  an open method under hepatic vascular exclusion in 1  and resection of the occlusive portal segment followed by portal reconstruction in 4  
class4	1314	in 8 of these patients the liver was cirrhotic  
class4	1314	the mode of hepatectomy consisted of bisegmetectomy or trisegmentectomy in 11  segmentectomy in one  and partial resection in one patient  
class4	1314	two patients died of portal thrombosis or hepatic failure in the hospital  
class4	1314	the mean survival in four patients was 12 months  
class4	1314	seven are still alive  mean  16 months   
class4	1314	in the corresponding period  nine patients with occlusive tumor thrombi of the portal confluence were hospitalized without operation and survived up to 4 months  mean  64 days  after detection of the tumoral occlusion  
class4	1314	the causes of death of the nine patients were bleeding esophageal varices  rupture of the tumor  or hepatic failure  
class4	1314	it was revealed that removal of tumor thrombi in the remnant portal vein contributes to  1  portal decompression   2  feasibility of arterial embolization  and  3  increase in resectability of the main tumor  
class4	1314	at present  this procedure might be regarded as an emergency procedure for the avoidance of the above lethal impendence  but it may open the door to an adjuvant therapy  
class4	1315	decollateralization with silicone rubber sheeting for advanced hepatocellular carcinoma  a preliminary report  
class4	1315	a new treatment method  interception of collaterals with a silicone rubber sheet  was applied to three patients with advanced hepatocellular carcinoma in whom arterial chemoembolization was assessed as ineffective because of the developed collateral feeding arteries  
class4	1315	this procedure was followed by arterial chemoembolization or intraportal infusion chemotherapy or both  
class4	1315	follow up celiac angiography confirmed that the long term decollateralization was achieved by shielding the liver with silicone rubber sheeting  
class4	1315	this technique resulted in partial responses without serious complications in all the patients including two who had no responses to chemoembolization before the procedure  
class4	1315	the response durations were 5  21  and 27  months  respectively  
class4	1315	one patient died of gastrointestinal bleeding 7 months after the decollateralization  
class4	1315	the other two patients are still alive  and the survivals after the procedure are 28 and 30 months  respectively  
class4	1315	this therapy is considered promising and may be worth choosing as an adjuvant treatment for advanced hepatic malignancies uncontrolled by arterial chemotherapy or chemoembolization  
class4	1316	the role of gastric resection in the management of multicentric argyrophil gastric carcinoids  
class4	1316	a patient with pernicious anemia  atrophic non antral gastritis  hypergastrinemia  and widespread hyperplasia of enterochromaffin like cells and manifest enterochromaffin like cell carcinoma was followed up during 39 months  including 15 months after gastric resection  
class4	1316	in this case normalization of gastrin levels did not prevent the development of multiple gastric carcinoids in the fundic mucosa  suggesting that factors other than gastrin are of importance in the pathogenesis  
class4	1317	portal vein resection with a new antithrombogenic catheter  
class4	1317	curative resection of pancreatic and hepatobiliary tumors is rarely possible because of local invasion  especially into the portal vein  
class4	1317	we developed a new antithrombogenic catheter using a heparinized hydrophilic polymer to allow portal vein bypass during resection of tumors invading the portal vein  
class4	1317	pancreatectomy or hepatectomy accompanied by portal vein resection was performed for pancreatic or hepatobiliary cancer  with an intraoperative shunt from the superior mesenteric vein to the femoral vein or from the superior mesenteric vein to the intrahepatic portal vein through the umbilical vein or the hepatic hilar portal vein  
class4	1317	use of the shunt prevented stasis in the superior mesenteric vein and hepatic ischemia even during prolonged occlusion of the portal vein  and portal vein resection was performed in 81 patients with hepatobiliary and pancreatic disease with greater safety and ease  
class4	1318	adoptive immunotherapy of human pancreatic cancer with lymphokine activated killer cells and interleukin 2 in a nude mouse model  
class4	1318	a pancreatic cancer cell line was grown in orthotopic and heterotopic positions in young swiss nih nude mice  which were tested with adoptive immunotherapy  
class4	1318	mice were injected with 1 x 10 7  human cancer cells in the subcutaneous tissue and duodenal lobe of the pancreas  
class4	1318	the mice were randomly divided into four groups  group ia  lak   il 2   n   25  received 2 x 10 7  human lymphokine activated killer  lak  cells from normal donors by tail vein injection followed by 10 000 units of human recombinant interleukin 2  il 2  given intraperitoneally every 12 hours for 28 days  group ib  il 2   n   27  was given the same dose of il 2 alone  group ic  rpmi 1640   n   18  received a placebo consisting of 1 ml of rpmi 1640 intraperitoneally every 12 hours  and group id  lak   n   14  received 2 x 10 7  lak cells but no il 2  
class4	1318	toxicity was significantly higher in group ib  with a mortality rate of 45 5   10 22 animals  versus a 0  mortality  0 25  in group ia  
class4	1318	none of the group ia or ib animals died of pancreatic cancer during the experiment  
class4	1318	the animals that did not receive il 2 died before 28 days in 14 2  of group ic and in 16 7  of group id  
class4	1318	the area under the growth curve of subcutaneous tumors during the course of treatment and the pancreatic tumor weight at the end of treatment were compared in each group  
class4	1318	subcutaneous tumors had a reduced rate of growth in group ia animals compared to all the other treatments  
class4	1318	pancreatic tumor growth was slowed in group ia  
class4	1318	the animals treated with il 2 alone  group ib  showed some slowing of tumor growth that was intermediate between group ia  group ic  and group id  
class4	1318	a similar experiment was done with irradiated  375 rad  mice  
class4	1318	nine nude mice with tumors were treated with lak   il 2  group iia   eight received il 2 alone  group iib   and seven received placebo  group iic   
class4	1318	the antitumor effect of il 2 alone was not present in the irradiated mice  
class4	1318	a highly significant difference persisted between group iia and all other groups  
class4	1318	there was no difference in the histologic characteristics of tumors in control mice and in mice with inhibited tumor growth treated with il 2 or il 2 and human lak cells  
class4	1318	these results show that adoptive immunotherapy with human lak cells and human recombinant il 2 is effective against human pancreatic cancer growing in nude mice  
class4	1318	this effect is independent from antitumor activity from il 2 administrations alone  
class4	1319	radiation therapy of early  stages i and ii a  seminoma of testis after initial orchiectomy  
class4	1319	with initial orchiectomy and radiation therapy  the prognosis of the patients with early  stages i and ii a  testicular seminoma is nearing almost 100 percent  
class4	1319	thirty two patients with stage i and 13 patients with stage ii a seminoma of the testis were treated with initial orchiectomy  
class4	1319	this was followed by estimation biochemical markers and radiologic investigations  
class4	1319	all the patients with stage i disease received radiotherapy to the ipsilateral pelvic and para aortic nodes  
class4	1319	the patients with stage ii a disease also received radiation therapy to the supradiaphragmatic regions  
class4	1319	the disease free survival in both groups of patients was found to be 100 percent  
class4	1320	management of superficial g2  pta and pt1  bladder cancer  
class4	1320	a total of 143 patients with superficial g2  pta  pt1  bladder cancer  48 g2pta  95 g2pt1  presenting between 1970 through 1987 were reviewed  
class4	1320	of 48 patients with g2pta followed for up to eighteen years  g3 recurrence developed only in 1  2 0    and invasive cancer  greater than pt2  developed only in 2  4 2    
class4	1320	they both received radiotherapy and have responded completely  
class4	1320	there have been no cancer related deaths  
class4	1320	in contrast  in the 95 patients in whom the basement membrane had been breached  pt1   higher grade tumor  g3  developed in 11  11 5    and 15  16   had recurrences with invasion of muscle  greater than pt2   
class4	1320	among these there were 7  7 3   cancer related deaths  
class4	1321	radiologic staging of chest in testicular seminoma  
class4	1321	we investigated the usefulness of chest x ray  cxr   conventional planar tomography  tom   and computerized axial tomography  cat  in evaluating patients with stages i and ii testicular seminoma  
class4	1321	all patients had a cxr  and 22 patients had either tom or cat as part of initial staging  
class4	1321	no occult pulmonary or mediastinal nodal disease was found during initial staging  and none of the patients manifested recurrence of tumor in these sites as a first event  
class4	1321	review of the literature corroborates our finding of a very small thoracic failure rate in early stage seminoma  
class4	1321	routine use of cat or tom is not indicated in staging these patients  
class4	1322	oncocytic renal tubular adenoma  so called oncocytoma  in seventeen year old girl  
class4	1322	renal tubular neoplasms  adenomas or adenocarcinomas  are rare in children or young adults  
class4	1322	herein  we report an oncocytic renal tubular adenoma  so called oncocytoma  that was found in a seventeen year old girl  
class4	1322	preoperative evaluation included aspiration of this tumor  and we suggest that preoperative aspiration is an important procedure in the diagnosis and management of suspected renal tumors in children and young adults  
class4	1323	intravesical condyloma acuminatum with progression to verrucous carcinoma  
class4	1323	condyloma acuminatum is a common form of venereal disease  
class4	1323	most patients with condylomata acuminata suffer from only the local cosmetic and irritative effects of the lesions  
class4	1323	few patients have progression to aggressive  regionally distributed lesions that can be life threatening  
class4	1323	we describe a forty three year old white woman who had a seventeen year history of scleroderma with extravesical and intravesical condylomata acuminata  
class4	1323	during two years of conservative management with transurethral excision  electrocoagulation  and intravesical chemotherapy  the disease progressed to involve the entire bladder and resulted in obstructive renal insufficiency that required anterior exenteration and urinary diversion  
class4	1323	the natural history of the disease is described  and the relevant literature is reviewed  
class4	1324	constitutional symptoms in patients with germ cell neoplasms  
class4	1324	a patient with a mediastinal germ cell neoplasm evidenced fever  weight loss  pruritus  and painful adenopathy on ingestion of alcohol  
class4	1324	retrospective review revealed that 9 percent of 104 patients with advanced germ cell neoplasm evidence constitutional symptoms at presentation  
class4	1325	natural history of cardiac rhabdomyoma in infancy and childhood  
class4	1325	although spontaneous regression of cardiac rhabdomyoma has been reported  prognosis is still considered to be poor and surgery continues to be indicated  
class4	1325	the experience with rhabdomyoma diagnosed in live infants over a 20 year period was reviewed  
class4	1325	diagnosis by angiography or echocardiography was accepted only if multiple tumors were present or if tuberous sclerosis was also diagnosed  
class4	1325	nine patients  3 diagnosed prenatally and the remaining 6 at age less than 8 months  were identified as having a total of 24 tumors  
class4	1325	measurements in 2 planes demonstrated at least some evidence of regression in 24 patients  100    with 20 of 24 having complete resolution  
class4	1325	one patient required delayed surgery for excision of a subaortic ridge that appeared at the site of a resolved tumor  
class4	1325	our findings suggest that pediatric cardiac rhabdomyoma is most often a benign condition in which spontaneous regression is the rule  
class4	1325	surgery is recommended only for patients with refractory dysrhythmias or severe hemodynamic compromise  
class4	1326	diet and female sex hormone concentrations  an intervention study for the type of fat consumed  
class4	1326	a possible mechanism by which dietary fat may influence the development of breast cancer is by influencing the concentration of female sex hormones  
class4	1326	this study investigated the effect of alteration in the type of fat consumed on concentrations of female sex hormones in serum  
class4	1326	female volunteers were randomly assigned to continue on their usual meat eating diet  change to a vegetarian diet  or change to a diet that was predominantly vegetarian but where fish was consumed at least three times per week  
class4	1326	change to the vegetarian or fish diet had little effect on diet total hormone concentrations  however  the amount of estradiol was significantly decreased in the vegetarian group  
class4	1326	when nutrient consumption was correlated with hormone concentrations  prolactin was directly associate with fat consumption  sex hormone binding globulin was inversely associated with fat consumption  particularly cholesterol consumption   and the proportion of nonprotein bound estradiol was directly associated with complex carbohydrate consumption  
class4	1327	dietary fat and risk of breast cancer  
class4	1327	the relationship between dietary fat and subsequent risk of breast cancer was studied in 3988 initially cancer free finnish women aged 20 69 y  
class4	1327	during a follow up period of 20 y  54 breast cancer cases were diagnosed  
class4	1327	risk of breast cancer was significantly inversely related to energy intake and nonsignificantly inversely related to absolute fat intake  
class4	1327	a positive association between energy adjusted total fat intake and occurrence of breast cancer was also observed  
class4	1327	the relative risk in the highest tertile as compared with the lowest tertile was 1 7  95  confidence limits 0 6 4 8   
class4	1327	the corresponding relative risks were 1 4  0 5 3 7  for saturated fatty acids  2 7  1 0 7 4  for monounsaturated fatty acids  1 2  0 6 2 8  for polyunsaturated fatty acids  and 2 2  1 0 5 0  for cholesterol intake  
class4	1327	adjustment for different potential confounding factors did not alter the results  
class4	1327	the present data suggest that breast cancer is associated inversely with energy intake and weakly positively with energy adjusted fat intake  
class4	1328	breast cancer and dietary and plasma concentrations of carotenoids and vitamin a  
class4	1328	a case control study of breast cancer was conducted in buffalo  
class4	1328	participants completed a food frequency questionnaire and donated a fasting blood sample before definitive workup for breast masses  
class4	1328	dietary and plasma concentrations of carotenoids and retinol for 83 women found to have breast cancer were compared with those of 113 women found to be free of breast cancer  control subjects   
class4	1328	there were no case control differences in dietary estimates of vitamin a intake or in plasma alpha carotene and lycopene  
class4	1328	however  subjects with breast cancer had lower concentrations of plasma beta carotene than did control subjects  p   0 02   
class4	1328	there was no overall association between plasma retinol and breast cancer but a positive relationship was observed between retinol and breast cancer in the subgroup with low beta carotene values  
class4	1328	these results suggest that low plasma beta carotene is associated with increased risk of breast cancer  
class4	1328	other studies will need to determine whether low carotene concentrations are a subtle effect of the disease or might be causally related to breast cancer  
class4	1329	follicular neoplasms of the thyroid in men older than 50 years of age  a dna flow cytometric study 
class4	1329	the clinical behavior of follicular neoplasms of the thyroid in elderly men can be difficult to predict on histologic grounds alone  
class4	1329	to assess the usefulness of dna flow cytometry in predicting the metastatic potential of these tumors  the authors studied 44 primary and metastatic follicular neoplasms of the thyroid by dna flow cytometry of paraffin embedded tissue  
class4	1329	the neoplasms were obtained from 44 men ranging in age from 50 to 79 years  mean  60   
class4	1329	there were 29 follicular adenomas  11 primary follicular carcinomas  neoplasms with capsular and or vascular invasion   and 4 metastatic follicular carcinomas  
class4	1329	follow up information was available on 40 of the 44 patients  
class4	1329	the mean follow up was 114 months  
class4	1329	twenty five of the 29 follicular adenomas had a diploid dna content  2  7   were tetraploid  and the dna histograms on 2 were not interpretable  
class4	1329	all patients with follicular adenomas had no evidence of disease  ned  at last follow up  
class4	1329	eight of the 11 primary follicular carcinomas were diploid  
class4	1329	six of these patients had ned  one died with carcinoma at 82 months  and no follow up was available on one  
class4	1329	three  27   of the primary follicular carcinomas were aneuploid or tetraploid  
class4	1329	two of these patients had ned  and the third died with carcinoma 84 months after diagnosis  
class4	1329	two of the four metastatic follicular carcinomas were diploid and two  50   were aneuploid or tetraploid  
class4	1329	one of the two patients with diploid metastatic follicular carcinomas died with carcinoma  as did one of the two patients with aneuploid metastatic follicular carcinomas  
class4	1329	these results suggest the following   1  follicular carcinomas are more likely to be aneuploid or tetraploid than are follicular adenomas   2  follicular neoplasms without capsular or vascular invasion may include a small number of aneuploid or tetraploid tumors  and  3  dna ploidy does not add to the prognostic value of histologic studies alone  
class4	1330	potential value of hormone receptor assay in carcinoma in situ of breast  
class4	1330	the estrogen receptor  er  expression of invasive breast cancer has been extensively studied both biochemically and with specific monoclonal antibodies against er  
class4	1330	relatively few studies have attempted to characterize er pattern in breast carcinoma in situ  cis  and in other premalignant lesions  
class4	1330	in the current study  the authors investigated the pattern of er expression in 62 cases of breast cis  30 of which had a component of invasive cancer  and 36 cases of atypical hyperplasia  
class4	1330	paraffin sections of formalin fixed breast tissue underwent enzyme pretreatment to expose nuclear antigenic sites as previously described  
class4	1330	breast tissues then underwent estrogen immunocytochemical assay using specific monoclonal antibodies  abbott laboratory  chicago  il   
class4	1330	the cases were evaluated for heterogeneity  intensity of staining  and percentage of er positive cells  
class4	1330	an attempt was made to study the relation between the pattern of er expression  nuclear pleomorphism  and type of cis  
class4	1330	the results of er immunocytochemical assay showed positive nuclear staining for er in 75  of the cis  73  of cis with invasive cancer  and 100  of atypical hyperplasias  
class4	1330	er expression in cis agreed with that in the invasive carcinoma in 29 of 30 cases  
class4	1330	this study also suggests that comedocarcinoma has a higher incidence of negative er expression than the other types of cis  particularly when it is associated with significant nuclear pleomorphism  
class4	1330	there was no significant difference in er tumor heterogeneity between premalignant and malignant lesions  
class4	1331	survey of histologic specimens of human cancer for human papillomavirus types 6 11 16 18 by filter in situ hybridization  
class4	1331	histologic specimens  317  of genital and nongenital cancers and normal tissue were analyzed for the presence of the dna of human papillomavirus  hpv  6  11  16  and 18 by filter in situ hybridization performed on paraffin embedded  formalin fixed tissue  histofish   
class4	1331	hpv dna was found in 73 of 172  42   anogenital lesions and 17 of 116  15   nonanogenital carcinomas  
class4	1331	no hpv dna was found in normal mouse skin  five samples   human autopsy liver  two samples   or kidney  eight samples   or in carcinomas of the breast  three samples   bladder  five samples   or colon  nine samples   
class4	1331	of the nongenital tumors  hpv dna was found in the carcinomas of the lung  2 of 5   anus  7 of 18   esophagus  9 of 39   buccal cavity  1 of 5   and larynx  5 of 50   
class4	1331	hpv dna was also detected in 2 of 11 histologically normal specimens of the cervix and 1 of 3 human skin lesions  
class4	1331	the detection of hpv dna in carcinomas of the lung  larynx  and esophagus as well as in the anogenital region confirms recent suggestions that hpv types 6  11  16  and 18 have a wider association with different types of cancer than previously believed  
class4	1331	the study also shows that histofish is a useful method for detecting hpv dna in histologic specimens  
class4	1332	improved flow cytometric determination of proliferative activity  s phase fraction  from paraffin embedded tissue  
class4	1332	recent studies suggest that proliferative activity  s phase fraction  spf   may have greater prognostic significance than total nuclear dna content  however  relatively few studies have examined spf from paraffin embedded tissue because of significant contamination of histograms with debris  
class4	1332	in this study  cell cycle analysis was performed on 124 matched tissue specimens  
class4	1332	fresh tissue was divided into two equal portions  one portion was frozen  whereas the other portion was processed and embedded in paraffin  
class4	1332	s phase could be determined for both frozen and paraffin embedded tissue in 81 cases  
class4	1332	correlation between spf from frozen and paraffin embedded tissue was demonstrated  r   0 80  when debris was subtracted from histograms with the use of two new subtraction algorithms referred to as multicut and singlecut  
class4	1332	unlike other debris subtraction algorithms  the quantity and distribution of debris calculated by these algorithms are dependent on the magnitude and position of histogram peaks  
class4	1332	a lesser degree of correlation was demonstrated with the use of a standard exponential debris subtraction algorithm  r   0 67   
class4	1332	correlation of spf for aneuploid cases was greater when spf was calculated as a percentage of the aneuploid cell population rather than as a percentage of the entire cell population  
class4	1332	this was attributed to the observation that the proportion of aneuploid cells from paraffin embedded tissue was less than that from frozen tissue  
class4	1332	the results of this study indicate that spf can be calculated from paraffin embedded tissue with values comparable to those obtained from frozen tissue  
class4	1332	the ability to calculate spf reliably from paraffin embedded tissue should allow additional evaluation of this parameter as a prognostic indicator  
class4	1333	demonstration of lipiodol in paraffin sections using a modified silver impregnation technique  
class4	1333	to demonstrate postangiographic lipiodol  lip  in hepatocellular carcinoma  hcc  in paraffin sections  direct impregnation of formalin fixed tissue blocks with silver nitrate  agno3  was followed by routine processing  
class4	1333	lip appeared as black globules in the sinusoids  
class4	1333	ninety four tissue blocks from 13 postangiographic lip hccs and 69 from 8 non lip hccs and 4 fatty livers were studied  
class4	1333	seventy two of 73 negative controls and all positive blocks as seen on soft tissue radiographs  strs  were correctly coded  specificity 98 6   sensitivity 100    
class4	1333	twenty six of the 44 lip negative areas on strs from lip cases contained scanty globules of less than 10 microns in diameter  
class4	1333	fatty change gave no positive readings  
class4	1333	thus  modified agno3 impregnation is a simple  accurate means of detecting lip in high quality paraffin sections suitable for tumor diagnosis and  if applied to postangiographic lip  ultrasonographically guided liver biopsy  can verify that a biopsy has reached a suspected tumor focus  
class4	1334	immunophenotypic aberrancy in adult acute lymphoblastic leukemia  
class4	1334	some recent reports indicate a high frequency of immunophenotypic aberrancy in acute lymphoblastic leukemia  all   
class4	1334	to investigate this issue with regard to adult all  the authors reviewed the immunophenotyping data from 39 cases analyzed in their clinical laboratory  
class4	1334	flow cytometric analysis of peripheral blood and or bone marrow was performed with the use of a panel of 21 b cell  t cell  and myeloid monoclonal antibodies  moabs   
class4	1334	the surface antigen profiles of the leukemic cells were compared with those of normal bone marrow and thymic counterparts  as defined by current models  
class4	1334	twenty six cases were b precursor all  8 were t all  and 3 were b all  burkitt s leukemia   
class4	1334	only two cases coexpressed lymphoid and myeloid antigens  
class4	1334	in contrast  intralineage aberrancy was quite common  
class4	1334	immunophenotypes from 13 of 26 b precursor all cases deviated from normal b lineage marrow cells as defined by a recent classification  
class4	1334	the t all cases were also immunophenotypically heterogeneous  
class4	1334	this high incidence of aberrant antigen expression in adult all suggests that leukemogenesis also involves aberrant differentiation rather than purely a process of maturational arrest  
class4	1335	microstaging of squamous cell carcinomas  
class4	1335	the clinical classification of squamous cell carcinoma  which was established primarily by the international union against cancer  uicc   does not permit optimal estimation of expected metastasis  
class4	1335	the authors  results indicate that metastasis can be more accurately estimated on the basis of invasion depth  histopathologic grading  and especially tumor thickness  
class4	1335	one essential advantage of these criteria is that they can be established by a histopathologist  
class4	1335	it is interesting to note that in the authors  collective no carcinoma less than 2 mm thick metastasized  that is  a relatively high percentage of carcinomas  48   can be graded as no risk carcinomas  
class4	1335	the risk of metastasis for undifferentiated carcinomas greater than 6 mm thick that have infiltrated the musculature  the perichondrium  or the periosteum  however  is quite high  
class4	1335	tumors between 2 and 6 mm thick with moderate differentiation and a depth of invasion that does not extend beyond the subcutis can be classified as low risk carcinomas  
class4	1336	mucinous adenocarcinoma of the prostate with endobronchial metastasis  
class4	1336	endobronchial metastases can manifest clinical symptoms and x ray findings mimicking a centrally located bronchogenic carcinoma  
class4	1336	the authors recently encountered a case of endobronchial metastasis from a mucinous adenocarcinoma of the prostate that was originally diagnosed as a primary bronchogenic carcinoma  
class4	1336	the correct diagnosis was made on the basis of the morphologic similarities between the primary prostatic lesion and the lung lesion and was corroborated by immunohistochemical analyses  
class4	1337	malignant rhabdoid tumor of the liver  a distinct clinicopathologic entity  
class4	1337	a malignant rhabdoid tumor occurring as a primary hepatic neoplasm in a six month old white infant is reported  
class4	1337	it was treated by an attempt at total resection involving right hepatic lobectomy and by chemotherapy with cis platinum  vp 16  and adriamycin  
class4	1337	despite this  recurrence of the tumor resulted in the girl s death within three months  
class4	1337	the neoplasm showed typical light microscopic features of malignant rhabdoid tumor as well as filamentous cytoplasmic inclusions by electron microscopic examination and staining for both cytokeratin and vimentin by immunohistochemistry  
class4	1337	the classic clinicopathologic features of this tumor support the concept that malignant rhabdoid tumors similar to those of the kidney may occur in extrarenal sites  
class4	1338	primary malignant melanoma of the lower respiratory tract  report of a case and literature review  
class4	1338	the authors report a case of primary bronchial malignant melanoma  occurring in a 34 year old woman presenting with persistent cough  
class4	1338	at bronchoscopic examination  a polypoid mass was found to occlude the left mainstem bronchus  
class4	1338	biopsies showed a malignant epithelioid tumor resembling an atypical carcinoid  
class4	1338	histochemistry  electron microscopic study  and immunohistochemistry confirmed the diagnosis of melanoma  
class4	1338	physical examination and additional clinical history to exclude other possible primary sites were negative  
class4	1338	the patient underwent thoracotomy with left pneumonectomy  
class4	1338	nineteen months after resection she was found to have a histologically similar tumor involving her left adrenal gland  
class4	1338	review of the literature shows that melanoma of the lower respiratory tract has been reported only in adults and has a tendency to present as a central polypoid growth that may be responsive to surgical resection  
class4	1339	clinicopathologic features and long term results of alpha fetoprotein producing gastric cancer  
class4	1339	during a 10 yr period  24 cases of alpha fetoprotein producing gastric cancer were experienced in our department  
class4	1339	the mean age was 62 5 yr  and the sex ratio of males to females was 3 1  
class4	1339	borrmann ii and iii types of gastric cancer were predominant  83 3    
class4	1339	the prognosis was dismal  
class4	1339	most of the patients  including three radically operated cases of early gastric cancer  died from liver metastasis within 2 yr  
class4	1339	the 1   3   and 6 yr survival rates were 37 5   8 3   and 8 3   respectively  for all cases and 75 0   25 0   and 25 0  for radically operated cases  
class4	1339	the incidences of synchronous and metachronous liver metastasis were 31 8  and 40 9   significantly higher than the incidences of afp negative gastric cancer  p less than 0 91   
class4	1339	despite radical gastrectomy  metachronous liver metastasis occurred in 75 0  of the cases  
class4	1339	two radical hepatic resections  including extended right lobectomy  were performed in one patient with early gastric cancer who had repeated metachronous liver metastasis  
class4	1339	however  the tumor recurred immediately  
class4	1339	apparently  radical gastrectomy or hepatic resection alone may not suffice for this particular type of cancer  
class4	1339	the methods of treatment and follow up considered should be different from that for other types of gastric cancer  
class4	1340	adenocarcinoma arising in barrett s esophagus after total gastrectomy 
class4	1340	a 64 yr old japanese male who underwent a partial gastrectomy for a duodenal ulcer at the age of 21  a total resection of the remnant stomach for a stomal ulcer at age 25  and in whom barrett s esophagus was diagnosed at age 47  was found to have a tumor at the distal esophagus and was operated on by thoracic esophagectomy  
class4	1340	the tumor was a well to moderately differentiated adenocarcinoma invading down to the muscularis propria  
class4	1340	the entire esophageal mucosa in the resected specimen was lined by columnar epithelium  
class4	1340	this tumor was thought to derive from the barrett s esophageal epithelium  
class4	1341	granular cell tumor of the esophagus  endoscopic ultrasonographic demonstration and endoscopic removal  
class4	1341	a 35 yr old japanese man with a granular cell tumor of the esophagus that was removed by endoscopic polypectomy is presented  
class4	1341	radiography and endoscopy showed a 20 x 12 mm sessile protrusion in the distal esophagus  
class4	1341	endoscopic ultrasonography demonstrated the hypoechoic mass in the submucosa without continuity to the muscularis propria  
class4	1341	the lesion was successfully treated by endoscopic polypectomy without complications  
class4	1341	the cross sections of the resected specimen were quite in agreement with the ultrasonographic findings  
class4	1341	endoscopic ultrasonography is valuable to assess the exact location and extent of the tumor  and to determine the indication for endoscopic polypectomy  
class4	1342	diffuse hemangiomatosis of the spleen  splenic hemangiomatosis presenting with giant splenomegaly  anemia  and thrombocytopenia  
class4	1342	in an elderly patient with oligosymptomatic giant splenomegaly  clinical and laboratory data were nondiagnostic  while nonhomogeneous splenic enlargement was the only finding detected by imaging procedures  
class4	1342	splenectomy was performed and diffuse hemangiomatosis of predominantly capillary type found  
class4	1342	the failure of imaging techniques to even hint at the nature of the underlying disorder is comprehensible in view of the organ being essentially replaced in toto by the abnormal vascular channels  
class4	1342	diffuse splenic hemangiomatosis  a rare condition  may cause hypersplenism  and its diagnosis may be elusive because of misleading patterns on imaging  
class4	1343	a chance to cut is a chance to cure  
class4	1343	fifty seven patients underwent local excision of an invasive distal rectal cancer as an initial operative procedure with curative intent  
class4	1343	five year survival was 82 5   and the rectal cancer specific mortality rate was only 10 5   
class4	1343	the level of wall invasion  vascular permeation  tumor ulceration  mobility  and differentiation were the criteria studied for prognosis  
class4	1343	poor prognostic factors included mucinous cell differentiation and full thickness invasion  and in these cases  abdominoperineal resection was recommended  
class4	1343	none of the 27 patients without these adverse prognostic factors died from rectal cancer  
class4	1343	the other factors did not appear to influence the outcome  and local excision of distal rectal cancer would be the treatment of choice in such selected patients  
class4	1344	ten year prospective study on the development of renal cell carcinoma in dialysis patients  
class4	1344	a prospective study was undertaken to investigate the development of renal cell carcinoma in dialysis patients  
class4	1344	three renal cell carcinomas were detected among 96 hemodialysis patients in 1979  and screening by computed tomographic  ct  scan was continued yearly until 1989  
class4	1344	during this 10 year period  one renal cell carcinoma was found in the second year and another in the ninth year  
class4	1344	autopsy performed on seven of 19 patients who died showed one case of small clear cell carcinoma accompanying acquired cystic disease  
class4	1344	in 33 males  kidneys were found to have enlarged 2 7     1 7 times over the 10 year follow up due to acquired cysts  while no change in kidney volume was noted in 24 females  
class4	1344	native kidneys in nine of 12 patients who maintained functioning grafts were reduced in size  
class4	1344	the patient with the largest kidney enlargement  11 5 times  died from retroperitoneal bleeding in 1989  
class4	1344	these prospective study results suggest that both the incidence and prevalence of renal cell carcinoma in dialysis patients is high  
class4	1344	furthermore  major complications of acquired renal cystic disease seem to occur predominantly in males  
class4	1345	the mutation for medullary thyroid carcinoma with parathyroid tumors  mtc with pts  is closely linked to the centromeric region of chromosome 10  
class4	1345	two new morphs  f and g  detected by the centromeric alpha satellite probe p alpha 10rp8 and d10z1 in hinfi digests are linked to the psti polymorphisms of d10z1  confirming their chromosome 10 location  
class4	1345	the f and g morphs were in strong linkage disequilibrium with each other but were in weak linkage disequilibrium with the a and b morphs defined in psti digests  
class4	1345	data for haplotypes formed by using the a and f morphs improved the lod score for linkage between the disease locus for multiple endocrine neoplasia type 2a  men2a  and d10z1  z   14 06 at theta   0  in the six large families studied by wu et al  
class4	1345	furthermore  the locus that codes for a distinct phenotype  medullary thyroid carcinoma  mtc  with parathyroid tumors  pts  and no pheochromocytomas  pheos   referred to as mtc with pts   in one of the families was closely linked to two markers  d10z1 and rbp3  with lodscores of 2 86 and 3 54  respectively  at theta   0  
class4	1345	a possible allelic association was noted between disease phenotypes and centromeric haplotypes  
class4	1345	the phenotype mtc and pheos with and without pts was associated with the same relatively common centromeric haplotype  a   b f g   in the four families in which all four morphs could be determined  while the phenotype mtc with pts was associated with the rare centromeric haplotype  a b f g   in one family  
class4	1346	a new dna marker  d10s94  very tightly linked to the multiple endocrine neoplasia type 2a  men2a  locus  
class4	1346	combined somatic cell hybrid and linkage studies between d10s94 and five pericentromeric loci  fnrb  d10z1  men2a  rbp3  and d10s15  have localized the new dna sequence pcl1 a1s 6 c23 at d10s94 to 10q11 2  
class4	1346	no recombinants were observed between d10s94 and d10z1 or men2a  
class4	1346	d10s94 maps in proximal 10q11 2 very near to men2a  
class4	1346	there are three possible orders for the six loci that we investigated from the centromeric region of chromosome 10  
class4	1346	at present the genetic data do not allow us to order men2a with respect to d10z1 and d10s94  
class4	1346	the three possible orders are fnrb d10z1 d10s94 men2a rbp3 d10s15  fnrb d10z1 men2a d10s94 rbp3 d10s15  and fnrb men2a d10z1 d10s94 rbp3 d10s15  
class4	1346	in view of the fact that no recombinants between d10s94 and men2a or between d10s94 and d10z1 were observed  the combined haplotypes formed from rflps and d10z1 and d10s94 will increase the informativeness and accuracy of genotype prediction for at risk members of the families having the men 2a syndrome  particularly when the affected parent is female  
class4	1346	the localization of d10s94 with respect to men2a will prove valuable in experiments directed toward cloning the men2a locus  
class4	1347	the importance of cytogenetic studies in adult acute lymphocytic leukemia  
class4	1347	purpose  the prognostic importance of pretreatment bone marrow cytogenetic studies in adults with acute lymphocytic leukemia treated at a single institution  with an identical treatment program  is described  
class4	1347	patients and methods  a total of 105 patients with a documented morphologic diagnosis of acute lymphocytic leukemia were reviewed for the purpose of this analysis  
class4	1347	all patients had an extensive workup at presentation  and cytogenetic analysis was performed in 103 patients  using the giemsa banding technique with trypsin pretreatment on 24 hour cultured cells  
class4	1347	results  the specific cytogenetic classification in the 103 patients who had the karyotypic analysis was as follows  diploid 27   philadelphia chromosome positive 13   hyperdiploid 12   b cell karyotype 6   6q  and 14q  abnormalities 4   pseudodiploid 8   hypodiploid 2   and insufficient metaphases 28   
class4	1347	b cell  6q  or 14q   and philadelphia chromosome positive karyotypes tended to correlate with other known negative prognostic factors  
class4	1347	patients with diploid  hyperdiploid  pseudodiploid  and hypodiploid karyotypes or with insufficient metaphases could be combined into one group with a favorable prognosis  
class4	1347	in this group  the remission rate with induction chemotherapy was 89   the median complete remission duration was 26 months  and the median survival was 25 months  with a 3 year survival rate of 45   
class4	1347	patients with philadelphia chromosome positive  b cell  and 6q  or 14q  abnormalities collectively had an unfavorable prognosis  
class4	1347	their response rate to induction chemotherapy was 65   the median response duration was 7 months  and the median survival was 8 months  with a 3 year survival rate of less than 10   
class4	1347	conclusion  we conclude that the pretreatment bone marrow karyotype is an important part of the evaluation of adults with acute lymphocytic leukemia and provides significant prognostic information  
class4	1348	endometrioma of the liver  
class4	1348	hepatic endometriosis is extremely rare  
class4	1348	we describe a patient sent to us with epigastric pain as the only symptom and who was found to have associated endometrioma of the liver and left ovary  
class4	1348	we suggest a gynecologic evaluation before surgery for hepatic cyst of unknown cause  
class4	1349	hemoperitoneum as a result of coital injury without associated vaginal injury  
class4	1349	hemoperitoneum as a result of coital injury without associated vaginal injury is an extremely rare entity  and evidence by only five cases that have been reported in the medical literature to date  
class4	1349	we report five additional cases encountered in two medical centers  
class4	1349	two of these were ruptured corpus luteum cysts  one was a laceration of the round ligament  another was a laceration of an ovary  and the fifth was rupture of a serous cystadenoma  
class4	1349	this diagnosis should be considered in patients with hemoperitoneum after coitus  
class4	1350	management of selected cystic adnexal masses in postmenopausal women by operative laparoscopy  a pilot study  
class4	1350	twenty five postmenopausal patients were predicted to have benign masses by screening criteria that included ultrasonographic findings of a cystic adnexal mass less than 10 cm with distinct borders and no evidence of irregular solid parts  thick septa  ascites  or matted bowel  and a normal serum ca 125 value  less than 35 u ml   
class4	1350	all 25 masses were accurately predicted to be benign  
class4	1350	the size of the cysts on ultrasonography ranged from 3 to 9 cm with a mean of 5 cm  
class4	1350	twenty two patients  88   were successfully managed by operative laparoscopy and adnexectomy  
class4	1350	mean operative time was 70 minutes and mean postoperative hospital stay was 12 hours  
class4	1350	mean time of return to normal activity was 5 days  
class4	1350	three patients required laparotomy  
class4	1350	we conclude that removal of these cystic adnexal masses by operative laparoscopy is an acceptable alternative in carefully selected postmenopausal women  
class4	1351	ultrasonographic assessment of placental abnormalities  
class4	1351	current ultrasonographic techniques offer a novel approach for the identification of a wide variety of placental abnormalities usually described postnatally by the pathologist  
class4	1351	placental vascular lesions  placental tumors  and abnormal placentation are potentially associated with perinatal complications and their diagnosis in utero may influence the pregnancy management  
class4	1351	an ultrasonographic classification of placental lesions that is based on their location  size  echogenicity  and number is proposed  
class4	1351	repeated ultrasonographic examination  together with biologic investigations  is important for the prenatal differential diagnosis of most these lesions and for full understanding of their pathophysiologic characteristics and significance  
class4	1352	preferential mitogenic activity for myoblast like cells can be extracted from uterine leiomyoma tissues  
class4	1352	the presence of mitogen s  in leiomyoma extracts stimulating cells with the fibroblast  myoblast  and osteoblast phenotype was documented  
class4	1352	mitogenic activity in leiomyoma extracts was acid stable and sensitive to tryptic digestion  
class4	1352	reverse phase high performance liquid chromatography successfully separated mitogen s  with preferential activity for myoblast cells from mitogens with a broad type of cell specificity and from inhibitors  
class4	1352	this leiomyoma derived preferential activity for myoblasts was absent in identically treated myometrial and endometrial extracts  
class4	1352	this suggests that leiomyoma derived substances with preferential growth factor activity for myoblast like cells may play a role in the pathophysiologic characteristics of uterine leiomyomas  
class4	1353	practical aspects of pulsatile gonadotropin releasing hormone administration  
class4	1353	pulsatile administration of gonadotropin releasing hormone represents a major advance in the treatment of anovulation in women who fail to ovulate with clomiphene citrate and is an alternative for many women who currently receive human menopausal gonadotropin  
class4	1353	four issues must be addressed before administering pulsatile gonadotropin releasing hormone   1  safety   2  efficacy   3  convenience  and  4  cost  
class4	1353	each of these issues will be affected by the three major decisions a physician makes with gonadotropin releasing hormone therapy   1  patient selection   2  route of administration  and  3  dose of gonadotropin releasing hormone  
class4	1353	the ideal candidate for gonadotropin releasing hormone therapy is a patient with an absence of endogenous pulsatile gonadotropin releasing hormone  as seen in hypothalamic amenorrhea  
class4	1353	although women with polycystic ovarian disease can be treated with pulsatile gonadotropin releasing hormone  a decreased ovulation rate should be expected  
class4	1353	the route of administration  intravenous or subcutaneous  and the degree of monitoring can be tailored by the physician to fit each patient s needs  
class4	1353	pulsatile gonadotropin releasing hormone therapy is a safe  effective  convenient  and economical alternative to human menopausal gonadotropin for ovulation induction in women resistant to clomiphene  
class4	1354	ocular adnexal kaposi s sarcoma in acquired immunodeficiency syndrome  
class4	1354	we examined histopathologically 18 ocular adnexal kaposi s sarcoma lesions related to acquired immunodeficiency syndrome  
class4	1354	these lesions were classified into three types  
class4	1354	type i consisted of thin  dilated vascular channels lined by flat endothelial cells with lumen containing erythrocytes  
class4	1354	type ii featured plump  fusiform  endothelial cells  often with a hyperchromatic nucleus and foci of immature spindle cells and occasional slit vessels  
class4	1354	type iii was characterized by large aggregates of densely packed spindle cells with hyperchromatic nuclei  occasional mitotic figures  and abundant slit spaces often containing erythrocytes in between  
class4	1354	clinically  type i and type ii tumors were patchy and flat  less than 3 mm in height  and of less than four months  duration  
class4	1354	type iii tumors were nodular and elevated  greater than 3 mm in height   
class4	1354	we describe the clinical and histopathologic types of kaposi s sarcoma that may help in diagnosis  
class4	1355	traumatic enucleation for posterior uveal melanoma  
class4	1355	two features of eyes enucleated for posterior uveal melanoma that may serve as indicators for traumatic enucleation and relate to dissemination of tumor cells at the time of enucleation are myelin artifact of the optic nerve head and acute hemorrhage within the tumor  
class4	1355	myelin artifact occurs when crushed optic nerve tissue is squeezed into the eye at the time of enucleation  
class4	1355	intralesional hemorrhage may occur during surgery and may be correlated with fluctuations in intraocular pressure  
class4	1355	we reviewed 519 cases of posterior uveal melanoma treated by enucleation between 1950 and 1970  
class4	1355	without knowledge of the follow up data  we examined histologic sections for myelin artifact  intralesional hemorrhage  subretinal hemorrhage  callender cell type  size of tumor  necrosis  and scleral or orbital invasion  
class4	1355	neither myelin artifact nor intralesional hemorrhage were independent prognostic risk factors  
class4	1355	these findings do not support or refute the hypothesis that excessive trauma during enucleation results in a worse prognosis  
class4	1356	a randomized study of methanol extraction residue of bacille calmette guerin as postsurgical adjuvant therapy of uveal melanoma  
class4	1356	a randomized controlled clinical trial of methanol extracted residue of bacille calmette guerin adjuvant treatment of posterior uveal melanoma was undertaken  
class4	1356	of 113 patients  34 patients received adjuvant immunotherapy and 79 patients received no treatment  
class4	1356	no difference in survival was observed between the adjuvant treated group and the control group of patients  
class4	1356	this study found that the size of the tumor was a highly significant risk factor for death caused by metastasis of uveal melanomas  
class4	1356	the standard deviation of the nucleolar area of the neoplastic cells was a significant risk factor  even though patients with tumors composed of callender s spindle type cells were not included in the study  
class4	1357	the value of nucleolar organizer regions in uveal melanoma  the collaborative ocular melanoma study group  
class4	1357	silver staining of nucleolar organizer regions is an objective method for evaluating the malignancy of a variety of tumors  
class4	1357	we studied 126 ciliochoroidal melanomas  three coincidental nevi that occurred in eyes with melanomas  and one magnocellular nevus collected from the collaborative ocular melanoma study to determine the effectiveness of the silver stained nucleolar organizer region technique in assessing the malignant potential of these tumors  
class4	1357	malignant lesions demonstrated higher mean silver stained nucleolar organizer region counts  4 347  than benign nevi  1 855   p less than or equal to  0001   
class4	1357	among malignant melanomas  mixed cell melanomas had slightly higher counts than spindle cell melanomas  p less than or equal to  0001   but this difference was not important clinically  
class4	1357	results were also compared to other histopathologic variables  which disclosed correlation of silver stained nucleolar organizer regions with mitoses and tumor size  
class4	1357	comparison with computerized cytomorphometric analyses of prognosis also disclosed significant correlation  
class4	1357	this technique may prove to be a useful adjunct in the assessment of malignancy and treatment response of uveal melanomas  
class4	1358	immunohistologic properties of benign and malignant mixed tumor of the lacrimal gland  
class4	1358	we studied the immunohistopathologic features of normal lacrimal gland  benign mixed tumor  and malignant mixed tumor of the lacrimal gland  
class4	1358	primary antisera were to keratin  muscle specific actin  vimentin  and glial fibrillary acid protein  
class4	1358	keratin stained in occasional myoepithelial cells in normal gland  ductal epithelium in normal gland and the tumors  and occasional stromal epithelioid cells in the tumors  
class4	1358	muscle specific actin stained in myoepithelium and vascular smooth muscle in normal gland and the tumors  and occasional spindle shaped and clusters of stromal cells in the tumors  
class4	1358	vimentin staining was nonspecific  
class4	1358	glial fibrillary acid protein stained in occasional myoepithelial cells in normal gland and polyhedral stromal cells in benign mixed tumor  
class4	1358	our findings indicate that ductal epithelium develops into the epithelial component  and some cells in the stroma and myoepithelium develop into some cells in the stroma of benign and malignant mixed tumor of the lacrimal gland  
class4	1359	a clinicopathologic study of the eyes in familial adenomatous polyposis with extracolonic manifestations  gardner s syndrome   
class4	1359	the eyes of a 51 year old woman with familial adenomatous polyposis and extracolonic manifestations  gardner s syndrome  were obtained postmortem and studied by light microscopy and by transmission and scanning electron microscopy  
class4	1359	we found a generalized abnormality in melanogenesis of the retinal pigment epithelium and at least three types of pigmented lesions  
class4	1359	the histologic findings in one type of lesion were consistent with congenital hypertrophy of the retinal pigment epithelium or benign pigmented nevus of the retinal pigment epithelium  
class4	1359	the other two types of lesion were most consistent with hamartomatous malformations of the retinal pigment epithelium featuring cellular hypertrophy  hyperplasia  and rarely retinal invasion and formation of a minute mushroom shaped tumor  
class4	1359	these histopathologic findings indicate a generalized effect of the familial adenomatous polyposis gene on the retinal pigment epithelium  
class4	1359	this oncogene  which is responsible for tumor formation in the gastrointestinal tract  soft tissues  bone  and other locations in patients with familial adenomatous polyposis  also leads to a generalized defect in melanogenesis and focal lesions of the retinal pigment epithelium  
class4	1360	increase of beta 1 6 branched oligosaccharides in human esophageal carcinomas invasive against surrounding tissue in vivo and in vitro  
class4	1360	the  glcnac beta 1 6man   beta 1 6  branched n glycosidic oligosaccharides expressed on tumor cells have been found to contribute to malignant and metastatic potential in experimental tumor models  
class4	1360	phaseolus vulgaris leukoagglutinin  l pha  requires the beta 1 6 linked lactosamine antenna for high affinity binding and was used histochemically to characterize the distribution of these sugar structures in human esophageal squamous cell carcinomas from 42 patients  
class4	1360	leukoagglutinin reactive carcinoma cells in the invasive tumors were distributed predominantly on the outer surface of the tumor adjacent to the surrounding tissue  
class4	1360	furthermore  when te 1 cells  a human esophageal squamous cell carcinoma line  were cultured in a collagen gel matrix to obtain colonies in a three dimensional form  these colonies exhibited high affinity for l pha binding only in the outer cell layer facing the collagen matrix  unrelated to the cell growth cycle  
class4	1360	these findings suggest that the increase in beta 1 6 branched oligosaccharides in esophageal carcinomas is an important trait of the tumor in the invasion into the surrounding tissue  
class4	1361	vimentin is preferentially expressed in high grade ductal and medullary  but not in lobular breast carcinomas  
class4	1361	two hundred sixty two invasive breast carcinomas dating from 1979 to 1984 were tested for vimentin and keratin on formaldehyde fixed paraffin embedded sections  
class4	1361	none of 26 lobular carcinomas expressed vimentin  
class4	1361	vimentin expression in 10  or more of tumor cells was found in 78  of medullary  14 of 18   in 16  of ductal not otherwise specified  nos   35 of 214   and in two of four mucinous carcinomas  
class4	1361	a further seven tumors showed vimentin expression in less than 1  to 10  of the cells  
class4	1361	vimentin was expressed in tumor cells of 30   28 of 93  of grade iii invasive ductal nos carcinomas versus 7   7 of 105  of grade ii and 0  of grade i carcinomas  0 of 10   
class4	1361	vimentin was found to be preferentially expressed in tumors growing in broad  often anastomosing bands or sheets with extensive necrosis  scanty supportive stroma  high nuclear grade  and numerous mitoses  
class4	1361	the authors conclude that vimentin is not detected in lobular carcinomas  but is preferentially expressed in medullary and in high grade ductal nos breast carcinomas  
class4	1362	inhibition of angiogenesis and tumor growth in the brain  suppression of endothelial cell turnover by penicillamine and the depletion of copper  an angiogenic cofactor  
class4	1362	microvascular proliferation  a hallmark of malignant brain tumors  represents an attractive target of anticancer research  especially because of the quiescent nonproliferative endothelium of the normal brain  
class4	1362	cerebral neoplasms sequester copper  a trace metal that modulates angiogenesis  
class4	1362	using a rabbit brain tumor model  normocupremic animals developed large vascularized vx2 carcinomas  
class4	1362	by contrast  small  circumscribed  relatively avascular tumors were found in the brains of rabbits copper depleted by diet and penicillamine treatment  cdpt   
class4	1362	the cdpt rabbits showed a significant decrease in serum copper  copper staining of tumor cell nuclei  microvascular density  the tumor volume  endothelial cell turnover  and an increase in the vascular permeability  breakdown of the blood brain barrier   as well as peritumoral brain edema  
class4	1362	in non tumor bearing animals  cdpt did not alter the vascular permeability or the brain water content  
class4	1362	cdpt also inhibited the intracerebral growth of the 9l gliosarcoma in f 344 rats  with a similar increase of the peritumoral vascular permeability and the brain water content  
class4	1362	cdpt failed to inhibit tumor growth and the vascularization of the vx2 carcinoma in the thigh muscle or the metastases to the lung  findings that may reflect regional differences in the responsiveness of the endothelium  the distribution of copper  or the activity of cuproenzymes  
class4	1362	metabolic and pharmacologic withdrawal of copper suppresses intracerebral tumor angiogenesis  angiosuppression is a novel biologic response modifier for the in situ control of tumor growth in the brain  
class4	1363	coexpression patterns of vimentin and glial filament protein with cytokeratins in the normal  hyperplastic  and neoplastic breast  
class4	1363	the authors studied by immunohistochemistry the intermediate filament  if  protein profile of 66 frozen samples of breast tissue  including normal parenchyma  all variants of fibrocystic disease  fcd   fibroadenomas  cystosarcoma phylloides  and ductal and lobular carcinomas  
class4	1363	monoclonal antibodies  mabs  to cytokeratins included mab ka 1  which binds to polypeptide 5 in a complex with polypeptide 14 and recognizes preferentially myoepithelial cells  mab ka4  which binds to polypeptides 14  15  16 and 19  individual mabs to polypeptides 7  13  and 16  17  18  and 19  and the mab mixture ae1 ae3  
class4	1363	the authors also applied three mabs to vimentin  vim   and three mabs to glial filament protein  gfp   
class4	1363	selected samples were studied by double label immunofluorescence microscopy and by staining sequential sections with some of the said mabs  an mab to alpha smooth muscle actin  and well characterized polyclonal antibodies for the possible coexpression of diverse types of cytoskeletal proteins  
class4	1363	gel electrophoresis and immunoblot analysis also were performed  
class4	1363	all samples reacted for cytokeratins with mabs ae1 ae3  although the reaction did not involve all cells  
class4	1363	monoclonal antibody ka4 stained preferentially the luminal secretory cells in the normal breast and in fcd  whereas it stained the vast majority of cells in all carcinomas  
class4	1363	monoclonal antibody ka1 stained preferentially the basal myoepithelial cells of the normal breast and fcd while staining tumor cell subpopulations in 4 of 31 carcinomas  
class4	1363	vimentin positive cells were found in 8 of 12 normal breasts and in 12 of 20 fcd  in most cases  vim reactive cells appeared to be myoepithelial  but occasional luminal cells were also stained  
class4	1363	variable subpopulations of vim positive cells were noted in 9 of 20 ductal and in 1 of 7 lobular carcinomas  
class4	1363	glial filament protein reactive cells were found in normal breast lobules and ducts and in 15 of 20 cases of fcd  with rare exceptions  gfp reactivity was restricted to basally located  myoepithelial appearing cells  
class4	1363	occasional gfp reactive cells were found in 3 of 31 carcinomas  
class4	1363	evaluation of sequential sections and double label immunofluorescence microscopy showed the coexpression of certain cytokeratins  possibly including polypeptides 14 and 17  with vimentin and alpha smooth muscle actin together with gfp in some myoepithelial cells  
class4	1363	the presence of gfp in myoepithelial cells was confirmed by gel electrophoresis and immunoblotting  
class4	1363	our results indicate that coexpression of cytokeratin with vimentin and or gfp is comparatively frequent in normal basal myoepithelial cells of the breast  abstract truncated at 400 words   
class4	1364	a b blood group antigens in tissues of ab heterozygotes  emphasis on normal and neoplastic urothelium  
class4	1364	the tissue distribution of the a and b blood group antigens was studied in 41 individuals with the heterozygous ab red blood cell  rbc  phenotype  
class4	1364	a total of 134 biopsies from a variety of normal tissues  94 from urothelium and 40 from other tissues  were examined  
class4	1364	in addition  changes in the expression of these antigens associated with neoplastic transformation were evaluated in 70 biopsies from transitional cell carcinomas of 19 ab heterozygous patients  
class4	1364	there was heterogeneity in the distribution of tissue a and b antigens  depending on the cell type  as well as among cells of the same type  
class4	1364	ninety one percent of ab heterozygotes expressed both a and b antigens in normal epithelial cells  with a mosaic distribution clearly apparent in 50  of these individuals  
class4	1364	in 21  of these subjects  the a antigen was undetectable in the vascular endothelial cells in all biopsies from several organs  
class4	1364	in most  79   transitional cell neoplasms  only one of the two antigens was consistently expressed  
class4	1364	the results of this study may have implications for the clonal or specific gene deletion theories of neoplasia  
class4	1364	they also demonstrate the existence of a subgroup of ab individuals in whom the a antigen is absent specifically from the vascular endothelium  
class4	1365	flow cytometric analysis of the mechanism of methylmercury cytotoxicity  
class4	1365	flow cytometric analysis of murine erythroleukemic cells  melc  exposed in vitro to 2 5 to 7 5 mumol l  micromolar  methylmercury  mehg  reveals a dose dependent decrease in the rate of dna synthesis  rate of passage through the s phase of the cell cycle   manifested as the accumulation of most of the cells in the s phase  and a modest accumulation of cells in the g2 m phase of the cycle  
class4	1365	light microscopy reveals a progressive increase in chromosomal damage  condensation  pulverization   
class4	1365	at or above 10 mumol l mehg  progression through all the phases of the cell cycle is blocked and mitotic cells are arrested irreversibly in anaphase  with most exhibiting arrangement of chromosomes in a wreathlike ring formation  
class4	1365	also the cells exhibit both nuclear propidium iodide  pi  fluorescence  indicative of loss of viability  and concurrent cytoplasmic carboxyfluorescein  cf  fluorescence  viable cells exhibit cf fluorescence and exclude pi   
class4	1365	in addition  there is a dose dependent increase in cellular refractive index  90 degrees light scatter   an apparent decrease in cell volume  axial light loss   and progressive resistance to detergent  np 40  mediated cytolysis  
class4	1365	resistance to detergent mediated cytolysis is indicative of fixation  protein denaturation  cross linking  and so on  of the plasma membrane cytoplasm complex  
class4	1365	our findings indicate that dna synthesis is the primary target of mehg cytotoxicity and that apparent targets and degree of cytotoxicity are a complex function of dose  
class4	1366	expression of aminopeptidase n  cd13  in mesenchymal tumors  
class4	1366	for a long time  cd13 molecules have been considered to be restricted to myeloid cells and related neoplasms  
class4	1366	meanwhile  however  expression of cd13 has also been detected in some hepatocellular  gallbladder  renal  and lung carcinomas  and even in some fibrosarcomas and malignant melanomas  
class4	1366	in this study  expression of cd13 antigen was immunohistochemically examined in non neoplastic mesenchymal cells  along with 33 benign and 83 malignant mesenchymal tumors  met  using cd13 monoclonal antibodies  mab  my7  u71  wm 15  and mou48  
class4	1366	in non neoplastic mesenchymal cells  expression of cd13 was restricted to perivascular fibrocytes blasts  tissue histiocytes  osteoclasts  and to the perineurium of peripheral nerve trunks  
class4	1366	under neoplastic conditions  cd13 was detectable in some tumors of smooth muscle  fibrous  fibrohistiocytic  synovial  osteogenic  and peripheral nerve sheath origin  and even in some tumors of adipose tissue  
class4	1366	tumors of striated muscle origin  of autonomic ganglia  and of cartilage forming tissues were cd13 negative throughout  
class4	1366	thus in most but not all tumors studied the pattern of expression of cd13 mirrors the situation found in their cells of origin  
class4	1366	these findings enrich the data on expression of leukocyte differentiation antigens in extra hematopoietic tissues  
class4	1366	expression of cd13  which meanwhile is known to be identical to aminopeptidase n  an important peptide cleaving enzyme  in only some met might reflect a special functional state of these neoplasms  
class4	1367	immunocytochemical localization of progesterone receptors in endocrine cells of the human pancreas  
class4	1367	progesterone receptors  pgr  have been immunocytochemically localized in the nuclei of several  40  to 75   endocrine cells of the human pancreas and in a more variable number of neoplastic cells of 7 of 18 endocrine pancreatic tumors  
class4	1367	conversely the exocrine epithelial cells of the pancreas did not exhibit any pgr immunoreactivity in normal as well as in different pathologic conditions  including pancreatic adenocarcinomas  
class4	1367	estrogen receptors were not detected in any of the pancreatic samples investigated  
class4	1367	double immunocytochemical experiments have documented that pgr immunoreactivity in normal langerhans islets is a consistent feature of most  75   glucagon producing a cells  of approximately 5  to 20  of insulin producing b cells  and of a variable percentage of pancreatic polypeptide  pp  producing cells  ranging from 5  to 70   
class4	1367	these figures were not affected by the sex  age  or underlying disease of the patients  
class4	1367	the reported findings corroborate previous clinical and experimental evidence indicating that sex steroid hormones may have some regulatory effects on the functional activity of the endocrine pancreas  
class4	1368	immediate versus delayed shoulder exercises after axillary lymph node dissection  
class4	1368	a total of 144 evaluable patients with breast cancer were enrolled in a multicenter  randomized  prospective study to establish the role of delayed shoulder exercises on wound drainage and shoulder function after axillary lymph node dissection  
class4	1368	patients in group 1  n   78  started active shoulder exercises 1 day postoperatively  
class4	1368	patients in group 2  n   66  started on the eight postoperative day  following 1 week of immobilization of the arm  
class4	1368	patients in group 2 had 14  less wound drainage volume than those in group 1  600     436 ml versus 701     398 ml   this difference  however  was not significant  
class4	1368	also  no differences could be established between the two groups when duration and volume of wound drainage  number and volume of seroma aspirations  wound complication rates  and shoulder function were compared 6 months after surgery  
class4	1369	variations in sensitivity after sectioning the intercostobrachial nerve  
class4	1369	the authors present a prospective study of the variations in sensitivity that appear in the armpit and arm after the intercostobrachial nerve has been sectioned in a modified radical mastectomy  
class4	1369	of a total of 208 patients studied between 1978 and 1987  the intercostobrachial nerve was sectioned in 139 patients  whereas in 30 it remained intact  in 39 patients only peripheral branches of the nerve were sectioned  
class4	1369	the patients were examined at regular postoperative intervals in order to evaluate their sensitivity both to touch and to pain in the axilla and arm  
class4	1369	four hundred thirty three examinations were carried out and the 3 operative groups were assessed accordingly  
class4	1369	after the nerve was sectioned  there was increasing anesthesia in the armpit and hypoesthesia on the posterointernal face of the arm  while for the patients in whom the intercostobrachial nerve remained intact  these alterations were less intense and long lasting  
class4	1369	significant statistical differences between the two groups also exist  
class4	1369	in the absence of axillary lymphatic ganglia infiltrated by the tumor  the conservation of the intercostobrachial nerve is recommended  
class4	1370	anaesthetic problems in ex situ resection of the liver  
class4	1370	ex situ resection of the liver is a new surgical technique for treatment of liver tumours not amenable to conventional surgery  
class4	1370	this paper describes the cardiovascular and metabolic changes that occurred in nine consecutive such patients  
class4	1370	no severe haemodynamic or pulmonary complications occurred  
class4	1370	specific problems were encountered during the prolonged anhepatic period  which lasted an average of 5 96  sd 1 46  hours  
class4	1370	significant metabolic and coagulation disorders occurred 2 to 3 hours after hepatectomy because of complete loss of hepatic function  
class4	1370	the predominant findings during the anhepatic period were hypoglycaemia and severe metabolic acidosis  mainly from increased levels of lactic acid  
class4	1370	exogenous administration of dextrose 5  at an average rate of 188 ml hour was necessary to maintain normoglycaemia  while correction of metabolic acidosis required 403  sd 159 79  mmol of sodium bicarbonate  supplemented by hyperventilation  
class4	1370	tris hydroxymethylaminomethane was used when sodium overload was thought to be a problem  
class4	1370	there was a marked decrease of factor v and fibrinogen  a moderate thrombocytopenia and fibrinolysis  
class4	1370	the severity of these alterations was dependent on the duration of the anhepatic period and the primary function of the re implanted liver  
class4	1371	anesthesia for craniotomy  a double blind comparison of alfentanil  fentanyl  and sufentanil  
class4	1371	using a prospective  randomized  and double blind study design  alfentanil  n   15   fentanyl  n   14   or sufentanil  n   16   in combination with n2o  were administered to patients undergoing craniotomy for supratentorial tumor resection  
class4	1371	physicians were given two syringes  one of which was labeled as  load  for the initial loading dose and the other as  maintenance  for continuous infusion  
class4	1371	the concentration of drug in each syringe was adjusted to permit administration on a milliliter per kilogram basis  
class4	1371	the target loading doses for alfentanil  fentanyl  and sufentanil were 75  10  and 1 microgram kg  respectively  and initial infusion rates were 33 5  2 0  and 0 3 microgram kg 1 h 1  respectively  
class4	1371	additional supplementary boluses and changes in maintenance infusion rate were made according to predetermined guidelines  
class4	1371	isoflurane  in increasing 0 2  inspired increments  was used only when the maximum allowed opioid dose had been given  i e   supplementary bolus doses equal to 75  of the calculated loading dose or supplementary bolus doses equal to 50  of the calculated loading dose combined with a 50  increase in the maintenance infusion rate   
class4	1371	opioid infusions were stopped at the time of bone flap replacement  
class4	1371	antihypertensive medications and naloxone were subsequently given at the discretion of the anesthesiologist  
class4	1371	group demographics were not different  
class4	1371	total volumes of drug were similar among groups indicating equipotent preparations  
class4	1371	administration of isoflurane  antihypertensive medications  and naloxone were not different among groups  
class4	1371	although decreases in blood pressure seen with induction were similar among groups  alfentanil treated patients received ephedrine more frequently before intubation  
class4	1371	thirty minutes after entry into the postanesthesia recovery area  respiratory rate and ph were lowest in sufentanil treated patients  
class4	1372	infection during chronic epidural catheterization  diagnosis and treatment  
class4	1372	a potentially serious complication of long term epidural catheterization in cancer patients is infection  
class4	1372	the early signs of infection were studied in 350 patients in whom long term epidural catheters were inserted  
class4	1372	three areas of the catheter track were found to be involved  exit site and superficial catheter track infection  and epidural space infection  
class4	1372	the authors identified the early signs of infection in each area and the progress of the infection from the deep track to include the epidural space in four of these patients  
class4	1372	all 19 patients who developed deep track or epidural infections were successfully treated with antibiotics and catheter removal  
class4	1372	none of the patients required surgery for spinal cord decompression  
class4	1372	catheters were replaced in 15 of the 19 treated patients who requested them after treatment with no recurrent infections  
class4	1372	it was concluded that use of long term epidural catheterization is associated with a definable epidural infection rate  
class4	1372	the use of epidural opioid analgesia is an effective and safe means of obtaining pain relief for terminally ill patients when patients are monitored for possible infection and receive prompt treatment when the diagnosis is established  
class4	1373	the single breath nitrogen test  mortality  and cancer  
class4	1373	the relationship between indices of the single breath nitrogen test and mortality  overall cancer incidence  and respiratory cancer incidence was examined in a cohort of 876 men  46 to 69 yr of age  examined in 1974 and followed until june 1985  
class4	1373	closing volume  closing capacity  and slope of phase iii were not related to mortality or cancer  
class4	1373	in contrast  fev1 was related to mortality  with an estimated relative mortality risk of 1 37  95  confidence interval  1 11 to 1 70  per liter under the expected fev1  given height  age  and smoking  but fev1 was not related to cancer  
class4	1373	inability to perform acceptable single breath nitrogen test tracings was related to mortality with a relative mortality risk of 2 03  1 45 to 2 85   but not to cancer  
class4	1373	we conclude that indices of the single breath nitrogen test have no predictive value concerning overall mortality and cancer incidence  
class4	1374	frequency and clinical implications of monoclonal antibody detection of tumor associated antigens in serum of patients with lung cancer  
class4	1374	we previously showed that a panel of monoclonal antibodies  mab   5e8  5c7  and 1f10  that detect serum tumor associated antigens  taa  could distinguish patients with lung cancer from those without to a highly significant degree  
class4	1374	however  among patients with lung cancer  the frequency and clinical importance of serum taa expression were not established  
class4	1374	therefore  we analyzed the serum and initial clinical characteristics of 52 philadelphia va patients with newly diagnosed lung cancer seen over a 13 month period  
class4	1374	a modified semiquantitative elisa was employed to determine mab reactivity  
class4	1374	our cohort was characterized by a mean age of 65     9 year  sd  and mean karnovsky score of 74     10  marked weight loss was present in 28 subjects  and 39 presented with either stage iii or iv disease  
class4	1374	the panel detected taas in 38 of 52 cases  sensitivity 73   95  cl  60 83    including 13 of 22 squamous cell  9 of 12 adenocarcinoma  10 of 11 undifferentiated  and 6 of 7 small cell carcinomas  
class4	1374	no significant differences were found between the reactive and nonreactive patients in terms of age  stage at presentation  histologic subtype  performance status  or weight loss  
class4	1374	however  1f10 and 5c7 were each associated with a greater risk of early death by cox proportional hazard analysis  p   0 017 and 0 006  respectively  even when other prognostic variables are accounted for  
class4	1374	we conclude that specific serum taa can be detected in the majority of lung cancer patients with all major histologic subtypes in a cohort with advanced tumors and poor prognostic indices  
class4	1375	cecal diverticulitis presented as a cecal tumor  
class4	1375	seven patients diagnosed as having acute appendicitis were operated on and a cecal wall mass due to cecal diverticulitis was found  
class4	1375	in two patients the mass could not be separated from the cecal wall and right colectomy was performed  
class4	1375	in five patients  in whom the mass could be separated from the cecum  conservative operations  three diverticulectomies and two wedge resections  were performed  thus avoiding needless  more extensive surgery  
class4	1376	jejunal rectal fistula as a complication of postoperative radiotherapy  
class4	1376	we present the case of a patient with an unusual  complex enteric fistula with multiple tracts and associated abscesses  
class4	1376	the fistula was a late complication of radiotherapy  administered three years earlier  after resection for carcinoma of the sigmoid colon  
class4	1376	most of the small bowel was involved in the radiation induced disease  
class4	1376	a wide resection was performed successfully  
class4	1376	this report reviews current literature on intra abdominal postradiotherapy injuries  particularly intestinal fistulae  
class4	1377	risk for colon adenomas in patients with rectosigmoid hyperplastic polyps 
class4	1377	objective  to determine whether hyperplastic polyps found in the rectosigmoid area of the colon are associated with proximal adenomas  and to judge whether patients with distal hyperplastic polyps found during sigmoidoscopy might benefit from full colonoscopy  
class4	1377	design  data on patients having colonoscopy collected prospectively according to a set protocol  
class4	1377	the size and location of all polyps were noted  and all polyps were biopsied  
class4	1377	setting  two university hospitals  
class4	1377	patients  one thousand eight hundred and thirty six consecutive patients referred for colonoscopy between 31 december 1987 and 31 august 1989  
class4	1377	results  of the 970 patients who met eligibility requirements  274  28 3   had adenomas and 108  11 1   had hyperplastic polyps  
class4	1377	the proportion of patients with distal hyperplastic polyps and proximal adenomas  31 9   was similar to the proportion of those without distal hyperplastic polyps  23 0    crude odds ratio  1 57  95  ci  0 77 to 3 06   
class4	1377	after adjusting for age and sex  the results were unchanged  adjusted odds ratio  1 53  ci  0 82 to 2 88   
class4	1377	patients with distal adenomas  on the other hand  were three times more likely to have proximal adenomas than those without distal adenomas  adjusted odds ratio  3 42  ci  1 99 to 5 88   
class4	1377	conclusions  distal hyperplastic polyps are not strong predictors of risk for proximal adenomas  
class4	1377	based on the magnitude of the risk difference  we do not believe that finding a hyperplastic polyp during sigmoidoscopy justifies doing a full colonoscopy to search for proximal adenomas  
class4	1377	because rectosigmoid adenomas are associated with proximal adenomas  however  small polyps seen during sigmoidoscopy should be biopsied to determine their type  
class4	1377	colonoscopy should be reserved for patients who are proved to have adenomas  
class4	1378	tumor cell lines established in vitro  an independent prognostic factor for survival in non small cell lung cancer  
class4	1378	objective  to determine the relation between in vitro establishment of tumor cell lines and survival in patients with non small cell lung cancer  
class4	1378	design  cohort study  
class4	1378	setting  single institution tertiary care center  
class4	1378	patients  one hundred twenty three consecutive patients with non small cell lung cancer from whom a viable tumor specimen could be obtained  
class4	1378	intervention  tumor tissue was removed at the time of entry into a therapeutic protocol  
class4	1378	the tumor tissue was processed in the laboratory for attempted cell line establishment  
class4	1378	patients classified as potentially curable  stages i  ii  and iiia  were treated with surgical resection  radiation therapy  or a combination  
class4	1378	patients suitable for palliative therapy only  stages iiib and iv  were treated with radiation therapy with or without chemotherapy  
class4	1378	chemotherapy was based on in vitro drug sensitivity when available  
class4	1378	cell line establishment was correlated to clinical outcome  
class4	1378	measurements and main results  univariate analysis of survival was done using the log rank test  multivariate analysis was done by cox modeling step up and step down techniques  
class4	1378	cell lines were established from the tumor specimens of 25 patients  20    
class4	1378	those patients experienced a median survival of 7 months compared with 18 months in patients from whom cell lines could not be established  p less than 0 001   
class4	1378	in the 61 patients with potentially curable disease  8 patients  13   with cell lines established had a median survival of 8 months compared with 32 months for those without cell lines established  p   0 001   
class4	1378	in the 62 palliative group patients  the median survival of the 17 patients  27   from whom tumor cell lines were established was 5 months compared with 7 months for those without cell lines  p   0 15   
class4	1378	multivariate analysis in both groups showed cell line establishment to be a significant indicator of prognosis  p less than 0 0001 for curable group  p less than 0 01 for palliative group   
class4	1378	conclusion  in vitro tumor growth is related to decreased patient survival  which in turn reflects the biologic aggressiveness of cancers giving rise to these tumor cell lines  
class4	1379	the internist in the management of head and neck cancer  
class4	1379	the general internist has an important role in the management of head and neck squamous cell cancers  
class4	1379	this heterogeneous group of cancers must be accurately diagnosed and staged before planning treatment  
class4	1379	curability is directly related to stage at presentation and  because most patients with such cancers present to internists first  these physicians must be familiar with presenting symptoms and must be suspicious enough to refer patients with symptoms for appropriate evaluation  
class4	1379	the work up of patients with suspected unknown primary cancer presenting as adenopathy is detailed  and the physician is cautioned not to immediately proceed to open biopsy  
class4	1379	as many as 10  of such primary cancers remain undetected  although  with proper therapy  the 5 year survival rate for squamous cell cancer of the head and neck is 60   
class4	1379	those patients cured of head and neck cancer still face significant psychosocial and medical problems  including hypothyroidism  xerostomia  and a 20  rate of second primary cancer  
class4	1379	head and neck cancer is highly preventable  75  of cases are related to tobacco and alcohol use  
class4	1379	smokeless tobacco has gained popularity among young americans and is associated with an increased incidence of head and neck cancer at several sites  
class4	1379	education is crucial  and internists must seek strategies to stop patients from using tobacco products  
class4	1379	other etiologic factors include industrial carcinogens  epstein barr virus  and diet  
class4	1379	retrospective serologic and dietary recall studies of vitamin a suggest an etiologic role of diet  vitamin a analogs have been tested in preneoplastic lesions  
class4	1379	to reduce mortality from head and neck cancers  the general internist must play a central role in prevention and early detection  
class4	1380	colorectal cancer  evidence for distinct genetic categories based on proximal or distal tumor location 
class4	1380	purpose  to examine studies of normal colon and colorectal cancer for evidence that the location of the primary tumor proximal or distal to the splenic flexure of the colon may determine distinct genetic categories of this disease  
class4	1380	data identification  studies were identified through a manual search of journals  through medline  and through review of bibliographies in identified articles  
class4	1380	study selection  approximately 300 articles were examined  
class4	1380	about 150 articles were excluded because tumor location was not reported or was reported in a way that did not permit correlation with results or conclusions  
class4	1380	data extraction  articles were selected either because the presentation of data permitted correlation of results with anatomic regions of the colon or because they were relevant to inherited colorectal cancer  
class4	1380	results of the analysis  differences were noted in biologic properties of proximal and distal segments of normal fetal and adult colonic epithelium and in the epidemiologic  pathologic  cytogenetic  and molecular features of proximal and distal colorectal cancer  
class4	1380	some differences correlated with the features of inherited colorectal cancer  proximal  nonpolyposis or distal  and polyposis forms   
class4	1380	conclusions  developmental and biologic differences in proximal and distal colon may reflect differing susceptibilities to neoplastic transformation  
class4	1380	differences in proximal and distal colorectal cancer suggest that each may arise through different pathogenetic mechanisms  
class4	1380	proximal tumors appear to represent a genetically more stable form of the disease and may arise through the same mechanisms that underlie inherited nonpolyposis colon cancer  
class4	1380	distal tumors show evidence of greater genetic instability and may develop through the same mechanisms that underlie polyposis associated colorectal cancer syndromes  
class4	1381	histopathologic grading of salivary gland neoplasms  ii  acinic cell carcinomas  
class4	1381	acinic cell carcinomas display varied cytoarchitectural patterns of growth that should allow for formulation of histopathologic grading  
class4	1381	grading of these carcinomas may serve to identify subsets whose biologic behavior is more aggressive than the usually accepted low grade behavior of acinic cell carcinomas as a group  
class4	1381	to that end  a three level histopathologic grading scheme is presented  
class4	1382	myasthenic thymus and thymoma are selectively enriched in acetylcholine receptor reactive t cells  
class4	1382	we compared t cell proliferative responses to acetylcholine receptor  achr  and to purified protein derivative  ppd   of tuberculin  of hyperplastic thymus  thymoma  and blood cells from patients with myasthenia gravis  mg   
class4	1382	hyperplastic mg thymus cells gave significantly higher and more consistent responses to achr than parallel cultures of autologous blood cells  whereas responses to ppd showed an opposite trend  
class4	1382	thus there was a preferential localization of achr reactive t cells in the hyperplastic mg thymus  
class4	1382	furthermore  there was a strong correlation between blood and thymus cell responses to ppd  but not to achr   arguing that the hyperplastic mg thymus contains a sample of sensitized peripheral t cells  
class4	1382	by contrast  both achr  and ppd responsive t cells were almost undetectable in thymus from nonmyasthenic patients  which is evidently much less receptive to circulating t cells  
class4	1382	cells from mg thymomas showed the highest stimulations by achr but did not consistently react to ppd  
class4	1382	however  the uninvolved thymus adjacent to these thymomas behaved almost identically to the hyperplastic samples described above  
class4	1382	our interpretation is that achr specific t cells are initially sensitized in the mg thymoma but are selectively trapped in the hyperplastic thymus after being primed elsewhere  
class4	1383	cutaneous t cell lymphoma  parapsoriasis en plaque   an association with pityriasis lichenoides et varioliformis acuta in young children  
class4	1383	pityriasis lichenoides et varioliformis acuta  pleva  and pityriasis lichenoides chronica  plc  are related benign disorders without recognized association with cutaneous t cell lymphoma  ctcl   
class4	1383	we report the cases of two children with documented pleva evolving into ctcl over several years  
class4	1383	one child had the clinical lesions of plc but the dermatopathologic findings of pleva at age 2 years  
class4	1383	at age 12 years  he had skin changes of poikiloderma atrophicans vasculare and dermatopathologic findings consistent with parapsoriasis en plaque  
class4	1383	the second child presented at age 7 years with scaling dermatitis and dermatopathologic findings of pleva  
class4	1383	at age 12 years  the histologic diagnosis was parapsoriasis  
class4	1383	monoclonal antibody studies performed on biopsy specimens from both patients revealed 70  to 100  cells staining with cd5  80  to 90  staining with cd4  30  to 50  staining with cd8  and an increase in cd1 staining cells in the papillary dermis  indicating a predominantly helper t cell infiltrate  
class4	1383	we believe that plc and pleva may be part of the spectrum of ctcl  
class4	1383	furthermore  ctcl may be more common in young children than once thought  
class4	1384	my7 monoclonal antibody for diagnosis of cutaneous t cell lymphoma  
class4	1384	infiltrate in cutaneous t cell lymphomas  ctcls  is composed mainly of cd4 helper cells with a phenotype very similar to that of benign cutaneous lymphoid infiltrate  
class4	1384	my7  cd13  is a monoclonal antibody that is normally expressed on peripheral granulocytes and monocytes but also cross reacts with an antigen expressed on epidermal basal cells  
class4	1384	we studied my7 expression on basal cells of the epidermis and cd4 cell infiltrate in 34 ctcls  11 pseudolymphomas  and 29 other benign cutaneous lesions  
class4	1384	an indirect immunofluorescence technique with double labeling and an immunoperoxidase technique were used  
class4	1384	we found that in benign inflammatory infiltrate  less than 10  of cd4 cells expressed my7 antigen associated with normal my7 monoclonal antibody labeling of basal cells  whereas in ctcls more than 50  of cd4 tumoral cells in dermis expressed my7 antigens  however  basal cells were my7 negative  
class4	1384	thus  it is demonstrated that my7 monoclonal antibody with its double modulation on epidermis  basal cells  and dermis  cd4 cells  has diagnostic value for differentiating ctcls with cd4  my7  tumor cells in dermis and my7 negative basal cells from benign inflammatory lesions with cd4  my7  cells in dermis and my7 positive basal cells  
class4	1384	this modulation of my7 labeling could be related to the secretion of epidermal cytokines  
class4	1385	positive results of combined therapy of surgery and intraperitoneal hyperthermic perfusion for far advanced gastric cancer  
class4	1385	to evaluate the clinical efficacy of intraperitoneal hyperthermic perfusion  iphp  for far advanced gastric cancer  particularly with peritoneal seeding  we investigated the survival times of 59 patients who underwent distal subtotal gastrectomy  total gastrectomy  or total gastrectomy combined with concomitant resection of some of the remaining intra abdominal organs  
class4	1385	in all the 30 patients given iphp  no cancer cells were present posthyperthermically in the lavage from the douglas pouch  
class4	1385	the 30 patients given iphp lived longer than the 29 patients not given iphp  p   0 001   with a 1 year survival rate of 80 4  in the former group compared to 34 2  in the latter  
class4	1385	with respect to a comparison of survival time of patients with peritoneal seeding  7 patients not given iphp had a 6 month survival rate of 57 1  and did not survive more than 9 months  whereas 20 patients given iphp had 1  and 2 year survival rates of 78 7  and 45 0   respectively  here the difference was significant  p   0 001   
class4	1385	the iphp and control groups without peritoneal metastasis included 10 and 22 patients  respectively  and the 1 year survival rates are 85 4  and 45 3   respectively  
class4	1385	the survival rates of the former exceeded those of the latter  with p   0 015 by the generalized wilcoxon test  
class4	1385	thus this combined therapy offers the promise of extended survival for patients with far advanced gastric cancer  
class4	1386	intrarectal ultrasonography in rectal cancer staging and in the evaluation of pelvic disease  clinical uses of intrarectal ultrasound  
class4	1386	accurate preoperative staging of a rectal cancer patient may impact heavily on subsequent management  
class4	1386	this study attempts to evaluate the accuracy of intrarectal ultrasonography  irus  in staging rectal cancers compared to clinical and pathologic examination  
class4	1386	in addition the accuracy of irus was assessed in a group of patients with uncertain pelvic perirectal disease after a negative physical examination  
class4	1386	in a prospective manner  52 cancer patients were staged with digital exam and irus  
class4	1386	accuracy rates were 48  and 83   respectively  compared to pathologic evaluation in assessing wall penetration  and irus identified positive lymph nodes in 12 of 17 cases  
class4	1386	in patients with pelvic disease  irus corresponded with pathologic diagnosis in 15 of 17 cases and revealed new information in 6 patients  
class4	1386	intrarectal ultrasonography appears to be the most accurate imaging technique for staging rectal cancers and demonstrates promise in the evaluation of perirectal pelvic disease  
class4	1387	localization and peptide content of endocrine pancreatic tumors  
class4	1387	endocrine pancreatic tumors contain and frequently secret neurohormonal peptides  
class4	1387	this phenomenon can be used as a diagnostic and classifying tool  
class4	1387	this study analyzes 31 patients operated on because of an endocrine pancreatic tumor  including the diagnostic procedures and the localization methods  
class4	1387	in 15 insulinoma cases only 6 patients had a positive arteriography  while all 11 selective pancreatic vein samplings were positive  
class4	1387	the immunoreactivity showed that  besides insulin  most tumors also contained other peptides  
class4	1387	of four gastrinoma cases the arteriography was positive in three  but the selective vein sampling localized the tumor in all  
class4	1387	the tumor s content of peptides showed mixed patterns  
class4	1387	in the four glucagonomas  the arteriography was positive in all and the venous sampling performed in three of the cases also was positive  
class4	1387	in five pancreatic polypeptide containing tumors  pp omas  the arteriography was positive in four and sampling performed in two was positive in both  
class4	1387	in the pp omas the peptide pattern showed that these tumors frequently contain several peptides  
class4	1387	we used selective pancreatic vein sampling in 21 cases with positive result in all  
class4	1387	in the cases in which arteriography was negative  the sampling results helped the surgeon to find the tumor  
class4	1387	the peptide pattern in the tumors varied greatly and most tumors were multihormonal  
class4	1388	localization and surgical treatment of occult insulinomas  
class4	1388	management of patients with biochemical evidence of insulinoma and negative preoperative imaging studies  occult  tumors is controversial  varying from primarily medical management to aggressive  blind nearly total pancreatectomy to extirpate the tumor  
class4	1388	since 1982  12 consecutive patients with occult insulinoma underwent preoperative portal venous sampling  pvs  for insulin followed by surgical exploration with intraoperative ultrasound  ious   
class4	1388	eleven of twelve patients  92   had insulinoma removed and were cured  
class4	1388	portal venous sampling correctly predicted the location of the insulinoma in 9 patients  75   and that no tumor would be found in another patient  
class4	1388	a fourfold insulin gradient in the pancreatic tail of one patient correctly predicted that a distal pancreatectomy would remove the insulinoma despite the fact that neither palpation nor ious identified any tumor  
class4	1388	intraoperative ultrasound was the single best method to identify occult tumors because it correctly identified 10 of 11 insulinomas that were found  including five pancreatic head tumors that were not palpable  
class4	1388	palpation identified five insulinomas  
class4	1388	of the 10 tumors that were identified during operation by palpation or ultrasound  ious identified significantly more  100  versus 50   p   0 03  and guided the successful enucleation of each  
class4	1388	the results support the strategy of preoperative pvs and operation with ious to localize and remove insulinoma in patients with occult tumors  
class4	1388	most tumors  75   will be correctly localized to a specific pancreatic region by preoperative pvs and identified by ious  83    allowing simple enucleation and biochemical correction of hypoglycemia  
class4	1388	morbid blind pancreatic resections are no longer indicated and long term medical management of hypoglycemia should be reserved for the occasional patient  8   who fails preoperative pvs and operation guided by ious  
class4	1389	surgical management of pheochromocytoma with the use of metyrosine  
class4	1389	despite recommended preoperative preparation with alpha adrenergic blockers  severe hemodynamic instability may occur during operations to resect pheochromocytoma  
class4	1389	we combined the alpha blocker phenoxybenzamine with the tyrosine hydroxylase inhibitor metyrosine in an attempt to better manage the hypertension of patients with pheochromocytoma undergoing surgical resection  
class4	1389	this report reviews the cases of 25 consecutive patients undergoing surgery for known intra abdominal pheochromocytoma  
class4	1389	each patient had elevated serum or urine levels of catecholamines or their metabolites  
class4	1389	nineteen patients were prepared before operation with phenoxybenzamine and metyrosine and six patients were given phenoxybenzamine alone  
class4	1389	there were no significant differences in maximum  minimum  or mean blood pressure before or after tumor resection between patients who received metyrosine and those who did not  
class4	1389	however careful review suggested that those who received metyrosine had more severe disease as judged by biochemical criteria  
class4	1389	study of selected patients matched for age and severity of disease suggested that the intraoperative blood pressure management of patients prepared with phenoxybenzamine and metyrosine was facilitated  
class4	1389	in addition metyrosine prepared patients lost less blood and required less volume replacement during surgery than did non metyrosine prepared patients  
class4	1389	there were no apparent differences in postoperative fluid requirements  
class4	1389	although the study is not a prospective randomized trial  a retrospective review of patients managed with the combination of phenoxybenzamine and metyrosine suggests that surgery to resect pheochromocytoma can be better performed with both drugs than with phenoxybenzamine alone  
class4	1389	the combination regimen appears to result in better blood pressure control  less blood loss  and the need for less intraoperative fluid replacement than does the traditional method of single agent alpha adrenergic blockade  
class4	1390	strategy for lymphadenectomy in lung cancer three centimeters or less in diameter 
class4	1390	we have surgically treated 221 patients with a primary lung cancer 3 0 cm or less in diameter  
class4	1390	there were 8 patients with a tumor 1 0 cm or less in diameter  group a   84 with a tumor 1 1 to 2 0 cm in diameter  group b   and 129 with a tumor 2 1 to 3 0 cm in diameter  group c   
class4	1390	the incidence of n0  n1  and n2 disease was 100   0   and 0   respectively  for patients in group a  83   5   and 12  in group b  and 62   12   and 25  in group c  n0 versus n2  p less than 0 01   
class4	1390	for the 63 patients with regional lymph node involvement   skipping  metastasis was present in 28 6   
class4	1390	the 5 year survival rate was 80  for group a  74  for group b  and 51  for group c  group b versus group c  p less than 0 01   
class4	1390	of the 121 patients who underwent complete resection and were followed up for 5 years  41  had recurrence  8  with local recurrence and 33  with distant metastasis  
class4	1390	therefore  it is important to do as complete a resection as possible together with mediastinal lymphadenectomy  
class4	1390	efforts to detect systemic spread should be made at the time of preoperative evaluation  even when the lung tumor is small  
class4	1391	surgical management of pulmonary metastatic leiomyosarcoma with gross endobronchial extension  
class4	1391	metastatic leiomyosarcoma occasionally is seen with gross endobronchial extension without invasion of the bronchial wall  
class4	1391	these patients have major airway obstruction and partial or total atelectasis of the lung  
class4	1391	precise bronchoscopic assessment coupled with intraoperative bronchotomy allows the surgeon to determine the origin of the tumor and to save uninvolved pulmonary parenchyma  
class4	1391	our experience with 4 such patients illustrates the possibility of saving lung tissue despite total bronchial obstruction  
class4	1392	giant chest wall tumor resulting from tissue reaction to foreign bodies  
class4	1392	three patients are reported in whom chest wall tumors developed 19 to 28 years after thoracoplasty and increased in size with time  
class4	1392	the tumors could be removed operatively with good results  
class4	1392	all tumors were composed of hematoma and necrotic material  and in all cases they revealed foreign bodies microscopically  
class4	1392	diagnosis and possible etiological factors are discussed  
class4	1393	thoracoscopic treatment of spontaneous pneumothorax using carbon dioxide laser  
class4	1393	in an effort to improve the success rate of the previously described thoracoscopic electrocautery ablation technique of spontaneous pneumothorax  the carbon dioxide laser was evaluated in 12 patients  
class4	1393	the recurrent  5 patients  or persistent  7 patients  spontaneous pneumothoraces were caused by rupture of  1  blebs in 6 patients   2  intrapulmonary apical type ii bullae in 3 patients  and  3  diffuse bullous emphysema  type iii  in 3  
class4	1393	the air leaks were successfully sealed in all but 1 patient with ruptured type ii bulla  
class4	1393	surgical specimen from this single failure suggested that the entire inner lining of the bullae must be thermocoagulated  
class4	1393	this technical modification led to successful outcome in 2 subsequent cases  
class4	1393	with the use of carbon dioxide laser  it was possible to treat not only small blebs but all types of bullae causing spontaneous pneumothorax  
class4	1393	laser thoracoscopy is effective and safe in treating spontaneous pneumothorax  
class4	1394	vagal schwannoma  
class4	1394	a patient with a benign encapsulated intrathoracic vagal schwannoma is presented and the literature is reviewed  
class4	1394	the right paratracheal tumor was identified incidentally on a chest film and excised using a right thoracotomy  
class4	1394	although rare  vagal schwannomas should be considered for any mediastinal mass along the vagus nerves especially when the paratracheal tumor produces minimal or no respiratory symptoms suggesting a slow growing  encapsulated process  
class4	1395	successful fontan type operation for a nonresectable right ventricular tumor  
class4	1395	a large intracavitary right ventricular tumor in a 24 year old patient was considered nonresectable because it involved the interventricular septum  the free ventricular walls  and the tricuspid valve  
class4	1395	surgical palliation consisted of closure of the tricuspid and pulmonary valves  and the right atrium was anastomosed to the pulmonary artery bifurcation  
class4	1395	the patient is asymptomatic 7 years after operation  and the neoplasm  a rhabdomyoma  has not increased in size  
class4	1396	mediastinal hibernoma  a rare tumor  
class4	1396	hibernoma is an uncommon soft tissue tumor that is derived from the remnants of fetal brown fat  
class4	1396	review of the world medical literature revealed 90 cases  6 of which were intrathoracic  
class4	1396	we present the seventh case of intrathoracic hibernoma  in this case  the hibernoma was within the mediastinum without direct invasion of other structures  
class4	1397	acute hypercalcemic crisis after an open heart operation  
class4	1397	acute hyperparathyroidism developed in a previously normocalcemic 64 year old woman during the first week after a coronary operation  
class4	1397	prolonged qt interval in the electrocardiogram and hypercalcemia were documented on the fourth postoperative day  
class4	1397	neck exploration on the fifth postoperative day revealed a lower right parathyroid adenoma  
class4	1397	parathyroidectomy resulted in rapid and dramatic improvement of the clinical picture and normalization of laboratory values  
class4	1398	long term results of operation for non small cell lung cancer in the elderly  
class4	1398	we surgically treated 185 patients with non small cell lung cancer who were 70 years old or older  
class4	1398	the operative mortality rate was 3   and the 5 year survival rate was 48   
class4	1398	the mortality and prognosis were similar to those in younger patients  
class4	1398	the number of elderly patients who smoked heavily or who had ventilatory defects was high  but the incidence of pneumonectomy was low  
class4	1398	there were no differences based on age in regard to histological type  tnm classification  and curability  
class4	1398	pulmonary complications occurred in 21  of the elderly patients and were correlated with preoperative pulmonary function and smoking habits  
class4	1398	when the elderly are to undergo elective pulmonary resection for lung cancer  the preoperative evaluation of pulmonary function should be thorough  and both preoperative and postoperative physical therapy should be given  
class4	1398	if postoperative pulmonary function is predicted to be less than 0 8 l m2 of vital capacity and 0 6 l m2 of forced expiratory volume in 1 second  a limited resection or nonsurgical therapy should be considered  
class4	1399	congenital tracheoesophageal fistula associated with carcinoma of the lung in an adult  
class4	1399	a rare case of adult congenital h type tracheoesophageal fistula was diagnosed  
class4	1399	subsequently  at operation  large cell  undifferentiated carcinoma of the right middle lobe with extension to the right lobe and adherence to the diaphragm was documented  
class4	1399	the diagnosis  surgical intervention  and 4 year follow up are presented  
class4	1400	bronchial anomaly of the right upper lobe  
class4	1400	this case report presents a rare anomaly of right upper lobe bronchial anatomy  
class4	1400	during routine right upper lobe resection for carcinoma  a common right upper and middle lobe bronchus was found  
class4	1400	the resection was completed as a right upper and middle bilobectomy  
class4	1400	knowledge of this uncommon variant was beneficial in performing the pulmonary resection  
class4	1400	a review of the literature is presented  
class4	1401	squamous carcinoma metastatic to the sternum  
class4	1401	a 63 year old man had a 10 x 16 cm sternal mass 18 months after a second aortocoronary bypass operation  
class4	1401	the resected lesion was a metastatic tumor of squamous histology  
class4	1401	no primary tumor was found  
class4	1401	the diagnostic work up and treatment options are presented  
class4	1402	malignant thymoma presenting as intracardiac tumor and superior vena caval obstruction  
class4	1402	a case of malignant thymoma with intracardiac infiltration and intrinsic superior vena caval obstruction due to the tumor is reported  
class4	1402	intracardiac invasion by a thymoma is rare and for this reason is believed worthy of a report  
class4	1403	empiric treatment of fungal infections in the neutropenic host  review of the literature and guidelines for use  
class4	1403	persistent fever that is refractory to broad spectrum antibacterials is common in neutropenic patients undergoing induction chemotherapy of acute leukemia  
class4	1403	clinical experience suggests that many of these patients are infected with fungi  
class4	1403	until recently  data supporting the role of empiric antifungal therapy in this setting were limited to small groups of patients or postmortem reports  
class4	1403	evolving evidence in larger patient populations supports data from smaller series  febrile neutropenic patients who have failed to respond to a 4  to 7 day course of broad spectrum antibacterials may benefit from the early initiation of antifungal therapy  
class4	1403	patients with fungal colonization or pulmonary infiltrates and adult patients who have not received previous fungal prophylaxis may especially benefit from the early use of antifungal drugs  
class4	1403	amphotericin b has been the  gold standard  for empiric antifungal therapy  although the newer azoles may be useful in certain situations  
class4	1404	systemic therapy in metastatic colorectal cancer  
class4	1404	fluorouracil based chemotherapy regimens have been utilized in metastatic colorectal cancer for more than 30 years  
class4	1404	early attempts at defining an optimal treatment schedule and use in combination with other drugs failed to significantly improve results  
class4	1404	in contrast  the clinical effectiveness of fluorouracil has been improved by continuous infusion administration and modulation with folinic acid  
class4	1404	both approaches have increased the response rate compared with results achieved with traditional bolus schedules  the effect on survival has been less significant  
class4	1404	unfortunately  expense and  in some instances  toxicity have also been increased  which detracts from their overall usefulness  
class4	1404	clinical studies that evaluate fluorouracil chemotherapy in combination with biological response modifiers are ongoing and will be areas of intense research during the next few years  
class4	1405	acute renal failure in obstructive jaundice in cholangiocarcinoma  
class4	1405	this study was aimed at defining the natural history of renal failure in obstructive jaundice due to cholangiocarcinoma  which is an important health problem in northeastern thailand  
class4	1405	sixty four patients among a total of 130 patients with obstructive jaundice secondary to cholangiocarcinoma who developed acute renal failure were studied retrospectively  
class4	1405	analysis was made with respect to clinical features  laboratory findings  and outcome  
class4	1405	the development of renal failure before surgery was observed in all patients  
class4	1405	it was nonoliguric in 80  and was associated with severe jaundice  gram negative infection  42    hypotension  31    hypoproteinemia  30    hyponatremia  56    and hypokalemia  63    
class4	1405	the mean duration of renal failure was 2 weeks  
class4	1405	all patients underwent surgery for the relief of jaundice  
class4	1405	seventy seven percent of the patients survived and had recovery of renal function after the relief of jaundice  
class4	1405	twenty three percent of the patients died of infection  
class4	1405	clinical data highlight the higher serum bilirubin levels and the frequent occurrence of hyponatremia  hypokalemia  and hypotension in renal failure  
class4	1405	their possible roles in contributing to the development of renal failure are discussed  
class4	1406	medical comorbidity of major depressive disorder in a primary medical practice  
class4	1406	despite much speculation about the relationship between depression and medical comorbidity in primary care settings  few investigators have examined this issue empirically  
class4	1406	using a two stage screening procedure  we assessed 618 patients aged 18 to 64 years in an academic general medicine clinic  
class4	1406	forty one patients  6 6   suffered from a current episode of major depressive disorder  mdd   
class4	1406	we compared this group with a 20  random sample of nondepressed patients  
class4	1406	while patients with mdd were younger  mean age  41 1 vs 47 2 years   they were assessed by the duke university severity of illness scale as having more severe medical illness  
class4	1406	patients with mdd were more likely to have malignant tumors and  ill defined conditions  than nondepressed patients  
class4	1406	the 18 patients with mdd  44   who were correctly diagnosed by their physicians had less severe medical illness than those whose depression was clinically undetected  
class4	1406	a logistic regression model predicting mdd group membership included female gender  younger age  higher duke university severity of illness scale score  and more frequent inactive ill defined diagnoses  
class4	1406	these findings are consistent with assertions   1  patients with mdd have more physical illness than nondepressed patients and or  2  somatic symptoms and disability caused by mdd add to the burden of physical illness  
class4	1407	pheochromocytoma presenting as rhabdomyolysis and acute myoglobinuric renal failure  
class4	1407	we report the case of a previously healthy young woman who presented with the sudden onset of rhabdomyolysis and myoglobinuric renal failure  requiring hemodialysis for 3 weeks  
class4	1407	common causes of rhabdomyolysis were ruled out  as renal function returned  severe hypertension was noted and a pheochromocytoma was diagnosed  
class4	1407	we suggest that pheochromocytoma causes rhabdomyolysis and myoglobinuria via catecholamine mediated vasoconstriction and skeletal muscle ischemia  
class4	1408	lower extremity weakness as the initial manifestation of lung cancer  published erratum appears in arch phys med rehabil 1991 jan 72 1  61  
class4	1408	a 55 year old woman had progressive lower extremity weakness  
class4	1408	she had an 80 pack per year history of cigarette smoking  
class4	1408	electromyographic findings were consistent with the lambert eaton myasthenic syndrome  
class4	1408	despite a normal chest x ray  normal laboratory studies  and negative bronchoscopy  investigation for lung cancer was pursued  
class4	1408	the final thoracotomy and pathology reports indicated a diagnosis of oat cell carcinoma  
class4	1408	after treatment with chemotherapy and radiation therapy  clinical and electrophysiologic findings have resolved  
class4	1408	two years after diagnosis  the patient remains in good health without evidence of recurrence  
class4	1409	needle localized mammographic lesions  results and evolving treatment strategy  
class4	1409	from january 1981 to december 1987  932 needle localization breast biopsies were performed at our institution for mammographically detected abnormalities  
class4	1409	we reviewed 531 needle localization breast biopsy procedures performed during two periods  january 1981 to june 1984  n   311  and january to august 1987  n   220  to compare results and treatment patterns  and to determine the prevalence of the missed lesions  
class4	1409	mammographic abnormalities detected on routine screening accounted for a larger proportion of needle localization breast biopsies in the later series  94  30   of 311 vs 94  43   of 220   
class4	1409	however  the rate at which carcinoma was identified remained constant at 29  as did the percentage of cancers that were invasive  46  vs 51    
class4	1409	overall  the rate of malignant diagnoses after needle localization breast biopsy was lowest in asymptomatic women undergoing routine screening mammography  44  24   of 188  and significantly higher in women undergoing mammographic follow up of the contralateral breast after treatment for breast cancer  28  43   of 65   
class4	1409	there were seven missed lesions in 531 needle localization breast biopsies  necessitating a second procedure in six and interval mammograms in one  
class4	1410	hepatic vein reconstruction for preserving remnant liver function  
class4	1410	hepatic malignancies often infiltrate to the major hepatic vein  
class4	1410	recently  we performed hepatic resection combined with hepatic vein reconstruction for preserving remnant liver function in three such patients  
class4	1410	one patient had a saphenous vein graft  
class4	1410	postoperative liver function of the patients who underwent hepatic vein reconstruction was compared with those of eight patients who underwent hepatic resection of segments vii and viii  
class4	1410	the right hepatic vein in four of them was resected and in the remaining four was preserved by skeletalization using an ultrasonic aspirator  
class4	1410	although four patients with right hepatic vein resection showed severe lowering of liver function after surgery  the postoperative course of patients with preservation or reconstruction of the right hepatic vein maintained good liver function  
class4	1410	liver regeneration of three patients with hepatic vein reconstruction was good on computed tomography  
class4	1410	besides this report  to our knowledge  there is no other report of hepatic vein reconstruction for preserving the remnant liver function  
class4	1410	problems with hepatic resection combined with hepatic vein reconstruction are discussed  
class4	1410	we conclude that hepatic vein reconstruction is one of the means for extending indication of the malignant tumor resection of the liver  
class4	1411	primary malignant peritoneal mesothelioma  a report of seven cases and a review of the literature  
class4	1411	mesothelioma of the peritoneum is a rare malignant neoplasm easily mistaken by both surgeon and pathologist for one of the more common neoplasms of the abdomen  
class4	1411	review of our records from metropolitan area hospitals for the past 15 years identified seven patients with primary peritoneal mesotheliomas  
class4	1411	their diagnosis  management  and survival is analyzed  
class4	1411	we report a case of an extended survivor  7 years  and one of a long term survivor  15 years   as well as what we believe to be the only case in the literature presenting with a coexistent malignant neoplasm  
class4	1411	prevention of this commonly fatal neoplasm is linked to avoiding occupational exposure to asbestos  long term survival for a few patients may be achieved with correct identification of the neoplasm and aggressive management  
class4	1411	this report includes a review of the literature  
class4	1412	management of perineal wounds following abdominoperineal resection with inferior gluteal flaps  
class4	1412	our experience treating perineal wounds secondary to abdominoperineal resection  either for inflammatory bowel disease or cancer  is presented  
class4	1412	a total of 16 patients were treated either on a delayed basis or at the same time as the abdominoperineal resection  
class4	1412	all wounds were closed using the inferior gluteal myocutaneous flap  
class4	1412	fifteen of 16 patients have achieved healing  eight of whom had no complications  
class4	1412	only minor revisions or local wound care were required in the remaining patients  with only one patient failing to heal  
class4	1412	our results compare favorably with previous reports of treatment of this difficult problem  
class4	1413	the papillary cystic neoplasm of the pancreas  an increasingly recognized clinicopathologic entity  
class4	1413	the clinical course of the papillary cystic neoplasm of the pancreas is contrasted with that of the pancreatic ductal adenocarcinoma  
class4	1413	the former occurs predominantly in young women  has a low malignant potential  and is highly curable with surgical treatment  
class4	1413	three cases are reported that illustrate the typical clinical features and the indolent nature of the tumor  
class4	1413	one case was discovered after blunt abdominal trauma resulted in rupture of the tumor and hemoperitoneum  
class4	1413	all cases were treated by pancreatic resection with preservation of the spleen  an important consideration in younger patients  
class4	1413	all patients were free of disease at long term follow up  
class4	1413	increasing awareness of this tumor has resulted in the reclassification of several tumors and should lead to better recognition by surgeons caring for patients with pancreatic diseases  
class4	1414	retrovirus from human t cell leukemia virus type i associated myelopathy is the same strain as a prototype human t cell leukemia virus type i  
class4	1414	a retrovirus was isolated from a t cell line that was established from lymphocytes in the cerebrospinal fluid of a patient with human t cell leukemia virus type i associated myelopathy  ham   and its genome was sequenced  
class4	1414	the nucleotide sequence of the 3  half of the total genome was identical in 99 5  of the nucleotides to that of the prototype human t cell leukemia virus type i that was derived from a patient with adult t cell leukemia  
class4	1414	these results indicate that the same retrovirus human t cell leukemia virus type i is associated with both a neurological disease  ham  and a lymphoproliferative disease  adult t cell leukemia  
class4	1415	molecular phenotype of a pediatric small round cell tumor  
class4	1415	molecular probes were used to characterize an unusual small round cell abdominal tumor arising from the fallopian tube of a 15 year old girl  
class4	1415	dna and rna extracted from the tumor and adjacent normal tissue was subjected to southern and northern blot analysis using a variety of different probes  
class4	1415	n myc oncogene rna was greatly expressed in the tumor  but was not expressed in normal tissue or amplified in chromosomal dna  
class4	1415	insulin like growth factor ii rna was similarly overexpressed in the neoplasm  but not in normal tissue  
class4	1415	while histopathologic studies could not distinguish between a neuroectodermal neoplasm and wilms  tumor  electron microscopy and the pattern of gene expression was most consistent with wilms  tumor  
class4	1416	decrease in cerebral metabolic rate of glucose after high dose methotrexate in childhood acute lymphocytic leukemia  
class4	1416	we measured changes in the regional cerebral metabolic rate of glucose  rcmrglu  using 18f fluorodeoxyglucose and positron emission tomography for the assessment of neurotoxicity in childhood acute lymphocytic leukemia treated with high dose methotrexate  hd mtx  therapy  
class4	1416	we studied 8 children with acute lymphocytic leukemia  mean age  9 6 years  treated with hd mtx  200 mg kg or 2 000 mg m2  therapy  
class4	1416	cmrglu after hd mtx therapy was most reduced  40   in the patient who had central nervous system leukemia and was treated with the largest total doses of both intrathecal mtx  it mtx  and hd mtx  
class4	1416	cmrglu in the whole brain after hd mtx therapy was reduced by an average of 21   p less than 0 05   
class4	1416	the reductions of cmrglu in 8 patients were correlated with total doses of both it mtx  r   0 717  p less than 0 05  and systemic hd mtx  r   0 784  p less than 0 05   
class4	1416	cmrglu of the cerebral cortex  especially the frontal and occipital cortex  was reduced more noticeably than that of the basal ganglia and white matter  
class4	1416	we suggest that the measurement of changes in rcmrglu after hd mtx therapy is useful for detecting accumulated mtx neurotoxicity  
class4	1417	photodynamic therapy with chloroaluminum sulfonated phthalocyanine  
class4	1417	to study the vascular effects of a new photosensitizing agent independent of the influence of tumor growth  a cutaneous wound model was used  
class4	1417	six week old harlan sprague dawley  fuzzy  rats were surgically wounded in a standard fashion  
class4	1417	the animals were then divided into three groups  the first group received chloroaluminum sulfonated phthalocyanine only  the second group was treated with light only  and a third group was treated with both chloroaluminum sulfonated phthalocyanine and light  
class4	1417	photodynamic therapy with chloroaluminum sulfonated phthalocyanine had a direct effect on the neovasculature of a healing wound  
class4	1417	the vasodilatation that was seen in the wound neovasculature that occurred 12 hours after the completion of chloroaluminum sulfonated phthalocyanine photodynamic therapy may have indicated a therapeutic  window  at which other therapies can be employed to improve clinical efficacy  
class4	1418	photodynamic therapy in the treatment of squamous cell carcinoma of the head and neck  
class4	1418	photodynamic therapy is an experimental modality for tumor treatment based on the combined action of the tumor localizing agent  ie  hematoporphyrin derivative  and red light  
class4	1418	from 1985 through 1989  26 patients were treated using hematoporphyrin derived drugs and 630 nm light delivered by a tunable dye laser  
class4	1418	all patients had biopsy proved squamous cell carcinoma of the head and neck  and they had either failed the traditional treatment modalities or refused conventional therapies  
class4	1418	histological complete responses were achieved in 20  77   of 26 patients and partial responses in 5  19   of 26 patients for periods up to 48 months  
class4	1418	only minimal toxic reaction was noted in the group  
class4	1418	as a guide to treatment planning for a patient group with large tumors  we used an optical dosimetry model based on tissue optics  
class4	1418	the rate of complete responses to this treatment was 8  73   of 11  
class4	1418	our data indicate that photodynamic therapy is capable of inducing significant clinical and histological responses in the majority of those treated  and in some patients a prolonged response is produced  
class4	1418	in certain select head and neck malignancies  photodynamic therapy has an important role as a treatment modality  
class4	1419	leiomyosarcoma of the sinonasal tract  a clinicopathologic study of nine cases  
class4	1419	the clinicopathologic features of nine cases of sinonasal tract leiomyosarcoma  sntl  referred to the armed forces institute of pathology  washington  dc  during the period from 1970 through 1988 are described  
class4	1419	this report represents the largest study to date on sntl  and our results are compared with the 21 previously reported cases of sntl  
class4	1419	of the nine cases described  patients ranged in age from 22 to 86 years  mean  55 years   
class4	1419	the most frequent clinical presentation was nasal obstruction unilaterally  
class4	1419	the neoplasms were limited solely to the nasal cavity in four cases  44   and involved both the nasal cavity and paranasal sinuses in the remaining five cases  
class4	1419	light microscopic  immunocytochemical  and ultrastructural features served to characterize these tumors as malignant neoplasms of smooth muscle origin  
class4	1419	in contrast with previous studies  immunocytochemistry was employed to differentiate sntl from other spindle cell malignancies of the region  using newly available monoclonal antibodies to smooth muscle antigens  
class4	1419	treatment was surgical  
class4	1419	radiotherapy or chemotherapy did not appear to affect the progression of the disease  
class4	1419	furthermore  no relationship was found between the aggressiveness of sntl and morphologic parameters  eg  mitotic count and tumor size   
class4	1419	instead  prognosis was dependent on the distribution of disease at presentation  
class4	1419	of all 30 patients with sntl described to date  10 had the neoplasm confined solely to the nasal cavity  
class4	1419	the 10 neoplasms did not recur  
class4	1419	we conclude that sntl may best be regarded as a locally aggressive neoplasm with only limited metastatic potential and that it could be curable by complete surgical excision  
class4	1420	flow cytometric dna content of adenoid cystic carcinoma of submandibular gland  correlation of histologic features and prognosis  
class4	1420	flow cytometric analysis of nuclear dna content was performed in 26 adenoid cystic carcinomas of the submandibular gland using archived  paraffin embedded tissues  
class4	1420	the dna content was compared with multiple histologic parameters and clinical course  
class4	1420	ten carcinomas  38   were aneuploid and 16  62   diploid  
class4	1420	aneuploid carcinomas demonstrated a higher frequency of solid cytoarchitecture  lymph node metastases  and advanced clinical stage  as compared with diploid carcinomas  
class4	1420	other histologic features predicting aggressive clinical behavior also correlated with abnormal dna content and included invasion of nerves larger than 0 25 mm and intravascular extension  
class4	1420	our data suggest that dna content analysis can be an effective objective parameter in the clinicopathologic assessment of adenoid cystic carcinoma  
class4	1421	improving diagnostic accuracy of cervical metastases with computed tomography and magnetic resonance imaging  
class4	1421	elective neck dissection in patients with head and neck cancer continues to be controversial  
class4	1421	the management of these patients would be greatly facilitated by improvements in predicting cervical metastases  
class4	1421	recent investigations have suggested that computed tomography and magnetic resonance imaging are more sensitive in detecting cervical metastases than physical examination  
class4	1421	the department of otolaryngology at the ohio state university hospitals  columbus  undertook a prospective study to compare the preoperative sensitivities of physical examination  computed tomography  and magnetic resonance imaging with pathologic findings in 27 patients undergoing neck dissections for head and neck cancer  
class4	1421	the results indicate that computed tomography and magnetic resonance imaging were more sensitive  84  and 92   respectively  than physical examination  75    although the results did not achieve statistical significance  
class4	1421	the sensitivity of combined computed tomography and magnetic resonance imaging was 90   
class4	1422	the in vivo biologic effect of interleukin 2 and interferon alfa on natural immunity in patients with head and neck cancer  
class4	1422	given the association of deficient natural immunity with the risk of metastatic disease  the ability to activate natural killer cell function may have a therapeutic significance  
class4	1422	the effect of continuous infusion of interleukin 2 plus intramuscular interferon alfa on natural immune status was  therefore  analyzed in eight patients with head and neck cancer  
class4	1422	also evaluated was the effect of interleukin 2 interferon alfa therapy on lymphokine activated killer cell activity as well as total lymphocyte count  percent of lymphocyte subsets  and levels of both circulating immune complexes and antibody classes  
class4	1422	both the percent and absolute number of natural killer cells  ie  cd56  cd3  lymphocytes  within peripheral blood as well as natural killer cell activity against k562 targets increased significantly with treatment  
class4	1422	the remaining immune parameters were not significantly altered  
class4	1422	the demonstrated capacity to modulate natural immune function supports the potential use of interleukin 2 containing regimens as a preventive measure against metastatic disease in patients with head and neck cancer  
class4	1423	metastasizing pleomorphic adenoma of the nasal septum  
class4	1423	pleomorphic adenoma is the most common benign tumor of glandular tissue occurring in the head and neck region  
class4	1423	there have been several reports of metastasis of this benign appearing tumor from the salivary glands to distant sites  suggesting hematogenous spread and implantation  
class4	1423	although occurrence of pleomorphic adenoma on the nasal septum has been described  to our knowledge this is the first reported case of recurrent septal pleomorphic adenoma with histologically benign tissue in an enlarged metastatic ipsilateral submandibular lymph node  suggesting lymphatic spread  
class4	1423	the literature concerning the subject is reviewed  
class4	1423	wide septal excision and modified neck dissection is the recommended treatment  
class4	1424	chondrosarcoma of the larynx  diagnosis with magnetic resonance imaging and computed tomography  
class4	1424	chondrosarcomas are the most common sarcomas of the larynx  
class4	1424	they are generally slow growing lesions with insidious onset of symptoms  
class4	1424	we are presenting a case of chondrosarcoma that recurred 10 years after excision of a presumed chondroma  
class4	1424	computed tomographic and magnetic resonance imaging  mri  scans were performed  
class4	1424	both studies delineated the lesion nicely  
class4	1424	to the best of our knowledge  this is the first report on mri characteristics of chondrosarcoma of the larynx  
class4	1424	a review of the literature regarding the use of computed tomography in the management of chondrosarcoma is presented  
class4	1424	the mri characteristics are discussed and the two scanning modalities are compared  
class4	1424	computed tomography is an excellent study in its ability to demonstrate the extent of the lesion within the laryngeal skeleton  
class4	1424	furthermore  it is more highly sensitive than plain roentgenograms in the detection of calcifications that are highly suggestive of chondrosarcoma  
class4	1424	alternatively  mri can also demonstrate the lesion within the larynx but it has the added advantage of superior contrast resolution of the tumor and paralaryngeal tissues  
class4	1424	when the three dimensional imaging capacity of mri is considered as well  mri seems to be the superior study  
class4	1425	reliability of colposcopy and directed punch biopsy 
class4	1425	a group of 118 women underwent laser cone biopsy  
class4	1425	data were collected routinely on proforma case notes and entered into a computerized database  
class4	1425	the histology of the cone biopsies was compared with that of previous  colposcopically directed punch biopsies  with the cytology of smears taken in the clinic and with the colposcopic diagnosis  
class4	1425	the punch biopsy had a 54  false negative rate and neither of the two microinvasive carcinomas biopsied in this way were detected by the biopsy  
class4	1425	ten of 24 women with negative punch biopsies had cin iii in the cone  
class4	1425	when the punch biopsy showed cin ii or worse  the cone biopsy confirmed the presence of cin in 86   
class4	1425	there was some evidence of false negative cone biopsies  
class4	1425	the data suggest that management should not be based solely upon the punch biopsy result but should include consideration of the cytology and colposcopy findings  
class4	1425	excisional methods of treatment are more likely to reveal early invasion and adenocarcinoma in situ  
class4	1426	the management of primary fallopian tube carcinoma  
class4	1426	the outcome of 30 patients with primary fallopian tube carcinoma is described  
class4	1426	treatment varied over the 22 year period of accrual and included combinations of surgery  radiotherapy and chemotherapy  
class4	1426	there was an apparent increase in stage at treatment with time which was probably related to more precise staging at laparotomy and the greater use of computerized tomography  
class4	1426	the median survival for all patients was 28 months and the 5 year survival was 18   
class4	1426	ten patients received postoperative chemotherapy for residual disease with an overall response rate of 80  and median progression free and overall survival times of 14 and 21 months respectively  
class4	1426	the pattern of relapse was similar to that seen in ovarian carcinoma  with all but one patient having the pelvis or abdomen as the main site of recurrence  
class4	1426	primary fallopian tube carcinoma has a response to treatment and a tumour biology similar to that of ovarian carcinoma  
class4	1426	it is recommended that the management of this uncommon malignancy should continue to be along the lines of ovarian carcinoma  with initial treatment by cytoreductive surgery followed by chemotherapy or radiotherapy for residual disease  
class4	1427	interleukin 6  il 6  is an intermediate in il 1 induced proliferation of leukemic human megakaryoblasts  
class4	1427	we have examined the in vitro effects of recombinant human  rh  interleukin 1  il 1  on the growth of purified megakaryoblasts obtained from patients with acute megakaryoblastic leukemia  
class4	1427	we demonstrate that both il 1 alpha and il 1 beta treatment of these cells led to stimulation of dna synthesis  as shown by increase of 3h thymidine incorporation up to 35 fold  and also resulted in colony formation of leukemic megakaryoblasts  
class4	1427	however  the stimulatory effect of il 1 was dependent on endogenous production of il 6  because addition of neutralizing monoclonal antibody  moab  to il 6 abrogated the stimulatory activity of il 1  
class4	1427	in contrast  neutralizing moabs to granulocyte  g  colony stimulating factor  csf   granulocyte macrophage  gm  csf  and macrophage  m  csf failed to counteract the growth enhancing effects of il 1  
class4	1427	leukemic megakaryoblasts accumulated il 6 mrna and released il 6 protein into their culture supernatant when exposed to rh il 1 but failed to disclose transcripts for g   gm   and m csf under these conditions  
class4	1427	analysis of il 6 receptor  il 6r  transcript levels demonstrated that megakaryoblasts constitutively expressed il 6r mrna and that these transcripts are down regulated to undetectable levels upon exposure to il 1 and il 6  
class4	1427	increase of 3h thymidine incorporation by megakaryoblasts could be duplicated by exogenous il 6 that could be blocked by neutralizing moab to il 6  
class4	1427	in conclusion  our results suggest that leukemic megakaryoblasts could produce and secrete il 6  and express il 6r  and that the growth enhancing effect of il 1 on these cells is indirect  via production of il 6 by leukemic cells  
class4	1428	induction of in vitro graft versus leukemia activity following bone marrow transplantation for chronic myeloid leukemia  
class4	1428	we studied the in vitro effects of lymphokine activated killer  lak  cells from the peripheral blood of chronic myeloid leukemia  cml  patients after allogeneic and syngeneic bone marrow transplantation  bmt   
class4	1428	lak cells were generated by incubating peripheral blood mononuclear cells from patients post bmt with recombinant interleukin 2  il 2   500 u ml  in 10  ab serum for 7 days  
class4	1428	they were phenotyped and tested for activity in a standard 4 hour 51cr release assay  n   37  and in a cfu gm assay  n   24   
class4	1428	we found that the lak cells were mainly activated natural killer cells  but some were cd3  t cells  
class4	1428	in the 51cr release assay lak cells from 20 of 33  61   allogeneic and 2 of 4 syngeneic recipients killed recipient cml cells and in 22 of 37  60   cases also killed the hla disparate cml cells  
class4	1428	in the cfu gm assay the lak cells incubated together with the cml cells in liquid culture before plating inhibited  p less than  05  colony growth in 16 of 22 allogeneic and 2 of 2 syngeneic recipients  
class4	1428	cell cell contact was necessary for optimal effect  
class4	1428	there was little or no inhibition of proliferation of donor marrow cfu gm  
class4	1428	this in vitro graft versus leukemia  gvl  effect could also be demonstrated after lak effectors were depleted of cd3  t cells  
class4	1428	it was inducible in recipients of both t cell depleted and t cell replete donor marrow and in recipients with or without graft versus host disease  
class4	1428	these results suggest that a major histocompatibility complex unrestricted gvl effect is inducible following allogeneic and syngeneic bmt  
class4	1428	the use of il 2 lak cells after bmt could reduce the risk of relapse  
class4	1429	deletion of the human retinoblastoma gene in primary leukemias  
class4	1429	as an initial step in evaluating the role of tumor suppressor genes in leukemogenesis  we surveyed primary leukemia cells from 130 patients for possible deletion of the retinoblastoma susceptibility  rb  gene by southern blot analysis  
class4	1429	two of them clearly showed homozygous deletion of rb alleles  
class4	1429	the first patient was a pre b acute lymphoid leukemia  all  associated with a cytogenetic translocation  t 14 16  q24 q22   
class4	1429	the deletion was located at the 3  portion of the rb gene  very close to the site of rb gene deletion recently identified in an all cell line  
class4	1429	the absence of rb110 protein was further confirmed by western blot analysis  
class4	1429	the second patient was a chronic myelomonocytic leukemia  cmmol   terminated in acute blastic transformation  
class4	1429	deletion of the 5  portion of rb gene was found in leukemic cells in the chronic stage  
class4	1429	the results indicated that inactivation of the rb gene occurred in certain cases of leukemia  
class4	1429	its significance warrants further study  
class4	1430	expression of p glycoprotein in adult t cell leukemia cells  
class4	1430	we have examined the expression of p glycoprotein  p gp  in adult t cell leukemia  atl  samples from 25 patients  
class4	1430	based on immunoblotting with a monoclonal antibody against p gp  c219  8 of 20 atl patients were p gp positive at the initial presentation  
class4	1430	all 6 patients at the relapsed stage were p gp positive  and refractory to chemotherapy  
class4	1430	the expression of mdr1 mrna in p gp positive atl cells was increased at the relapsed stage of one patient  
class4	1430	p gp of this patient was photolabeled with  3h azidopine and the labeling was inhibited with nimodipine  vinblastine and progesterone  
class4	1430	these results suggest that p gp expressed in atl cells from patients at relapsed stage has the same binding site s  for the drugs as that in multidrug resistant cells  and is correlated with the refractory nature of the cells to chemotherapy  
class4	1431	association of bcl 1 rearrangements with lymphocytic lymphoma of intermediate differentiation  
class4	1431	previous studies using classical cytogenetics have demonstrated the presence of the t 11 14   q13 q32  chromosomal translocation in some cases of lymphocytic lymphoma of intermediate differentiation  idl   a distinct type of low grade b cell lymphoma  
class4	1431	this finding suggested that the bcl 1 region  located at band q13 of chromosome 11  might be involved in this neoplasm  
class4	1431	using a genomic probe from the major breakpoint area of the bcl 1 locus  we identified rearrangements of the bcl 1 region in 10 of 19 cases  2 of which comigrated with a rearranged allele of the immunoglobulin heavy chain gene joining region  
class4	1431	in contrast  bcl 1 rearrangements were not found in other types of low grade b cell lymphoma  specifically in 36 cases of chronic lymphocytic leukemia small lymphocytic lymphoma  cll sll  and 27 cases of follicular lymphoma  fl   
class4	1431	to further assess the molecular pathology of idl  we analyzed these cases for rearrangements of the bcl 2 proto oncogene  which is associated primarily with follicular lymphomas  
class4	1431	none of the 19 cases of idl had rearrangements  
class4	1431	furthermore  none of the 36 cases of cll sll showed bcl 2 rearrangements  whereas  as expected  21 of 27 cases of fl had rearrangements of the bcl 2 locus  
class4	1431	our findings demonstrate an association between a rearranged bcl 1 region with approximately 50  of idls and suggest that abnormalities of this locus may be important in the pathogenesis of idl  
class4	1432	psychological outcomes of different treatment policies in women with early breast cancer outside a clinical trial 
class4	1432	objectives  to assess outside a clinical trial the psychological outcome of different treatment policies in women with early breast cancer who underwent either mastectomy or breast conservation surgery depending on the surgeon s opinion or the patient s choice  
class4	1432	to determine whether the extent of psychiatric morbidity reported in women who underwent breast conservation surgery was associated with their participation in a randomised clinical trial  
class4	1432	design  prospective  multicentre study capitalising on individual and motivational differences among patients and the different management policies among surgeons for treating patients with early breast cancer  
class4	1432	setting  12 district general hospitals  three london teaching hospitals  and four private hospitals  
class4	1432	patients  269 women under 75 with a probable diagnosis of stage i or ii breast cancer who were referred to 22 different surgeons  
class4	1432	interventions  surgery and radiotherapy or adjuvant chemotherapy  or both  depending on the individual surgeon s stated preferences for managing early breast cancer  
class4	1432	main outcome measures  anxiety and depression as assessed by standard methods two weeks  three months  and 12 months after surgery  
class4	1432	results  of the 269 women  31 were treated by surgeons who favoured mastectomy  120 by surgeons who favoured breast conservation  and 118 by surgeons who offered a choice of treatment  
class4	1432	sixty two of the women treated by surgeons who offered a choice were eligible to choose their surgery  and 43 of these chose breast conserving surgery  
class4	1432	the incidences of anxiety  depression  and sexual dysfunction were high in all treatment groups  
class4	1432	there were no significant differences in the incidences of anxiety and depression between women who underwent mastectomy and those who underwent lumpectomy  
class4	1432	a significant effect of surgeon type on the incidence of depression was observed  with patients treated by surgeons who offered a choice showing less depression than those treated by other surgeons  p   0 06   
class4	1432	there was no significant difference in psychiatric morbidity between women treated by surgeons who offered a choice who were eligible to choose their treatment and those in the same group who were not able to choose  
class4	1432	most of the women  159 244  gave fear of cancer as their primary fear rather than fear of losing a breast  
class4	1432	the overall incidences of psychiatric morbidity in women who underwent mastectomy and those who underwent lumpectomy were similar to those found in the cancer research campaign breast conservation study  
class4	1432	at 12 months 28  of women who underwent mastectomy in the present study were anxious compared with 26  in the earlier study  and 27  of women in the present study who underwent lumpectomy were anxious compared with 31  in the earlier study  
class4	1432	in both the present and earlier study 21  of women who underwent mastectomy were depressed  and 19  of women who underwent lumpectomy in the present study were depressed compared with 27  in the earlier study   conclusions  there is still no evidence that women with early breast cancer who undergo breast conservation surgery have less psychiatric morbidity after treatment than those who undergo mastectomy  
class4	1432	women who surrender autonomy for decision making by agreeing to participate in randomised clinical trials do not experience any different psychological  sexual  or social problems from those women who are treated for breast cancer outside a clinical trial  
class4	1433	chronic anaemia  hyperbaric oxygen and tumour radiosensitivity  
class4	1433	anaemia is an important factor in the response of some human tumours to radiotherapy  
class4	1433	the outcome is also influenced by whether the treatment is given in air or high pressure oxygen  hpo   
class4	1433	the present study examined the relationship between anaemia and tumour response to radiation given in air or hpo in c3h mice transplanted with a mammary adenocarcinoma using a growth delay assay to assess the radiation response  
class4	1433	chronic anaemia was induced by the use of a low iron diet and was characterized by a significant reduction in host haematocrit and whole blood viscosity  
class4	1433	in addition  anaemia was associated with a right shift in the oxyhaemoglobin dissociation curve and an increase in the volume doubling time of the tumour  but there was no change in the concentration of 2 3 diphosphoglycerate in the red cells  
class4	1433	radiation studies with these anaemic mice demonstrated that the tumour radiosensitivity was decreased when treatment was given in air  
class4	1433	hpo was successful in overcoming the increased radioresistance associated with anaemia  
class4	1433	this result suggested that tumours grown in anaemic mice have a higher hypoxic fraction than those grown in control mice  
class4	1433	changes in host physiology with chronic anaemia may contribute to the benefit seen with hpo but such alterations per se may be inadequate to maintain tumour oxygenation when treatment is given in air  
class4	1434	lipiodol computerized tomography  how sensitive and specific is the technique in the diagnosis of hepatocellular carcinoma  
class4	1434	computerized tomography  ct  following the intra arterial injection of lipiodol  lipiodol ct  was performed on 60 patients suspected of having a hepatocellular carcinoma  hcc   
class4	1434	four main patterns of uptake of the lipiodol within the liver were seen on ct  
class4	1434	of the 14 well circumscribed lesions with dense homogeneous uptake of lipiodol  13 were confirmed to be hccs  
class4	1434	of the 25 lesions with dense patchy uptake of lipiodol at the periphery and or in the centre  19 were confirmed to be hccs  
class4	1434	in 18 patients  in whom only ill defined faint patchy uptake of lipiodol was present in the liver  or in whom no hepatic uptake was present at all  only one patient was found later to have an hcc  
class4	1434	of the three hypodense lesions in the liver with no lipiodol uptake  one was found to be necrotic hcc  one a cholangiocarcinoma and one a regenerative nodule  
class4	1434	in the diagnosis of hcc  lipiodol ct had an overall sensitivity of 97 1   an accuracy of 88 3  and a specificity of 76 9   
class4	1434	of the 34 patients with hcc  only 23 were solitary at diagnosis  
class4	1434	the size of the hccs ranged from 0 8 cm to 11 cm in diameter with the median size at 2 2 cm  
class4	1434	eleven of 34 hccs  32 3   were resectable  
class4	1434	we conclude that  as part of a screening programme for high risk patients  
class4	1434	lipiodol ct is useful in the early detection of hccs  
class4	1434	the technique also plays an important role in determining whether the tumour should be resected or managed with chemotherapy  
class4	1434	by detecting hccs while still small  the resectability rate can also be improved  
class4	1435	choroid plexus cysts and chromosomal defects 
class4	1435	during a 4 year period  83 pregnant women with fetal choroid plexus cysts were investigated in our unit  
class4	1435	abnormal karyotypes were found in 20 fetuses  including trisomy 18  n   16   trisomy 13  n   1   triploidy  n   1  and translocation down s syndrome  n   2   
class4	1435	all fetuses with chromosomal defects had structural malformations in addition to the choroid plexus cysts  
class4	1436	clinical management of port wine stain in infants and young children using the flashlamp pulsed dye laser  
class4	1436	the flashlamp pulsed dye laser  flpdl  at 585 nm  a wavelength well absorbed by oxyhemoglobin  causes highly selective vascular injury  
class4	1436	in addition  the 450 microsecond pulse duration produced by this laser approximates the thermal relaxation time for dermal blood vessels thereby confining the energy to the target  
class4	1436	this new laser effects excellent lightening of port wine stain  pws  in infants and young children without the adverse complications of hypertrophic scarring  permanent pigmentation abnormality  or textural changes  complications often seen with conventional laser systems  
class4	1436	the flpdl now permits treatment of this patient population expected to gain the most benefit from early laser therapy in a much safer manner  before the psychological complications of being a  marked  person develop  
class4	1436	the purpose of this report is to   1  describe the theoretical considerations behind achieving selective removal of pws that can be understood and used by a nonsurgically oriented practitioner  and  2  describe the practical application of the device used in the clinical management of infants and young children  
class4	1437	predictive value of congenital hypertrophy of the retinal pigment epithelium as a clinical marker for familial adenomatous polyposis  
class4	1437	one hundred forty eight members of 53 kindreds with familial adenomatous polyposis  fap  were examined for congenital hypertrophy of the retinal pigment epithelium  chrpe  and extracolonic manifestations  ecm  to assess the value of chrpe as a predictive marker for fap  
class4	1437	based on eye examination results  the families were divided into 2 groups  
class4	1437	in a first group of 34 families  all 61 members diagnosed as having polyps and 13 of the 33 patients at risk had 4 or more lesions distributed in both eyes  
class4	1437	by contrast  in a second group of 18 families  all 32 polyposis patients and all 18 members at risk had less than 4 lesions  
class4	1437	extra colonic manifestations were present in 26 of 34 families in the first group and in 11 of 18 families in the second group  
class4	1437	data on one family with ambiguous ancestry were reviewed separately  
class4	1437	the existence of 4 or more chrpe lesions distributed in both eyes seems to be a congenital marker for fap  present in 65 4 percent of families  
class4	1437	when present in a family  1  it is found in all diagnosed patients in that family  2  can therefore be considered predictive for the development of polyps in other family members who carry the trait  and 3  if confirmed by longer follow up  may possibly preclude members without the trait from further evaluation and surveillance  
class4	1438	effects of preoperative radiotherapy on rectal cancer  preliminary report on combining radiation with intratumor injections of peplomycin and bromodeoxyuridine  
class4	1438	between 1976 and 1983  61 patients with advanced rectal cancer underwent miles  operation at the authors  institution  
class4	1438	all lesions were located 10 cm or less from the anal verge  
class4	1438	of these patients  25 were treated by surgery alone and 36 were given preoperative radiotherapy  
class4	1438	the total dose was 42 6 gy   30 6 gy  1 8 gy fr x 5 week   delivered to the entire pelvis plus an additional 12 gy  3 0 gy fr x 4 week  delivered to the primary tumor  
class4	1438	of 36 patients  21 were administered intratumor injections of peplomycin and bromodeoxyuridine at the time of boost radiation and 15 were treated without intratumor injections  
class4	1438	during the follow up period  3 to 9 years   in the groups of patients who underwent radiation  there was only one local failure  2 8 percent   
class4	1438	in contrast  in the group of patients treated by surgery alone  eight local failures occurred  32 percent   
class4	1438	the intratumor injection significantly enhanced the effect of radiation on tumor regression  
class4	1438	the incidence of positive lymph nodes was higher in patients in the surgery alone group than it was in the groups treated with radiation  
class4	1438	there was no difference in the rate of distant metastasis among the three treatment groups  
class4	1438	the five year survival rate for the radiation with intratumor injection group  radiation alone group  and surgery alone group  was 77 8  69 2  and 56 0 percent  respectively  
class4	1438	no severe complication was experienced  
class4	1439	erythrocyte stearic acid desaturation in patients with colorectal carcinoma  
class4	1439	the erythrocyte stearic oleic acid ratio  saturation index  was investigated as a means of differentiating between control subjects  n   146  and patients with benign  n   48  and malignant  n   117  colorectal disease and patients undergoing postoperative follow up after curative resection  n   49   
class4	1439	erythrocyte fatty acid profiles were determined by gas liquid chromatography  
class4	1439	neither age  sex  dukes  stage  nor degree of differentiation of the tumors had a significant effect on the erythrocyte saturation index  
class4	1439	the erythrocyte saturation index was lower in patients with primary and recurrent colorectal cancer compared with control subjects and patients with inflammatory bowel disease or benign colonic polyps  p less than 0 0001   
class4	1439	the erythrocyte saturation index was not found to be useful in the postoperative follow up of these patients  
class4	1439	using both saturation index and age as a means of differentiating between patients with primary colorectal cancer and control subjects gave a sensitivity of 67 percent and a specificity of 81 percent  
class4	1440	nitrite from inflammatory cells  a cancer risk factor in ulcerative colitis  
class4	1440	elevated levels of luminal nitrite and a lowered luminal ph were found in 77 percent of patients with acute ulcerative colitis  
class4	1440	no luminal nitrite was found in healthy control subjects  
class4	1440	nitrites are a secretory product of activated macrophages and neutrophils of the lamina propria  whereas the lowered luminal ph is due to diminished bicarbonate formation by impaired colonocytes  
class4	1440	a hypothesis is put forward that nitrites  lowered ph  and bacterial amines are conducive to formation of carcinogenic n nitroso compounds  which reflect a cancer risk in patients with ulcerative colitis dependent on the type and extent of inflammatory cell activation as well as metabolic impairment of colonic epithelial cells  
class4	1441	passage of a colon  cast  after anoabdominal rectal resection  report of a case  
class4	1441	the authors report a case of the passage of a total colonic j pouch  cast  per anus after anoabdominal rectal resection and colonic j pouch anal anastomosis  
class4	1441	this occurred without development of cuff abscess and was not due to occlusion of the inferior mesenteric artery  
class4	1441	this was successfully treated  with preservation of anal function  with resection of the colonic j pouch by transanal approach  
class4	1442	characterization in vitro of a human tumor necrosis factor binding protein  a soluble form of a tumor necrosis factor receptor  
class4	1442	tumor necrosis factor  tnf  is a pleiotropic mediator of inflammatory responses  
class4	1442	a cysteine rich  highly glycosylated 30 kd tnf binding protein  tnf bp  purified from urine may have a role in regulation because it protects in vitro against the biological effects of tnf  
class4	1442	the cytotoxic effect of tnf on the fibrosarcoma cell line wehi 164 was inhibited by 50  at a 10 fold excess of tnf bp  
class4	1442	the binding of tnf to the receptor was partially reversed after the addition of tnf bp  
class4	1442	results from biosynthetic labeling of cells with 35s cysteine followed by immunoprecipitation with anti tnf bp indicated that tnf bp is formed and released at the cell surface by cleavage because no corresponding cellular polypeptide was observed  
class4	1442	a cellular 60 kd polypeptide  which was immunoprecipitated with anti tnf bp  may correspond to the transmembrane tnf receptor molecule and be the precursor of tnf bp  
class4	1442	thus  tnf bp appears to be a soluble form of a transmembrane tnf receptor  
class4	1442	moreover our results demonstrate that the production of tnf bp is increased when the tnf receptor is downregulated in cells by treatment with tnf or by activation of protein kinase c with phorbol esters  
class4	1442	tnf bp may be an important agent that blocks harmful effects of tnf  and  therefore  useful in clinical applications  
class4	1443	whole body lipolysis and triglyceride fatty acid cycling in cachectic patients with esophageal cancer  
class4	1443	whole body lipolytic rates and the rate of triglyceride fatty acid cycling  reesterification of fatty acids released during lipolysis  were measured with stable isotopic tracers in the basal state and during beta adrenergic blockade with propranolol infusion in five cachectic patients with squamous cell carcinoma of the esophagus  five cachectic cancer free  nutritionally matched control patients  and 10 healthy volunteers  
class4	1443	resting energy expenditure and plasma catecholamines were normal in all three groups  
class4	1443	the basal rate of glycerol appearance in blood in the patients with cancer  2 96     0 45 mumol kg 1 min 1  was similar to that in the nutritionally matched controls  3 07     0 28 mumol kg 1 min 1   but 48  greater than in the normal weight volunteers  2 00     0 16 mumol kg 1 min 1   p   0 028   
class4	1443	the antilipolytic effect of propranolol and the rate of triglyceride fatty acid cycling in the patients with cancer were also similar in the cachectic control group and approximately 50  greater than in the normal weight volunteers  but the differences were not statistically significant because of the variability in the data  
class4	1443	we conclude that the increase in lipolysis and triglyceride fatty acid cycling in  unstressed  cachectic patients with esophageal cancer is due to alterations in their nutritional status rather than the presence of tumor itself  
class4	1443	increased beta adrenergic activity may be an important contributor to the stimulation of lipolysis  
class4	1444	potent toxicity of 2 chlorodeoxyadenosine toward human monocytes in vitro and in vivo  a novel approach to immunosuppressive therapy  
class4	1444	lymphoid cells were thought to be uniquely susceptible to excess 2  deoxyadenosine  dado   when exposed to inhibitors of adenosine deaminase  ada   
class4	1444	however  we now find that human monocytes are as sensitive as lymphocytes to dado or to the ada resistant congener 2 chloro 2  deoxyadenosine  cldado   
class4	1444	monocytes exposed in vitro to cldado  or to dado plus deoxycoformycin rapidly developed dna strand breaks  
class4	1444	both the dna damage and the toxicity of cldado or dado toward monocytes were blocked by deoxycytidine  but not by inhibitors of poly adp ribose  polymerase  
class4	1444	a partial decrease in rna synthesis and a gradual decline of cellular nad were early biochemical events associated with monocyte dna damage  
class4	1444	low cldado concentrations  5 20 nm  inhibited monocyte phagocytosis and reduced the release of interleukin 6  
class4	1444	higher cldado concentrations led to a dose  and time dependent loss of monocyte viability  
class4	1444	circulating monocytes disappeared within 1 wk in patients with cutaneous t cell lymphoma or with rheumatoid arthritis during continuous cldado infusion  
class4	1444	the marked sensitivity of human monocyte function and survival to cldado in vitro  together with the monocyte depletion in patients receiving cldado chemotherapy  suggests that cldado or other dado analogues offer a novel therapeutic strategy for chronic inflammatory and autoimmune diseases characterized by inappropriate monocyte deployment or function  
class4	1445	elevated insulin receptor content in human breast cancer  
class4	1445	the growth of breast cancer cells is under the regulation of hormones  growth factors  and their receptors  
class4	1445	in the present study  we have employed a new  sensitive  and specific radioimmunoassay for the direct measurement of insulin receptors in surgical specimens of breast cancers  
class4	1445	in 159 specimens the insulin receptor content was 6 15     3 69 ng 0 1 mg protein  
class4	1445	this value was more than sixfold higher than the mean value found in both 27 normal breast tissues obtained at total mastectomy  0 95   0 68  p less than 0 001  and in six normal specimens obtained from reduction mammoplasty  0 84     0 78  p less than 0 001   
class4	1445	the insulin receptor content in breast cancer tissues was also higher than in any normal tissue investigated including liver  pezzino  v   v  
class4	1445	papa  v  
class4	1445	trischitta  a  
class4	1445	brunetti  p a  
class4	1445	goodman  m k  
class4	1445	treutelaar  j a  
class4	1445	williams  b a  
class4	1445	maddux  r  
class4	1445	vigneri  and i d  
class4	1445	goldfine  1989  
class4	1445	am  
class4	1445	j  
class4	1445	physiol  
class4	1445	257 e451 457   
class4	1445	the insulin receptor in breast cancer retained its ability to both bind insulin and undergo insulin induced tyrosine kinase activation  
class4	1445	immunostaining of the specimens revealed that the insulin receptor was present in malignant epithelial cells  but was not detected in stromal and inflammatory cells  
class4	1445	univariant analysis revealed that the insulin receptor content of the tumors correlated positively with tumor size  p   0 014   histological grading  p   0 030   and the estrogen receptor content  p   0 035   
class4	1445	there were no significant correlations between insulin receptor content and the age  body weight  menopausal status  and nodal involvement of the patients  
class4	1445	these studies indicate  therefore  that the insulin receptor content is increased in breast cancers and raise the possibility that the insulin receptor may have a role in the biology of these tumors  
class4	1446	epidermal growth factor regulates the in vitro sensitivity of human ovarian carcinoma cells to cisplatin  
class4	1446	cisplatin  ddp  is the most effective drug for the treatment of human ovarian cancer  but the mechanisms that determine sensitivity to the cytotoxic action of ddp are not well understood  
class4	1446	treatment of two human ovarian carcinoma cell lines with epidermal growth factor  egf  simultaneously increased sensitivity to ddp and caused a persistent change in morphology in the absence of any mitogenic effect  
class4	1446	sensitization to ddp was shown to be dependent on both egf concentration and egf receptor number in c127 mouse fibroblasts expressing the human egf receptor after transfection with a pbpv plasmid construct containing the human egf receptor gene under control of the transferrin receptor 3  inducible regulator  
class4	1446	sensitization of human ovarian carcinoma cells to ddp was not blocked by inhibition of protein synthesis  
class4	1446	egf did not enhance sensitivity to ddp or alter morphology in ddp resistant human ovarian carcinoma cells despite the presence of functional egf receptors on these cells  
class4	1446	these results showed that elements of the signal transduction pathway activated by egf determined cellular sensitivity to ddp  and that a ddp resistant phenotype is associated with a defect in this signal transduction pathway  
class4	1447	a phosphatase activity present in peripheral blood myeloid cells of chronic myelogenous leukemia patients but not normal individuals alters nuclear protein binding to transcriptional enhancers of interferon inducible genes  
class4	1447	cytoplasmic protein from peripheral blood myeloid cells of chronic myelogenous leukemia  cml  patients altered the electrophoretic mobility of complexes formed between nuclear proteins and interferon inducible transcriptional enhancers  
class4	1447	immature myeloid marrow cells  blasts and promyelocytes  have a higher level of this activity than do mature myeloid marrow cells  bands and polys   
class4	1447	this activity  which is not detectable in the peripheral blood cells of normal individuals  is at least 50 fold higher in cml marrow blasts and promyelocytes than that found in marrow blasts and promyelocytes of normal individuals  
class4	1447	this activity was inhibited by in vivo incubation of immature myeloid cells with the phosphatase inhibitor  sodium orthovanadate  0 2 mm   and by adding orthovanadate  20 mm  directly to cytoplasmic proteins of myeloid cells  
class4	1447	interferon alpha  1 000 u ml  reduced the effects of the cml myeloid cell cytoplasmic protein on the electrophoretic mobility of nuclear protein dna complexes  
class4	1447	these data suggest that a unique phosphatase may be involved in the abnormalities in cml which are modulated by interferon alpha  
class4	1448	quality control practices in centralized tumor registries in north america  
class4	1448	a survey of quality control practices was mailed to 73 central registries in the u s  
class4	1448	and canada  
class4	1448	the response rate was 88   with respondents representing a wide range of registry characteristics and reporting strategies  
class4	1448	while registries expressed different priorities in data use  80  of respondents felt quality control data were important in the identification of problems  
class4	1448	the most common method of quality control was acceptance sampling  used by 97  of respondents   and took the form of visual review  recoding and edit checking  
class4	1448	computer based edit checks were almost universally used  95    
class4	1448	process control methods of any sort were used by only 22  of respondents with less than 4  of registries reporting formal quantitative criteria  
class4	1448	sixty one percent of respondents reported conducting one or more designed studies  e g  
class4	1448	reabstracting or casefinding studies  but only 20  of those made the results public  
class4	1448	greater emphasis should be placed on development of quantitative process controls  experimental design of quality control studies  and formal analyses and reporting of study results  
class4	1449	adverse mortality experience of a southwestern american indian community  overall death rates and underlying causes of death in pima indians  
class4	1449	as part of an ongoing epidemiologic study  the death rate and causes of death during 1975 through 1984 were determined in pima indians who resided in the gila river indian community  gric  in 1965 and later  
class4	1449	death certificates were available for 677 of the 681 deaths  
class4	1449	in 78  of the deaths  the underlying cause recorded on the death certificate agreed with the cause determined after review of all available relevant records  
class4	1449	the age  and sex adjusted average annual death rate for the gric population  1639 100 000  was 1 9 times  95  ci 1 7 2 0  the 1980 rate for the u s  
class4	1449	all races  878 100 000   
class4	1449	in pima males  whose death rate was substantially higher than that of pima females  the age adjusted death rate was 2 3 times that in u s  
class4	1449	males  all races  
class4	1449	moreover among males 25 34 years of age  the pima death rate was 6 6 times that for the u s  
class4	1449	all races  
class4	1449	diseases of the heart and malignant neoplasms caused 59  of u s  
class4	1449	deaths in 1980  but only 19  of gric deaths  
class4	1449	by contrast  the age  and sex adjusted mortality rate in the gric pima was 5 9 times the rate of the u s  
class4	1449	all races for accidents  6 5 times for cirrhosis  7 4 times for homicide  4 3 times for suicide  and 11 9 times for diabetes  
class4	1449	tuberculosis and coccidioidomycosis were important causes of death in the pima  for whom infectious diseases was the tenth leading cause of death  
class4	1449	the findings indicate that programs to improve the adverse mortality experience of the gric population should emphasize factors related to fatal accidents  alcoholic cirrhosis  homicide  suicide  diabetes mellitus  and infectious diseases  
class4	1449	young pimas  especially the males  should be the primary focus of such preventive efforts  
class4	1449	these findings and recommendations probably apply to many native american populations  
class4	1450	shortcut method to calculate the sample size in trials of screening for chronic disease  
class4	1450	one of the first questions arising in the planning of a randomized trial to evaluate mortality reduction by screening concerns the sample size of the trial required to detect an expected mortality reduction in the study group for given significance level alpha  and power 1   beta  
class4	1450	if estimates exist of the underlying average annual incidence rate of the disease ra and the annual mortality rate delta a or survival data for patients in the population under consideration before screening started  then a simple formula for the probability of dying from the disease within t years after entry into the trial can be given for the control group  
class4	1450	standard formulas may then be used for sample size calculations in randomized trials  which compare the risk of death from the disease in the control and the study group accrued at t years after entry  
class4	1450	a simple correction for loss of follow up  due to mortality from other causes or  for instance  migration is possible  
class4	1451	atheroemboli to the lower urinary tract  a marker of atherosclerotic vascular disease  a case report  
class4	1451	atheroemboli to the lower genitourinary tract may serve as a marker for disseminated atheroembolic disease  a highly lethal condition  
class4	1451	a case presentation and review of our institional experience is presented  
class4	1452	family cancer syndrome  a study of the kindred of a man with osteogenic sarcoma of the mandible  
class4	1452	several familial cancer syndromes have been identified  
class4	1452	the syndrome of sarcomas  breast cancer and other neoplasms  known as li fraumeni syndrome  is characterized by several different neoplasms presenting at young ages with autosomal dominant transmission and a high incidence of second primaries  
class4	1452	in this paper  we studied six generations  51 people  of the family of a 24 year old man with osteogenic sarcoma of the mandible  
class4	1452	twelve malignancies in 11 people  including several rare tumors  were revealed  
class4	1452	mean age of presentation was 24 years old  
class4	1452	nine of the 11 patients died of disease  
class4	1452	one developed a second primary  
class4	1452	two tumors presented in the head and neck  
class4	1452	transmission was autosomal dominant  
class4	1452	the karyotypes of two family members were normal  
class4	1452	identification of li fraumeni syndrome in a family is important in determining appropriate follow up for the patient and family  
class4	1452	such families are models for studying carcinogenesis  
class4	1453	chondrosarcoma of the head and neck  
class4	1453	chondrosarcoma is a malignancy rarely encountered in the head and neck  
class4	1453	in an attempt to define this tumor s characteristics and response to therapy  all cases of chondrosarcoma treated at the university of michigan over the past 25 years were retrospectively studied  
class4	1453	fourteen cases originating in the nose and paranasal sinuses  mandible  temporal bone  and larynx were reviewed  
class4	1453	aggressive surgical resection was the mainstay of treatment  and resulted in an overall survival of 70   with an average follow up of 3 5 years  
class4	1453	survival was highest in primary temporal bone lesions  and lowest in paranasal sinus lesions  
class4	1453	unresectable lesions were not cured by other modalities  
class4	1453	this study  therefore  continued to support the crucial role of wide surgical resection in the treatment of head and neck chondrosarcoma  but conservative resection  when needed to preserve important structures  has resulted in long term survival  
class4	1454	the melanocyte and melanoma  
class4	1454	this paper reviewed some of the interesting biological aspects of melanocytes and their relationship to the nevus and to melanoma  
class4	1454	it also proposed a rationale for  adequate  surgery in the management of melanoma according to level  depth  margins  and trends in treatment  
class4	1454	these propositions were derived from an analysis of 995 cases of melanoma of the head and neck  
class4	1455	a palmar dermatosis linked to occult carcinoma of the upper thorax  head and neck  bazex s syndrome and tripe palm  
class4	1455	an unusual  persistent  corregated to honeycombed thickening of the palms accompanied by tenderness around the fingernails was found to be a cutaneous marker for internal malignancy  
class4	1455	this combination of signs and symptoms has been reported under two clinical entities  bazex s syndrome and tripe palm  
class4	1455	this paraneoplastic syndrome is of interest to head and neck surgeons due to the location of the primary tumor  the site of metastatic disease  and the ability to cure the cutaneous disease by surgical removal of the primary tumor  
class4	1455	in our patient  a squamous cell carcinoma of the lung not detectable on chest x ray presented as a cervical mass accompanied by cutaneous changes on the palms and fingernails  
class4	1455	recognition of the relationship of the dermatologic changes to malignancy of a specific body region eventually led to the detection of the primary tumor  
class4	1455	the characteristics of these paraneoplastic syndromes were reviewed in this report  
class4	1456	the cancer prevention reminder system  
class4	1456	the cancer prevention reminder system is a computer based system designed to increase the delivery of periodic health maintenance procedures  
class4	1456	the program provides printed reminders that identify patients  overdue procedures  prints summary reports of the percentage of patients who are eligible and overdue for a procedure  and prints mailing labels for patients  
class4	1456	we performed a randomized  controlled trial in which the effects of computer based reminders were compared with those of two other interventions among residents in a university based group practice  
class4	1457	prophylaxis of aphakic cystoid macular edema without corticosteroids  a paired comparison  placebo controlled double masked study  
class4	1457	prior investigations have reported that topical nonsteroidal anti inflammatory drug  nsaid  therapy prevents the development of postoperative angiographic signs of angiographic cystoid macular edema  cme   
class4	1457	however  these studies include concurrent use of corticosteroids  
class4	1457	the current study reports therapeutic efficacy for ketorolac ophthalmic solution  an nsaid  in the prophylaxis of angiographic aphakic cme  acme  after cataract surgery without concurrent corticosteroids for the first time  
class4	1457	fifty patients with bilateral cataracts were enrolled in this placebo controlled  paired comparison  double masked study  
class4	1457	eleven patients had evidence of angiographic acme on postoperative day 40  
class4	1457	two of these patients demonstrated bilateral acme  one patient had acme in the nsaid treated eye  and eight patients demonstrated acme in the placebo treated eye  
class4	1457	this is a statistically significant difference favoring drug treatment  
class4	1457	the signs of anterior ocular inflammation were greater in the eyes with acme  
class4	1457	this study suggests prophylactic treatment of acme may be possible without the risks of concurrent corticosteroid toxicity  
class4	1457	in addition  a higher incidence of acme in black patients  22   is observed in this study than has been recognized previously  
class4	1458	ki 67 immunostaining in uveal melanoma  the effect of pre enucleation radiotherapy  
class4	1458	the reactivity of 33 choroidal and ciliary body melanomas with monoclonal antibody ki 67  which recognizes a proliferation associated nuclear antigen  has been assessed and compared with clinicopathologic parameters  
class4	1458	in 23 cases  8 gy irradiation was given 2 days before enucleation  
class4	1458	nonirradiated melanomas had a significantly higher proliferation rate as defined by staining with monoclonal antibody ki 67 as compared with irradiated tumors  p   0 007   
class4	1458	similarly  a strong relationship was found between pre enucleation irradiation and low mitotic activity  p   0 001   
class4	1458	there was no significant correlation between the presence of ki 67 positive nuclei and histologic classification  largest tumor diameter  localization of the tumor  age  sex  scleral invasion  pigmentation  and lymphocytic infiltration  
class4	1458	the relevance of ki 67 immunohistochemistry for the assessment of the life prognosis of patients with uveal melanoma has to be studied prospectively  
class4	1459	immunoblastic t cell lymphoma presenting as an eyelid tumor  
class4	1459	a 59 year old white man presented with an ulcerating mass of the left upper eyelid of 6 months  duration  
class4	1459	a biopsy specimen of the tumor was diagnosed as an immunoblastic t cell malignant lymphoma  
class4	1459	the lesion completely regressed after 4000 cgy of cobalt 60 radiation therapy  
class4	1459	in the ensuing 33 months  multiple  widespread skin nodules of the same neoplasm developed including a right upper eyelid tumor  
class4	1459	to the authors  knowledge  this is the first reported case of an immunoblastic t cell lymphoma initially manifesting as an eyelid neoplasm  
class4	1460	emergent signs of cancer  recognizing them early in the office or er  
class4	1460	primary care physicians have a crucial role in recognition of potentially emergent conditions in patients with known or suspected cancer  
class4	1460	this task presents a significant challenge because the initial manifestations of these conditions are usually nonspecific  
class4	1460	in most cases  therapy is far more effective when diagnosis is made at the earliest possible point  
class4	1460	thus  physicians should become familiar with conditions commonly seen in cancer patients  such as superior vena cava syndrome  malignant pericardial effusion  spinal epidural metastasis  and altered mentation from brain metastases  metabolic encephalopathy  or hypoglycemia  
class4	1461	585 nm for the treatment of port wine stains  
class4	1461	although the flashlamp pulsed dye laser has been successfully used for the treatment of port wine stains  pws  at 577 nm  a number of adult patients had incomplete clearance of their birthmarks with this treatment modality because of residual vessels lying beyond the 0 75 mm penetration depth of 577 nm irradiation  
class4	1461	fifteen adult patients  of whom nine were previously treated with limited success at 577 nm  group a   and six untreated patients  group b  were included in the study  
class4	1461	for the group a patients  treatment with 585 nm produced successful clearance of the birthmark  
class4	1461	for the six patients in group b  parallel treatment of different sites of the same lesion coupled with skin biopsies and histologic examination revealed that a change in the wavelength from 577 to 585 nm allowed the laser light to penetrate from the midreticular dermis into the subcutaneous fat  
class4	1461	this explained the clearance achieved at 585 nm and not at 577 nm  
class4	1462	reasons why mastectomy patients do not have breast reconstruction  
class4	1462	breast reconstruction after mastectomy is valuable  yet only a small percentage of eligible patients ever have reconstruction  
class4	1462	little has been done to determine why so few patients proceed with reconstructive surgery  
class4	1462	a homogeneous population of mastectomy patients  some of whom underwent breast reconstruction while others did not  were surveyed regarding their attitudes about breast reconstruction  
class4	1462	a total of 245 women were surveyed  
class4	1462	one hundred and fifty eight  64 percent  responded  71 of whom had been reconstructed while 87 had not  
class4	1462	comparison of the responses of the two groups suggests factors that play a role in determining whether the mastectomy patient will accept or decline the option of breast reconstruction  
class4	1462	considerations that made it less likely that a woman would pursue reconstruction included advanced age at the time of mastectomy  concern about complications from further surgery  uncertainty about outcome  and fear about the effect of reconstruction on future problems with breast cancer  
class4	1462	marital status  receiving chemotherapy  or knowing a patient who had a bad result from reconstruction did not affect the decision  
class4	1462	an awareness and understanding of these factors may be helpful to physicians in counseling patients and in increasing the number of women who enjoy the benefits of breast reconstruction  
class4	1463	mammographic measurements before and after augmentation mammaplasty  
class4	1463	thirty five augmented women underwent mammography using both the standard implant compression technique and  when possible  the implant displacement technique  all had preaugmentation film screen mammography available for evaluation  
class4	1463	the area of mammographically visualized breast tissue before and after augmentation mammaplasty was measured using a transparent grid  
class4	1463	patients with subglandular implants had a mean decrease of 49 percent of measurable tissue area with compression mammography and a 39 percent decrease with displacement mammography  
class4	1463	patients with submuscular implants had a 28 percent decrease in measurable tissue area with compression mammography and a 9 percent decrease with displacement mammography  
class4	1463	anterior breast tissue was seen better with displacement mammography  posterior breast tissue  with compression mammography  
class4	1463	most patients had some degree of parenchymal scarring and lower image quality after augmentation  
class4	1463	state of the art mammography was not possible in most patients augmented with silicone gel filled implants  
class4	1464	combined tensor fasciae latae musculocutaneous flap and sartorius musculocutaneous flap for the repair of wide defects of the lower leg  
class4	1464	the tensor fasciae latae musculocutaneous flap has great advantages for reconstruction of the abdominal wall  but the medial border of its territory is limited to the thigh  
class4	1464	in order to expand the territory  a combined tensor fasciae latae musculocutaneous flap and sartorius musculocutaneous flap was devised  
class4	1464	this flap was successfully used to resurface a large defect in the lower leg as a distally based musculocutaneous flap  
class4	1464	the advantages of this flap are its extremely large territory  the fact that total necrosis of the flap cannot occur  and that as a proximally or distally pedicled flap it is suitable for large defects in the abdominal wall  lower leg  and gluteal region  
class4	1465	metabolism of human gliomas  assessment with h 1 mr spectroscopy and f 18 fluorodeoxyglucose pet 
class4	1465	localized hydrogen 1 magnetic resonance  mr  spectroscopy and fluorine 18 fluorodeoxyglucose  fdg  positron emission tomography  pet  were employed to obtain metabolic information from intracranial gliomas  
class4	1465	advantages and difficulties associated with comparison of results from the two modalities were realized  
class4	1465	forty patients were studied with h 1 mr spectroscopy  
class4	1465	mr signal intensities from lactate  n acetylaspartate  naa   choline  and creatine from a volume of interest containing the tumor and a contralateral volume were obtained and evaluated  
class4	1465	naa signal intensities were generally decreased in the tumor spectra  and choline signal intensities were elevated  
class4	1465	h 1 mr spectroscopy was unsuccessful in eight patients  and fdg pet scans were not obtained in four of the patients with successful mr spectroscopic examinations  
class4	1465	lactate signal intensity was detected in 10 of the 28 patients who had successful h 1 mr spectroscopic and fdg pet studies  
class4	1465	lactate signal intensities were observed in lesions shown at fdg pet to be hypermetabolic  as well as in lesions found to be hypometabolic  
class4	1466	chemical shift imaging of human brain  axial  sagittal  and coronal p 31 metabolite images  
class4	1466	multivoxel magnetic resonance  mr  spectroscopy and novel data analysis techniques were developed to obtain high quality phosphorus 31 metabolite images from the human brain and to overlay each metabolite distribution directly onto corresponding hydrogen 1 mr images  
class4	1466	the p 31 mr spectroscopic data were acquired by means of three dimensional chemical shift imaging  phase encoding in three spatial dimensions  on a 1 5 t clinical instrument equipped with a specially designed quadrature p 31 birdcage coil constructed in the authors  laboratory  
class4	1466	axial  sagittal  and coronal metabolite images based on the area for any one of five peak regions  phosphodiester  phosphocreatine  gamma  alpha  and beta adenosine triphosphate  were generated from 8 x 8 x 8 or 12 x 12 x 8 csi arrays with voxel sizes of 27 cm3 and 12 cm3  respectively  
class4	1466	the positions of these images were aligned with anatomic features by means of the voxel shifting capability of the fourier transform  
class4	1466	direct overlays of these metabolite images on corresponding proton images demonstrated excellent correlation with anatomy  factors indicating the utility of this technique for viewing p 31 metabolite levels in all areas of the brain simultaneously  
class4	1467	rhabdomyosarcomas in the head and neck  mr imaging evaluation  
class4	1467	to determine the typical magnetic resonance  mr  signal intensity characteristics of rhabdomyosarcomas  short repetition time  tr  short echo time  te   t1 weighted  and long tr  proton density and t2 weighted  images of 13 patients with rhabdomyosarcomas of the head and neck were retrospectively reviewed  
class4	1467	seven patients received gadopentetate dimeglumine injections  
class4	1467	the most common mr appearance was that of a homogeneous mass  hyperintense to both muscle and fat on long tr long te images and isointense or minimally hyperintense to muscle on short tr short te images  
class4	1467	all lesions of the patients who received gadopentetate dimeglumine enhanced markedly  
class4	1467	two lesions had intratumoral hemorrhage  and six were markedly heterogeneous in signal intensity  
class4	1467	similar mr signal intensity patterns have been described for lymphomas and nasopharyngeal carcinomas  
class4	1467	the forte of mr imaging lies in its ability to delineate precisely the extent of the rhabdomyosarcoma  
class4	1468	mucocele of the cystic duct remnant in eight liver transplant recipients  findings at cholangiography  ct  and us  
class4	1468	the case histories and radiologic studies of eight liver transplant recipients who developed a mucocele of the allograft cystic duct remnant were retrospectively evaluated  
class4	1468	all patients had clinical and or laboratory evidence of biliary obstruction or cholangitis from 2 weeks to 3 3 years following transplantation  
class4	1468	cholangiographic  ultrasound  us   and computed tomography  ct  images were available for review in eight  five  and four patients  respectively  
class4	1468	cholangiograms demonstrated an extrinsic mass compressing the common hepatic duct in seven of eight patients  
class4	1468	us and ct showed fairly well  to well defined round fluid collections adjacent to the common hepatic duct in three and two patients  respectively  
class4	1468	the findings of this study suggest that the detection at cholangiography of an extrinsic mass compressing the common hepatic duct appears to be specific for a mucocele of the allograft cystic duct remnant  
class4	1468	ct and us images may offer confirmatory evidence  
class4	1469	colorectal tumors  an in vitro study of high resolution mr imaging  
class4	1469	to study the potential utility of magnetic resonance  mr  imaging in staging colorectal tumors  15 resected colonic segments containing 17 elevated lesions were examined on a 1 5  or 1 9 t superconductive mr system  
class4	1469	the whole intestinal wall was apparent as three or five layers on images obtained with a short repetition time  tr  and short echo time  te  and as six or eight distinct layers  including the intestinal wall proper as well as an adherent mucus layer and an outer layer of pericolonic fat  on the long tr te images  
class4	1469	in cases of colonic carcinoma  mr images correlated well with the pathologic findings  including the macroscopic growth pattern  depth of mural invasion  and the presence of foci of calcific tumor necrosis and pools of extracellular mucin  colloid   
class4	1469	these features suggest that mr imaging may be valuable in the clinical evaluation of colorectal tumors  
class4	1470	colonic stenoses  use of oral barium when retrograde flow is completely obstructed on barium enema studies  
class4	1470	forty patients with complete obstruction to retrograde barium flow on barium enema examinations  without clinical or radiographic evidence of obstruction  were studied further with orally administered barium in the same session  
class4	1470	all patients had undergone aborted double contrast barium enema studies and had received antispasmodics intramuscularly before the examination  
class4	1470	the authors describe the technique  as well as the clinical and radiologic findings  that allows the safe ingestion of oral barium in patients with stenotic lesions of the colon  
class4	1470	in all patients  oral barium passed through the small bowel and the stenotic site in an average of 148 minutes  with no complications  
class4	1470	in seven patients  there were synchronous lesions in the colon and small bowel  and the findings were determined better with oral barium studies in 19 patients  
class4	1470	if a barium enema study is done and retrograde passage of barium is obstructed by a lesion in the left side of the colon  additional diagnostic information can be obtained by giving the patients oral barium  
class4	1470	this practice is safe if precise criteria are applied  
class4	1471	hepatic tumors  signal enhancement at doppler us after intravenous injection of a contrast agent  
class4	1471	experiments were carried out to detect and establish the origin of doppler and echo signal enhancement in small vessels of the systemic circulation and of tumors after intravenous injection of a contrast agent  
class4	1471	eight woodchucks  marmota monax  were studied  each woodchuck had naturally occurring hepatocellular carcinoma  
class4	1471	injections of 0 1 4 0 ml of air filled human serum albumin microspheres were administered into a hind limb or jugular vein  
class4	1471	ultrasound  us  examination included transabdominal duplex scanning  color doppler imaging  placement of a doppler transducer on the exposed tumor  and surgical implantation of pulsed doppler cuffs  
class4	1471	doppler signals were assessed by recording color doppler images and results of spectral analysis  
class4	1471	while subjective echo level was unaffected within the tumors  dramatic doppler signal enhancement was recorded in both normal and tumor vessels  
class4	1471	at optimum dose levels  a signal gain of approximately 10 db was recorded from the tumor  
class4	1471	analysis showed that the echo enhancement was due to the presence of the contrast agent in branches of the hepatic artery  
class4	1471	these results suggest that tumor detection may be enhanced by intravenous administration of a us contrast agent  
class4	1472	receptor imaging  application to mr imaging of liver cancer  
class4	1472	a new contrast agent for magnetic resonance  mr  imaging  directed to asialoglycoprotein  asg  receptors on hepatocytes  was used for detection of liver cancer in rats  
class4	1472	ultrasmall superparamagnetic  mean size  12 nm  particles of iron oxide  uspios  were targeted to asg receptors by coating particles with arabinogalactan  ag   
class4	1472	liver t2 relaxation times decreased more effectively after a single intravenous administration of ag uspio than after an equal dose of a conventional superparamagnetic liver mr contrast agent  ami 25  mean size  72 nm   
class4	1472	receptor affinity studies demonstrated that receptor mediated attachment and subsequent cellular endocytosis do not occur in primary malignant  hepatocellular carcinoma  or metastatic  adenocarcinoma  tumors  because the surface asg receptors are lost during malignant dedifferentiation  
class4	1472	in vitro relaxation and in vivo mr imaging experiments of liver tumors show that targeting uspio to hepatocytes rather than to the mononuclear phagocytic system allows a considerable dose reduction  increases tumor liver contrast  and potentially allows distinction of asg positive  benign hepatocellular  and asg negative  malignant hepatocellular  tumors  
class4	1473	hilar malignancy  treatment with an expandable metallic transhepatic biliary stent  
class4	1473	an expandable metallic transhepatic biliary endoprosthesis was used to treat 20 patients with hilar malignancy and isolated right and left intrahepatic ducts  
class4	1473	in 12 patients  only one intrahepatic ductal system was drained  in eight patients  both systems were drained  
class4	1473	in five patients  both systems were drained through a single transhepatic track by arrangement of two stents in a t configuration  
class4	1473	the initial technical success rate in placing the stents and achieving internal drainage was 100   
class4	1473	complications necessitating further intervention occurred in two of the 20 patients  
class4	1473	short term clinical follow up was available for 19 of the 20 patients  
class4	1473	two months after stent insertion  two patients complained of persistent jaundice  two patients died without jaundice  and 15 patients were free of symptoms of biliary obstruction  
class4	1473	a variety of geometric configurations are possible with this endoprosthesis  
class4	1473	the relative merits of these stent arrangements are discussed  and a new technique for placing the stents in a t configuration is described  
class4	1474	invasive papillary carcinoma of the breast  mammographic appearance  
class4	1474	the mammographic findings in 18 patients with invasive papillary carcinoma were studied retrospectively  
class4	1474	the mammograms of 10 patients showed a multinodular pattern  and seven patients had solitary nodules  
class4	1474	one patient had an irregular  ill defined mass in the retroareolar region  
class4	1474	two patients were found to have carcinoma in the contralateral breast  and two patients had intraductal carcinoma adjacent to the invasive papillary carcinoma  
class4	1474	the varied mammographic features that may occur with this rare breast malignancy are discussed  
class4	1475	mixed form  diffusely scattered calcifications in breast cancer with apocrine features 
class4	1475	diffusely scattered calcifications visible with mammography are almost always benign  
class4	1475	certain patterns  however  should arouse concern  
class4	1475	for example  extensive comedocarcinoma is associated with large areas of mammographically visible calcium deposition  
class4	1475	the authors identified 10 women in whom calcifications were visible throughout large volumes of breast tissue at mammography  
class4	1475	the calcifications did not resemble those typical of extensive comedocarcinoma  yet they were associated with extensive breast cancer  
class4	1475	their mammographic pattern was characterized by a strikingly wild  chaotic appearance with profuse deposition of calcium  
class4	1475	as in many cancers  the particles were heterogeneous  but unlike in most carcinomas  many deposits had a typically benign morphology  
class4	1475	histologic examination showed that even these typically benign calcifications were associated with malignant cells  
class4	1475	the authors believe that the apocrine features displayed by many of the cancer cells in these 10 patients may explain the unusual profusion of calcium deposits  
class4	1476	cystic rheumatoid arthritis  description of a nonerosive form  
class4	1476	in a study of patients with rheumatoid arthritis  ra   9   n   70  were found to have a cystic form  
class4	1476	at radiologic examination of these patients with cystic ra  the first abnormality seen consisted of periarticular intraosseous cysts without erosions  
class4	1476	the cysts were distributed symmetrically  most often located at the proximal side of the joints and predominantly around the proximal interphalangeal  metacarpophalangeal  and wrist joints of the hands and the first interphalangeal and metatarsophalangeal joints of the feet  
class4	1476	computed tomographic scans showed the peripheral intraosseous location of the cysts  
class4	1476	magnetic resonance images showed that the cysts may contain fluid  inflamed synovia  or both  
class4	1476	cysts can be an important feature in the diagnosis of ra and a supplement to the criteria of the american rheumatism association  
class4	1476	osteoporosis  joint space narrowing  and joint destruction occurred less frequently in patients with cystic ra than in patients with classic ra  
class4	1476	of the patients with cystic ra  54  were male  and 50  were seronegative  
class4	1476	this study is a supplement to and an enlargement on earlier descriptions of cyst predominance in ra  
class4	1477	widespread inflammatory response to osteoblastoma  the flare phenomenon  
class4	1477	a case of vertebral osteoblastoma caused a diffuse  reactive inflammatory infiltrate in two vertebrae  adjacent ribs  and the paraspinous soft tissues  
class4	1477	the authors call this the flare phenomenon  
class4	1477	on magnetic resonance images the diffuse inflammatory response caused a misleading appearance that simulated a malignant process  lymphoma or ewing sarcoma   
class4	1477	a computed tomographic myelogram was diagnostic  
class4	1478	small cell lung cancer  staging with mr imaging  
class4	1478	small cell lung cancer is an aggressive neoplasm  metastases are detected in two thirds of patients at diagnosis with use of conventional staging  which includes bilateral bone marrow biopsy  bone scintigraphy  and computed tomography  ct  of the head and abdomen  
class4	1478	in 25 patients  small cell lung cancer was staged prospectively with both conventional staging and a magnetic resonance  mr  imaging protocol that included 1 5 t mr imaging of the pelvis  abdomen  spine  and brain  
class4	1478	according to conventional staging  14 patients had extensive disease and 11 patients had limited disease  according to staging with mr  19 patients had extensive disease and six had limited disease  
class4	1478	all metastatic disease sites seen with conventional staging were identified on mr images  
class4	1478	mr images showed additional metastatic involvement in bone  four patients  and liver  three patients  not detected at conventional staging  
class4	1478	a low attenuation hepatic lesion on a ct scan was identified as a hemangioma on mr images  
class4	1478	these preliminary data suggest that small cell lung cancer may be accurately staged with use of a single mr imaging study  
class4	1479	small nodular lesions in the lung periphery  new approach to diagnosis with ct  
class4	1479	to evaluate relationships between lesions in the lung periphery and surrounding structures  particularly vessels and bronchi  axial multiplanar reconstruction  ampr  computed tomography  ct  was used to study 26 patients who underwent surgical resection of pulmonary nodules less than 3 cm in diameter  
class4	1479	findings at ampr ct  conventional ct  and digital radiographic tomography were compared with findings obtained at evaluation of the resected specimen with regard to the ability to display the relationships between vessels  bronchi  and lesions  
class4	1479	ampr ct was significantly superior to conventional ct and digital radiographic tomography in detecting involvement of pulmonary vessels  p less than  001   
class4	1479	involvement of pulmonary veins was seen in all lung cancers  whereas such involvement was seen in only one of eight nonneoplastic lesions  
class4	1479	thus  involvement of pulmonary veins is strongly suggestive of malignancy  
class4	1479	ampr ct permits three dimensional visualization and morphologic assessment of pulmonary nodules  
class4	1480	retroviral recombination and reverse transcription  
class4	1480	recombination occurs at a high rate in retroviral replication  and its observation requires a virion containing two different rna molecules  heterodimeric particles   
class4	1480	analysis of retroviral recombinants formed after a single round of replication revealed that  i  the nonselected markers changed more frequently than expected from the rate of recombination of selected markers   ii  the transfer of the initially synthesized minus strand strong stop dna was either intramolecular or intermolecular   iii  the transfer of the first synthesized plus strand strong stop dna was always intramolecular  and  iv  there was a strong correlation between the type of transfer of the minus strand strong stop dna and the number of template switches observed  
class4	1480	these data suggest that retroviral recombination is ordered and occurs during the synthesis of both minus and plus strand dna  
class4	1481	germ line p53 mutations in a familial syndrome of breast cancer  sarcomas  and other neoplasms 
class4	1481	familial cancer syndromes have helped to define the role of tumor suppressor genes in the development of cancer  
class4	1481	the dominantly inherited li fraumeni syndrome  lfs  is of particular interest because of the diversity of childhood and adult tumors that occur in affected individuals  
class4	1481	the rarity and high mortality of lfs precluded formal linkage analysis  
class4	1481	the alternative approach was to select the most plausible candidate gene  
class4	1481	the tumor suppressor gene  p53  was studied because of previous indications that this gene is inactivated in the sporadic  nonfamilial  forms of most cancers that are associated with lfs  
class4	1481	germ line p53 mutations have been detected in all five lfs families analyzed  
class4	1481	these mutations do not produce amounts of mutant p53 protein expected to exert a trans dominant loss of function effect on wild type p53 protein  
class4	1481	the frequency of germ line p53 mutations can now be examined in additional families with lfs  and in other cancer patients and families with clinical features that might be attributed to the mutation  
class4	1482	biopsy of the breast for mammographically detected lesions  
class4	1482	we prospectively studied 718 women who underwent biopsy of the breast for suspicious  mammographically detected mammary lesions in an attempt to identify key clinical risk factors  as well as roentgenographic characteristics associated with the appearance of early carcinoma of the breast  
class4	1482	patients with a benign outcome had an average age of 55 years versus 63 years for patients with carcinoma of the breast  
class4	1482	seventy six per cent of these patients had no previous history of mammary problems  20 per cent had a positive family history for carcinoma of the breast  58 per cent were premenopausal and 21 per cent had used birth control pills  
class4	1482	except for age  p less than 0 001   the distribution of clinical risk factors was equal among patients with benign or malignant outcomes  
class4	1482	suspicious mammographic findings included mass lesions  53 per cent   calcifications  36 per cent  and the association of both  11 per cent   
class4	1482	the predominant wolfe pattern on mammography was p1  36 per cent   
class4	1482	no relationship was observed between wolfe pattern and malignant conditions  
class4	1482	in this group of patients  mammography was poorly specific  however  the positive predictive value increased with age and is related to the age specific prevalence of carcinoma of the breast  
class4	1482	eight hundred and twenty five lesions were removed  
class4	1482	twenty five per cent  n   203  of the specimens taken at biopsy contained carcinoma  
class4	1482	stellate mass lesions were highly suggestive of a malignant growth  p less than 0 0001   
class4	1482	no relationship between the size of the suspicious mammographic mass and the malignant lesion was observed  
class4	1482	a marked correlation  chi square test with yate s correction  was observed between malignant tumor and lesions with a linear or branching pattern  more than 15 calcifications  or small sized calcifications  
class4	1482	the presence of a mass with calcifications was associated with carcinoma in 34 per cent  
class4	1482	the incidence of invasive carcinoma was much higher for mass lesions  81 per cent  than for suspicious calcifications  56 per cent   p less than 0 0001   
class4	1483	trends in conserving treatment of invasive carcinoma of the breast in females  
class4	1483	this population based study presents trends in the treatment of node negative invasive carcinoma of the breast in females during the 1980s in the detroit metropolitan area  
class4	1483	it was done to determine whether or not there has been a significant shift toward conservation of the breast from 1980 to 1987  
class4	1483	trend analyses of surgical treatment  tumor size  node status  year of diagnosis  age and race were performed for 13 217 patients drawn from the metropolitan detroit cancer surveillance system  
class4	1483	a significant increase in the use of conserving the breast was observed  with younger women receiving this treatment option more often than older women  
class4	1483	implications for a continuing shift in the biologic findings and treatment of carcinoma of the breast are discussed  
class4	1484	correlation between hyperthermoradiosensitivity and clinical effect in carcinoma of the esophagus  
class4	1484	the correlation between hyperthermoradiosensitivity evaluated by an in vitro succinate dehydrogenase inhibition  sdi  test and the histopathologic effects of hyperthermochemoradiotherapy  hcr therapy  were investigated in 43 patients with carcinoma of the esophagus  
class4	1484	the succinate dehydrogenase  sd  activity of tissue fragments taken at biopsy was assayed after exposure to heat  43 degrees c   and radiation  6 grays  was done  
class4	1484	the sensitivity to radiation plus heat treatment was estimated by the percentage of sd activity of the treated cells  compared with that of the control cells  
class4	1484	the 43 patients were divided into three groups according to the degree of sd activity after exposure to radiation plus heat treatment  
class4	1484	the sd activity was less than 50 per cent in group 1  highly sensitive   between 50 and 70 per cent in group 2  moderately sensitive   more than 70 per cent in group 3  less sensitive   
class4	1484	eighteen of 20 in group 1  11 of 17 in group 2 and two of six in group 3 were classified as being histopathologically  effective  for hcr therapy  
class4	1484	the two year survival rate for groups 1  2 and 3 were 55 5  34 9 and zero per cent  respectively  while there were no statistical differences with regard to prognostic factors  
class4	1484	these data suggest that in vitro activities of sd correlate well with the clinical effectiveness of hcr therapy  
class4	1484	therefore  it is recommended that a sd inhibition test be included among the guidelines for clinical management  
class4	1485	neoplastic changes in the stomach after gastrectomy  
class4	1485	partial gastric resection for benign ulcer disease has been associated with an increased incidence of mucosal dysplasia and invasive adenocarcinoma  particularly 15 to 20 years after resection  
class4	1485	these remnant carcinomas are particularly virulent with little hope of resection or cure once symptoms occur  
class4	1485	using a planned protocol of routine endoscopic surveillance with biopsy  the goal was to identify early markers of neoplasia  that is  dysplasia  and a diagnosis of adenocarcinoma of the gastric remnant  while both resection and cure were possible  
class4	1485	between july 1980 and august 1988  yearly flexible gastroscopic examination and random biopsy have been performed on 163 patients at least ten years after gastrectomy for benign ulcer disease  
class4	1485	all biopsy results were interpreted for findings of dysplasia and early gastric adenocarcinoma  
class4	1485	results of this ongoing screening program revealed dysplasia of the gastric remnant in nine patients with eventual findings of adenocarcinoma in four of this group  
class4	1485	these patients underwent total gastrectomy with findings of limited disease  
class4	1485	five patients with mucosal dysplasia continue to be observed at six month intervals  
class4	1485	three additional gastric carcinomas were found on initial gastroscopic screening  while one patient had adenocarcinoma diagnosed during a third yearly gastroscopic examination  
class4	1485	these eight asymptomatic patients with adenocarcinoma in the gastric remnant had a postgastrectomy interval which ranged from 15 to 29 years  mean of 26 5 years   
class4	1485	the results of this study support the concept of neoplastic change in the gastric remnant as a function of time from initial gastric resection  
class4	1485	findings of dysplasia on random biopsy indicate a greater likelihood of development of carcinoma of the gastric remnant and identify a subset of patients requiring aggressive endoscopic surveillance  
class4	1486	therapeutic dilemmas associated with antenatally detected ovarian cysts  
class4	1486	fifteen instances of ovarian cysts detected antenatally are reported  
class4	1486	seven cysts more than 5 centimeters in diameter were treated surgically because of clinical signs  such as palpable abdominal mass  vomiting and abdominal distension  
class4	1486	seven cysts less than 5 centimeters in diameter  and one cyst more than 5 centimeters in diameter began to regress spontaneously within six months after birth  
class4	1486	because the pathophysiologic nature of neonatal ovarian cysts has not been elucidated and because the borderline between physiologic and pathologic factors is still unclear  we propose a more conservative approach in the management of neonatal ovarian cysts to avoid unnecessary operations  
class4	1487	intraoperative pressure profile measurement and continence mechanism adjustment in the indiana pouch urinary reservoir  
class4	1487	we have described herein a simple pressure transducer system which helps the surgeon to tailor suture placement and achieve a continent ileocecal reservoir  
class4	1487	it seems that fewer lembert sutures than previously recommended are necessary to create a continent reservoir  although further study is needed  
class4	1488	magnetic resonance imaging of experimental rat brain tumors  histopathological evaluation  
class4	1488	using rg c6 glioma transplanted rats  we studied precontrast and postcontrast magnetic resonance imaging  extravasation of evans blue  and histology  
class4	1488	in all rats  tumor was enhanced with gadolinium diethylenetriaminepentaacetic acid  gd dtpa   
class4	1488	the necrotic portion in the tumor  however  was not enhanced  
class4	1488	hemorrhage and hydrocephalus were clearly visualized on both the precontrast and postcontrast images  
class4	1488	blood brain barrier disrupted areas stained with evans blue and areas enhanced with gd dtpa on magnetic resonance imaging were nearly consistent  
class4	1488	it is suggested that the mechanism of brain tumor enhancement with gd dtpa on magnetic resonance imaging is simply related to the degree of alteration of the blood brain barrier  
class4	1488	the gd dtpa enhanced magnetic resonance imaging  even with low magnetic field  is useful for the evaluation of size  shape  and location of experimental rat brain tumors  
class4	1489	third ventricle cavernous angioma  report of two cases  
class4	1489	cavernous angioma arising in the third ventricle is an extremely rare disease  
class4	1489	we have reviewed five cases previously reported  as well as our own two cases  and discuss the clinical characteristics of and surgical approach to cavernous angioma at this site  
class4	1489	the bifrontal craniotomy and interhemispheric translamina terminalis approach minimize the damage to the brain and allow for an approach to the third ventricle in a wide operative field with minimal compression of the brain itself  
class4	1489	we have found this approach to be suitable for surgery on angiomas of the anterior half of the third ventricle  
class4	1490	magnetic resonance imaging of vertebral osteoblastoma  a report of two cases  
class4	1490	two patients with vertebral osteoblastoma evaluated with computed tomography and magnetic resonance imaging are presented  
class4	1490	a literature review revealed that cases of osteoblastoma originating within the vertebral body are exceedingly rare  
class4	1491	aqueductal  pencil  glioma presenting as neurogenic pulmonary edema  a case report  
class4	1491	a case of neurogenic pulmonary edema due to hydrocephalus  without initial neurological deficit  is described  
class4	1491	computed tomography demonstrated a ring enhancing lesion in the tectum of the mesencephalon obstructing the aqueduct of sylvius  
class4	1491	the lesion  on autopsy  was a rare mesencephalic glioma described in the literature as a  pencil glioma  of the aqueduct  
class4	1492	computed tomography and bronchoscopy in chest radiographically occult main stem neoplasm diagnosis and nd yag laser treatment in 8 patients  
class4	1492	we studied 8 adult patients with variable symptoms of cough  dyspnea  stridor  wheezing  or hemoptysis  
class4	1492	fiberoptic bronchoscopy in all showed complete or nearly complete endobronchial obstruction of a main stem bronchus by neoplasm with a mean bronchial diameter of 1 9 mm     1 6 mm  mean     standard deviation   
class4	1492	in 4 patients  a lobar bronchus was also completely obstructed  
class4	1492	no mass was visible on chest radiographs of any patient  however  computed tomography in each showed main stem endobronchial obstruction  lobar obstruction  4 instances in 3 patients   and in 6 patients hypoperfusion of the involved lung  
class4	1492	computed tomographic scan showed additional abnormalities that were unsuspected on viewing chest radiographs or at bronchoscopy  including mediastinal adenopathy in 3 patients and an extraluminal tumor component in 4  
class4	1492	after therapy with nd yag laser  main stem airway diameter increased to a mean of 9 6 mm     1 0 mm  p less than  05  and pulmonary functions improved  
class4	1492	results suggest the complementary role of computed tomography and fiberoptic bronchoscopy in the detection and laser treatment planning of chest radiographically occult severe neoplastic obstruction of the main stem bronchus  
class4	1493	correlation of free phenytoin to serum albumin in cancer patients  
class4	1493	the objectives of this study were to compare the total and free phenytoin serum concentrations of cancer patients with hypoalbuminemia with those of cancer patients with normal serum albumin and to correlate the percentage of free phenytoin with the albumin concentration  
class4	1493	a total of 22 patients were studied  13 with normal albumin concentration and 9 with low albumin  
class4	1493	the mean free phenytoin in the normal albumin group was 9 9      1 3  percent and 17 6      4 6  percent in the low albumin group  
class4	1493	with the groups combined  the mean free phenytoin was 13 1 percent  range 8 3 22 2  with the albumin range of 20 45 g l  
class4	1493	there was a significant negative correlation  r    0 9  p less than 0 001  between the percentage of free phenytoin and the measured serum albumin  
class4	1493	in cancer patients  the serum albumin concentration appears to be the key factor that determines the percentage of free phenytoin  
class4	1493	in cancer patients with low serum albumin concentration  the total and free phenytoin concentration should be measured for adequate assessment of phenytoin therapy  
class4	1494	fine needle aspiration cytology and flow cytometry of intracystic papillary carcinoma of breast 
class4	1494	to define criteria for cytologic diagnosis of intracystic papillary carcinoma  icpc   the authors retrospectively reviewed the fine needle aspiration  fna  cytologic specimens of eight cases of histologically proven icpc of breast  
class4	1494	the patients were five black and three white women  56 87 years of age  
class4	1494	the fna specimen was cyst fluid in four cases  bloody in three  clear in one   
class4	1494	all the aspirates showed cellular smears with small and large clusters of cells with papillary and or cribriform configurations and numerous single epithelial cells  
class4	1494	the cells were cuboidal to columnar with minimal atypia  
class4	1494	icpc was suggested by fna in each case  and all the patients underwent surgical excision or mastectomy  
class4	1494	flow cytometry  performed on fresh fna specimen in one case and on paraffin embedded surgical tissue in all eight cases  showed seven tumors to be aneuploid and one to be diploid  
class4	1494	the authors contend that icpcs of breast have distinct cytomorphologic features that can be recognized by fna  
class4	1494	because icpc may present in cyst fluid  either bloody or clear  all breast cyst fluids from postmenopausal women should be examined cytologically  
class4	1494	flow cytometric demonstration of an aneuploid population may assist in confirming malignancy in this lesion  
class4	1495	ki67 index and s phase fraction in human breast carcinomas  comparison and correlations with prognostic factors  
class4	1495	in a prospective study of 148 consecutive breast adenocarcinomas  proliferative indices of the same surgical tumor sample were performed by immunohistologic staining  ki67 index  with the use of the ki67 monoclonal antibody  which binds to a nuclear antigen only expressed in cycling cells  and by flow cytometry derived s phase fraction  spf   
class4	1495	measurable ki67 and spf indices were obtained in 142 cases and 99 cases  respectively  and in 96 cases by both methods  
class4	1495	in aneuploid tumors  a significant but low  p less than 0 05  r   0 3  relationship was observed between ki67 index and spf  
class4	1495	when compared with clinical  pathologic  and biochemical parameters these two proliferative indices were shown to be associated with nuclear grading and mitotic index  
class4	1495	additionally  correlations were observed between ki67 index and node involvement  p less than 0 02  and between spf and estrogen receptors  p   0 002   
class4	1495	these results show that  1  proliferative indices are obtained in 96  of surgical samples with ki67 versus 67  with spf and that  2  ki67 index and spf may provide complementary data with respect to prognosis  
class4	1496	cytologic features of poorly differentiated  insular  carcinoma of the thyroid  as revealed by fine needle aspiration biopsy  
class4	1496	the authors report on the cytologic features of six cases of poorly differentiated  insular  carcinoma  ic  of the thyroid  a recently described variety of thyroid tumor intermediate between well differentiated and anaplastic neoplasms  
class4	1496	it is characterized by trabecular and or alveolar growth patterns  merging with follicular areas  and by the absence of pleomorphism in the tumor cells  
class4	1496	fine needle aspiration biopsy  fnab  materials  both smears and cell block preparations  from six patients were reviewed after the diagnosis of ic was confirmed on the surgical specimen  
class4	1496	the following cytologic features were consistently found  high cellularity and necrotic background  low grade of atypia  trabeculae and or clusters  possibly associated with microfollicles  of cells with poorly defined cytoplasm  and cytoplasmic vacuoles containing thyroglobulin  
class4	1496	nuclear inclusions and grooving of the nuclear surface were additional features  
class4	1496	preoperative diagnosis suggestive of ic might be of value for planning surgical treatment and subsequent therapy  
class4	1497	diagnosis and localization of prostate carcinoma by fine needle aspiration cytology and correlation with histologic whole organ sections after radical prostatectomy  
class4	1497	twenty nine patients with clinical stage t1 2  no  mo prostate carcinoma were treated by retropubic radical prostatectomy  
class4	1497	diagnosis was made by fine needle aspiration biopsy from six to eight separate sectors of the prostate  
class4	1497	at the time of biopsy  diagrams of the palpated organ were drawn  depicting the location of the lesion and the site of each biopsy  
class4	1497	without the examiners  knowledge of cytologic data  extirpated prostate glands were examined with whole organ histologic sections  and carcinomas were scored according to the method of gleason  
class4	1497	the location and extent of all typical and malignant foci were mapped on a standard diagram  
class4	1497	the results of preoperative cytologic examination were compared with postoperative histopathologic findings  showing a tendency toward underestimation of both the extent and degree of differentiation of the carcinomas during cytologic examination  
class4	1497	in no case were these parameters overestimated during cytologic examination  
class4	1497	the gleason score correlated well with the presence of capsular and seminal vesicle invasion  
class4	1498	immunocytochemical profile of benign and carcinomatous effusions  a practical approach to difficult diagnosis  
class4	1498	one of the great challenges in the cytodiagnosis of effusions is the distinction between reactive mesothelium histiocytes and cancer cells  
class4	1498	this is notably true in patients having undergone radiation and or chemotherapy  
class4	1498	to establish whether monoclonal antibodies  moabs  could be used as reliable diagnostic adjuvants  the authors retrospectively and blindly studied 60 cases diagnosed by standard cytologic criteria  malignant  benign  and equivocal   with a panel of seven readily available moabs  cytokeratins  vimentin  ema  b72 3  alpha cea  hmfg 2  and leu m1  and the lectin ulex europaeus i  
class4	1498	all 18  100   malignant cases showed reactivity with ema and hmfg  whereas 17  95   and 11  61   reacted with b72 3 and alpha cea  respectively  
class4	1498	combinations of  1  ema   b72 3   2  ema   alpha cea  and  3  ema   alpha cea   b72 3 displayed positivity in 17  95    11  61    and 10  56   malignant cases  respectively  
class4	1498	of the 18 benign cases  7 reacted with hmfg and 2 each with ema and b72 3  
class4	1498	only one case  5 5   reacted with both ema and b72 3  
class4	1498	based on these results  the 24 equivocal cases were regrouped into 14 malignant and 10 benign cases  
class4	1498	follow up effusions obtained within the ensuing three months in all these patients allowed the authors to unequivocally confirm the diagnosis in all but five  
class4	1498	the combination of ema and b72 3 moabs detected malignant cells in 95  of the cases  with a 3 5  incidence of false positive cases in this study  
class4	1498	a panel of ema  b72 3  and alpha cea moabs should prove the most useful and simple approach to the correct diagnosis in most questionable effusions  
class4	1498	some of the potential pitfalls are discussed  
class4	1499	unusual variants of adrenal pseudocysts with intracystic fat  myelolipomatous metaplasia  and metastatic carcinoma  
class4	1499	five previously unreported cases of adrenal pseudocysts are described that demonstrate a wider range of histologic appearances than has been previously recognized in these lesions  
class4	1499	one pseudocyst removed from an asymptomatic 59 year old female contained intracystic nests of cytologically malignant cells of unknown origin  
class4	1499	workup revealed a left breast mass  which on biopsy showed an infiltrating ductal carcinoma with neoplastic cells that were cytologically similar to those found within the cyst contents  
class4	1499	four other pseudocysts are described with variable numbers of intracystic vascular structures and benign adrenal cortical cells  
class4	1499	in addition  intracystic mature adipose tissue was observed in all four cases  with myelolipomatous metaplasia found in one  
class4	1499	awareness of the wide histologic variability of these lesions should improve diagnostic accuracy and allow distinction from adrenocortical neoplasia and myelolipoma  
class4	1500	secondary t cell lymphoproliferation after marrow transplantation  
class4	1500	secondary lymphoproliferative syndromes in immunosuppressed patients have been characterized as polyclonal or monoclonal b lineage disorders nearly always associated with epstein barr virus  ebv  infection  
class4	1500	the authors now report three patients with a distinctly different lymphoproliferative syndrome  
class4	1500	two patients with common acute lymphoblastic leukemia antigen  calla   cd10  positive acute lymphoblastic leukemia and one patient with acute myelogenous leukemia  respectively  received high dose chemoradiotherapy followed by marrow transplantation from either an hla identical sibling or hla mismatched parent  
class4	1500	all three patients developed severe graft versus host disease  gvhd   requiring immunosuppressive treatment with corticosteroids  
class4	1500	a secondary malignant t cell lymphoproliferation occurred 2  21  and 43 months  respectively  after marrow transplantation  
class4	1500	in all three cases the lymphoid cells expressed t cell surface antigens and were morphologically and immunophenotypically distinct from the malignant cells present before transplantation  
class4	1500	one tumor was of host cell origin  one was probably of donor origin  and the tumor origin in the third case could not be determined  
class4	1500	the authors were unable to find any evidence for ebv  human t cell lymphotropic virus type i or ii  human immunodeficiency virus  or human herpesvirus 6  
class4	1501	primary lymphoma of the central nervous system in two children with acquired immune deficiency syndrome  
class4	1501	postmortem examination disclosed central nervous system non hodgkin s lymphoma in two children who died of acquired immune deficiency syndrome  aids  at 6 and 14 months of age  respectively  
class4	1501	systemic signs of lymphoma were not present  
class4	1501	the b cell origin and clonality of the neoplastic cells were established by immunohistochemistry in one case and by molecular analysis of immunoglobulin gene rearrangement in the other  
class4	1501	moreover  in the latter case the neoplastic cells were characterized by the presence of a single episomal ebv genome  
class4	1501	according to these data  the monoclonal b cell proliferation occurred after ebv infection  thus suggesting a possible pathogenetic role of ebv in the early stages of lymphomagenesis  
class4	1502	strategy for breakpoint cluster region analysis in chronic myelocytic leukemia in a routine clinical laboratory  
class4	1502	despite the increasing reliance on breakpoint cluster region  bcr  determinations in diagnosis of chronic myelocytic leukemia  cml   few reports have dealt with the practical aspects of specimen analysis  
class4	1502	in the setting of a routine molecular diagnostics laboratory  samples from 68 patients with active cml were evaluated for bcr rearrangements  with the use of a variety of enzymes and two probes  
class4	1502	the data have been used to develop an efficient strategy for bcr screening and breakpoint determination  
class4	1502	screening with the universal bcr  ubcr  probe on xba i and bgi ii digests yielded bcr rearrangements in 100  of the ph1 positive patients and three of the seven ph1 negative patients  giving bcr analysis a sensitivity of 100   
class4	1502	a single enzyme screen using the ubcr probe would have resulted in a false negative rate of 10   
class4	1502	the false negative rate was determined during the breakpoint site analysis from additional digests hybridized to both the 3  and ubcr probes  
class4	1502	the false negative rate for the 3  probe was 26 5   because of deletions or 5  rearrangements  
class4	1502	the method of breakpoint site determination was dependent on screening results  
class4	1502	in 78  of cases  one additional hybridization with two enzyme digests was required  
class4	1502	during breakpoint site analysis  a rare false negative result was also demonstrated with bam hi and eco ri  
class4	1502	this screening strategy has made bcr analysis competitive with cytogenetic analysis at the authors  institution  although turnaround time may be slightly longer  bcr analysis can yield information  such as detecting bcr positive ph1 negative patients and determining breakpoint site  that cannot be obtained by cytogenetics  
class4	1503	angiocentric lymphoma with histologic features of neoplastic angioendotheliomatosis presenting with predominant respiratory and hematologic manifestations  report of a case and review of the literature 
class4	1503	neoplastic angioendotheliomatosis  nae  is a rare fatal disease characterized by widespread intravascular proliferations of neoplastic mononuclear cells  
class4	1503	clinically  dermatologic and bizarre neurologic manifestations usually predominate  
class4	1503	the origin of the neoplastic cells remains still undetermined  
class4	1503	the authors report a patient with nae peculiar with respect to the following points   1  the patient predominantly manifested respiratory symptoms and hematologic findings and lacked cutaneous or neurologic manifestations  and  2  immunohistochemical and molecular genetic studies showed the b cell nature of the neoplastic cells  although previous cases with predominant respiratory or hematologic manifestations were reported to be of endothelial origin  
class4	1503	despite the rarity  this type of nae or angiocentric lymphoma should be recognized because it is easily confused with other disorders  particularly vasculitis or thrombotic thrombocytopenic purpura  
class4	1504	myofibroblastoma of the tongue  an immunohistochemical  ultrastructural  and flow cytometric study  
class4	1504	a case of myofibroblastoma arising in the tongue of a 77 year old man is described  
class4	1504	the patient presented with a submucosal tongue mass without other associated symptoms  
class4	1504	the tumor was 2 cm in diameter  well circumscribed  and composed of uniform spindle cells arranged in fascicles  
class4	1504	electron microscopic examination and immunohistochemistry demonstrated a myofibroblastic origin for the tumor cells  
class4	1504	dna flow cytometric analysis showed a diploid dna content of this tumor  
class4	1504	to the authors  knowledge  this is the first report of myofibroblastoma occurring in the tongue  
class4	1505	multiple myeloma and acute megakaryoblast leukemia in spent phase polycythemia vera  
class4	1505	the spontaneous and simultaneous occurrence of multiple myeloma and megakaryoblast leukemia with myelodysplastic features in a case of spent phase polycythemia vera is well documented  
class4	1505	in support of the morphologic characteristics of the bone marrow  immunocytologic studies show proliferation of monoclonal plasma cells and megakaryoblasts  
class4	1505	the cytogenetic findings of 20q  and unbalanced t 1 7  are consistent with myelodysplastic and leukemic transformation of the bone marrow  
class4	1505	these transformations expand observations on variable and spontaneous lineage commitments as the consequence of alterations of the hematopoietic stem cell clone  
class4	1505	these data are in support of the changing insights in hematopoiesis as a process of ordered commitment of the stem cell with sequential lineage potentials  
class4	1506	patency rate of implantable devices during long term intraarterial chemotherapy  
class4	1506	intraarterial implantable drug delivery systems have been considered as an alternative method for treating patients with unresectable liver malignancies  
class4	1506	however  catheter problems with external implanted devices have resulted in limited application of chemotherapy  
class4	1506	the introduction of subcutaneous devices offers an opportunity for long term locoregional chemotherapy  
class4	1506	twelve external intraarterial catheters were implanted into 12 patients and 52 subcutaneously placed devices into 51 patients  all with various hepatic malignancies  
class4	1506	retrospective analyses comparing those two intraarterial systems were conducted taking into account the function and complication rate  hepatic artery thrombosis  infection  leaking  hemorrhage  and dislocation   
class4	1506	the follow up time for the external system was two to eight months  median five weeks   the thrombosis rate 33 3   and the infection rate 25   
class4	1506	one instance of severe bleeding from the hepatic artery occurred during chemotherapy  
class4	1506	one catheter dislocated  
class4	1506	for the subcutaneously implanted intraarterial devices the follow up time was five to forty one months  median sixteen months   the thrombotic complication rate 17 3   and the infection rate 7 6   all patients with simultaneous bowel surgery   
class4	1506	catheter dislocation one year later required reimplantation  in 1 patient therapy had to be discontinued because of a catheter leak  
class4	1506	the overall function rate was 71 3  with a median follow up time of eight months  
class4	1506	anticoagulation therapy for subcutaneously implanted devices starting from the beginning of intraarterial chemotherapy is recommended to achieve long term patency  
class4	1506	no implantation should be preformed simultaneously with bowel surgery  
class4	1506	the subcutaneously placed intraarterial devices had a higher function rate and were available for a longer period as compared with external implanted catheters  
class4	1507	intraocular lens complications  
class4	1507	the authors implanted intraocular lenses  iol  in 780 eyes and considered complications of this surgery  dividing the complications into intraoperative and postoperative  the latter early and late  
class4	1507	the most frequent intraoperative complications were  hyphema  vitreous injury  pupil deformation with an iol in the anterior chamber  ac   and hyphema and corneal lesions with an iol in the posterior chamber  pc   
class4	1507	among the early postoperative complications of an iol in the ac the authors noticed striate keratopathy and uveal flare and postoperative transitory ocular hypertension and striate keratitis with an iol in the pc  
class4	1507	moreover  in late postoperative complications in ac implantation they observed  cystoid macular edema  bullous keratitis  retinal detachment  late uveitis  opacification of posterior capsule  eccentric displacement of the iol  and less frequently  cystoid macular edema in pc implantations  
class4	1507	the authors prefer iol implantation in the pc after extracapsular cataract extraction  since this surgery causes less problems in the cornea  vitreous  and retina  
class4	1508	effect of bleomycin on hematoporphyrin derivative phototherapy of solid tumors  
class4	1508	hematoporphyrin derivative phototherapy  hpd pt  has been successfully used to localize and treat superficial squamous cell cancers  
class4	1508	bleomycin sulfate is a glycopeptide antibiotic that has antineoplastic properties against squamous cell cancers  
class4	1508	because both hpd pt and bleomycin chemotherapy are accepted forms of treatment for squamous cell cancer and their cytotoxicity is mediated by singlet oxygen and oxygen radicals  we studied the possibility of enhancing the response of solid tumors to hpd pt by combining this modality with systemic bleomycin chemotherapy in a murine tumor model  
class4	1508	bleomycin did not enhance hpd pt significantly  
class4	1508	also  we are not confident that hpd pt alone or in combination with other agents can eradicate solid tumors  it certainly did not in this syngeneic murine tumor model  
class4	1509	endoscopic management of early supraglottic cancer  
class4	1509	an initial endoscopic surgical approach to early supraglottic cancer provides the surgeon with the ability to accurately stage these lesions  avoiding possible undertreatment while allowing for a valuable treatment option for those supraglottic cancers with histologically incontrovertibly superficial disease  
class4	1509	early invasion of the preepiglottic and paraglottic spaces can be determined accurately without altering or delaying any treatment option  open surgical excision  radiotherapy  or chemotherapy   
class4	1509	the tendency of supraglottic cancers to transgress the natural foramina of the epiglottis is well established  and the concern about this depth of invasion is reflected by the 1977 revised staging criteria  which required assessment of the preepiglottic space  pes   
class4	1509	along with the microscope and the carbon dioxide laser  the adjustable supraglottiscope facilitates the determination of pes invasion and facilitates en bloc excision of superficial supraglottic cancers  
class4	1509	the resulting morbidity typically is no different from that with routine direct endoscopy and biopsy  
class4	1510	the association of selected cancers with service in the us military in vietnam  ii  soft tissue and other sarcomas  the selected cancers cooperative study group 
class4	1510	as part of a series of investigations into the health of vietnam veterans  we conducted a population based  case control study of soft tissue and other sarcomas between 1984 and 1988  
class4	1510	all men born between 1929 and 1953 and diagnosed in an area covered by eight cancer registries were considered eligible  
class4	1510	controls were selected by random digit dialing  
class4	1510	analyses of 342 men with pathologically confirmed sarcoma and 1776 controls showed that vietnam veterans had a relative risk of 1 0 for sarcoma in comparison with men who did not serve in vietnam  95  confidence interval  0 6 to 1 6   
class4	1510	restriction of the analysis to the 254 men with soft tissue sarcoma yielded a relative risk of 0 9  95  confidence interval  0 5 to 1 6   
class4	1510	several attributes of military service in vietnam  eg  branch  duration of service  military region  and other characteristics that may have been associated with the use of agent orange  were examined  and none was associated with an increased risk for the development of sarcoma  
class4	1510	furthermore  no morphologic type of sarcoma was overrepresented among vietnam veterans  
class4	1510	results were unchanged if vietnam veterans were compared with  1  other veterans or  2  men who never served in the military  
class4	1510	this study  which had 97  power to detect a relative risk of 2 0 for all sarcomas  provides no evidence that the risk for the development of soft tissue or other sarcomas is increased among veterans 15 to 25 years following service in vietnam  
class4	1511	the association of selected cancers with service in the us military in vietnam  iii  hodgkin s disease  nasal cancer  nasopharyngeal cancer  and primary liver cancer  the selected cancers cooperative study group 
class4	1511	as part of a series of investigations into the health of vietnam veterans  we conducted case control studies involving 310 men with hodgkin s disease  48 with nasal carcinoma  80 with nasopharyngeal carcinoma  130 with primary liver cancer  and 1776 controls between 1984 and 1988  
class4	1511	all men born between 1929 and 1953 and diagnosed in an area covered by eight cancer registries were considered eligible as cases  controls were recruited by random digit dialing  
class4	1511	whereas the study had excellent power  96   to detect a twofold increase in risk for hodgkin s disease among vietnam veterans  its ability to detect a similarly elevated risk in the other cancers was limited  ranging from 38   nasal carcinoma  to 75   primary liver cancer   
class4	1511	analyses showed that risks among vietnam veterans relative to other men were 1 1  hodgkin s disease   0 7  nasal carcinoma   0 5  nasopharyngeal carcinoma   and 1 2  primary liver cancer   
class4	1511	none of these relative risks was significantly different from 1 0  
class4	1511	similar results were obtained if vietnam veterans were compared with  1  other veterans or  2  men who never served in the military  
class4	1511	an examination of several attributes of military service in vietnam  eg  branch  duration of service  and other characteristics that may have been associated with the use of agent orange  failed to identify any groups of veterans who were at increased risk for hodgkin s disease  
class4	1511	small numbers limited further analyses of nasal  nasopharyngeal  and liver cancer  
class4	1511	these results provide no evidence that  15 to 25 years following service in vietnam  the risk of these malignant neoplasms is higher among veterans  
class4	1512	lymphomatoid granulomatosis presenting as ulcerodestructive gastrointestinal tract lesions in patients with human immunodeficiency virus infection  a new association  
class4	1512	we describe cases of severe odynophagia  extensive oral ulcerations  and bowel perforation in patients with human immunodeficiency virus infection that were caused by lymphomatoid granulomatosis  
class4	1512	such presentations in human immunodeficiency virus infected individuals are usually ascribed to other causes and may be incorrectly treated on an empiric basis  
class4	1512	in addition  deep tissue specimens obtained at the margin of ulcerative lesions are often necessary for definitive diagnosis  
class4	1512	we review our limited treatment experience with zidovudine  interferon alfa  and h2 blockers in our patients  
class4	1512	based on the markedly increased frequency in which lymphomatoid granulomatosis is being diagnosed at our institution in the post human immunodeficiency virus era  we postulated an association between these two entities  
class4	1513	the dichotomous distribution of gastrinomas  
class4	1513	our experience with 47 sporadic gastrinomas suggests that no less than 85  of these tumors are located to the right of the superior mesenteric artery  
class4	1513	this finding is unexpected because approximately 75  of insulinomas and glucagonomas are located to the left of the superior mesenteric artery  
class4	1513	all of our extrapancreatic gastrinomas have been located to the right  
class4	1513	these observations prompted us to determine if other extrapancreatic gastrinomas were also predominantly located to the right side  
class4	1513	we searched the world s literature and found 10 cases of ovarian gastrinomas and one case of a renal gastrinoma  
class4	1513	nine of these remote extrapancreatic gastrinomas were located on the right side  
class4	1513	this distribution of remote extrapancreatic gastrinomas is similar to our experience with peripancreatic gastrinomas  
class4	1513	this unexpected right sided preponderance of both remote and peripancreatic gastrinomas suggests a common origin for both  
class4	1514	generation of human monoclonal antibodies against colon cancer  
class4	1514	lymphocytes from regional lymph nodes of patients with colon cancer were fused with a human lymphoblastoid cell line with or without in vitro immunization  
class4	1514	the efficacy of these two protocols for the generation of human monoclonal antibodies against colon cancer was investigated  
class4	1514	the hyperplastic lymph nodes adjacent to the tumor were the best source of b lymphocytes  
class4	1514	fusion frequency and the number of tumor reactive clones were markedly increased when the in vitro immunization protocol was applied prior to fusion  
class4	1514	as a stimulant in in vitro immunization  the supernatant of pokeweed mitogen stimulated t lymphocytes was superior to the supernatant of mixed lymphocytes culture  
class4	1514	carcinoembryonic antigen at 20 micrograms l seemed to be the optimal dose for in vitro immunization  
class4	1514	the reactivities of human monoclonal antibodies thus generated were measured by enzyme linked immunosorbent assay and confirmed by immunoperoxidase staining  
class4	1514	combining in vitro immunization with lymphocytes of cancer patients may lead to the successful production of clinically useful human monoclonal antibodies  
class4	1515	detection of primary colorectal cancer with indium 111 monoclonal antibody b72 3  
class4	1515	b72 3 is a murine monoclonal antibody of the immunoglobulin subclass igg1 directed against tag 72  a cell surface antigen present on colorectal carcinoma cells  
class4	1515	we investigated the utility of scanning with indium 111 labeled b72 3 in 16 patients with a high clinical suspicion of or biopsy proven primary colorectal cancer  
class4	1515	each patient received 1 or 2 mg of b72 3 monoclonal antibody labeled with 152 mbq of indium 111  
class4	1515	patients underwent scanning 2 to 3 days and 7 days after infusion by planar and emission computed tomography  
class4	1515	nineteen lesions were confirmed in 12 patients  
class4	1515	three patients with benign polyps had true negative monoclonal antibody scans  
class4	1515	indium 111 labeled imaging of b72 3 detected nine of 19 lesions  
class4	1515	unsuspected tumor sites were identified by monoclonal antibody scan in three patients  
class4	1515	by detection of additional abdominal disease and extra abdominal spread  indium 111 labeled scanning of b72 3 directly affected treatment in 18  of patients  
class4	1516	metastatic ciliary body carcinoid tumor  
class4	1516	a 50 year old man with a history of systemic carcinoid had decreased right eye vision and a darkly pigmented cilio choroidal mass  
class4	1516	results of ultrasonographic and fluorescein angiographic examinations were consistent with a malignant melanoma  
class4	1516	fine needle aspiration biopsy of the lesion identified it as a carcinoid metastasis  
class4	1516	the patient refused both radiation and enucleation  complete excision with a cyclochoroidectomy was performed  
class4	1516	histopathologic examination showed a carcinoid neoplasm covered by marked hyperplasia of the retinal pigment epithelium that produced the pigmented appearance of the lesion  
class4	1517	a study of immunoglobulin g in the cerebrospinal fluid of 1007 patients with suspected neurological disease using isoelectric focusing and the log igg index  a comparison and diagnostic applications  
class4	1517	cerebrospinal fluid and serum immunoglobulin g from 1007 patients with suspected neurological disease were analysed by 2 methods  isoelectric focusing for the detection of oligoclonal banding  and quantitative measurement of igg and albumin for the formulation of a log igg index  
class4	1517	a comparison of the 2 methods in the detection of local synthesis of igg showed that isoelectric focusing not only gave a much higher yield overall  with 282 patients showing local synthesis versus 225 for the log igg index  but also a higher specificity  with a false positive rate of 0  versus 3 5   
class4	1517	in addition  of the 282 patients positive by isoelectric focusing only 163  58   were positive by the log igg index  
class4	1517	of the 1007 patients studied  206 had multiple sclerosis  ms   and isoelectric focusing showed local synthesis in 95  of clinically definite cases  with a 90  detection rate overall  
class4	1517	the log igg index was positive in only 67  of clinically definite cases  with an overall 59  detection rate  
class4	1517	thus with the exceptions noted above  local synthesis of igg as defined by isoelectric focusing is confined to demyelinating  inflammatory  infectious and postinfectious disorders  
class4	1517	our results compare very favourably with the published sensitivities of magnetic resonance imaging in the detection of abnormalities in multiple sclerosis  and better than those for evoked potentials  
class4	1517	where both these investigations are readily available isoelectric focusing provides a useful adjunct  
class4	1517	for the majority of physicians and neurologists who do not have ready access to magnetic resonance imaging  isoelectric focusing is an excellent alternative  
class4	1517	we would also recommend that it become the standard for the measurement of igg abnormalities in the cerebrospinal fluid and that the use of quantitative data be abandoned for routine purposes  
class4	1518	oral contraceptives and breast cancer  review and meta analysis  
class4	1518	to evaluate the relation between use of oral contraceptives and the incidence of breast cancer  the authors reviewed the epidemiologic literature and used quantitative methods to summarize the data  
class4	1518	study results for any use of oral contraceptives were pooled using a model that accounted for both interstudy and intrastudy variability  
class4	1518	the authors also explored interstudy variability and modeled a duration effect relation between oral contraceptive use and breast cancer  
class4	1518	case control and follow up studies were considered separately  
class4	1518	overall  the authors observed no increase in the risk of breast cancer for women who had ever used oral contraceptives  even after a long duration of use  
class4	1518	these results were consistent across study design  
class4	1518	however  data combined from case control studies revealed a statistically significant positive trend  p   0 001  in the risk of premenopausal breast cancer for women exposed to oral contraceptives for longer duration  
class4	1518	this risk was predominant among women who used oral contraceptives for at least 4 years before their first term pregnancy  relative risk   1 72  95  confidence interval   1 36 to 2 19   
class4	1518	additional study is required to determine whether this finding in a subgroup of exposed women is confirmed and whether the risk remains increased with advancing age  
class4	1519	predictive value of tumor estrogen and progesterone receptor levels in postmenopausal women with advanced breast cancer treated with toremifene  
class4	1519	the predictive value of estrogen receptor  er  concentrations was evaluated in a group of 113 postmenopausal patients with estrogen receptor positive  er greater than 7 fmol mg protein  advanced breast cancer  
class4	1519	in 103 patients  tumors were also sampled for progesterone receptor  pgr  determination  
class4	1519	all patients were treated with toremifene  a novel antiestrogen  60 mg daily  
class4	1519	the median er in 51 responders was 78 fmol mg protein  and in 62 nonresponders  51 fmol mg protein  the median pgr levels were 40 and 37 fmol mg protein  respectively  
class4	1519	the response rate in patients with er less than 50 fmol mg protein was 38   and 51  in the group with er greater than 50 fmol mg protein  not significant  ns    
class4	1519	the response rate in patients with pgr less than 10 fmol mg protein was 42   and in patients with greater than 10 fmol mg protein  44   
class4	1519	the duration of response in patients with er greater than 50 fmol mg protein was significantly longer than with lower er levels  p   0 002   
class4	1519	pgr was not associated with the duration of response  
class4	1519	in cox s multiple regression analysis  er was an independent prognostic factor  p   0 005  for response duration  
class4	1519	thus  the er concentration of tumor tissue predicts the duration of response but not the response rate to toremifene in patients with advanced breast cancer  
class4	1519	the pgr status does not predict the response rate or the duration of response  
class4	1520	combined modality therapy for locally advanced non small cell lung carcinoma  
class4	1520	multi modality treatment consisting of cisplatin  vp 16  and 5 fluorouracil chemotherapy given concomitantly with external beam radiation was used to treat 64 patients with locally advanced stage iii non small cell lung carcinoma  
class4	1520	this regimen was used in a preoperative fashion for four cycles in patients considered surgically resectable and with curative intent for six cycles in the remainder of patients  
class4	1520	the clinical response rate for the entire group was 84  and the overall local control rate was 74   
class4	1520	the median survival was 13 months with a median follow up for live patients of 19 months  
class4	1520	the actuarial 3 year survival and disease free survival rates were 30  and 23   respectively  
class4	1520	histologic complete response was 39  and appeared to predict for survival  
class4	1520	the 3 year actuarial survival and disease free survival rates for 23 resected patients were 69  and 45   respectively  with the complete histologic responders having a disease free survival of 78   
class4	1520	the pattern of first recurrence did not appear to differ by histology or presence of lymph nodes in this subset of patients  
class4	1520	the actuarial 3 year survival and disease free survival rates for inoperable patients receiving six cycles of treatment were 18  and 23   respectively  
class4	1520	the local control was 67  with the majority of these patients having stage iiib disease  
class4	1520	the mountain international staging system appeared to predict for operability  local recurrence  and survival  
class4	1520	this concomitant treatment regimen is feasible  with the major toxicities being leukopenia  nausea  and vomiting  
class4	1521	low dose preoperative radiation postpones recurrences in operable rectal cancer  results of a randomized multicenter trial in western norway  
class4	1521	a randomized  multicenter clinical trial was conducted in western norway to study the effectiveness of preoperative radiation therapy in operable rectal cancer  given at a dosage of 3150 cgy in 18 fractions  2 to 3 weeks before radical surgery  
class4	1521	three hundred nine patients were entered into the trial between may 1976 and december 1985  
class4	1521	after radiation no tumor was seen in 4 5  of the patients  
class4	1521	there was no increased morbidity or mortality at surgery  
class4	1521	the 5 year survival for evaluable patients was 57 5  in the control group and 56 7  in the radiotherapy group  
class4	1521	for patients operated on for cure the 5 year survival was 60 9  and 64 2  in the control group and radiotherapy group  respectively  
class4	1521	radiation significantly delayed both local and distant recurrences in patients in the radiation group who had curative resection from 13 3 months in controls to 27 1 months  
class4	1521	the local recurrence rate in the corresponding groups was 21 1  and 13 7   respectively  
class4	1521	we conclude that higher preoperative radiation doses should be used in new trials as a higher dosage may transform the observed positive effects into a survival benefit  
class4	1522	comparison of lymphangiography and computed tomography scanning in evaluating abdominal disease in stages iii and iv hodgkin s disease  a southwest oncology group study  
class4	1522	the authors reviewed the records of 139 patients who had laparotomy plus computed tomography  ct  and or lymphangiograms  lag  as part of a their staging workup for hodgkin s disease  in accordance with southwest oncology group  swog  protocol 7808  
class4	1522	they evaluated the relative ability of ct and lag to detect disease in the abdomen  
class4	1522	two regions of the abdomen were designated  the upper and the lower  to further examine the capabilities of ct and lag in the lower abdomen and ct in the upper abdomen  
class4	1522	a lag was more sensitive  p less than 0 05  than ct in detecting positive lower abdominal nodes  
class4	1522	in the upper abdomen  ct scan had low sensitivity for detecting positive nodes  liver  or spleen  
class4	1522	this study suggests that lag of the lower abdomen provided more information than ct  and therefore should not be abandoned as a valid method for detecting nodal disease  
class4	1523	piroxicam decreases postirradiation colonic neoplasia in the rat  
class4	1523	this study evaluated the effects of the nonsteroidal antiinflammatory agent piroxicam on chronic radiation proctitis in the rat  
class4	1523	forty female wistar rats received a 2250 cgy dose of irradiation to the distal 2 cm of the colon  
class4	1523	twenty received piroxicam 8 0 mg kg orally 30 minutes before exposure and 24 hours after exposure  20 rats served as irradiated controls  
class4	1523	all animals were evaluated by colonoscopy 1 and 3 weeks postexposure and every third week until death or killing at 1 year  
class4	1523	at killing  colons were removed for light microscopic examination  
class4	1523	one year postirradiation results showed no differences in mortality  vascular changes  acute inflammation  colitis cystica profunda  or rectal stricture between the control and piroxicam treated groups  
class4	1523	however  at 1 year postirradiation the control group demonstrated neoplasia in 15 of 19 animals compared with eight of 20 animals in the piroxicam treated group  
class4	1523	the first endoscopic appearance of colonic neoplasm occurred at 15 weeks postirradiation in one control irradiated rat whereas the first evidence of endoscopic neoplasm in the piroxicam treated group did not occur until 36 weeks postirradiation  
class4	1523	histologic examination documented a tendency toward a greater presence of adenocarcinomas in the control group compared with the piroxicam treated group  
class4	1523	the authors conclude that piroxicam treatment significantly decreased the incidence of colonic neoplasia in general as well as delayed the endoscopic appearance of colonic neoplasia in rats after pelvic irradiation  
class4	1524	diffuse sclerosing variant of papillary carcinoma of the thyroid  clinical importance  surgical treatment  and follow up study  
class4	1524	a diffuse sclerosing variant is not very rare among papillary carcinomas of the thyroid when the patients are female and younger than 30 years of age  
class4	1524	the variant is characterized by diffuse involvement of one or both thyroid lobes  with dense sclerosis  patchy lymphocytic infiltration  and abundant psammoma bodies  
class4	1524	controversy still exists concerning its prognosis  
class4	1524	we reviewed our experience with 14 patients treated between 1958 and 1988  
class4	1524	all patients were young females  their age being from 10 to 28 years with a mean of 19 6  
class4	1524	hashimoto s thyroiditis had been suspected in nine patients before they came to our clinic  
class4	1524	nowadays the diagnosis of this cancer is possible when we have this entity in mind and detect abundant psammoma bodies either by ultrasonography or by soft tissue roentgenography of the neck  
class4	1524	total thyroidectomy with modified neck dissection was carried out in eight patients  subtotal thyroidectomy with neck dissection in five  and lobectomy with neck dissection in one  
class4	1524	all of them are alive and well without distant metastasis at a mean follow up of 16 years  
class4	1524	because most of the patients with this variant of papillary carcinoma are young women and the prognosis is favorable  a complete resection without causing later recurrence  but also cosmetic and complication free surgery  should be considered  
class4	1525	can internal mammary chain treatment decrease the risk of death for patients with medial breast cancers and positive axillary lymph nodes  
class4	1525	the effect of internal mammary chain treatment on each type of malignant death related event was analyzed in 1195 patients with operable breast cancer and histologically involved axillary lymph nodes  
class4	1525	a group of 135 patients who had no internal mammary chain treatment was compared with a control group of 1060 patients who were treated by surgery and or postoperative radiation therapy  
class4	1525	in a multivariate analysis taking into account age  clinical size of the tumor  histoprognostic grading  and the number of positive axillary lymph nodes  quantitative interaction tests were used to determine whether the effects of internal mammary chain treatment on each type of malignant event were significantly different for patients with a lateral tumor compared with those with a medial tumor  
class4	1525	the authors found that the effects of this treatment on the risks of distant metastases and of secondary breast cancer were not the same for the patients with a medial tumor as for those with a lateral tumor  
class4	1525	for the untreated patients with a medial tumor  the risks of distant metastases and second breast cancer were  respectively  1 6  p   0 02  and 2 9  p   0 02   compared with the treated patients  
class4	1525	conversely  for women with lateral tumor  no difference between the two treatment groups was observed  
class4	1525	thus  internal mammary chain treatment may improve long term survival rate in patients with a medial tumor and positive axillary lymph nodes essentially by decreasing the risk of development of distant metastases  mainly brain  distant lymph nodes  multiple simultaneous metastases  and or a secondary breast cancer  
class4	1526	superficial esophageal carcinoma  surgical treatment and the results  
class4	1526	we report 92 patients treated with esophagectomy for superficial esophageal carcinoma  sec  9 1  of all resected esophageal cancers at our institution   
class4	1526	the operative mortality rate was 5 4   
class4	1526	in 24 cases  cancer invasion was limited to the mucosa  and in 68 to the submucosa  
class4	1526	twenty three patients in the former group had no lymph node involvement  whereas 24 patients  35 3   of the latter group had lymph node metastases  
class4	1526	the 5 year survival rate after surgery for patients with sec limited to the mucosa was 83 5   which was significantly better than that for carcinoma invading the submucosa  54 9    
class4	1526	no recurrent disease occurred in patients with lesions limited to the mucosa  
class4	1526	in conclusion  an esophagectomy with wide lymphadenectomy is necessary to provide a better prognosis for sec invading the submucosa  whereas a less extensive treatment may be considered for sec limited to the mucosa  
class4	1527	the concept of locally advanced gastric cancer  effect of treatment on outcome  the gastrointestinal tumor study group  
class4	1527	in previous gastrointestinal tumor study group  gitsg  reports  gastric cancer patients with locally unresectable disease  treated with combined radiation and chemotherapy had a shorter median survival  40 weeks  but more remained alive at 4 years  18   when compared to those randomized to receive chemotherapy alone  76 weeks and 6   respectively   
class4	1527	to further test the concept that combined modality therapy might increase the number of long term survivors  a second protocol was designed  but with three major modifications  
class4	1527	a course of chemotherapy would precede the 5 fluorouracil potentiated radiation therapy  
class4	1527	doxorubicin would be added to the 5 fluorouracil plus methyl ccnu combination  
class4	1527	radiation therapy would be given as a single course of 4320 cgy  with 5 fluorouracil given daily for 3 days at the beginning and end of the course  
class4	1527	median survival of 46 patients treated with chemotherapy alone was 59 weeks  with 11  alive after 3 years  
class4	1527	following combined modality therapy  median survival was 62 weeks  but only 7  lived 3 years  
class4	1527	although the problem of early deaths in the combined modality group was resolved  long term survival with combination therapy was not demonstrated in this study  
class4	1528	lack of relationship between perioperative blood transfusion and survival time after curative resection for gastric cancer  
class4	1528	to better comprehend the relationship between perioperative blood transfusion and survival time after curative gastrectomy for advanced gastric cancer  the authors reviewed retrospectively data on 568 patients treated in their clinics from 1965 to 1983  
class4	1528	of these 568  195  34 3   required no blood transfusion and 373  65 7   required transfusions within the perioperative period  
class4	1528	univariate analysis indicated that the survival time of the transfusion recipients was significantly less than that of the patients who had no transfusions  p less than 0 01   
class4	1528	in subgroups of the authors  patients stratified to adjust for stage of disease  there was  however  no significant difference between the survival rates  
class4	1528	subsequently  multivariate analysis  using the cox regression analysis  which adjusted for sex  age  and other covariates  indicated that perioperative blood transfusion was not a useful factor for predicting survival time  
class4	1528	multivariate analysis suggested that tumor size  p less than 0 01   degree of invasion into the gastric wall  p less than 0 01  and status of lymph node metastasis  p less than 0 01  were the most important covariates after curative gastrectomy for advanced gastric cancer  
class4	1528	the authors  findings revealed the lack of any relationship between perioperative blood transfusion and survival time of patients who underwent curative resection for advanced gastric cancer  
class4	1529	transrectal ultrasonography of rectal carcinoma  
class4	1529	preoperative transrectal ultrasonographic staging of 38 patients with known adenocarcinoma of the rectum was performed  
class4	1529	six of these patients had preoperative radiation therapy  
class4	1529	of the 32 without radiation therapy  transrectal ultrasonography  trus  correctly staged disease limited to the rectum in 90   18 of 20  and transmural extension in 50   6 of 12   for a sensitivity for evaluating transmural extension of 50   specificity of 90   positive predictive value of 75   and a negative predictive value of 25   
class4	1529	nineteen patients had positive nodes  
class4	1529	the sensitivity and specificity of detecting nodal metastases by trus were 63  and 85   
class4	1529	the positive and negative predictive values were 86  and 61   respectively  
class4	1529	trus was slightly superior to digital rectal examination in staging patients because of its superior ability to detect adenopathy  
class4	1529	adjacent organ involvement was correctly evaluated in five of six patients  peritumoral fibrosis was misinterpreted as tumor extension into uterus and ovary in one woman  
class4	1529	tumor shrinkage in all patients undergoing radiation therapy was identified  but fibrosis and edema made staging by trus unreliable in those patients  
class4	1530	the effect of dietary omega 3 fatty acids  fish oil  on azoxymethanol induced focal areas of dysplasia and colon tumor incidence  
class4	1530	maxepa  ma   a fish oil high in omega 3 fatty acids  was combined with various levels of corn oil  co   rich in omega 6 fatty acids  and fed to female cf1 mice  
class4	1530	the three fish oil blends with co and the two co levels of the diets studied were as follows  16 0  co   4 4  ma  diet 1   10 2  co   10 2  ma  diet 2   4 4  co   16 0  ma  diet 3   20 4  co  diet 4   and 4 4  co  diet 5   
class4	1530	the diets were provided 2 weeks before weekly subcutaneous injection of saline or azoxymethanol  aom   
class4	1530	studies of epithelial cell proliferation and the incidence of focal areas of dysplasia  fad  involved six weekly aom injections  
class4	1530	one week after the last aom injection and 1 hour before killing  mice were injected with tritiated thymidine  3htdr   
class4	1530	no differences in any proliferative parameters were found among the five groups of saline treated mice  
class4	1530	among the aom treated animals  those fed diet 3 showed significantly fewer cells per crypt and significantly fewer labeled cells gland than co diets 4 and 5  
class4	1530	additionally  the distribution of s phase cells in crypts of aom treated mice fed diet 3 most closely resembled that of the saline controls  
class4	1530	the greatest alteration in the distribution of proliferative cells was observed in the high co diet  diet 4  and the lowest ma level  diet 1   
class4	1530	mice fed diets 2 and 3 had significantly fewer fad 500 microns of distal colonic serial sections than those fed the high co diet  diet 4   
class4	1530	mice involved in chronic tumor incidence studies received only three weekly injections of the same dose of aom  
class4	1530	regardless of diet  approximately 88  of all tumors arose in the distal colon  
class4	1530	a significantly larger tumor bearing population was observed in both the high co diet 4 and the lowest maxepa  ma  diet  diet 1  compared with the incidence in ma diets 2 and 3 and the low co diet 5  
class4	1530	a diet with a ratio of omega 6 to omega 3 fatty acids of approximately 1 0 apparently prevented the development of an adenoma type proliferative pattern thereby reducing fad numbers and subsequent tumor incidence  
class4	1531	aneuploidy in pancreatic insulinomas does not predict malignancy  
class4	1531	nuclear deoxyribonucleic acid  dna  ploidy studies with paraffin embedded archival material from 14 pancreatic insulinomas were performed by flow cytometry  
class4	1531	clinical follow up  2 to 17 years  mean  8 years  was obtained for all patients  
class4	1531	half of the tumors had a normal dna histogram and half exhibited an abnormal dna profile consistent with dna aneuploidy  
class4	1531	six of the seven patients with aneuploid tumors are alive and disease free  2 to 5 years postresection   and one is alive with metastatic disease  
class4	1531	of the seven patients with tumors showing normal dna profiles  five are alive and disease free  one is dead of disease  and one is alive with metastatic disease  
class4	1531	these data suggest that dna ploidy analysis is unlikely to provide useful prognostic information for patients with insulinomas  
class4	1532	comparative study of cutaneous t cell lymphoma and adult t cell leukemia lymphoma  clinical  histopathologic  and immunohistochemical analyses  
class4	1532	an important disease entity distinct from cutaneous t cell lymphoma  ctcl  in japan is adult t cell leukemia lymphoma  atl   which usually shows the same phenotype as ctcl  i e   a helper inducer t cell phenotype  cd4 cd8    and usually involves the skin  
class4	1532	clinically  both ctcl and atl are heterogeneous in nature  
class4	1532	in this study  we demonstrated differences between ctcl and atl in terms of clinical and immunopathologic cell surface features  
class4	1532	in patients with atl  the predominant clinical findings were peripheral lymph node involvement  skin lesions  hepatosplenomegaly  leukemic manifestations  and an aggressive course  
class4	1532	in patients with ctcl  by contrast  only skin lesions predominated at the onset of the disease and a relatively good prognosis was demonstrated  
class4	1532	phenotypic heterogeneity of atl in the skin  i e   cd4 cd8   cd4 cd8   and cd4 cd8   was demonstrated  
class4	1532	expression of leu8  cd7  leu9   and cd45ra  2h4  was high in both the skin infiltrating atl cells and peripheral blood and lymph node atl cells compared with that in the skin infiltrating ctcl cells  
class4	1532	expression of cd25  il 2r   cd71  okt9   hla dr  and hla dq was higher in the skin infiltrating atl cells than in ctcl cells  
class4	1532	expression of cd29  4b4  was high  and that of cd45ra  2h4  was low in both the skin infiltrating atl and ctcl cells compared with the peripheral blood and lymph node atl cells  
class4	1532	expression of cd45ro  uchl 1  was not significantly high in the skin infiltrating ctcl cells compared with that in atl cells  
class4	1532	the most significant phenotypic difference between atl cells and ctcl cells was the expression of leu8  lymph node homing receptor   cd7 and cd25 antigens on the cell surface  and the main phenotypic difference between skin infiltrating atl and ctcl cells and peripheral blood and lymph node atl cells was the expression of cd29 and cd45ra  
class4	1532	these findings confirm that the difference in antigen expression on the cell surface might reflect the clinical features of atl and ctcl  and suggest that the predominant phenotype of peripheral blood and lymph node atl cells is that of naive  relatively immature or activated t cells  and that ctcl cells are previously activated  memory  t cells  
class4	1532	in other words  ctcl cells do not share the same origin as atl cells  
class4	1532	these observations support the concept that atl is a disease distinct from ctcl  
class4	1533	von willebrand factor in head and neck cancer  
class4	1533	laboratory abnormalities in blood coagulation factors are common in patients with cancer but the significance is unknown  
class4	1533	twenty eight patients with head and neck cancer were studied at the time of diagnosis  
class4	1533	twenty five were advanced stage  iii or iv  patients  
class4	1533	levels of clotting factors  antithrombin iii  and plasminogen were normal  
class4	1533	levels of von willebrand factor  vwf   both antigenic and functional  ristocetin cofactor   were elevated  
class4	1533	this group of patients were followed for a minimum of 41 months  median  48 months   
class4	1533	fifteen patients died within the follow up period  
class4	1533	von willebrand factor levels were significantly higher in these 15 than the 13 survivors  
class4	1533	extreme elevation of ristocetin cofactor  greater than 300 u dl  was seen in six of the 15 patients who died and in none of the survivors  
class4	1533	plasma vwf is elevated in head and neck cancer and the level measured at the time of diagnosis may have prognostic and potentially therapeutic implications  
class4	1534	tumor factors predicting for prognosis in metastatic breast cancer  the presence of p24 predicts for response to treatment and duration of survival  
class4	1534	fifty one patients with metastatic breast cancer were investigated to determine tumor parameters with prognostic significance  
class4	1534	investigations included determinations of p24 content by immunocytochemical means using a monoclonal antibody to p24 protein  immunocytochemical analysis of estrogen and progesterone receptors  ploidy analysis by flow cytometry  and histologic grading  
class4	1534	there were significant correlations between the presence of p24 and estrogen receptor  between histologic grade and p24 expression  and between estrogen and progesterone receptors  
class4	1534	of the tumor factors investigated only p24 protein was  however  of prognostic significance  
class4	1534	patients with p24 positive tumors had a significantly higher rate of response to treatment as well as more prolonged duration of response and duration of survival from diagnosis of metastatic disease  
class4	1534	none of the other variables investigated were significantly predictive of outcome  
class4	1534	p24 protein may be a useful predictor of prognosis in metastatic breast cancer  
class4	1535	clinicopathologic features of hepatocellular carcinoma in young patients  
class4	1535	to investigate clinicopathologic characteristics of hepatocellular carcinoma  hcc  in young adults  excised tumors from 21 patients younger than 45 years  young group  were compared with findings in tumors from 204 patients older than 45  old group   
class4	1535	in the young group hcc showed  1  a high incidence of positive hepatitis b virus surface antigen  hbsag   young 71 4  versus old 20 1     2  relatively well preserved hepatocellular function  indocyanine green test  young 10 7     8 8  versus old 20 6     10 8     3  low incidence of histologically verified concomitant cirrhosis  young 52 4  versus old 78 4    and  4  a more advanced stage of the disease in tnm classification  stage iii  young 52 4  versus old 18 1    
class4	1535	with respect to survival rates achieved by surgery  there was no statistically significant difference between the two groups  
class4	1535	thus  hepatitis b virus may relate to the occurrence of hcc in the young patients  
class4	1535	despite the advanced stage in the young group  survival rate after surgery was comparable with that achieved in the old group  
class4	1535	these observations mean that a close periodic surveillance of young adults with a positive hbsag is required to detect hcc at an early stage  
class4	1535	treatment of patients with hbsag using interferon or vidarabine and hepatitis b vaccine should be made to convert hbsag to negative in these individuals  
class4	1536	angiocentric immunoproliferative lesion t cell non hodgkin s lymphoma and the acquired immune deficiency syndrome  a case report and review of the literature  
class4	1536	the lesions known as lymphocytic vasculitis  polymorphic reticulosis  midline malignant reticulosis  lethal midline granuloma   lymphomatoid granulomatosis  and angiocentric lymphoma form what have been collectively termed the angiocentric immunoproliferative lesions  ail   
class4	1536	because of recent reports demonstrating clonal rearrangements of the t cell receptor in these lesions  the ail are now thought to represent a continuous spectrum of post thymic t cell non hodgkin s lymphoma  nhl   
class4	1536	nhl associated with the acquired immune deficiency syndrome  aids  represents intermediate or high grade b cell malignancies in hiv infected patients that may be etiologically related to the epstein barr virus  ebv   
class4	1536	there have been reports of ebv associated t cell nhl  ail  and large granular lymphocyte  lgl  proliferations  as well as hiv associated t cell neoplasia  lgl t cell proliferations  and ail  
class4	1536	we describe a case of polymorphic reticulosis  lethal midline granuloma  arising in an hiv infected individual  who later progressed to aids  and review the literature on hiv associated and ebv associated t cell neoplasia  lgl t cell proliferations  and ail  
class4	1536	the etiology of this ail t cell nhl  especially in relation to ebv and hiv  is discussed  
class4	1537	disseminated strongyloidiasis with central nervous system involvement diagnosed antemortem in a patient with acquired immunodeficiency syndrome and burkitts lymphoma  
class4	1537	a 45 year old man presented with central nervous system involvement as the initial manifestation of disseminated infection with strongyloides stercoralis  
class4	1537	several concurrent clinical factors contributed to this event  all related to the patient s immunosuppression  including high grade lymphoma  corticosteroid therapy  and acquired immunodeficiency syndrome  
class4	1537	this is only the third case of cns involvement in disseminated strongyloidiasis diagnosed antemortem  
class4	1538	abnormal vitamin b6 status in childhood leukemia  
class4	1538	vitamin b6 is involved in many biological processes of potential relevance to carcinogenesis and tumor growth  including dna synthesis and maintenance of immunocompetence  yet very little information exists on b6 nutritional status in childhood leukemia  
class4	1538	using a radioenzymatic assay  the authors measured plasma pyridoxal 5  phosphate  plp   the biologically active form of b6  in 11 newly diagnosed untreated children with leukemia and 11 age matched controls  
class4	1538	the children with leukemia had significantly lower plp levels than the controls  
class4	1538	in 26 additional leukemia patients and 26 additional controls  a high performance liquid chromatography assay also demonstrated lower plasma plp levels in childhood leukemia compared with controls  
class4	1538	these differences were significant for both acute lymphoblastic leukemia  all  and for acute nonlymphoblastic leukemia  anll   
class4	1538	the plp values did not correlate with indices of leukemia cell burden  but did correlate with reported b6 intake  suggesting that illness related diet changes are at least partially responsible for the low plp levels  
class4	1538	before any chemotherapy  overall nutritional status was suboptimal in 53  of all cases and 57  of anll cases  
class4	1538	newly diagnosed children with leukemia have suboptimal overall nutrition as well as suboptimal vitamin b6 status  
class4	1539	simultaneous hepatoblastoma in identical male twins  
class4	1539	identical male twin infants who in 1987 presented with hepatoblastoma at the age of 7 months are reported  
class4	1539	twin b was admitted for investigation due to enlarged liver and spleen  
class4	1539	he was found to have an inoperable hepatoblastoma of fetal type and was treated with chemotherapy and local irradiation  
class4	1539	however  7 months after the chemotherapy the tumor recurred  
class4	1539	the asymptomatic twin a was examined because of the known familial cases  and he proved to have an identical tumor  
class4	1539	he was successfully radically operated on and 2 years after the chemotherapy is still doing well with no evidence of tumor  
class4	1539	as the mother and the maternal grandmother had polyps in the colon  quite probably the hepatoblastomas of the twins were associated with familial adenomatous polyposis  
class4	1540	melanoma and soft tissue sarcoma in seven patients  
class4	1540	seven patients with both melanoma and sarcoma were seen at the dana farber cancer institute  boston  ma  over a 4 year period  
class4	1540	three had additional malignant neoplasms  one of these patients also had the hereditary cutaneous malignant melanoma  dysplastic nevus syndrome  
class4	1540	these observations suggest the possibility of a biologic relationship between melanoma and sarcoma  the nature of which remains unknown  
class4	1541	the epidemiology of cancer among hispanic women  the experience in florida  
class4	1541	to explore cancer incidence among hispanic women living in dade county  florida  data were analyzed from the statewide cancer registry  
class4	1541	for all but three sites  hispanics had lower rates of the 15 most prevalent cancers than non hispanics  
class4	1541	however  higher rates of cancer among hispanics were noted for cancers of the gallbladder  liver  and heart and soft tissue  
class4	1541	subgroups of women had significantly higher rates of cervical cancer and thyroid cancer  
class4	1541	lower rates among hispanics were observed for cancers of the esophagus  vagina  breast  colon  buccal cavity and pharynx  and malignant melanoma  
class4	1541	these data suggest that most cancer sites traditionally higher among us latino women were not higher among dade hispanics  and that sites more common among non hispanics have not yet shown an increased incidence among hispanic women in dade county  
class4	1542	increasing incidence of cecal and sigmoid carcinoma  data from the connecticut tumor registry  
class4	1542	we have studied both the distribution and incidence of colorectal cancer using the connecticut tumor registry  the oldest tumor registry in the united states  
class4	1542	during the time period 1973 to 1985  left sided colon cancers accounted for 63  of the cancers  right sided cancers 33   and cancers with unspecified sites 4   
class4	1542	indeed  this pattern of distribution has remained constant for 25 years  
class4	1542	for the period 1935 to 1985  we calculated the sex specific  age adjusted  normalized to the 1970 u s  
class4	1542	census  incidence  
class4	1542	age adjusted incidence of rectal cancer has remained stable for 50 years  for men  22 8 cases 100 000 year  and for women  13 9 cases 100 000 year  
class4	1542	during these 50 years  the age adjusted incidence of cecal carcinoma for men has increased from 3 6 to 16 7 cases 100 000 year  while for women  it has increased from 4 9 to 14 2 cases 100 000 year  
class4	1542	sigmoid carcinoma for men has increased from 8 8 to 18 7 cases 100 000 year  and for women  it has increased from 7 7 to 12 8 cases 100 000 year  
class4	1542	the incidence of colon cancer at each site has been and continues to be increasing at a constant rate  
class4	1542	age adjusted incidence for all colorectal cancers has increased from 35 2 to 70 2 cases 100 000 year for men and from 32 1 to 49 2 cases 100 000 year for women  
class4	1542	thus  distribution of colorectal cancers by site in connecticut has remained stable for 25 years  
class4	1542	more importantly  however  the age adjusted incidence of colon cancer has continued to increase for 50 years  whereas that of rectal cancer has remained relatively stable  
class4	1543	rapid diagnosis of lung cancer from palpable metastases by needle thrust  
class4	1543	this study encourages the use of percutaneous fnb to diagnose and stage advanced lung cancer in patients with palpable metastases in supraclavicular lymph nodes or soft tissues  
class4	1543	percutaneous fnb of metastases is much easier to learn than transthoracic needle aspiration  the superficial target is anchored and sampled with multiple passes using a short needle grasped directly in the fingers  
class4	1543	it is fast  accurate  economical and nearly free of risk and pain  
class4	1543	the technique saves time and money because it is the only procedure needed by many patients with palpable disease in stage iiib and iv  
class4	1543	bronchoscopy  transthoracic needle aspiration and open surgical biopsy thus can be avoided in most patients with palpable metastases  
class4	1543	prompt diagnosis by fnb of metastases speeds palliation for patients with urgent need  
class4	1543	tumor cell type from fnb correlated with cytologic findings from sputum samples  bronchoscopy specimens and autopsy results  
class4	1544	elevated prostaglandin e2 levels in bronchoalveolar lavage fluid of patients with bronchogenic carcinoma  
class4	1544	understanding local pulmonary immunoregulatory mechanism s  in patients with carcinoma of the lung is an important step towards the development of innovative methods of treatment  
class4	1544	prostaglandin e2 plays an integral role in immunoregulation  
class4	1544	therefore  we evaluated pge2 concentrations in balf from 18 patients with bronchogenic carcinoma  compared to that from six patients with pulmonary diseases other than carcinoma and ten normal smokers of similar age  
class4	1544	the level of pge2 in patients with lung carcinoma  158 1     88 7 pg ml  was significantly  p less than 0 001  higher than the other two groups  16 2     6 9 and 4 4     3 4 pg ml   
class4	1544	levels of pge2 also varied among patients with carcinoma of different cell types  
class4	1544	patients with sqca had significantly  p less than 0 001  higher levels of pge2  242 7     29 4 pg ml  than patients with adca or scca  82 3     27 9 and 66 3     15 2 pg ml  respectively   
class4	1544	furthermore  there was a marked difference in pge2 concentration between carcinomatous lung and clinically noninvolved lung in patients with sqca and adca  
class4	1544	further study is warranted to determine the interactions between pge2 and other cytokines  interleukin 1  il 2  and tumor necrosis factor   as well as the activity of cytolytic lymphocytes  lak cells  in the lungs of patients with bronchogenic carcinoma  
class4	1545	bronchogenic carcinoma in situ on the carina eradicated by endobronchial biopsy  
class4	1545	squamous cell carcinoma in situ of the bronchus is a rare disorder in an isolated clinical setting  
class4	1545	we present a case of carcinoma in situ located on the carina with excisional biopsy via a fiberoptic bronchoscope and no recurrence after five years  
class4	1545	to our knowledge  this represents the only case of carcinoma in situ treated solely with excisional biopsy  
class4	1545	this case further emphasizes the importance of securing biopsy specimens for all mucosal abnormalities and raises the possibility of limited excision as sole therapy for carcinoma in situ  
class4	1546	11 beta hydroxyandrostenedione  a marker of adrenal function in hirsutism  
class4	1546	to assess the role of the adrenal glands in the development of hirsutism  levels of 11 beta hydroxyandrostenedione  11 beta oha   17 alpha hydroxyprogesterone  17 ohp   dehydroepiandrosterone sulphate  dheas   androstenedione  delta 4a   and free and total testosterone  t  were measured in 63 hirsute females and 30 control patients  
class4	1546	six of the hirsute patients had basal levels of 11 beta oha and 17 ohp and responses to adrenocorticotropic hormone that were significantly greater than these values in controls and the other hirsute women  
class4	1546	these women were designated as having an adrenal source for their hirsutism  
class4	1546	women with polycystic ovarian syndrome and idiopathic hirsutism had normal values of 11 beta oha and 17 ohp  
class4	1546	levels of total and free t  dheas and delta 4a were significantly higher than control values in all of the hirsute women  
class4	1546	this study demonstrates that 11 beta oha can be used as a marker to assess the adrenal contribution to hirsutism  
class4	1547	neodymium  yag laser hysteroscopy in large submucous fibroids  
class4	1547	the preoperative use of a potent  subcutaneously injected gonadotropin releasing hormone agonist  gnrh a  was evaluated in a series of 60 women with large submucosal fibroids  
class4	1547	myomectomy by hysteroscopy and nd yag laser was easily performed  
class4	1547	in 12 cases  the largest portion of the myoma was not inside the uterine cavity and myomectomy was carried by a two step hysteroscopy  
class4	1547	in women who wished to become pregnant  a pregnancy rate of 66  was achieved  
class4	1547	advantages of preoperative use of a gnrh a are  1  the significant decrease of the fibroid size   2  a lower fluid absorption  and  3  the restoration of a normal hemoglobin concentration  
class4	1548	enteric neuronal autoantibodies in pseudoobstruction with small cell lung carcinoma  
class4	1548	severe gastrointestinal dysmotility is a newly recognized paraneoplastic syndrome that occurs with small cell lung carcinoma  
class4	1548	thirty four patients with small cell carcinoma  of whom 5 had chronic intestinal pseudoobstruction and 29 had no digestive symptoms  were studied serologically  
class4	1548	four of the 5 patients with gut dysmotility had immunoglobulin g antibodies reactive with neurons of the myenteric and submucosal plexuses of jejunum and stomach in an indirect immunofluorescence assay  
class4	1548	antibodies of this type were not found in any of the 29 patients who had no gut dysmotility  nor were they found in patients with chronic idiopathic intestinal pseudoobstruction  n   8   ovarian cancer  n   20   or epilepsy  n   4  or in normal subjects  n   9   
class4	1548	in 4 of the patients with paraneoplastic pseudoobstruction  antibodies in highly diluted serum  1 4000 1 8000  bound selectively to nuclei and cytoplasm of neuronal elements in the gut  
class4	1548	this novel autoantibody activity suggests that intestinal pseudoobstruction occurring in patients with small cell carcinoma may have an autoimmune basis  
class4	1548	from a clinical standpoint  serological testing offers a simple means for determining which patients with gut dysmotility syndromes may have associated small cell carcinoma  thereby enabling earlier diagnosis and treatment of the tumor  
class4	1549	clinical application of ras gene mutation for diagnosis of pancreatic adenocarcinoma  
class4	1549	most pancreatic adenocarcinomas are known to have ras gene  oncogene  mutations  
class4	1549	the site of the mutations is localized in codon 12 of k ras gene  
class4	1549	such high incidence and localization of the ras gene mutations have not been observed in any other human malignancies  
class4	1549	polymerase chain reaction and direct sequencing method enabled us to analyze dna sequence around codon 12 of k ras gene in small quantities of specimens obtained from needle biopsies and aspirate samples for pathological diagnosis  
class4	1549	all the materials obtained from 12 patients with pancreatic adenocarcinoma showed the mutations  whereas those obtained from 6 patients with chronic pancreatitis showed no mutations  
class4	1549	in several cases using the mutations of k ras gene as a marker  this analysis supplemented conventional pathology and cytology in making the diagnosis of pancreatic adenocarcinoma  
class4	1549	the analysis of ras gene mutations was useful for the clinical diagnosis of pancreatic adenocarcinoma  
class4	1550	expression of class ii molecules on intestinal epithelial cells in humans  differences between normal and inflammatory bowel disease  
class4	1550	expression of class ii antigens on human intestinal epithelial cells was assessed using a sensitive avidinbiotin peroxidase technique  
class4	1550	hla dr was present predominantly in the normal small bowel with diminished but evident expression in the colon  
class4	1550	hla dp staining was less prominent  and hla dq was absent  
class4	1550	in inflammatory bowel disease the expression of both hla dr and hla dp was increased  but that for hla dq remained absent  suggesting an inherent defect in the ability of intestinal epithelial cells to express hla dq  
class4	1550	in related experiments  an interferon gamma treated malignant epithelial cell line t84 also failed to stain for hla dq and hla dp despite the presence of hla dr  
class4	1550	isolated rnas for all three subclasses of hla d were detectable by slot blot analysis  suggesting that the lack of hla dq expression relates to posttranscriptional defects in intestinal epithelium  
class4	1550	these and other differences with conventional class ii antigen positive accessory cells  macrophages b cells  may help to explain the unique properties of intestinal epithelial cells as antigen presenting cells  
class4	1551	screening colonoscopy in asymptomatic average risk persons with negative fecal occult blood tests  
class4	1551	colonoscopy was performed on 210 asymptomatic average risk persons  aged 50 75 years  who had negative fecal occult blood test results  
class4	1551	colonoscopy was complete to the cecum in 209 subjects  
class4	1551	fifty three subjects  25   had adenomas and two had cancer  
class4	1551	all of the adenomas greater than or equal to 1 cm in size and both cancers occurred in subjects aged greater than or equal to 60 years  
class4	1551	fifty one percent of subjects with adenomas and one with cancer had no neoplasms distal to the sigmoid descending colon junction  
class4	1551	one subject had a major postpolypectomy hemorrhage that stopped spontaneously  
class4	1551	screening colonoscopy  therefore  has a high yield for detection of neoplasms in asymptomatic average risk persons aged greater than or equal to 60 years with negative fecal occult blood test results  
class4	1551	the yield is low in persons aged 50 54 years and intermediate in persons aged 55 59 years  
class4	1552	modified van nes rotationplasty for osteosarcoma of the proximal tibia in children 
class4	1552	above knee amputation has been the traditional treatment for osteosarcoma of the proximal tibia  
class4	1552	recent advances in chemotherapy have encouraged the development of limb salvage techniques  
class4	1552	van nes rotationplasty for malignant lesions of the distal femur has increased in popularity as a reconstructive technique  but no similar procedure has been described for lesions of the proximal tibia  
class4	1552	we have developed a modified rotationplasty for this lesion and have performed it in four children  
class4	1552	the surgical technique  postoperative management and results of the procedure are described  
class4	1552	two patients had delayed wound healing  
class4	1552	no other complications have developed and our patients were disease free at follow up  while the appearance of the leg was well accepted by the patients and their parents  
class4	1552	this procedure is a useful addition to the armamentarium of the tumour surgeon for the treatment of malignant lesions of the proximal tibia  
class4	1553	parosteal osteosarcoma  treatment by wide resection and prosthetic replacement  
class4	1553	we have reviewed 20 cases of parosteal osteosarcoma treated by wide local resection and prosthetic replacement and followed up for six to 17 years  
class4	1553	limb function was excellent in 85   
class4	1553	one patient with grade iii histological disease developed pulmonary metastases  
class4	1553	four patients had local recurrences  which were related to repeated preliminary biopsies  inappropriate siting of biopsy and vascular encroachment by the tumour  
class4	1553	after this mode of treatment  the outcome was not related to medullary invasion by the tumour  
class4	1554	marjolin s ulcer  a review and reevaluation of a difficult problem  
class4	1554	the formation of an epidermoid carcinoma in nonhealing scar tissue  a marjolin s ulcer  is a well described neoplasm  
class4	1554	these lesions are  however  frequently overlooked and often inadequately treated  
class4	1554	this paper reviews six cases of scar tissue carcinoma  
class4	1554	all lesions were secondary to various kinds of burns  
class4	1554	four of the marjolin s ulcers were well differentiated squamous cell carcinomas  
class4	1554	one was a moderately differentiated squamous cell carcinoma  and one was a malignant melanoma  
class4	1554	the average age at presentation was 59 years  and the mean interval from time of burn injury to appearance of neoplasm was 36 8 years  
class4	1554	the lesions varied in anatomic location and involved the upper extremities  lower extremities  and scalp  
class4	1554	in addition to the case studies  this paper reviews the literature and provides a logical treatment plan for a patient with a marjolin s ulcer  
class4	1554	because these lesions can be very aggressive  a well thought out treatment plan is necessary to optimize care and assure patient survival  
class4	1555	embryologic fusion planes and the spread of cutaneous carcinoma  a review and reassessment  
class4	1555	it has long been held that embryologic fusion planes influence the spread of skin cancer  
class4	1555	embryologic fusion planes have been implicated in the depth of invasion  horizontal spread  and recurrence of cutaneous carcinoma  
class4	1555	however  these structures have never been studied in detail  
class4	1555	a review of the surgical literature reveals considerable confusion regarding the exact nature  location  and tumor interactions of these fusion planes  
class4	1555	we review the gross and microscopic development of sites of embryologic fusion  
class4	1555	we examine histologic sections through fusion sites in normally developed adult and fetal fresh cadaver specimens  
class4	1555	our studies  supported by our review of developmental anatomy  indicate that fusion planes do not persist as identifiable anatomic structures that would influence tumor spread  
class4	1556	effect of the topical anesthetic emla on the efficacy of pulsed dye laser treatment of port wine stains  
class4	1556	emla cream  eutectic mixture of local anesthetics  is a new topical anesthetic composed of 25 mg lidocaine and 25 mg prilocaine in an oil in water emulsion cream  
class4	1556	it has been found to be very effective for local anesthesia prior to venepuncture  minor surgical procedures  and pulsed dye laser  pdl  therapy for port wine stains  pws  in children  
class4	1556	however  since emla may cause vasoconstriction of cutaneous vessels  we tried to determine whether pretreatment with emla decreases the efficacy of subsequent pdl treatment  
class4	1556	we report eight patients between the ages of 4 and 32 years with pws who received two test site treatments prior to pdl treatment  
class4	1556	one site was pretreated with emla cream under occlusion for 60 minutes and then left unoccluded for 15 minutes prior to pdl test treatment  
class4	1556	the other site  in the same area of the pws and patient s body  was not pretreated with emla  
class4	1556	the test sites were compared 6 8 weeks later to determine whether emla decreased the degree of lightening of the pws compared to the non emla treated site  
class4	1556	we conclude that emla is an effective topical anesthetic for pdl treatment of pws and does not adversely affect the efficacy of the treatment  
class4	1557	use of mohs micrographic surgery to establish quantitative proof of heightened tumor spread in basal cell carcinoma recurrent following radiotherapy  
class4	1557	we compared 27 basal cell carcinomas  bccs  recurrent following radiotherapy and subsequently excised by mohs micrographic surgery to a control group of bccs recurrent following other treatment modalities and similarly excised  
class4	1557	mohs technique permitted precise  quantitative tumor assessment  obtained via a novel method utilizing three parameters  the number of surgical stages required for complete excision  the percentage increase between clinical preoperative tumor area and final postoperative defect area  and the presence of deep subcutaneous tissue invasion  
class4	1557	figures for the postradiation group were larger in all three categories  with the latter two revealing statistically significant differences versus the nonradiation group  
class4	1557	this study gives strong  direct quantitative support to the clinical impression that bcc recurrent following radiotherapy is a uniquely aggressive  invasive subset of recurrent bcc  
class4	1558	congenital midline nasal masses  diagnosis and management  
class4	1558	congenital midline nasal masses  cmnms  are rare lesions most commonly caused by dermoids  hemangiomas  nasal gliomas or encephaloceles  
class4	1558	we report a case of nasal glioma and discuss the embryologic development  evaluation  and management of such cmnms  
class4	1559	complete spontaneous regression of multiple basal cell carcinomas in the basal cell nevus syndrome  the possible role of transepithelial elimination  
class4	1559	a 36 year old latin american man with the basal cell nevus syndrome had multiple  soft  hairless  depressed scars of the face  scalp  neck  and back  ranging in size from 0 3 x 0 5 cm to 3 5 x 3 9 cm  
class4	1559	these areas had never been treated and previously were sites of basal cell carcinomas that underwent complete spontaneous regression 4 5 years from the date of onset  
class4	1559	pathology of these spontaneously regressed sites was consistent with the criteria established by curson and weedon  1979   
class4	1559	type iii transepithelial elimination was demonstrated for a basal cell carcinoma  
class4	1559	type iii transepithelial elimination may play a role in the spontaneous regression of basal cell carcinomas  
class4	1560	new primary basal cell carcinomas arising in skin flaps following mohs micrographic surgery for primary and recurrent basal cell carcinoma  
class4	1560	two patients developed new primary basal cell carcinomas  bccs  in skin flaps used to reconstruct wounds that followed an earlier primary bcc and a recurrent bcc treated by mohs micrographic surgery  
class4	1560	criteria for distinguishing a new primary bcc arising in a skin flap or full thickness skin graft at a previous treatment site for bcc from a truly recurrent bcc are presented  
class4	1560	the distinction between a new primary bcc and true tumor recurrence is important for accurate clinical assessment and may have a dramatic impact on the type of subsequent treatment  
class4	1560	in addition  there may be less medicolegal liability in the case of a new primary bcc arising at the site of a previously treated bcc than for a bcc that is determined to be recurrent  
class4	1561	oral diseases in older adults  clinical conference  
class4	1561	in the case presented  a 65 year old man with multiple dental  medical  and social problems benefited from interdisciplinary assessment and treatment  
class4	1561	despite his poor oral health status and oral health behaviors upon admission  patient education and dental therapy resulted in improved daily oral hygiene  elimination of oral diseases  and improved oral function  
class4	1561	the overall quality of life of any individual  particularly an older one  can be enhanced through oral disease prevention  health promotion  and  when indicated  dental therapy  
class4	1561	this patient was treated in a hospital environment with a well established team approach to geriatric care  
class4	1561	however  regardless of the care setting  the physician can play a key role in improving the oral health status and quality of life of older adults by including an oral screening examination as part of the periodic comprehensive geriatric assessment  recognizing oral pathology  requesting dental consultations and encouraging appropriate dental service utilization  
class4	1562	the gastrin hypothesis  implications for antisecretory drug selection  
class4	1562	newer potent and long acting inhibitors of acid secretion  such as the proton pump inhibitor omeprazole  are becoming available for general use  
class4	1562	these drugs promise to control acid peptic disease effectively in patients who do not respond adequately to conventional short acting h2 receptor antagonists  
class4	1562	the safety of chronic administration of these drugs has come into question  however  
class4	1562	lifelong profound inhibition of acid secretion in rats induced by superpotent inhibitors of acid secretion or subtotal fundectomy is associated with the development of carcinoid tumors of enterochromaffin like  ecl  cells in the gastric corpus  
class4	1562	available evidence supports a role of gastrin  which becomes chronically elevated in animals subjected to prolonged and profound hypochlorhydria  
class4	1562	in humans  hypergastrinemic states such as zollinger ellison syndrome and atrophic gastritis are associated with an increased risk of ecl cell carcinoid tumors  
class4	1562	such observations have raised concern that humans may also be susceptible to carcinoid tumor formation in response to potent inhibitors of acid secretion  
class4	1562	to date  however  no cases of carcinoid tumor have been attributed to the use of omeprazole in humans  
class4	1562	if achlorhydric doses are not used  significant hypergastrinemia can be avoided while effectiveness of treatment is maintained  
class4	1562	such measures should minimize any risk of ecl cell carcinoid tumors in humans taking potent long term antisecretory drugs  
class4	1563	epitope mapping of human thyroglobulin  heterogeneous recognition by thyroid pathologic sera  
class4	1563	thyroglobulin is the major ag of the thyroid gland involved in autoimmune pathologies  
class4	1563	epitope mapping was carried out with a rabbit polyclonal immune serum against fusion proteins expressed in prokaryotic cells  
class4	1563	after screening of an initial human thyroglobulin cdna library and subcloning of immunoreactive clones  seven epitopes were characterized and localized on the human thyroglobulin monomeric molecule  
class4	1563	one was close to each extremity of the molecule  and five others were concentrated in the middle  covering a sixth of this 2748 amino acid chain  
class4	1563	the immunoreactivities of 18 autoimmune sera from different thyroid pathologies were tested against the seven previously characterized epitopes  
class4	1563	those from hashimoto s thyroiditis were the most immunoreactive  
class4	1563	immune responses were heterogeneous for sera from different pathologies as well as for those from the same pathology  
class4	1563	the central epitopes and the near c terminal epitope  however  were the epitopes most often recognized by the immune sera  
class4	1563	these findings show that some autoepitopes overlap accurately with some heteroepitopes characterized by a polyclonal immune serum directed against the mature protein  
class4	1564	growth factor dependent differentiation along the myeloid and lymphoid lineages in an immature acute t lymphocytic leukemia  
class4	1564	bone marrow cells from a child with an immature  cd2   cd5   cd7   acute t lymphocytic leukemia  t all  were cultured in the presence and absence of human ril 2  il 3  or granulocyte macrophage  gm  csf  
class4	1564	cells cultured without growth factors failed to divide and those initiated in the presence of il 2 or gm csf underwent maturation and terminal t lymphoid or myelomonocytic differentiation  respectively  
class4	1564	in contrast  a permanent growth factor dependent cell line  designated tall 103 3  was established upon culture in il 3  
class4	1564	the tall 103 3 cells gradually lost the t cell specific markers and acquired a myeloid phenotype  cd15   cd33    
class4	1564	switching of the il 3 dependent cells at an early passage to medium containing only human ril 2 resulted in the establishment of a subline  named tall 103 2  with a t lymphoid phenotype  cd3   cd8   tcr gamma delta    cd7    
class4	1564	the tall 103 2 cells strictly require il 2 for growth  are irreversibly committed to the lymphoid lineage  and cannot survive in the presence of any other hemopoietic growth factor tested so far  
class4	1564	in contrast  the il 3 dependent tall 103 3 cells could be adapted to grow in synthetic  serum free  medium also in the presence of either gm csf or il 5  in which they retain a myeloid phenotype  
class4	1564	interestingly  after 18 mo in culture in il 3  the tall 103 3 cells can still be phenotypically converted to the lymphoid lineage upon addition of il 2  thus maintaining its bipotentiality  
class4	1564	despite the marked phenotypic differences  the tall 103 2 and tall 103 3 cell lines show the same karyotypes with multiple abnormalities present in the primary malignant clone and have identical rearrangements of the tcr gamma and  delta loci  thus confirming their derivation from a common precursor cell  
class4	1564	together  these findings indicate that the phenotype of immature t all cells can be drastically modified by the presence of specific hemopoietic growth factors in the environment  leading to either lymphoid or myeloid lineage commitment while leaving their karyotype and genotype intact  
class4	1565	antigen induced cross linking of the ige receptor leads to an association with the detergent insoluble membrane skeleton of rat basophilic leukemia  rbl 2h3  cells  
class4	1565	cross linking of the ige receptor on the surface of rat basophilic leukemia cells by multivalent ag  dnp bsa  causes a rapid conversion to a detergent insoluble form  
class4	1565	there is a concurrent increase in the amount of filamentous actin associated with the plasma membrane  
class4	1565	both the degree of receptor detergent insolubility and the rise in f actin content are rapid with a half maximal response of less than 1 min and can be rapidly reversed by the addition of monovalent ag  dnp lysine   
class4	1565	these two early steps in the triggering of rat basophilic leukemia cells can be dissociated from each other by pretreatment of the cells with either cytochalasin or sodium azide  
class4	1565	these reagents block the increase in f actin but have no effect on receptor detergent insolubility  
class4	1565	this indicates that microfilaments are not responsible for detergent insolubility of the receptor and that it may be the membrane skeleton that is interacting with the complex  
class4	1565	this was further confirmed by the finding that cross linking of the ige receptors on the surface of purified plasma membranes also leads to detergent insolubility of the receptor  
class4	1565	therefore  all of the components necessary for detergent insolubility of the receptor are present in the plasma membrane  and cytoplasmic components are not needed  
class4	1565	these results suggest that detergent insolubility and immobility of the cross linked receptors are caused by multivalent interaction with the membrane skeleton  
class4	1565	actin filaments may then interact with these receptor membrane skeletal complexes in order to produce large scale clustering and capping  
class4	1565	the membrane skeleton may therefore be acting as an intermediate structure between the cell surface receptors and microfilaments  
class4	1566	mapping the site of interaction between murine ige and its high affinity receptor with chimeric ig  
class4	1566	we have investigated the interaction of mouse  m  ige with its fc epsilon ri on rat basophilic leukemia cells using a set of chimeric ig that were constructed by exchanging homologous h chain c domains between human  hu  igg1 and mige  
class4	1566	binding affinities were examined with equilibrium and kinetic measurements  and we found that epsilon c gamma 3  mige with c epsilon 4 replaced by c gamma 3  was indistinguishable from mige  
class4	1566	the huigg1 and the other chimeric ig  which did not contain both c epsilon 2 and c epsilon 3  did not bind detectably to rat basophilic leukemia cells  ka less than 10 6  m 1   
class4	1566	the ability of these chimeric ig to stimulate a cellular response  degranulation  in the presence of multivalent ag was also tested  
class4	1566	the epsilon c gamma 3 was indistinguishable from mige in eliciting a high level of degranulation  whereas the other chimeric ig stimulated no response even when they were preaggregated to enhance their binding avidity  
class4	1566	these results demonstrate that c epsilon 4 may be replaced by c gamma 3 without affecting the binding and cell activating properties of mige  
class4	1566	the lack of binding by the other chimeric ig indicates that both c epsilon 2 and c epsilon 3 are necessary for the binding interaction  
class4	1567	ige receptor mediated phosphatidylinositol hydrolysis and exocytosis from rat basophilic leukemia cells are independent of extracellular ca2  in a hypotonic buffer containing a high concentration of k   
class4	1567	in isotonic buffer  ige receptor mediated exocytosis from rat basophilic leukemia cells is dependent on extracellular ca2   with half maximal degranulation requiring 0 4 mm ca2   
class4	1567	no significant exocytosis occurs in the absence of extracellular ca2   
class4	1567	this absolute requirement for ca2  is eliminated by suspending the cells in a hypotonic buffer containing 60 to 80 mm k   na  cannot substitute for k   
class4	1567	optimal ca2    independent exocytosis occurs in a buffer containing 20 mm dipotassium pipes  ph 7 1  40 mm kcl  5 mm glucose  7 mm mg acetate  0 1  bsa  and 1 mm egta  
class4	1567	the cells maintain this ca2    independent exocytosis even if they are preincubated with 1 mm egta for 40 min at 37 degrees c before triggering  
class4	1567	exocytosis is eliminated as isotonicity is approached by adding sucrose  nacl  kcl  or potassium glutamate to the buffer  
class4	1567	quin 2 fluorescence measurements reveal only a very small rise in  ca2  i when the cells are triggered in hypotonic buffer in the absence of extracellular ca2  and the presence of 1 mm egta  
class4	1567	in isotonic buffer  degranulation does not occur under conditions that lead to such a small rise in  ca2  i  
class4	1567	sustained ige receptor mediated phosphatidylinositol hydrolysis  which is also ca2  dependent in isotonic buffer  becomes independent of ca2  in the hypotonic buffer  
class4	1567	in fact  the rate of phosphatidylinositol hydrolysis in hypotonic buffer in the absence of ca2   and presence of 1 mm egta  is twice that observed in isotonic buffer in the presence of 1 mm ca2   
class4	1567	these data show that in hypotonic buffer  the requirement of ige receptor mediated pi hydrolysis for extracellular ca2  is eliminated  and degranulation proceeds with a  ca2  i of 0 1 microm  the baseline level of  ca2  i found in resting cells  
class4	1567	these results are consistent with the hypothesis that  in isotonic buffer  the ca2  requirement for mast cell degranulation is for the generation of second messengers via hydrolysis of membrane phosphatidylinositols  
class4	1568	primary intratemporal tumours of the facial nerve  diagnosis and treatment  
class4	1568	benign primary tumours of the facial nerve are uncommon  
class4	1568	a slowly progressive facial palsy should be considered the result of a nerve tumour until proven otherwise  
class4	1568	improvements in diagnostic imaging techniques of the temporal bone have increased the possibility of a correct pre operative diagnosis but facial nerve tumours remain a frequently ignored or misdiagnosed entity as a consequence of their subtle and protean clinical manifestations  
class4	1568	a series of 12 cases of primary facial nerve tumours is presented  
class4	1568	the clinical features  diagnostic modalities and treatment are discussed in relation to a review of the literature  
class4	1569	technetium 99m v  dimercaptosuccinic acid planar scintigraphy in head and neck cancer  clinical  scintigraphic and radiological study  
class4	1569	technetium 99m  tc99m  v  dimercaptosuccinic acid  dmsa  is an imaging agent which has been proposed as a scintigraphic marker for head and neck squamous cell carcinoma  
class4	1569	fifty four patients were studied of whom 51 had a head and neck tumour  
class4	1569	all patients were examined and then imaged using tc99m v  dmsa scintigraphy and computerized tomography  
class4	1569	scintigraphy was less sensitive than clinical examination in the detection of patients with cancer  patients with primary tumours and patients with metastatic neck disease  
class4	1569	ct was as sensitive and as accurate as clinical examination but more sensitive than tc99m v  dmsa in detecting patients with cancer and with primary tumours  
class4	1569	ct was more sensitive and more accurate than both clinical examination and tc99m v  dmsa scintigraphy in predicting which patients had metastatic neck disease  
class4	1569	although tc99m v  dmsa is accumulated by squamous cell carcinoma  its inability to detect low volume disease and apparent low specificity means it has no role to play in the management of patients with head and neck squamous cell carcinoma  
class4	1570	monomorphic adenomas of the major salivary glands  clinicopathological study of 44 cases  
class4	1570	we report 44 cases of monomorphic adenoma  ma  of the major salivary glands observed during the years 1979 1989  
class4	1570	all of these tumours were reviewed and classified on the basis of the world health organisation  who  criteria  
class4	1570	histological type  site  sex and age were considered  
class4	1570	34 cases of adenolymphoma were observed  all of them located in the parotid glands  10 ma without lymphoid stroma were located in both parotid and submandibular glands  
class4	1570	distinctive histological and clinico pathological features of the latter group of tumours are discussed  as well as the diagnostic criteria in distinguishing these tumours from pleomorphic adenoma and adenoid cystic carcinoma  
class4	1571	tumefactive fibroinflammatory lesions of the head and neck  
class4	1571	the term  tumefactive fibroinflammatory lesion  has been used to describe a fibrosclerosing disorder which has a locally destructive nature but is characterized by a benign histological appearance  
class4	1571	we report five patients  over a five year period  with such a lesion  
class4	1571	the clinical behaviour and surgical findings suggest the lesion to be an invasive malignancy  
class4	1571	however  the histological appearance of an admixture of chronic inflammatory cells and fibrosis is consistent with a benign condition  
class4	1571	we recommend surgical excision of the lesion as the mainstay of treatment  other studies report the use of steroids and radiotherapy  
class4	1572	osteoma of the middle ear  
class4	1572	osteomas involving the middle ear and causing a functional disturbance are rare  
class4	1572	we report a case of a patient with an osteoma arising from the lateral semicircular canal  
class4	1572	the main symptom was vertigo and to halt this the defect of the canal was obliterated with a bone chip and fibrin glue after removal of the tumour  
class4	1573	auro nasopharyngeal polyp and cholesteatoma  
class4	1573	we report the association of an auronasopharyngeal polyp arising in a congenitally abnormal middle ear and eustachian tube  
class4	1573	subsequently  ten years after removal of the polyp and insertion of a ventilation tube  there was recurrence of the polyp in association with cholesteatoma of the middle ear  
class4	1574	giant enterocystoma within an infant s tongue  
class4	1574	a rare developmental cyst within the tongue and submandibular triangle of a male infant containing heterotopic gastric and intestinal epithelium  enterocystoma  is described and its derivation discussed  
class4	1574	this cyst was of such a size as to cause feeding difficulties and partial airway obstruction during sleep  
class4	1574	following c t  
class4	1574	scanning  total obstruction necessitated an emergency tracheostomy  
class4	1574	successful enucleation via a median labiomandibulotomy was performed without further complication and two years later there is no sign of recurrence  
class4	1575	direct extension of laryngeal carcinoma to the skin of the neck  
class4	1575	invasion of the skin of the neck by laryngeal carcinoma is relatively uncommon  
class4	1575	twelve cases of cancer of the larynx fungating through the cervical skin are presented  
class4	1575	they mostly followed initial treatment by deep x ray therapy or partial laryngectomy  
class4	1575	a high tracheostomy was also considered to be a contributing cause for the occurrence of such a mishap  
class4	1575	the management and follow up of these patients is described  
class4	1576	late development of a squamous carcinoma in a reconstructed pharynx  
class4	1576	we report a case in which a squamous cell carcinoma was found to have arisen from a delto pectoral skin flap used in pharyngeal reconstruction  
class4	1576	the flap had been forming a neo pharynx for 24 years  
class4	1576	no other signs of recurrent disease had developed in this period  
class4	1576	this raises the possibility of tumour induction in heterotopic skin used for oropharyngeal reconstruction  
class4	1577	haemangiosarcoma of the maxillary antrum  
class4	1577	angiosarcomas are extremely rare in the head and neck and the histological diagnosis is often difficult  
class4	1577	we present a case of a haemangiosarcoma of the maxillary antrum in a 33 year old male  
class4	1577	the histological diagnosis and subsequent management are discussed  
class4	1578	enhanced hepatic drug clearance in patients with cystic fibrosis  
class4	1578	to examine whether hepatic drug metabolism is altered in patients with cystic fibrosis  cf   we evaluated the pharmacokinetics of three model pharmacologic substrates  antipyrine  a marker of hepatic oxidative metabolism  lorazepam  a marker of hepatic glucuronosyltransferase activity  and indocyanine green  icg   a marker of hepatic blood flow and biliary secretion  in 14 patients with cf  14 6 to 29 2 years of age  and in 12 children and adolescents with cancer  7 2 to 19 4 years of age   which was treated with only surgery and radiation  
class4	1578	each study subject received a single intravenous dose of the combined model substrates  0 03 mg kg lorazepam  10 mg kg antipyrine  and 0 5 mg kg icg  for 5 minutes  followed by repeated blood sampling  n   10  during a 24 hour postinfusion period  
class4	1578	patients with cf had a significantly greater plasma clearance of lorazepam  56 5     5 2 vs 25 9     1 9 ml min m2  and icg  892 5     176 4 vs 256 5     41 7 ml min m2  but not of antipyrine  27 2     3 8 vs 20 7     2 0 ml min m2  in comparison with control subjects  
class4	1578	the apparent steady state volume of distribution for lorazepam  icg  and antipyrine was significantly higher in the patients with cf  2 0   3 1   and 1 4 fold  respectively  than in control subjects  
class4	1578	clearance of the model substrates did not correlate with standard biochemical markers of hepatic function  
class4	1578	similarly  no significant relationships were observed between the clearance or steady state volume of distribution of the compounds and the national institutes of health prognostic scores for the patients with cf  
class4	1578	these data demonstrate that the plasma clearance of lorazepam and icg is increased in patients with cf and suggest that hepatic glucuronosyltransferase activity and biliary secretory capacity are enhanced in this disease  
class4	1579	vaginal removal of the pedunculated submucous myoma  historical observations and development of a new procedure  
class4	1579	a new method of vaginal removal of submucous fibroids was attempted on 151 patients  
class4	1579	the procedure involves dilation of the cervix with laminaria tents and removal of the submucous fibroid by grasping with appropriate instruments  
class4	1579	myomas were removed successfully in 92  of the patients  hysterectomy and abdominal myomectomy were avoided in all but four of them  
class4	1579	perforation occurred in two patients  
class4	1579	morbidity was minimal  
class4	1579	the four patients who desired pregnancy conceived  
class4	1580	laser therapy for vaginal intraepithelial neoplasia after hysterectomy  
class4	1580	in recent years there has been a marked increase in the number of reported cases of vaginal intraepithelial neoplasia  vain  after hysterectomy  
class4	1580	until about 10 years ago radiation or surgery had been the therapeutic modality mostly used for this disease  
class4	1580	more recently  topical drugs  such as bleomycin and 5 fluorouracil cream  have been used  but they are often ineffective and poorly tolerated  
class4	1580	for the last 14 years we have used the co2 laser for the treatment of vain and have treated a total of 143 patients  
class4	1580	our use of a combination of wire sutures through the vaginal mucosa and the introduction of fluids into the underlying submucosal areas allows retraction and ballooning of the recesses and scars and permits us to place the vaginal mucosa at right angles to the laser beam to allow complete treatment  
class4	1581	the cytobrush for evaluating routine cervicovaginal endocervical smears  
class4	1581	while the conventional wooden spatula cotton tipped applicator has remained the method of obtaining papanicolaou smears for most clinicians at the university of california at los angeles  the student health service  shs  adopted the zelsmyr cytobrush as its sole method of obtaining cervical samples in late 1986  
class4	1581	a study was done to define changes in both the adequacy of sampling and the detection rate for both squamous and glandular epithelial abnormalities with the cytobrush  
class4	1581	to accomplish this goal  1 000 cytobrush and 244 conventionally obtained smears were analyzed prospectively  and 3 864 shs samples obtained in 1986 prior to the change in method were reviewed retrospectively  
class4	1581	as compared to cervical samples obtained by conventional methods  the cytobrush smears contained significantly more endocervical cells and had fewer drying artifacts  
class4	1581	both methods obtained equivalent squamous samples and had similar final class distributions  
class4	1581	no case of endocervical adenocarcinoma carcinoma in situ or invasive adenocarcinoma was detected  
class4	1581	shs patients who had initial  no endocervical cells  samples but whose repeat sample did contain endocervical cells retained the same class in more than 75  of cases  
class4	1581	this study confirmed that the cytobrush technique produces papanicolaou smears with improved sampling of the squamocolumnar junction but questioned whether that results in an increased detection rate for cervical pathology  
class4	1582	carcinosarcoma and spindle cell carcinoma of the lung  clinicopathologic and immunohistochemical studies  
class4	1582	we examined pulmonary carcinomas with prominent sarcoma like lesions both clinicopathologically and immunohistochemically  
class4	1582	grossly  two tumors had predominantly endobronchial growths  four bulky parenchymal growths  and two endobronchial  parenchymally mixed growths  
class4	1582	in these eight patients  six tumors were completely resected  one patient was given irradiation only  and one patient died in the early postoperative period  
class4	1582	on the basis of specific differentiation of the sarcoma like lesions  the tumors were separated into three groups  two with  true  sarcoma differentiated into soft tissues such as striated muscle or osteoid tissue  three with a fibromatous sarcoma resembling atypical pseudosarcomatous stroma  and three with spindle cell carcinoma with evidence of epithelial differentiation  
class4	1582	the prognosis was poor  and tumors with specific differentiation into rhabdomyosarcoma  chondrosarcoma  or spindle cell carcinoma progressed more rapidly than did those with a fibromatous sarcoma  
class4	1582	because the fibromatous sarcoma like lesions were found to relate to a longer survival time for the patients  we wish to emphasize that a distinction of sarcomatous components should be made with regard to assessing the prognosis of pulmonary carcinoma with sarcoma like lesions  
class4	1583	utility of frozen section evaluation of lymph nodes in the staging of bronchogenic carcinoma at mediastinoscopy and thoracotomy  
class4	1583	we conducted a retrospective analysis of the utility of frozen section diagnoses in determining lymph node status at mediastinoscopy in 122 consecutive patients with bronchogenic carcinoma  
class4	1583	thirty five of 122 patients had one or more lymph nodes with frozen section evaluation positive for metastatic carcinoma  
class4	1583	subsequent nodal sections not in the original frozen section study revealed metastatic carcinoma in two additional patients  
class4	1583	the false negative rate was 1 6   
class4	1583	sensitivity was 94 6   
class4	1583	predictive value of negative frozen section evaluation results was 97 7   
class4	1583	because there were no false positive frozen section results  specificity and predictive value for positive results of frozen section evaluation were 100   
class4	1583	the statuses of individual lymph nodes from these 122 patients were also evaluated  
class4	1583	six hundred twenty lymph nodes were sampled from the mediastinum at mediastinoscopy  
class4	1583	frozen sections in 47 lymph nodes were positive  
class4	1583	subsequent nodal sections not in the original frozen sections examination revealed metastatic carcinoma in four additional lymph nodes  
class4	1583	the false negative rate was 0 6   
class4	1583	sensitivity was 92 2   
class4	1583	predictive value of negative results from frozen section evaluation was 99 3   
class4	1583	because there were no false positive frozen section results  specificity and predictive value for positive results of frozen section examination were 100   
class4	1583	we conclude that frozen section evaluation of lymph nodes at mediastinoscopy reliably indicates lymph node status  thus enabling the physician to decide whether to proceed to thoracotomy  
class4	1583	thus staging of the carcinoma and definitive surgery can be accomplished during a single anesthetic procedure  
class4	1583	combining mediastinoscopy and thoracotomy with frozen section diagnostic control also reduces both the length and cost of hospitalization  
class4	1584	diagnostic significance of carcinoembryonic antigen in the differential diagnosis of malignant mesothelioma  
class4	1584	the histologic and cytologic distinction of malignant mesothelioma from carcinomas metastatic to the pleura or peritoneum is often problematic  
class4	1584	for this reason immunologic methods are being increasingly used as diagnostic adjuncts  
class4	1584	this review summarizes 40 studies on the expression of carcinoembryonic antigen in mesotheliomas and in lung and other carcinomas involving the pleura or peritoneum  
class4	1584	carcinoembryonic antigen was identified immunohistochemically in 11  of mesotheliomas and in 84  of carcinomas examined and immunocytochemically  in serous effusions  in 4  and 58   respectively  
class4	1584	in serum and in pleural or ascitic fluid  significantly elevated levels of carcinoembryonic antigen are commonly associated with  lung  carcinomas but rarely with mesotheliomas  
class4	1584	thus  together with identification of the antigen in serum  pleural fluid  or ascitic fluid  immunohistochemical and immunocytochemical techniques for detecting carcinoembryonic antigen provide a valuable aid for distinguishing malignant mesothelioma from metastatic carcinomas  
class4	1585	primary osteosarcoma of the lung  report of two cases and review of the literature  
class4	1585	two cases of primary osteosarcoma of the lung are presented  
class4	1585	in one case  the radiologic  clinical  and cytologic findings led to a preoperative diagnosis of undifferentiated carcinoma of the lung  
class4	1585	in the second case  a lung nodule was discovered during postchemotherapy follow up in a patient with lymphoma  
class4	1585	fine needle aspiration in the second case showed lymphoma  and further chemotherapy was instituted  however  persistent growth of the nodule prompted a resection  
class4	1585	microscopic examination of the resected tumors in both cases revealed histologic features of high grade osteosarcoma  
class4	1585	flow cytometric analyses of the primary tumors showed abnormal hyperdiploid deoxyribonucleic acid populations in accordance with those seen in high grade malignant neoplasms  
class4	1585	immunohistochemical studies supported a mesenchymal origin for these tumors  
class4	1585	these tumors shared clinical features with other reported cases of primary osteosarcoma of the lung such as large size at diagnosis  occurrence in older individuals  and aggressive behavior  
class4	1586	common nonvenereal genital lesions  
class4	1586	there are a wide variety of local and systemic skin diseases that produce lesions in the genitoanal region  
class4	1586	these lesions may resemble those produced by sexually transmitted microorganisms  
class4	1586	the purpose of this article is to make physicians aware of the common skin diseases that produce lesions on the genitalia to avoid the inappropriate diagnosis of a sexually transmitted disease  
class4	1587	human recombinant gm csf in allogeneic bone marrow transplantation for leukaemia  double blind  placebo controlled trial  
class4	1587	in a randomised  double blind trial 20 patients with leukaemia received human recombinant granulocyte macrophage colony stimulating factor  gm csf  and 20 received placebo  for 14 days after allogeneic  matched sibling  bone marrow transplantation  
class4	1587	the neutrophil count recovered to 0 5 x 10 9  l 3 days earlier in the gm csf group than in the placebo group  not significant   and the median neutrophil count at 14 days was significantly higher in the gm csf group  1 90 vs 0 46 x 10 9  l   
class4	1587	the lymphocyte count was significantly higher in the gm csf than in the placebo group between days 10 and 15 after transplantation  but this difference was not associated with a higher incidence of graft versus host disease  
class4	1587	there was no evidence that gm csf was associated with a greater incidence of leukaemic relapse  
class4	1587	the gm csf group had lower haemoglobin concentrations and platelet counts and higher plasma urea  creatinine  and bilirubin than the placebo group  
class4	1587	the duration of hospital stay was the same for both patient groups  
class4	1587	further studies are now indicated to assess the overall effect of gm csf on outcome after allogeneic bone marrow transplantation  
class4	1588	paraneoplastic pemphigus  an autoimmune mucocutaneous disease associated with neoplasia  
class4	1588	background and methods  
class4	1588	we describe five patients with underlying neoplasms in whom painful mucosal ulcerations and polymorphous skin lesions developed  usually with progression to blistering eruptions on the trunk and extremities  
class4	1588	histologic examination showed vacuolization of epidermal basal cells  keratinocyte necrosis  and acantholysis  
class4	1588	immunofluorescence testing revealed atypical pemphigus like autoantibodies in perilesional epithelium and serum from all five patients  
class4	1588	we studied the antigenic specificities of the autoantibodies by indirect immunofluorescence and immunoprecipitation  using extracts of 14c labeled human keratinocytes  
class4	1588	igg purified from the serum of one patient was passively transferred to four neonatal mice to test for pathogenicity  
class4	1588	results  
class4	1588	immunofluorescence testing showed that the autoantibodies bound to the surface of tissues containing desmosomes  including complex and simple epithelia  and myocardium  
class4	1588	an identical and unique complex of four polypeptides with molecular weights of 250  230  210  and 190 was immunoprecipitated by all serum samples  
class4	1588	the 250 kd polypeptide comigrated with desmoplakin i  a protein found in the desmosomes of all epithelia   and the 230 kd antigen comigrated with the antigen of bullous pemphigoid  
class4	1588	cutaneous blisters  a positive nikolsky s sign  and epidermal and esophageal acantholysis developed in all mice into which the autoantibody was injected  
class4	1588	electron microscopy showed epidermal acantholysis similar to lesions of experimentally induced pemphigus vulgaris  
class4	1588	conclusion  
class4	1588	these five patients with cancer had a novel acantholytic mucocutaneous disease characterized by autoantibodies that were pathogenic after passive transfer  
class4	1588	the autoantibodies from these patients reacted with an antigen complex composed of desmoplakin i and the 230 kd antigen of bullous pemphigoid and two as yet unidentified epithelial antigens  
class4	1588	we suggest the term  paraneoplastic pemphigus  for this disease  
class4	1589	synthetic analogues of fumagillin that inhibit angiogenesis and suppress tumour growth  
class4	1589	neovascularization is critical for the growth of tumours and is a dominant feature in a variety of angiogenic diseases such as diabetic retinopathy  haemangiomas  arthritis and psoriasis  
class4	1589	recognition of the potential therapeutic benefit of controlling unabated capillary growth has led to a search for safe and effective angiogenesis inhibitors  
class4	1589	we report here the synthesis of a family of novel inhibitors that are analogues of fumagillin  a naturally secreted antibiotic of aspergillus fumigatus fresenius  
class4	1589	we first isolated this fungus from a contaminated culture of capillary endothelial cells  
class4	1589	purified fumagillin inhibited endothelial cell proliferation in vitro and tumour induced angiogenesis in vivo  it also inhibited tumour growth in mice  but prolonged administration was limited because it caused severe weight loss  
class4	1589	synthesis of fumagillin analogues yielded potent angiogenesis inhibitors   angioinhibins   which suppress the growth of a wide variety of tumours with relatively few side effects  
class4	1590	hippocampal sclerosis can be reliably detected by magnetic resonance imaging  
class4	1590	two independent blinded observers reported the preoperative mris in a series of 81 consecutive patients with intractable temporal lobe epilepsy who were undergoing temporal lobectomy  
class4	1590	we then compared the nature and lateralization of the mri abnormalities with the pathologic diagnosis and the side of lobectomy  
class4	1590	the mri criteria of hippocampal sclerosis were an increased t2 weighted signal and the signal s confinement to a unilaterally small hippocampus  
class4	1590	imaging was performed in coronal and axial planes  specially orientated along and perpendicular to the long axis of the hippocampal body  
class4	1590	we found diagnostic mri abnormalities in 25 of the 27 cases with pathologically proven hippocampal sclerosis  sensitivity 93   specificity 86    
class4	1590	in addition  we detected all 13 foreign tissue lesions on mri  
class4	1590	overall  we detected lateralized lesions on mri that correctly predicted the side of the epileptogenic temporal lobe in 72 cases  89    with 2 possible errors  
class4	1590	a learning effect in appreciating the relatively subtle mri changes of hippocampal sclerosis was apparent in our later cases  as shown by an improved correlation between the 2 observers  
class4	1590	this study demonstrates that hippocampal sclerosis can be identified on mri with a high degree of sensitivity and specificity  
class4	1591	large cystic optic glioma  
class4	1591	a 5 1 2 year old boy developed a huge cyst in his chiasmal glioma 4 years after radiation therapy  
class4	1591	the cyst produced obtundation but was successfully treated  
class4	1592	purification and characterization of an inhibitor  soluble tumor necrosis factor receptor  for tumor necrosis factor and lymphotoxin obtained from the serum ultrafiltrates of human cancer patients  
class4	1592	serum ultrafiltrates  suf  from human patients with different types of cancer contain a blocking factor  bf  that inhibits the cytolytic activity of human tumor necrosis factor alpha  tnf alpha  in vitro  
class4	1592	bf is a protein with a molecular mass of 28 kda on reducing sodium dodecyl sulfate polyacrylamide gel electrophoresis  sds page   
class4	1592	the active material was purified to homogeneity by a combination of affinity chromatography  page  and high pressure liquid chromatography  
class4	1592	amino acid sequence analysis revealed that bf is derived from the membrane tnf receptor  
class4	1592	purified bf blocks the lytic activity of recombinant human and mouse tnf alpha and recombinant human lymphotoxin on murine l929 cells in vitro  
class4	1592	however  bf inhibits the lytic activity of tnf alpha more effectively than it does that of lymphotoxin  
class4	1592	the bf also inhibits the necrotizing activity of recombinant human tnf alpha when coinjected into established cutaneous meth a tumors in balb c mice  
class4	1592	the bf may have an important role in  i  the regulation and control of tnf alpha and lymphotoxin activity in cancer patients   ii  interaction between the tumor and the host antitumor mechanisms  and  iii  use of systemically administered tnf alpha in clinical trials with human cancer patients  
class4	1593	epstein barr virus small nuclear rnas are not expressed in permissively infected cells in aids associated leukoplakia  
class4	1593	epstein barr virus  ebv  dna structure and gene expression were analyzed in tissue specimens from oral hairy leukoplakia  hlp   a mucocutaneous lesion that develops in patients infected with human immunodeficiency virus  hiv   
class4	1593	the structure of the terminal restriction enzyme fragments of ebv revealed that hlp is a permissive infection without a predominant  detectable population of ebv episomal dna  
class4	1593	in rna preparations from this uniquely permissive infection  ebv replicative mrnas could be identified by northern analysis  however  the virally encoded small nuclear rnas  the ebers  were not detected in most hlp rna preparations  
class4	1593	in situ hybridization detected eber expression in very rare cells  
class4	1593	these data indicate that unlike other viral small nuclear rnas  the ebers are not expressed during viral replication and must participate in the complex maintenance of latent ebv infection  
class4	1594	overexpression of normal and mutated forms of hras induces orthotopic bladder invasion in a human transitional cell carcinoma  
class4	1594	recent studies have shown that orthotopic  transurethral  transplantation of human bladder cancer cell lines into nude mice permits tumor growth that accurately reflects their clinical malignant status in the original host  
class4	1594	thus  such a system allows a unique opportunity to analyze the genetic events involved in the conversion of low grade bladder cancer  the vast majority of which are curable  to the high grade life threatening form of the disease  
class4	1594	since 5 10  of transitional cell carcinomas  tccs  have been shown to contain a mutated hras gene  and protein expression levels of all forms of hras have been correlated with tcc progression  we chose to study the contribution of the hras oncogene in bladder tumor progression  
class4	1594	we evaluated the effects of transfection of normal or mutated hras genes into a human tcc  called rt 4  that behaves as a superficial noninvasive papillary tumor after transurethral orthotopic inoculation into athymic nude mice  
class4	1594	we found that overexpression of either transfected normal or mutated hras genes converted rt 4 cells to express an invasive phenotype remarkably similar in nature to the clinical behavior of high grade bladder carcinomas  
class4	1594	these results suggest a role for overexpressed normal or mutated ras genes in human bladder carcinoma progression  and highlight the importance of using orthotopic inoculation systems for evaluation of the contribution of oncogenes to malignant tumor progression  
class4	1595	congenital biliary tract disease  
class4	1595	jaundice in the pediatric patient requires prompt and directed evaluation  
class4	1595	this dictum is highlighted in infants with biliary atresia  in whom the progressive sclerosing process results in complete obliteration of patent but microscopic hilar biliary structures by 4 months of age  
class4	1595	kasai s operation  if done before that time  will re establish bile drainage in 90  of infants  
class4	1595	one fourth to one third of patients achieve long term jaundice free survival  
class4	1595	complications of cholangitis  portal hypertension  and fat malabsorption are experienced by many patients  
class4	1595	in children with early or late operative failure  liver replacement now offers legitimate hope for extended survival  
class4	1595	choledochal cyst is a conglomerate of pancreaticobiliary anomalies consisting of a choledochal cyst  a common channel type pancreaticobiliary junction  intrahepatic cystic disease  and partial obstruction of the distal common bile duct  
class4	1595	many patients have one or more of these malformations  
class4	1595	it is now widely accepted that the preferred treatment of choledochal cyst is total excision of the diseased biliary duct with reconstruction by roux en y choledochojejunostomy  
class4	1595	 internal  excision avoids injury to other structures in the hepatoduodenal ligament  particularly if pericystic inflammation is present  
class4	1595	congenital perforation of the common bile duct responds in most cases to simple peritoneal drainage of the perforation  
class4	1595	retention of the tube cholecystostomy is useful for subsequent cholangiographic follow up  
class4	1595	tube cholecystostomy may also be useful for irrigation of the biliary tract in infants with inspissated bile syndrome  
class4	1596	cholangiocarcinoma  
class4	1596	the diagnosis of cholangiocarcinoma can now be made with greater rapidity and accuracy  
class4	1596	in the clinical setting of obstructive jaundice  a ct scan or sonogram may suggest cholangiocarcinoma if dilated intrahepatic ducts are seen with a nondilated extrahepatic biliary tree  
class4	1596	the diagnosis is confirmed by cholangiography  and the tumor is staged by the combination of cholangiography and angiography  
class4	1596	if the tumor extensively involves both lobes of the liver or involves the main portal vein or hepatic artery  the lesion is considered unresectable  
class4	1596	these patients are best palliated nonoperatively  but they should still have an attempt at a tissue diagnosis  as various other lesions can masquerade as cholangiocarcinoma  
class4	1596	in comparison  if the tumor is confined to or is distal to the hepatic duct bifurcation  extends into only one lobe of the liver  or involves only the right or the left portal vein or hepatic artery  the lesion may be resectable  and exploration is indicated  
class4	1596	as many as half of all patients explored with curative intent will have a successful resection  
class4	1596	various surgical options are appropriate for patients undergoing tumor resection  depending on the site and extent of the lesion  
class4	1596	similarly  several surgical options are possible for palliation in patients with unresectable cholangiocarcinoma  
class4	1596	the role of radiotherapy in the management of cholangiocarcinoma is uncertain  
class4	1596	our results  like those of many other retrospective analyses  suggest that radiotherapy prolongs survival after curative resection as well as after palliative stenting  
class4	1596	however  further data from randomized studies are necessary to support or refute this impression  
class4	1596	further studies of adjuvant chemotherapy or hormonal therapy will also be necessary to improve patient survival  
class4	1597	lithiumogenic disorders of the thyroid and parathyroid glands as surgical disease  
class4	1597	little notice has been paid in the surgical literature to problems with psychoeffective lithium  which by interfering with adenylate cyclase affects thyroid and parathyroid function  causing hypercalcemia  hyperparathyroidism  and hypothyroidism  
class4	1597	seven patients with lithiumogenic hyperparathyroidism occurring after years of lithium therapy underwent treatment and manifested osteoporosis  n   2   hypertension  n   2   nephrolithiasis  n   1   coma  n   1   rising hypercalcemia  n   1   goitrous myxedema  n   4   nephrogenic diabetes insipidus  n   2   renal failure  n   2   and hyperlipidemia  n   1   
class4	1597	disease directed parathyroidectomy  without morbidity  was curative  
class4	1597	unique laboratory findings included normal serum phosphorus and reduced urinary calcium and cyclic adenosine monophosphate values  
class4	1597	three separate cases of thyroid carcinoma after long term lithium therapy were also treated  being preceded by myxedema  n   2  and concurrent with hyperparathyroidism  n   1   
class4	1597	there has been only one previous report of lithium associated thyroid carcinoma  
class4	1597	all patients taking lithium should undergo surveillance for thyroid and parathyroid dysfunction and neoplasia  and appropriate surgical and medical treatment should be considered in each situation  
class4	1597	although hyperparathyroidism may be reversible with lithium discontinuance  such therapy may be obligatory for patient well being  thus dictating parathyroidectomy  
class4	1598	multiple parathyroid adenomas  report of thirty three cases  
class4	1598	an increasing number of patients with primary hyperparathyroidism are found to have two or three enlarged parathyroid glands  
class4	1598	of 865 patients successfully operated on by one surgeon  j n a    multiple enlarged parathyroid glands  adenomas  were found and resected in 33 cases  3 8    with resulting normocalcemia lasting from 1 to 22 years  mean 5 8   
class4	1598	twenty nine patients had two adenomas and four had three adenomas  
class4	1598	in 28 patients the multiple adenomas were synchronous  
class4	1598	twenty five patients underwent removal of all of the enlarged parathyroid glands in one operation  in three patients one adenoma was removed  reoperation for persistent hypercalcemia was performed  and a second adenoma was resected with cure  
class4	1598	in five patients one adenoma was removed  normocalcemia ensued for 3 to 18 years  and a second  metachronous  adenoma occurred and was resected successfully  
class4	1598	although 10 of 70 enlarged parathyroid glands removed were labeled hyperplasia  cure in all but one of our patients by selective resection of only enlarged parathyroid glands emphasizes the unreliability of histologic criteria in differentiating between parathyroid adenoma and hyperplasia  
class4	1598	based on this study  we support the existence of multiple adenomas and advocate removal of only macroscopically enlarged parathyroid glands in patients with primary hyperparathyroidism  
class4	1599	endosonography in the localization of parathyroid tumors  a preliminary study  
class4	1599	a preoperative transesophageal exploration of the parathyroids by endosonography was performed on 23 patients with primary hyperparathyroidism  
class4	1599	the system used was a 7 5 mhz transducer mounted on the tip of an endoscope with an external diameter of 13 mm  
class4	1599	the field of visualization was 360 degrees  
class4	1599	a retrograde exploration was done moving up from the aortic arch to the upper esophageal sphincter  
class4	1599	all patients underwent surgery afterward  and adenomas were found  
class4	1599	in 12 cases the adenoma was visualized  
class4	1599	all 12 adenomas were posteriorly located on the right side  four cases  and left side  eight cases  of the esophagus  
class4	1599	nine of these 12 tumors were on the posterior face of the thyroid lobes  with six tumors in the middle one third of the thyroid lobe and three in the lower one third of the thyroid lobe  
class4	1599	the other three tumors were located below the lower pole of the thyroid lobes in the upper posterior mediastinum  
class4	1599	mean tumor weight was 1165 mg  
class4	1599	of the 11 tumors that could not be visualized  eight tumors were anteriorly located  three of these tumors were on the anterior and lateral surface of the lower pole of the thyroid  and five were in the thyrothymic tracts  
class4	1599	the remaining three tumors were located on the back of the thyroid lobes  two of these tumors were at the upper esophageal sphincter  and one was on the side of the pharynx  
class4	1599	mean tumor size was 1334 mg  
class4	1599	localization of parathyroid tumors by endosonography appears possible but only if lesions are located posteriorly  close to the esophagus  
class4	1599	endosonography is not indicated before routine cervical exploration for primary or secondary hyperparathyroidism  
class4	1599	as in other such studies  endosonography could be useful in cases of persistent or recurrent hyperparathyroidism  
class4	1600	function in athymic nude mice of parathyroid heterografts from patients with primary hyperparathyroidism and secondary hyperparathyroidism  
class4	1600	heterotransplantation of adenomatous parathyroid glandular tissue from humans with primary hyperparathyroidism into athymic nude mice creates a unique animal model of this disease  
class4	1600	the mice manifest high concentrations of both midregion c terminal human parathyroid hormone and biologically active intact human parathyroid hormone relative to either mice with no implants or mice that received normal human parathyroid tissue  
class4	1600	secretion of these substances is maintained in most mice for at least 9 to 13 months after implantation  
class4	1600	in addition  animals that have experienced implantation exhibit other characteristics associated with human primary hyperparathyroidism including relative hypercalcemia and increased renal 25 hydroxyvitamin d 1 alpha hydroxylase activity  
class4	1600	we also measured these parameters in a group of nude mice that received transplantation of a similar mass of hyperplastic parathyroid tissue that was obtained from patients with uremic secondary hyperparathyroidism  
class4	1600	although we hypothesized that the level of human parathyroid hormone secretion from these implants would fall over time in response to the normal host environment  hormone levels remained as high as those in recipients of adenomatous heterografts  even after 9 to 13 months  
class4	1600	moreover  similar biologic effect of the excess parathyroid hormone  i e   relative hypercalcemia  hyperphosphatasemia  and increased 1 25 dihydroxyvitamin d biosynthesis  were detected  
class4	1600	these animal models should prove extremely useful in supplementing our understanding of hyperparathyroid disorder in man  
class4	1601	effects of tamoxifen and somatostatin analogue on growth of human medullary  follicular  and papillary thyroid carcinoma cell lines  tissue culture and nude mouse xenograft studies  
class4	1601	the knowledge that  1  the normal thyroid contains somatostatin   2  polypeptide growth factors influence thyroid cell function  and  3  thyroid cells contain steroid hormone receptors prompted us to add somatostatin analogue no  
class4	1601	201 995  sms   5 ng ml  and or tamoxifen citrate  tam   5 mumol l  to 7 day monolayer cultures  50 000 cells well  of three separate human thyroid carcinoma cell lines  dr081  medullary   wr082  follicular   and npa 87  papillary   
class4	1601	results  tabulated as cell numbers well  x10 5  on day 7  revealed that tam inhibited growth of medullary and follicular cells and that tam plus sms inhibited growth of papillary cells  
class4	1601	in vivo studies of subcutaneous tumor cell xenografts in nude mice have documented that tam  5 mg subcutaneous pellet  significantly inhibits the growth of medullary implants  
class4	1601	flow cytometric dna studies of medullary cell cultures demonstrated a reduced g2   m phase with tam treatment  
class4	1601	for papillary cell implants  tam plus sms  5 micrograms subcutaneously  twice daily  did not suppress tumor growth  
class4	1601	all three cell lines were negative for estrogen receptor  addition of estradiol  5 ng ml  to medullary cell cultures neither stimulated replication nor reversed the inhibitory effects of tam in vitro  
class4	1601	we conclude that  1  tam slowed the growth of a cell line of human medullary carcinoma  both in vitro and in vivo   2  this effect was not reversed by estradiol   3  tam plus sms inhibited replication of a papillary carcinoma cell line in vitro  but not in vivo  and  4  tam alone and tam plus sms inhibited replication of cultures of a human follicular thyroid carcinoma cell line  
class4	1601	tam and sms may be useful in treatment of some human thyroid carcinomas  
class4	1602	management of cushing s syndrome secondary to adrenal adenoma during pregnancy  
class4	1602	this report discusses our experience with two patients who had unilateral adrenalectomy during pregnancy as treatment for cushing s syndrome secondary to an adrenal adenoma  
class4	1602	previously only five patients with this clinical problem who underwent unilateral adrenalectomy during pregnancy had been reported  
class4	1602	we have reviewed the world literature on cushing s syndrome in pregnancy secondary to an adrenal adenoma  
class4	1602	a total of 19 patients who had unilateral adrenalectomy for this problem after the completion of pregnancy were identified  
class4	1602	the review of world literature and the two patients who are the subject of this report were the basis of our analysis of fetal death  neonatal complications  and maternal complications in seven pregnancies during which unilateral adrenalectomy was performed  group 1  compared to the 19 pregnancies that were associated with unilateral adrenalectomy at the completion of pregnancy  group 2   
class4	1602	of the seven pregnancies in group 1  one fetal death and no neonatal complications occurred  but fetal death and neonatal complications occurred in 12 of the 19 pregnancies in group 2  
class4	1602	four of the seven mothers in group 1 had complications  16 of the 19 mothers in group 2 had complications  
class4	1602	this study suggests that adrenalectomy during pregnancy should be considered as a therapeutic option in the management of cushing s syndrome secondary to an adrenal cortical adenoma  
class4	1603	the role of adrenalectomy in cushing s syndrome  
class4	1603	forty four patients with cushing s syndrome were treated by adrenalectomy between 1975 and 1989  
class4	1603	twenty patients had adrenal adenomas  13 with obvious cushing s syndrome and 7 whose disease was subclinical  detected after evaluation of an incidentally discovered adrenal mass  es   
class4	1603	twelve patients underwent bilateral adrenalectomies for cushing s disease after failed transsphenoidal explorations and pituitary irradiation  
class4	1603	six patients had primary adrenal hyperplasia  five as manifestations of carney s complex  
class4	1603	two others underwent bilateral adrenalectomies for ectopic adrenocorticotropic hormone from carcinoid tumors  
class4	1603	four patients had adrenocortical carcinoma treated with transabdominal adrenalectomy  
class4	1603	three are alive from 8 years to 5 months  
class4	1603	there was one postoperative death  2 3   caused by coagulopathy and multiple organ failure and three  7   minor postoperative complications  
class4	1603	follow up showed good to excellent results in 95  of patients  
class4	1603	it is concluded that adrenalectomy provides prompt relief from the severe morbidity of cushing s syndrome regardless of the cause  
class4	1603	it is the treatment of choice for adrenal adenomas  carcinomas  primary hyperplasia  and selected patients with cushing s disease  
class4	1604	time to recovery of the hypothalamic pituitary adrenal axis after curative resection of adrenal tumors in patients with cushing s syndrome  
class4	1604	the recovery time of the hypothalamic pituitary adrenal  hpa  axis after curative resection of adrenal tumors in patients with cushing s syndrome is poorly documented  
class4	1604	eight consecutive patients were treated with a standardized hydrocortisone replacement strategy after curative resection of a cortisol secreting tumor and the time to recovery of the hpa axis was determined  
class4	1604	hypercortisolism was documented by elevated 24 hour urinary free cortisol levels  
class4	1604	cure was documented by undetectable postoperative morning serum cortisol levels  
class4	1604	each patient received replacement hydrocortisone after surgery and was reevaluated every 3 to 6 months with an adrenocorticotrophic hormone  acth  stimulation test  
class4	1604	each patient was also monitored carefully for symptoms and signs of adrenal insufficiency  which was defined as symptoms consistent with this diagnosis that responded to increases in hydrocortisone levels  
class4	1604	after surgical resection  each patient was cured of hypercortisolism  
class4	1604	subsequently  despite replacement hydrocortisone  each patient had symptoms of hypocortisolism  and in four of eight patients the dose of hydrocortisone was increased to relieve the symptoms  
class4	1604	patients required a median time of 15 months  range  9 to 22 months  to recover a normal acth stimulation test and 19 months  range  12 to 24 months  to allow discontinuation of replacement doses of hydrocortisone  
class4	1604	the results suggest that surgical resection of a cortisol secreting adrenal tumor will result in rapid cure of hypercortisolism  but complete recovery of the hpa axis and discontinuation of replacement steroids will require between 1 and 2 years  
class4	1604	normal adrenal function  as assessed by the cortisol response to acth  returns despite replacement doses of hydrocortisone  and replacement doses of hydrocortisone can be tapered rapidly or discontinued after a normal acth stimulation test  
class4	1605	posttranslational gastrin processing depends on tumor morphology  
class4	1605	extracellular matrices have recently been demonstrated to alter cell morphology in culture  
class4	1605	altered cell morphology has been associated with changes in gene transcription and translation  but it is not known whether it also affects posttranslational processing  
class4	1605	using tyrosine o sulfation as a marker of processing  we studied the effects of various substrates on biologically active gastrin  irg  production and sulfation in gastrin containing tumor cells  gt cells   
class4	1605	dispersed gt cells were plated onto different substrates and then incubated  
class4	1605	culture media from days 4  7  and 28 were assayed with specific antibodies that recognize total irg and nonsulfated irg  
class4	1605	cells cultured on plastic and dried films of laminin  collagen  and matrigel  collaborative research inc   lexington  mass   flattened and formed monolayers of gt cells  
class4	1605	cells cultured on a porous membrane and hydrated gels of collagen and matrigel did not flatten but formed spheroids of gt cells  
class4	1605	the monolayer cultures showed an increase in sulfation with time but a decrease in irg production  
class4	1605	the spheroid cultures maintained a constant level of sulfation over time and  with the exception of matrigel  gel   also showed a decrease in irg production  
class4	1605	these results indicate that the level of sulfation was unchanged from that of the original tumor when cells were grown in spheroids but increased when cultured as monolayers  
class4	1605	it appears that alteration of the cellular milieu alters colony morphology  which in turn alters gastrin processing  
class4	1606	the utility of circulating levels of human pancreatic polypeptide as a marker for islet cell tumors  
class4	1606	the measurement of plasma levels of human pancreatic polypeptide  hpp  has been reported to be clinically useful in predicting the existence of pancreatic islet cell neoplasms in patients with familial multiple endocrine neoplasia type 1  fmen i  and the possible presence of metastatic disease in patients with islet cell tumors  
class4	1606	however  these studies have not been prospective and involve small numbers of patients  
class4	1606	in this study  fasting plasma samples from 36 patients with biopsy proved islet cell tumors were analyzed for hpp by radioimmunoassay and compared with age matched control subjects  
class4	1606	of 13 patients with fmen i who had islet cell tumors  7  54   had elevated plasma hpp levels before surgery  
class4	1606	after resection of all islet cell tumors  4 of 12 patients evaluated after surgery still had elevated levels  
class4	1606	fifteen patients had islet cell tumors that were localized  seven insulinomas and eight gastrinomas   but none of these patients had elevated hpp levels  either before or after surgery  
class4	1606	nine patients  including one with fmen i  with metastatic islet cell tumors to the liver were studied  three with more advanced disease had elevated hpp levels before surgery  
class4	1606	each of the nine patients underwent resection of all gross disease and the three patients with elevated preoperative levels had normal postoperative hpp levels  
class4	1606	our results indicate that basal plasma levels of hpp were not clinically useful  
class4	1606	the hpp levels did not reliably predict the presence of islet cell tumors in patients with fmen i  because 46  of patients with tumors did not have elevated plasma levels  and in those with elevated values hpp levels did not reliably predict the resection of all tumor  
class4	1606	plasma levels of hpp have no utility in patients with localized sporadically occurring islet cell tumors and limited utility  33   in predicting the presence of metastatic islet cell tumors to the liver  
class4	1607	extraadrenal retroperitoneal paragangliomas  natural history and response to treatment  
class4	1607	extraadrenal retroperitoneal paragangliomas  rp  are uncommon tumors  
class4	1607	because of their rarity  little is known of their natural history or response to treatment  
class4	1607	we reviewed 22 patients with rp who were seen at our center between 1949 and 1990  
class4	1607	the distribution of male and female patients was nearly equal  and the mean age was 42  
class4	1607	most patients were admitted with pain or a mass  and eight of 22 tumors were functional  
class4	1607	no significant difference was noted in duration of symptoms  size of the tumor  or survival between functional and nonfunctional tumors  
class4	1607	eleven of 22  50   rp metastasized and were therefore classified as malignant  
class4	1607	five year and 10 year disease free survival rates were 19  and 19  for tumors not resected and 75  and 45  for those completely resected  
class4	1607	once metastases occurred  the 5 year survival rate was 36   but no patient survived beyond 76 months  
class4	1607	predictors of survival included complete resection of the tumor but not size or functional status  
class4	1607	although some patients who received chemotherapy or radiotherapy had clinical responses  a survival benefit could not be shown  
class4	1607	rp have a high rate of malignant behavior and should be treated aggressively with operation  
class4	1607	late metastases are not uncommon  and prolonged follow up is necessary  
class4	1607	once metastases have occurred  some patients may have prolonged survival  
class4	1608	the effect of somatostatin on 5 hydroxytryptamine release from a carcinoid tumor  
class4	1608	one of the major manifestations of the carcinoid syndrome is secretory diarrhea thought to be due to overproduction of 5 hydroxytryptamine  5 ht   
class4	1608	synthetic somatostatin analogues have proved to be clinically effective in controlling this diarrhea  
class4	1608	we have established a continuous cell line from a human pancreatic carcinoid tumor that secretes 5 ht  
class4	1608	we examined the ability of the somatostatin analogue  sms 201 995  to inhibit 5 ht release in vitro  
class4	1608	tumor cells were exposed to sms 201 995  10  6  mol l   pentagastrin  10  9  mol l   acetylcholine  10  5  mol l   and isoproterenol  10  5  mol l  alone and in combination  5 ht release was assayed with high pressure liquid chromatography  
class4	1608	we found that pentagastrin  6 43     0 64 ng ml   isoproterenol  20 24     2 17 ng ml   and acetylcholine  12 39     1 10 ng ml  each stimulated release of 5 ht compared to control values  4 38     0 42 ng ml   
class4	1608	sms 201 995 significantly reduced release of 5 ht in response to isoproterenol and acetylcholine but did not inhibit the effect of pentagastin  
class4	1608	these data suggest that different agents do not act through the same pathway to stimulate 5 ht release from human pancreatic carcinoid cells  
class4	1609	intraatrial extension of thyroid cancer  technique and results of a radical surgical approach  
class4	1609	an occlusion of the superior vena cava by a tumor thrombus extending into the right atrium was diagnosed in three patients with a follicular thyroid cancer  
class4	1609	all patients showed the typical clinical picture of the superior vena cava syndrome  
class4	1609	a right parasternal thoracotomy was performed for preparation of the major vessels  
class4	1609	the superior vena cava was opened and the entire intravascular tumor thrombus was removed  
class4	1609	the cavotomy was closed directly in two patients  
class4	1609	in the third patient the left brachiocephalic trunk was resected and reconstructed with a vascular  polytetrafluoroethylene  graft  
class4	1609	this patient had bone and brain metastases and an occlusion of the graft 3 months after surgery after anticoagulation was stopped  
class4	1609	the other two patients were clinically symptom free without local recurrence 13 and 50 months after surgery  
class4	1609	an aggressive surgical approach is justified in grossly invasive thyroid cancer to decrease local recurrence and death rates  to correct the disturbing clinical symptoms of superior vena caval occlusion  and to prevent tumor embolism and the development of distant metastases  
class4	1609	by reducing tumor mass  an even better basis for radioiodine treatment can be prepared  
class4	1610	the intraoperative incidence of detectable bilateral and multicentric disease in papillary cancer of the thyroid  
class4	1610	this is a prospective study to determine the incidence of grossly detectable multicentric and bilateral cancer at operation in patients who  before surgery  were believed to have a unilateral lesion  
class4	1610	the opposite lobe was inspected at the time of operation and the surgeon made a determination as to whether there was bilateral and or multicentric disease present  
class4	1610	a total thyroidectomy was then carried out and the accuracy of the surgeon s judgment was established by permanent section pathologic examination  
class4	1610	fifteen of the 44 patients were assessed to have gross bilateral disease  
class4	1610	thirteen of these were confirmed by pathologic examination  
class4	1610	one case of microscopic bilateral disease was not recognized by the surgeon  
class4	1610	seventeen patients were thought to have unilateral multicentric disease  
class4	1610	fifteen of these cases were confirmed by microscopy and an additional seven cases were documented to have secondary foci  
class4	1610	it is obvious from this study that most disease that is called microscopic disease is actually palpable  
class4	1610	a review of the literature confirms this  
class4	1610	it was very unlikely for a patient who did not have unilateral multicentric disease to have a contralateral focus of carcinoma  
class4	1610	the incidence of bilateral disease was 32   and the incidence of multicentric disease was 50   the surgeon was very accurate in assessing this  
class4	1610	we believe that surgeons who advocate lobectomy as the primary treatment for thyroid cancer are recognizing grossly detectable disease in a significant number of patients and thus are doing total thyroidectomies in most patients with bilateral disease  
class4	1611	intraoperative decision making during thyroid surgery based on the results of preoperative needle biopsy and frozen section  
class4	1611	prognostic factors in well differentiated thyroid cancer are age of the patient and grade  size  distant metastasis  and extracapsular spread of the disease  
class4	1611	however  the surgeon is often not sure about the pathologic diagnosis of thyroid nodules  
class4	1611	the accuracy of preoperative studies  such as ultrasonography and thyroid scanning  is limited  
class4	1611	the most cost effective test is fine needle aspiration  the accuracy of which exceeds 80  in most series  
class4	1611	however  a large group of nodules exist for which aspiration cytologic studies are considered to be either suspicious or indeterminate  
class4	1611	the decision about the extent of thyroidectomy may be difficult in these patients  
class4	1611	intraoperative frozen section may help the surgeon to distinguish benign from malignant lesions  but as in fine needle aspiration  the major problem is the distinction between follicular adenoma and follicular carcinoma  
class4	1611	the frozen section diagnosis of follicular adenoma was changed to follicular carcinoma in one third of the cases  13 of 38 cases   
class4	1611	the decision about the extent of thyroidectomy in patients with follicular adenomas was based on other prognostic factors  such as age and sex of the patient and the size of the nodule  
class4	1611	the accuracy of frozen section diagnosis was 95   
class4	1611	our experience suggests that decisions regarding the extent of thyroidectomy can best be made by preoperative fine needle aspiration with confirmation by frozen section diagnosis in equivocal cases  
class4	1612	prognostic significance of nondiploid dna determined by flow cytometry in sporadic and familial medullary thyroid carcinoma  
class4	1612	to clarify the role of dna measurements in predicting outcome after surgical treatment of medullary thyroid carcinoma  mtc   we performed flow cytometric analysis in nuclear suspensions of 119 mtc tumors  
class4	1612	of the 119 patients  63  53   patients had sporadic tumors and 56  47   patients had familial tumors  survivors were followed for a mean of 13 years  
class4	1612	dna content was normal in 92  77   patients and abnormal  nondiploid  in 27  23   patients  
class4	1612	ten year cause specific mortality rates were 12   42   and 49  with diploid  tetraploid polyploid  or aneuploid tumors  p   0 0009  and were greater with nondiploid tumors both in the sporadic  p   0 012  and multiple endocrine neoplasia  familial  cases  p   0 114   
class4	1612	none of 27 patients with tnm stage i disease died of mtc  
class4	1612	in patients with tnm stages ii  iii  and iv disease  dna nondiploid tumors were associated with increased deaths from mtc  
class4	1612	in a cox proportional hazards model involving all 119 patients and adjusted for disease stage and inheritance pattern  nondiploid dna was independently associated with increased deaths from mtc  p   0 008   
class4	1612	in an identical cox model restricted to the 92 dna diploid tumors  an s phase fraction of 15 0  or more remained a significant variable  p   0 034  after adjustment for stage and inheritance pattern  
class4	1612	we therefore conclude that dna measurements do have a role to play in predicting outcome after surgical treatment of mtc  
class4	1613	clinicopathologic and flow cytometric dna study of medullary thyroid carcinoma  
class4	1613	sixty one patients with medullary thyroid carcinoma were investigated to establish relationships between the neoplasm s dna content  other clinicopathologic factors  and patient survival  at least 5 years  follow up   
class4	1613	there were 26  42 6   familial and 35  57 4   sporadic carcinomas  
class4	1613	forty two neoplasms  68 8   were diploid and 19  31 2   were aneuploid by flow cytometric assessment  
class4	1613	in univariate analysis  age  hereditary background  dna content  calcitonin immunoreactivity  and type of surgery were strong predictors of clinical outcomes  
class4	1613	in multivariate regression analysis  none of these factors was an independent prognosticator  
class4	1613	patients  gender  clinical stage  histologic subtype  and amyloid content of the tumor did not influence survival  
class4	1614	actin architecture of cultured human thyroid cancer cells  predictor of differentiation  
class4	1614	the actin cytoskeleton is important for cell structure and motility  
class4	1614	a disordered actin architecture has been correlated with a high metastatic potential in melanoma  fibrosarcoma  and colon cancer models  
class4	1614	thyrotropin is known to induce growth and differentiation in cultured thyroid cells  whereas the carcinogenic phorbol ester 12 o tetradecanoylphorbol 13 acetate  tpa  causes dedifferentiation and malignant transformation in many cell lines  
class4	1614	we therefore assessed the effect of thyrotropin and tpa on the actin architecture of ftc 133 human follicular thyroid cancer cells in continuous culture  
class4	1614	staining of filamentous actin with rhodamine phalloidin showed that 1 mu ml or 30 mu ml thyrotropin induced actin polymerization was detectable at 1 hour but more notable at 24 hours  
class4	1614	similarly tpa  0 008 to 10 mumol l  caused rapid actin fiber disruption and redistribution to the cell periphery  
class4	1614	secondary antibody staining for alpha actinin  a protein that binds and crosslinks actin  was more prominent after treatment with thyrotropin but decreased after tpa  
class4	1614	these findings indicate that the actin cytoskeleton has a dynamic response to trophic factors  
class4	1614	thyrotropin promoted actin polymerization  but tpa caused depolymerization  
class4	1614	these effects may correlate with cellular alpha actinin levels  
class4	1614	actin architecture may therefore reflect the state of differentiation of thyroid tumor cells  
class4	1615	n ras 61 oncogene mutations in hurthle cell tumors  
class4	1615	mutations of ras oncogenes are believed to play an important role in the initiation or progression of human tumors  
class4	1615	in thyroid tumors the incidence of ras activation by specific point mutations has been reported to range from 33  in follicular adenomas up to 60  in anaplastic carcinomas  
class4	1615	because of our long standing interest in hurthle cell tumors  we began a study of 70 such cases to determine the incidence of ras mutations and their clinical correlates  
class4	1615	analysis of n ras sequences at condon position 61  with the polymerase chain reaction method and oligonucleotide probe hybridization  showed point mutations of the normal codon caa  in eight tumor samples  
class4	1615	one was a mutation from caa to aaa  one from caa to cta   and six from caa to cga  
class4	1615	these mutations would result in amino acid substitutions of lysine  leucine  or arginine for the normal glutamine at position 61 in the n ras protein  
class4	1615	identical ras mutations in two tumors and some of their surrounding thyroid tissue may indicate that activating ras point mutations are an early event in carcinogenesis  
class4	1615	the incidence of mutations was 1 of 24  4   of the histologically benign tumors  5 of 34  15   of the intermediate tumors  with vascular or capsular permeation   and 2 of 12  17   in the malignant group  
class4	1615	four of these eight patients died of metastatic thyroid disease and four are alive without evidence of recurrence  
class4	1616	posterior mediastinal teratoma with abdominal extension  
class4	1616	posterior mediastinal benign teratomas are uncommon neoplasms in infancy  nine cases have been reported so far  
class4	1616	a one month old baby was found to have a benign posterior mediastinal teratoma infiltrating the lower oesophagus from the level of the carina through the oesophageal hiatus into the upper abdomen  
class4	1616	partial oesophagectomy provided a successful outcome  
class4	1617	are three substages of clinical b prostate carcinoma useful in predicting disease free survival  
class4	1617	the b1 nodule  a 1 5 cm area of induration surrounded on at least two sides by prostatic tissue of normal consistency  was defined by jewett in 1968 as the stage of prostatic cancer best suited for treatment and cure by radical prostatectomy  rp   
class4	1617	the area of prostatic induration suitable for rp was subsequently extended to less than one lobe  stage b1   this extension of induration was supported by the study of walsh and jewett in 1980 showing a 51 percent survival free of disease at fifteen year follow up  
class4	1617	subsequently  clinical staging systems evolved which substaged clinical b into three categories of induration  b1n   less than 1 5 cm nodule  b1   greater than 1 5 cm but less than one lobe  and b2   one lobe or both lobes  
class4	1617	to determine if digital assessment of these progressively greater degrees of induration would translate into different intervals to first progression  whether local or distant  we reviewed prostate diagrams and descriptions of all stage b patients treated by iodine 125 interstitial implant and external beam radiation therapy between 1974 and 1985 at our institution  
class4	1617	forty six patients had b1 nodules  78 patients b1  less than one lobe   and 52 patients b2  one lobe or greater   
class4	1617	mean follow up was fifty five months  
class4	1617	we found b1n  which was also associated with well differentiated grade and a normal acid phosphatase  to have the longest interval to progression  
class4	1618	radical prostatectomy versus expectant primary treatment in stages i and ii prostatic cancer  a fifteen year follow up  
class4	1618	a fifteen year follow up of a prospective  randomized study comparing placebo with radical prostatectomy as the primary treatment of early prostatic cancer is presented  
class4	1618	a total of 111 patients with clinical stage i or ii prostatic cancer  normal acid phosphatase levels  and negative findings on skeletal x ray film were evaluable  
class4	1618	thirty stage i patients and 20 stage ii patients received placebo only  31 stage i and 30 stage ii patients underwent radical prostatectomy  
class4	1618	the survival status for 95 patients  86   was established at the fifteen year follow up  
class4	1618	no significant differences in crude survival occurred in either stage or in both stages combined  
class4	1618	moreover  the survival curves closely followed reference curves based on expected u s  
class4	1618	mortality for men of comparable ages and races  
class4	1618	a statistically significant association between a high gleason histologic score and poor survival was established  
class4	1618	in this study  initial treatment with radical prostatectomy did not yield longer survival than initial placebo treatment alone  
class4	1618	however  the findings should be interpreted with caution  since sample size was small and staging procedure was simplified  
class4	1619	epididymal metastasis from prostatic adenocarcinoma mimicking adenomatoid tumor  
class4	1619	a case of epididymal metastasis from prostatic carcinoma is presented  
class4	1619	the initial histologic findings were suggestive of adenomatoid tumor  but a diagnosis of metastatic adenocarcinoma of prostatic origin has been established by prostatic acid phosphatase and prostate specific antigen immunoperoxidase staining  
class4	1620	femoral mononeuropathy after radical prostatectomy  
class4	1620	femoral mononeuropathy is a recognized complication following abdominal and vaginal hysterectomy  
class4	1620	retractor injury and lithotomy position were postulated mechanisms  
class4	1620	we report a femoral nerve lesion following a radical perineal prostatectomy  
class4	1621	testicular calcifications and neoplasia in patient treated for subfertility  
class4	1621	a subfertile male with a history of left cryptorchism underwent scrotal ultrasound that revealed stippled calcifications  without associated mass  in the right testicle  
class4	1621	six months later  while on a regimen of clomiphene citrate  a testicular tumor became palpable  
class4	1621	this was sonographically confirmed to be surrounding the calcifications  
class4	1621	testicular calcifications are most commonly associated with benign conditions  
class4	1621	we review the literature regarding their relationship to neoplasms and the significance of the ultrasonic findings  
class4	1621	furthermore  this is the sixth reported case of testicular tumor developing during hormonal treatment for oligospermia  
class4	1621	although these cases may be circumstantial  closer surveillance and screening ultrasound may be indicated for subfertile males taking clomiphene citrate  
class4	1622	papanicolaou smear cell recovery techniques used by primary care physicians  
class4	1622	nine hundred tennessee based internists  family physicians  and obstetrician gynecologists were randomly selected and surveyed to identify papanicolaou smear cell recovery methods used in their practices  
class4	1622	this 16 item survey also requested typical laboratory reporting procedures on papanicolaous smears  
class4	1622	the most frequently reported cell sampling technique was the combination cotton tipped applicator and spatula  which was used by 47 percent of all physicians  
class4	1622	use of the cervical cytobrush for papanicolaou smears  which has been shown to improve the detection of cervical dysplasia  was used alone or in combination by 19 percent of those surveyed  of whom 72 percent were gynecologists  
class4	1622	cervical sampling should contain cells from the transformation zone as evidenced by an adequate number of endocervical cells on the smear  
class4	1622	laboratories reporting the presence of endocervical cells were significantly different  p less than 0 05  among the specialties  with 26 percent of the internists   18 percent of the family physicians   and 15 percent of the obstetricians  laboratories not providing this information in their reports  
class4	1622	reporting inadequate smears is a necessary first step toward improved sampling technique  
class4	1622	without this information  physicians risk missing pathology through reports of false negative papanicolaou smears  
class4	1623	malignant melanoma presenting as nasal obstruction  
class4	1623	mucosal melanomas arising in the nasal cavity are rare tumors comprising less than 1 percent of all melanomas  
class4	1623	often  the common clinical symptom is nasal obstruction  
class4	1623	grossly  they may or may not be pigmented and frequently attain large sizes  
class4	1623	histologic diagnosis of these tumors may be difficult  requiring immunohistochemical or electron microscopic confirmation  
class4	1623	aggressive surgical management is the treatment of choice in clinical stage i disease  
class4	1623	subsequent surveillance for recurrence is mandatory  
class4	1623	markers such as 5 s cysteinyldopa may prove useful in staging  prognosticating  and postoperative surveillance for early recurrence  but their exact role has yet to be delineated  
class4	1623	ultimate prognosis is poor  
class4	1624	parental age in sporadic hereditary retinoblastoma  
class4	1624	of 104 children with sporadic hereditary retinoblastoma born between 1945 and 1970  we studied the age of their parents at the birth and compared this age with the mean age of parents at the birth of their children during the same period in the netherlands  
class4	1624	the mean age of fathers at the birth of their children with sporadic hereditary retinoblastoma  33 7 years  was significantly higher than the mean age of fathers at the birth of their children in the general population  32 5 years   p less than  05  one sided   
class4	1624	similarly  the mean age of mothers at the birth of their children with sporadic hereditary retinoblastoma  31 2 years  was significantly higher than the mean age of mothers at the birth of their children in the general population  29 5 years   p less than  05  one sided   
class4	1624	we further analyzed this parental age factor by measuring the relative risk of age groups and comparing the incidence of sporadic hereditary retinoblastoma in the various parental age groups with the incidence of sporadic hereditary retinoblastoma in the total population  
class4	1624	mothers 35 years of age or older had a relative risk of 1 7 to have a child with sporadic hereditary retinoblastoma compared with mothers in the population in general  p    006  one sided   
class4	1624	similarly  fathers 50 years of age or older had a relative risk of 5 0 to have a child with sporadic hereditary retinoblastoma compared with fathers in the population in general  p    04  one sided   
class4	1624	no parental age effect was found in children with nonhereditary retinoblastoma  
class4	1624	we conclude that a high paternal and a high maternal age are significant risk factors for sporadic hereditary retinoblastoma  
class4	1625	capillary haemangioma presenting as a lung pseudocyst  
class4	1625	a girl who developed a lung cyst at 24 hours of age during gentle ventilation for respiratory distress syndrome is reported  
class4	1625	instead of resolving as expected of a pseudocyst it continued to expand  
class4	1625	resection at 1 year of age showed a cyst entirely surrounded by capillary haemangioma  
class4	1625	aspiration of this cyst would have been dangerous  
class4	1626	indomethacin responsive hypercalcaemia associated with a renal sarcoma  
class4	1626	an infant presented with a non metastatic renal spindle cell sarcoma and hypercalcaemia  which resolved after treatment with indomethacin  
class4	1626	there was in vivo and in vitro evidence that hypercalcaemia was mediated by circulatory prostaglandins  
class4	1627	surgical strategy in thyroid disease  
class4	1627	over the past 8 years  311 patients have undergone surgical treatment by the senior authors for thyroid disease  
class4	1627	over 80  of the cases were performed by the head and neck surgical service at olive view county hospital  sylmar  calif  with the remainder performed at ucla affiliated institutions  
class4	1627	this service is an important source of thyroid surgical training for ucla head and neck residents who rotate through this major affiliate  
class4	1627	the purpose of this communication is to review our experience with these cases  to describe our overall surgical strategy  and to detail the specifics of our surgical procedure  which we have developed to safely train residents in the treatment of these challenging cases  
class4	1627	this article deals with the specific problems of preservation of the recurrent nerve  the parathyroid glands  and the techniques for reimplantation of injured parathyroid glands  the management of larger  substernal thyroid glands  and our techniques for partial thyroid surgery  
class4	1627	in addition  the difficult decisions in the management of thyroid cancer  such as completion thyroidectomy  the management of lymph node mestastases  and how tracheal  esophageal  or laryngeal invasion should be managed are discussed  
class4	1627	an initial section describing the general preoperative examination of these patients is also included  so that the proper surgical strategy can be developed prior to entering the operating room  
class4	1628	carotid body tumors  
class4	1628	the surgical management of carotid body tumors requires identification and preservation of neural and vascular structures without compromising resection of the neoplasm  
class4	1628	fifteen patients were examined and treated for carotid body tumors at the cleveland  ohio  clinic foundation from 1979 through 1987  
class4	1628	the benchmark of diagnosis is bilateral carotid angiography  
class4	1628	when neural structures are free of tumor  meticulous dissection facilitates their preservation  
class4	1628	large tumor size increases risk for arterial resection necessitating reconstruction  
class4	1628	the use of a vascular shunt minimizes the risk of cerebral ischemia  
class4	1628	postoperative intravenous digital subtraction angiography allows for evaluation of arterial repair  
class4	1628	a retrospective review of 15 carotid body tumor resections performed in 14 patients revealed no evidence of tumor recurrence  no mortality associated with surgical intervention  no postoperative cerebrovascular accident  and limited morbidity associated with unavoidable sacrifice of neural elements  
class4	1629	unknown primary squamous cell carcinoma metastatic to the neck  
class4	1629	we analyzed retrospectively 157 cases of metastatic neck squamous cell carcinoma from unknown primary sites  treated with surgery  radiotherapy  excisional biopsy  and combined modalities  
class4	1629	median follow up was 74 months  and overall actuarial survival was 55  at 5 years  
class4	1629	the surgery treated group  despite a higher rate of manifesting primary tumors  had significantly better survival at 5 years compared with those receiving radiation therapy  of whom 23  had residual disease after treatment  
class4	1629	primary tumors were discovered during follow up in 16  overall  
class4	1629	different treatments yielded comparable results in lower staged neck disease  nx  n1  n2a   while surgery appeared more effective in controlling advanced disease  n2b  n3a   
class4	1629	factors that affected survival include neck stage  connective tissue invasion  and presence of recurrent or residual disease after treatment  
class4	1630	oncogene amplification in squamous cell carcinoma of the head and neck  
class4	1630	cellular oncogenes appear to be involved in the control of normal cell growth and differentiation  
class4	1630	the abnormal activation of these genes in naturally occurring and experimentally induced cancers may have an important role in the expression of the malignant phenotype in cancer cells  
class4	1630	mechanisms for the activation of these genes include chromosomal translocation  point mutation  and dna amplification  
class4	1630	the amplification of specific oncogenes correlates with clinical prognosis in several human malignancies  including breast cancer and neuroblastoma  
class4	1630	we examined 21 fresh frozen human squamous cell carcinomas of the aerodigestive tract for amplification of 10 known cellular oncogenes  c myc  n myc  l myc  n ras  h ras  k ras  erb b  erb b2  raf  and int 2   using southern blotting techniques  
class4	1630	eleven of 21 tumors demonstrated a two fold to 11 fold amplification of the int 2 oncogene  one member of a family of genes related to basic fibroblast growth factor  
class4	1630	amplification of c myc  a gene that codes for a dna binding protein involved in the regulation of cell growth  was seen in two tumors  
class4	1630	none of the other eight genes studied were amplified in any of the tumor specimens  
class4	1631	intraoperative radiation of canine carotid artery  internal jugular vein  and vagus nerve  therapeutic applications in the management of advanced head and neck cancers  
class4	1631	as a step in the application of intraoperative radiotherapy  iort  for treating advanced head and neck cancers  preliminary information was obtained on the radiation tolerance of the canine common carotid artery  internal jugular vein  and vagus nerve to a single  high dose electron beam  
class4	1631	both sides of the neck of eight mongrel dogs were operated on to expose an 8 cm segment of common carotid artery  internal jugular vein  and vagus nerve  
class4	1631	one side of the neck was irradiated  using escalating doses of 2500  3500  4500  and 5500 cgy  
class4	1631	the contralateral side of the neck served as the unirradiated control  
class4	1631	at 3 and 6 months after iort  one dog at each dose level was killed  
class4	1631	none of the dogs developed carotid bleeding at any time after iort  
class4	1631	light microscopic investigations using hematoxylin eosin staining on the common carotid artery and internal jugular vein showed no consistent changes that suggested radiation damage  however  the masson trichrome stain and hydroxyproline concentration of irradiated common carotid artery indicated an increase in the collagen content of the tunica media  
class4	1631	marked changes in the irradiated vagus nerve were seen  indicating severe demyelination and loss of nerve fibers  which appeared to be radiation dose dependent  
class4	1631	four patients with advanced recurrent head and neck cancer were treated with surgical resection and iort without any acute or subacute complications  
class4	1631	the role of iort as a supplement to surgery  external beam irradiation  and chemotherapy in selected patients with advanced head and neck cancer needs further exploration  
class4	1632	use of the levator scapulae muscle flap in head and neck reconstruction  
class4	1632	there are numerous techniques available for reconstruction of defects following composite resection of oral cavity and oropharyngeal tumors  
class4	1632	no single technique is applicable in all situations  
class4	1632	the levator scapulae muscle flap is well known for its application in carotid protection  
class4	1632	little attention is paid to its usefulness in other aspects of head and neck reconstruction  
class4	1632	we have been using the levator scapulae muscle flap for a variety of reconstructive problems  
class4	1632	the flap is useful for buttressing intraoral suture lines  closing intraoral defects  and providing soft tissue to fill in dead spaces and bulk out lateral and anterior oral defects  
class4	1632	the levator flap was found to be easy to elevate  safe  and reliable with a minimum of wound complications  
class4	1632	a review of 18 patients  representative case studies  and a discussion of surgical technique and relevant anatomy and blood supply is presented  
class4	1633	parotid duct communicating with a labial pit and ectopic salivary cyst  
class4	1633	labial pits are usually described as blind epidermal invaginations of lip mucosa with occasional drainage of minor salivary gland secretions  
class4	1633	a case of an aberrant parotid duct in communication with both a unilateral  commissural labial pit and an interposed salivary cyst is presented  
class4	1633	a 7 year old boy who had experienced lifelong clear drainage from a congenital pit at his right oral commissure developed fever  pain  and a submucosal mass of the right cheek over a 6 week period  
class4	1633	a preoperative sialogram through the pit demonstrated a communication between the oral commissure fistula  an intervening salivary cyst  and a proximal tract from the cyst to the parotid gland  
class4	1633	an en bloc resection of the pit  fistula tract  and cyst was performed through a transoral approach  
class4	1633	the dissection was medial to the buccinator muscle  
class4	1633	there has been no recurrence of the cyst after 1 year follow up  
class4	1633	a description of labial pits and parotid duct anomalies is presented  however  to our knowledge  this combination of anomalies has not been previously described  
class4	1634	intraventricular diamorphine via an ommaya shunt for intractable cancer pain  
class4	1634	we describe two patients in whom diamorphine was administered into the intraventricular space via an ommaya reservoir  producing excellent pain relief  
class4	1634	the use of this technique for long term administration of analgesia is reviewed  
class4	1635	radiobiological studies in the naevoid basal cell carcinoma syndrome  
class4	1635	the naevoid basal cell carcinoma syndrome is described in a 43 year old male  
class4	1635	the response of dividing fibroblasts from this patient to the lethal effects of ionizing radiation was indistinguishable from that of a normal control  mean inactivation dose  d    1 74 gy and 1 68 gy  respectively  
class4	1635	however  these cells were defective in the repair of potentially lethal damage  d   2 36 gy and 3 26 gy  respectively   
class4	1635	the response to radiation of go t lymphocytes derived from the patient was similar to that of the control  
class4	1635	the frequency of mutant circulating t lymphocytes resistant to 6 thioguanine was 17 x 10  6  which was elevated when compared with age matched controls  
class4	1635	these results suggest an abnormality in the response of the fibroblasts to ionizing radiation damage  
class4	1636	the significance of leu 8 negative t cells in lymphoid skin infiltrates  malignant transformation  selective homing or t cell activation  
class4	1636	the expression of leu 8 was studied on skin biopsies from a large group of patients with benign and malignant skin disorders and correlated with the expression of t cell differentiation antigens and activation markers  
class4	1636	the effect of in vitro stimulation of peripheral blood t cells and t cell subsets on the expression of leu 8 antigen was also determined  
class4	1636	in all the skin diseases studied an inverse relationship was found between the proportions of cells expressing leu 8 and hla dr  
class4	1636	a deficiency of leu 8 positive cells was not specific for mycosis fungoides  but was also found in several reactive dermatoses  
class4	1636	stimulation of peripheral blood cells with phytohaemagglutinin  pha   concanavalin a  con a   and anti cd3 pma resulted in a considerable decrease of leu 8 antigen expression on day 3 in both cd4  and cd8  t cells  
class4	1636	these data suggest that the low proportion of leu 8  t cells in mycosis fungoides and several reactive skin disorders is not related to malignant transformation or selective homing of leu 8  t cells  but probably results from local t cell activation  
class4	1637	pachyonychia congenita complicated by hidradenitis suppurativa  a family study  
class4	1637	a family is described in which five of the six members with the jackson lawler type of pachyonychia congenita also had varying degrees of hidradenitis suppurativa  
class4	1637	we suggest an association between this type of pachyonychia congenita and hidradenitis suppurativa  
class4	1638	leukaemia complicating treatment for hodgkin s disease  the experience of the british national lymphoma investigation  
class4	1638	objective  to determine the incidence of and risk factors for the development of secondary acute leukaemia and myelodysplasia in patients treated in british national lymphoma investigation s studies of hodgkin s disease since 1970  
class4	1638	patients  2676 patients entered into hodgkin s disease studies between february 1970 and november 1986  
class4	1638	data accrued up to november 1988 were analysed  ensuring a minimum follow up period of two years  
class4	1638	design  retrospective analysis of multicentre trial data by case control and life table methods  
class4	1638	results  17 cases of secondary leukaemia were recorded in this group of 2676 patients  giving an overall risk at 15 years of 1 7   
class4	1638	the risks of leukaemia after chemotherapy alone and chemotherapy with radiotherapy were not significantly different  
class4	1638	the risk of leukaemia increased sharply with the amount of treatment given as measured by the number of attempts at treatment  
class4	1638	the 15 year risks of leukaemia were 0 2   2 3   and 8 1  for patients receiving one  two  or three or more attempts at treatment  
class4	1638	the highest risk  22 8  at 15 years  was observed in patients treated with lomustine  ccnu   and a case control study suggested that this was an independent risk factor  
class4	1638	the risk of secondary leukaemia was largely related to the overall quantity of treatment  although exposure to lomustine seemed to be an important risk factor  
class4	1638	treatment with both drugs and radiation was not more leukaemogenic than treatment with drugs alone  
class4	1638	the greatest risk of secondary leukaemia was seen in multiply treated patients who were unlikely to be cured of hodgkin s disease  
class4	1638	conclusions  avoidance of secondary leukaemia should be a minor factor in the choice of treatment for hodgkin s disease  
class4	1639	dilatation in the duplex kidney  3 unusual cases  
class4	1639	dilatation in the upper limb of a duplex ureter is usually secondary to obstruction and may be associated with a ureterocele  
class4	1639	by contrast  vesicoureteric reflux is the usual cause of a dilated lower moiety ureter  
class4	1639	we report 3 cases in which unusual or complex causes of dilatation of 1 limb of a duplex ureter were demonstrated  
class4	1640	surgical approach to the retrocrural lymph nodes  
class4	1640	removal of retrocrural lymph nodes requires an approach other than the infradiaphragmatic retroperitoneal access generally used in the surgical management of testicular tumours  
class4	1640	the transperitoneal route given access  at best  to the origin of the superior mesenteric artery  but advanced testicular tumours occasionally require retrocrural node dissection  
class4	1640	we describe a useful surgical approach to these nodes and the underlying anatomy  
class4	1641	nonpigmented congenital iris stromal cyst  
class4	1641	a nonpigmented iris stromal cyst was observed in the right eye of a 6 week old girl  
class4	1641	there was no past history of trauma or use of topical miotics  and the remainder of the ocular examination was normal  
class4	1641	the pathophysiology and management of this rare developmental anomaly are controversial  
class4	1642	the patterns of care outcome study for cancer of the uterine cervix  results of the second national practice survey  
class4	1642	this report summarizes the outcome results of the patterns of care study  pcs  of cancer of the uterine cervix from 565 patients treated in 1978  
class4	1642	the 5 year survival with no evidence of disease was  stage i  74   stage ii  56   and stage iii  33   
class4	1642	the 5 year local in field failure rate was  stage i  12   stage ii  27   and stage iii  51   
class4	1642	extent of parametrial involvement  unilateral versus bilateral  may be important in determining survival and local failure  
class4	1642	the four year actuarial survival was 58  for unilateral involvement versus 47  for bilateral  p   0 06   and the local failure rate was 32  for unilateral versus 45  for bilateral  p less than 0 05   
class4	1642	when analyzed by stage  patients with stage iib disease with unilateral parametrial involvement showed a trend toward improved survival and decreased local failure compared with those with bilateral stage iib cancers  p   0 1   
class4	1642	the use of intracavitary irradiation significantly improved survival and reduced local failures  
class4	1642	furthermore  the number of intracavitary applications was important  
class4	1642	when two or more intracavitary applications were used compared with one application  local in field failure was significantly reduced  29  versus 17  at 4 years  p less than 0 001   and four year survival was improved  60  versus 73   p   0 01   
class4	1642	the four year actuarial rate of major complications depended on the stage  stage i  8   stage ii  15   and stage iii  13   
class4	1642	there was a statistically significant increase in major complications in patients undergoing laparotomy for staging versus no laparotomy 23  versus 11  at 4 years  p less than or equal to 0 01  and a trend toward increased major complications in patients who were thin or had prior abdominal surgery  
class4	1642	this study confirmed the stage dependent outcome of treatment of cancer of the uterine cervix with radiation and indicated that further division of stage iib to indicate prognostic significance of unilateral or bilateral parametrial involvement may be warranted  
class4	1642	this study also confirmed the importance of intracavitary radiation in optimizing control established by the 1973 pcs  
class4	1642	it further suggests that where possible  two intracavitary insertions may yield better results than one insertion  
class4	1643	the influence of autologous lymphokine activated killer cell infusions on the toxicity and antitumor effect of repetitive cycles of interleukin 2  
class4	1643	twenty patients with refractory malignancies were treated with a protocol evaluating the addition of ex vivo activated autologous lymphokine activated killer  lak  cells to a clinically tolerable interleukin 2  il 2  regimen  four weekly cycles of human recombinant il 2 at 3 x 10 6  u m2 day by continuous infusion for 4 days week   
class4	1643	sixteen patients completed their induction month of therapy  two had a partial response  six had stable disease  and eight had progressive disease  
class4	1643	four patients had clinical toxicity preventing completion of the induction month of therapy  and one of these patients died during therapy  
class4	1643	significant clinical toxicities included decreased performance status  weight gain  catheter related thromboses  infectious complications  fever  hypotension  and dyspnea or hypoxemia requiring oxygen  
class4	1643	thus  the addition of lak cell infusions to this il 2 regimen did not cause a noticeable change in antitumor response rate but did not cause more severe toxicity  
class4	1644	carboplatin in childhood brain tumors  a children s cancer study group phase ii trial  
class4	1644	between october 1985 and march 1988  children s cancer study group institutions entered 95 patients with recurrent brain tumors into a phase ii trial of carboplatin 560 mg m2 every 4 weeks  
class4	1644	complete or partial responses were observed for one of 19 evaluable children with brainstem glioma  two of 14 with ependymoma  six of 19 with medulloblastoma or central nervous system primitive neuroectodermal tumor  pnet   and none of 15 with high grade astrocytoma  
class4	1644	of 33 children with medulloblastoma  ependymoma  or central nervous system pnet  five of 12 with no prior cisplatin exposure had responses  and two of 21 with prior cisplatin exposure had responses  p   0 03   
class4	1644	thirty four percent of patients had absolute neutrophil count nadirs less than 500 microliters  and 37  had platelet count nadirs less than 25 000 microliters  
class4	1644	sixteen percent had moderate to severe otoxicity  10  had nausea and vomiting  and none had nephrotoxicity  
class4	1645	interferon alpha 2a and 5 fluorouracil for advanced colorectal carcinoma  assessment of activity and toxicity  
class4	1645	preclinical data showed that the cytotoxic effects of 5 fluorouracil  5 fu  are augmented by interferon  ifn   
class4	1645	in a small study  13 of 17 patients with advanced colorectal cancer responded to a regimen of 5 fu with ifn  
class4	1645	using the same dose and schedule as in this pilot study  38 previously untreated patients with metastatic colorectal carcinoma were treated with continuous intravenous  iv  infusion of 5 fu 750 mg m2 daily for 5 days  followed by weekly bolus 5 fu at 750 mg m2 and subcutaneous ifn at 9 million units three times per week  
class4	1645	of 35 evaluable patients  nine  26   had a partial response  95  confidence limit  11  to 41    with a median response duration of 7 5 months  range  4 4 to greater than 11 7 months   
class4	1645	seven patients  20   had a minor response  and ten  28   had stable disease  
class4	1645	the most common toxicities observed were stomatitis  52   and diarrhea  43    
class4	1645	neurotoxicity was seen in 34  of patients and consisted of gait disturbance  dizziness  confusion  memory loss  and dementia  
class4	1645	because of toxicity  84  of patients required a reduction of the ifn dose by at least 50   and 63  required reduction of the 5 fu dose by at least 25   
class4	1645	although the combination of 5 fu and ifn in patients with advanced colorectal carcinoma has some activity  the regimen was toxic  and the observed response rate  26   was not substantially superior to alternative 5 fu programs  
class4	1646	conservative surgery and radiation therapy for soft tissue sarcoma of the wrist  hand  ankle  and foot  
class4	1646	seventy eight patients with soft tissue sarcoma  sts  arising in the distal extremities  wrist  hand  finger  ankle  foot  and toe  who were treated with conservation surgery and radiation therapy were studied retrospectively with respect to survival  local recurrence  functional limb preservation  complications  and distant metastasis  
class4	1646	after a median follow up of 7 9 years  actuarial 5 year and 10 year survival rates were 80  and 69   respectively  and disease free rates were 61  and 51  at the same times  
class4	1646	actuarial local control rates were 80  and 74  at 5 and 10 years  respectively  
class4	1646	fifteen patients  19   had local recurrence  but 12 of these were salvaged  
class4	1646	ultimately  53 patients  68   retained a normal or fairly normal extremity  six  8   needed amputation for complications  and 13  17   needed amputation to control recurrent disease  
class4	1646	the functional outcome was significantly better for patients with upper extremity lesions than for those with lower extremity tumors  even for the latter  this treatment strategy was preferable to amputation  
class4	1646	the incidence of hematogenous metastases from distal extremity sarcomas depends on the size of the primary tumor  
class4	1646	it was concluded that conservation surgery and radiation therapy  xrt  is an acceptable treatment strategy for sts arising in distal extremities  it yielded a high rate of disease control and functional limb preservation  
class4	1647	multiagent chemotherapy in relapsed acute lymphoblastic leukemia in children  
class4	1647	twenty seven evaluable children with early first bone marrow relapse of acute lymphoblastic leukemia were treated with an intensive induction consolidation and ongoing maintenance therapy  
class4	1647	induction therapy consisted of a 35 day course of daunomycin  vincristine  and prednisone  immediately followed by teniposide  cytosine arabinoside  ara c   and l asparaginase  
class4	1647	intrathecal methotrexate  hydrocortisone  and ara c were given through the induction consolidation phase  
class4	1647	twenty three of 27 patients achieved remission by the end of induction consolidation  
class4	1647	maintenance with the same drugs in a modified dosage schedule continued for approximately 2 years  
class4	1647	a small subgroup of patients who were m3 at day 35 but m1 at day 56  end of induction consolidation  and had a cumulative event free survival  efs  of only 0 40 at 6 months  all had relapsed by 15 months  
class4	1647	however  the efs for m1 patients by day 35 and maintained on chemotherapy was 0 64 at 12 months and 0 32 at 30  36  and 48 months  respectively  
class4	1647	although good reinduction and remission duration rates at 12 to 24 months were achieved and an apparent plateau in survival occurs at 30 months  fall off in survival would not be unexpected with probably less than 20  alive after 5 years  
class4	1648	a standard dose of radiation for  microscopic disease  is not appropriate  
class4	1648	elective irradiation of sites of potential occult tumor spread is often part of a patient s radiation therapy program  
class4	1648	the required radiation dose  d  depends on the probability that occult disease exists  p occ    the number of sites at risk  a   the number of tumor clonogens present  ni   their radiation sensitivity  and the desired control rate  
class4	1648	an exponential model of cell survival is used to quantify the importance of these factors  
class4	1648	control probability    1   pocc x  1   e ni x  sf2 d 2  a  sf2   surviving fraction after 2 gy  
class4	1648	implications for clinical radiation therapy include  1  
class4	1648	since the number of clonogens in an occult site may vary from 10 degrees to 10 8   ni is the major determinant of the required dose  
class4	1648	the intrinsic radiation sensitivity of the clonogens  sf2  is also extremely important in determining the dose  
class4	1648	other factors are less influential since they vary less  
class4	1648	2  
class4	1648	the variability of ni  8 logs  is larger than the variation in cell number seen with gross disease  1 cm3 versus 1000 cm3  3 logs   
class4	1648	when ni approximately 10 8   the required dose approaches that needed for small volume gross disease  10 9  cells  1 cm3   
class4	1648	3  
class4	1648	the dose prescribed to elective sites should reflect the risk of occult disease based on the primary tumor site  stage  and grade  
class4	1648	4  
class4	1648	regions where clinicoradiologic evaluation is difficult  e g   pelvis and obese neck  require higher doses because macroscopic tumor deposits may exist  
class4	1648	5  
class4	1648	relatively low doses  10 to 30 gy  are often thought to be inadequate for microscopic tumor  
class4	1648	however  similar doses have been reported to sterilize microscopic tumor in ovarian  rectal  bladder  breast  and head and neck carcinomas  
class4	1648	relatively low doses should not be discounted since they may be useful in select cases when normal tissue tolerances and or previous irradiation treatment limit the radiation dose  
class4	1649	primary central nervous system lymphoma in a pediatric patient with acquired immune deficiency syndrome  treatment with radiation therapy  
class4	1649	primary central nervous system  cns  lymphoma  an otherwise rare pediatric tumor  has been reported with increasing frequency in children with acquired immune deficiency syndrome  aids   
class4	1649	with current therapy  the outcome of this disease is invariably fatal  
class4	1649	the authors present a case of primary cns lymphoma in a 3 5 year old girl with aids who received treatment with total brain irradiation  
class4	1649	after treatment  the patient s mental status improved  the seizures resolved  and she had no further progression of her neurologic symptoms until she died of pneumonia 6 months later  
class4	1649	the autopsy revealed a necrotic mass at the site of the original tumor  
class4	1649	the brain stem and spinal cord  unirradiated  contained lymphomatous lesions  
class4	1649	the patient had extensive fibrinoid necrosis and leukoencephalopathy that were consistent with radiation induced cns damage  
class4	1649	coexisting aids encephalopathy also contributed to the patient s cns injury  
class4	1649	effective palliation of cns lymphoma in children with aids may be obtained with cranial irradiation  
class4	1649	pediatric aids patients may show more severe tissue effects from irradiation than unaffected children  
class4	1650	131i treatment of thyroid papillary carcinoma in a patient with renal failure  
class4	1650	procedures for 131i ablation in renal failure are not known  
class4	1650	in one patient receiving dialysis  detailed dosimetry and health safety aspects were obtained  
class4	1650	the results showed insignificant contamination of equipment  but a surprisingly significant reduction in biologic half life of 131i due to efficient dialysis extraction  
class4	1650	the data indicate that 131i ablation can be done safely and easily during dialysis but that much higher 131i doses must be used to achieve equivalent results to those obtained in patients with normal renal function  
class4	1651	the interplay of local and distant control in the cure of cervical cancer  
class4	1651	from 1978 to 1986  183 women with cervical cancer received definitive radiation therapy after extraperitoneal surgical staging  
class4	1651	relapse free rates were strong functions of pelvic lymph node metastases and cervical size  
class4	1651	the recurrence distribution consisted of 4  isolated local  13  isolated distant  and 17  combined local and distant failures  
class4	1651	with the assumption of independent local and distant failure probabilities  suit et al  s method was extended to assess potential improvement in cure attainable with perfect local and distant control  yielding local  lsa  and distant  dsa  survival advantages of 17  and 28   
class4	1651	various subsets of clinical stage  cervical size  pelvic node metastases  periaortic metastases  and peritoneal metastases had lsa from 12  to 27  and dsa from 12  to 71   
class4	1651	for any prognostic group  lsa never exceeded dsa  showing that effective systemic therapy would have a greater impact on improving survival than would advances in local and regional tumor control  
class4	1651	therapeutic implications and limitations of the extended lsa dsa model are discussed  
class4	1651	this form of analysis can be used to guide the intensity of local and distant treatment to maximize the cure of the patient with cancer  
class4	1652	the role of elective lymph node dissection in the management of patients with thick cutaneous melanoma  
class4	1652	a retrospective search of patients seen at the duke melanoma clinic from 1970 to 1986 identified 308 clinically stage i patients  with 4 0 to 10 0 mm cutaneous melanomas  
class4	1652	five year and ten year survival was 56  and 43   respectively  
class4	1652	elective lymph node dissection  elnd  was done in 116 patients  37 7    there was no difference in disease free interval  dfi  or survival between these patients versus patients treated with wide excision only  p   0 9   
class4	1652	thirty two patients  27 6   had pathologically positive nodes on elnd  
class4	1652	these patients had a shorter dfi  p   0 05  and survival  p   0 03  compared with patients with negative node dissections  
class4	1652	when further divided by breslow s thickness  this difference persisted in patients with 4 0 to 6 0 mm lesions  p   0 01   
class4	1652	however  for thicker lesions  greater than 6 0 mm   there was no difference in survival between the node negative and node positive groups  p   0 9   
class4	1652	the mean follow up was 7 1 years  
class4	1652	elective lymph node dissection was not done in 192 patients  78 of these recurred first in the regional nodes  
class4	1652	these 78 patients were compared with the 32 patients who had pathologically positive nodes by elnd to see if patient survival was improved by early removal of nodal disease  
class4	1652	there was no difference in dfi  p   0 5  or survival  p   0 3  between these two groups  
class4	1652	it is concluded that elnd may provide prognostic information for patients with thick cutaneous melanomas  
class4	1652	however  there was no change in dfi or ultimate survival when patients were followed  and nodes removed when clinically positive  
class4	1652	the authors do not recommend elnd for patients with thick melanomas because the risk of distant metastases outweighs any benefit of regional node dissection  
class4	1653	endoscopic and radiographic evaluation of the murine colon  
class4	1653	endoscopic and radiographic techniques have not been widely applicable in the evaluation of chemically induced murine colon cancer  
class4	1653	the authors investigated methods of cleansing the rat colon and refined endoscopic and radiographic techniques  
class4	1653	they compared total colonoscopy  tc  and air contrast  acbe  and single contrast barium enema  scbe  findings with those obtained at necropsy in rats with 1 2 dimethylhydrazine  dmh  induced colon cancer  
class4	1653	gastrograffin enemas with bisacodyl suppositiories showed complete evacuation of solid feces  
class4	1653	sprague dawley rats treated with dmh had their colons cleansed and then underwent tc  5 0 mm olympus bronchoscope  and either scbe or acbe  
class4	1653	colonoscopy and acbe were equally sensitive  81 5  and 76 3   respectively   although scbe was significantly insensitive in identifying lesions  p less than 0 001   
class4	1653	this study demonstrates that   1  mechanical cleansing of the rat colon is feasible   2  tc and barium radiology can be done routinely after mechanical cleansing  and  3  tc and double contrast be are sensitive in identifying colon lesions  
class4	1653	these techniques will provide a means for manipulation of murine tumors and in vivo surveillance  
class4	1654	immunohistochemical differentiation of basal cell epithelioma from cutaneous appendages using monoclonal anti glycoprotein antibody tnkh1  its application in mohs  micrographic surgery  
class4	1654	tnkh1  which was primarily developed to detect differentiated melanocytic tumor cells  was found to recognize basal keratinocytes of hair follicle and some basal keratinocytes of human epidermis  
class4	1654	thus  tnkh1 decorated the basal cells of following structures  epidermis  39 of 54  only part of each specimen  opes    upper hair follicle  one of 24  opes   lower hair follicle  21 of 21  very high rate of each specimen  vhes    sebaceous duct  14 of 15  vhes   sebaceous gland  ten of 14  germinative cells near duct   eccrine duct  three of 19  opes   
class4	1654	epithelial tumors  considered to be derived from or differentiating toward hair follicle such as trichilemmoma  one of one  vhes  and basal cell epithelioma  bce   32 of 32  vhes  were labeled not only in the peripheral cells but in their entirety  
class4	1654	on the other hand  epidermal tumors  such as seborrheic keratosis  ten of 11  opes   actinic keratosis  two of three  opes   and squamous cell carcinoma  one of two  opes   showed an irregular peripheral basal cell staining as in normal epidermis  
class4	1654	the apocrine sweat apparatus and eccrine secretory portion were negative  
class4	1654	eccrine ductal tumors such as syringoma  two tested   eccrine acrospiroma  one   and eccrine carcinoma  two  were tnkh1 negative  
class4	1654	taking advantage of this total labeling of bce versus peripheral labeling of the hair follicle  the authors could distinguish bce tissue from other structures clearly  
class4	1654	among confusing structures the upper hair follicle and the eccrine duct were excluded easily because of their negative staining with tnkh1  
class4	1654	the lower hair follicle was tnkh1 positive but only in the outer basal layer  whereas the bce was tnkh1 positive in its entire basaloid cells  
class4	1654	the result indicated that tnkh1 will be a useful antibody in mohs  micrographic surgery  
class4	1655	immunohistochemical demonstration of the placental form of glutathione s transferase  a detoxifying enzyme in human gliomas  
class4	1655	expression of the human placental form of glutathion s transferase  gst pi  in human gliomas was investigated by immunohistochemical methods  and the result was compared with that of normal human glial cells  
class4	1655	the gliomas in this study were composed of five benign astrocytomas  grade 2   ten anaplastic astrocytomas  grade 3   and 16 glioblastomas  grade 4   
class4	1655	normal human glial cells showed only a weak immunostaining response for gst pi in the cytoplasm or some nuclear membranes  
class4	1655	all of benign astrocytomas had diffusely weak gst pi immunostaining  resembling that of normal glial cells  
class4	1655	with increasing grade  gliomas showed a strongly positive reaction for gst pi  
class4	1655	the positive reactions were remarkable especially in the gemistocytes and giant cells in the high grade gliomas  
class4	1655	these results suggest that cells of gliomas have some detoxifying function and the expression of this detoxifying enzyme  gst pi  is related to the degree of malignancy of the gliomas  
class4	1656	helicobacter pylori and gastric carcinoma  serum antibody prevalence in populations with contrasting cancer risks  
class4	1656	this investigation examined the correlation between helicobacter pylori  hp  infection  as reflected in immunoglobulin g serum antibodies  and the risk of gastric cancer  
class4	1656	serum samples were obtained from populations with contrasting gastric cancer risks  
class4	1656	the highest prevalence of hp infection  93   was observed in the adult population at highest gastric cancer risk  the residents of pasto  colombia  
class4	1656	in the lower risk colombian city of cali  a 63  overall prevalence rate was found  
class4	1656	both children and adults were sampled in new orleans  louisiana  where gastric cancer rates are high for blacks but not for whites  
class4	1656	the prevalence of hp infection was significantly higher in black than in white adults  70  versus 43   p   0 0001  
class4	1656	a higher prevalence was also detected in black compared with white children  49  versus 32   p   0 01  however  an even greater disparity was noted when comparing children from two hospitals  regardless of race  which serve different socioeconomic groups  
class4	1656	a prevalence rate of 54  was found at charity hospital compared with 24   p   0 0001  at children s hospital  
class4	1656	our findings indicate that socioeconomic conditions  known to influence gastric cancer risk  are also important determinants of hp infection  
class4	1657	expression of placental alkaline phosphatase in gastric and colorectal cancers  an immunohistochemical study using the prepared monoclonal antibody  
class4	1657	the authors developed monoclonal antibodies  moab  against human placental alkaline phosphatase  plap   
class4	1657	four specific moab reacting only with plap and two nonspecific moab reacting equally with isozymes of alkaline phosphatase  hepatic  intestinal  and placental  were obtained  
class4	1657	immunohistochemical staining with the specific moab showed that the cell membrane and cytoplasm of cancer cells were stained in gastric and colorectal carcinoma  
class4	1657	the incidence of plap positivity was 23   25 of 107  of all gastric carcinomas  
class4	1657	among gastric carcinomas  the 42   13 of 31  positivity of highly differentiated carcinoma  papillary adenocarcinoma and well differentiated tubular adenocarcinoma  was a significantly higher rate than that found in poorly differentiated carcinoma  poorly differentiated adenocarcinoma and signet ring cell carcinoma  five of 41  12    
class4	1657	the incidence of plap positivity was 11   four of 35  in colorectal carcinoma  
class4	1657	in contrast  gastric adenoma  intestinal metaplasia  and noncancerous tissue adjacent to cancer did not show staining  
class4	1657	these results indicated that expression of plap was apt to occur in more highly differentiated gastric carcinoma and was highly specific for carcinoma in the gastrointestinal tract  although its incidence was not high  
class4	1658	prognostic significance of type iv collagen and laminin immunoreactivity in urothelial carcinomas of the bladder  
class4	1658	invasion of a carcinoma involves the degradation and penetration of the subepithelial basement membrane  bm   
class4	1658	this phenomenon might be used for histopathologic evaluation of neoplasms of the bladder  
class4	1658	the authors studied the clinicopathologic data and tissue specimens of 125 cases of urothelial carcinomas collected prospectively  
class4	1658	penetration of the bm was evaluated by immunohistochemical staining of the bm components laminin and type iv collagen  
class4	1658	the use of this parameter as a prognostic indicator in bladder cancer was assessed  
class4	1658	the 5 year survival rate of patients having tumors with an interrupted or absent bm was significantly lower than that of patients having tumors with an intact bm  
class4	1658	the rate of progression was greater in tumors with an interrupted or absent bm than in tumors with an intact bm  
class4	1658	no association was found between bm status and recurrence  
class4	1658	however  a significant correlation between tumor stage and bm staining was found  
class4	1658	a correlation was also found between ploidy and bm staining as well as between histologic grade and bm staining pattern  
class4	1658	when evaluating histologic grade  stage  ploidy  age  and bm score as prognostic parameters  the stage of bladder carcinomas turned out to be the most important factor in predicting the survival rate and the progression free survival  
class4	1658	however  bm staining was found to be of value for early identification of microinvasion and is helpful for correct staging of urothelial carcinomas  
class4	1659	primary breast lymphoma  an immunohistologic study of 20 new cases  
class4	1659	primary malignant lymphomas of the breast  pbl  are uncommon  
class4	1659	the authors report the clinical  histologic  and immunoperoxidase findings on 20 cases recorded at the alberta cancer registry over the last 23 years  
class4	1659	these cases were then added to material on 257 cases abstracted from the literature and analyzed  
class4	1659	it was found that there are two clinicopathologic types of pbl  
class4	1659	the first affects pregnant or lactating women with bilateral  diffuse disease  is rapidly fatal  and corresponds histologically to a burkitt s type lymphoma  
class4	1659	the second is unilateral at presentation and afflicts a broad age range  but primarily older women  
class4	1659	this has a variable course only part of which is predicted by histologic grade and stage  
class4	1659	tumor size  treatment  and side of presentation were not found to be significant prognostic factors  
class4	1659	histologically  these tumors can be grouped into large cell b cell lymphomas  monocytoid b cell lymphomas  mbcl   and undifferentiated  some of which may be t cell  
class4	1659	evidence suggesting that the mbcl of breast are the equivalent of the malignant lymphomas of the mucosa associated lymphoid tissues  malt  is reviewed  
class4	1659	the breast is a hormone dependent member of the malt and therefore it is interesting that two of these tumors were strongly positive for estrogen receptors  
class4	1660	estrogen receptor localization in normal and neoplastic epithelium of the uterine cervix  
class4	1660	to investigate the estrogen receptor  er  status of cells during carcinogenesis of the uterine cervix  the immunohistochemical reactivity for a monoclonal anti er antibody  h 222  was studied in 26 normal cervical specimens  21 cases of cervical intraepithelial neoplasia  cin   and 21 cases of invasive cervical carcinoma  
class4	1660	in addition  the presence of human papillomavirus  hpv  dna  types 6 11  16 18  or 31 33 35  was analyzed by in situ hybridization  
class4	1660	in the normal cervix  basal cells of the squamous epithelium  metaplastic cells  and endocervical glandular cells were er positive  
class4	1660	in contrast  neoplastic cells of cin  17 of 21 cases  and invasive carcinoma  19 of 21 cases  were er negative  
class4	1660	the remaining four cases of cin and two cases of invasive carcinoma were focally er positive  
class4	1660	the hpv dna analysis revealed that hpv dna in er negative cases was either types 16 18 or undetectable  but all er positive neoplasms contained hpv dna types 31 33 35  
class4	1660	these results suggest that most neoplastic cells in cin and invasive cervical carcinoma lose their er expression and that this may be related to the hpv dna types which they possess  
class4	1661	cancer antigen 125  carcinoembryonic antigen  and carbohydrate determinant 19 9 in ovarian tumors  
class4	1661	the authors studied data of combination assays of tumor markers  because simultaneous elevation of different types of tumor markers in the serum was puzzling  
class4	1661	they interpreted such phenomena regarding cancer antigen 125  carcinoembryonic antigen  and carbohydrate determinant 19 9 in ovarian tumors  
class4	1661	the tissue expression of the antigens was compared with preoperative serum levels  
class4	1661	several different factors were found to cause the simultaneous elevation of two or three of these markers in the serum  
class4	1661	furthermore  even when the levels of some of the tumor markers were raised in the serum  the ovarian tumor did not always produce the marker by itself  
class4	1661	this study indicates that immunohistochemical identification of a marker in tumor tissue is prerequisite to the use of that marker in the serum to monitor disease status  
class4	1662	chondrolipoangioma  a cartilage containing benign mesenchymoma of soft tissue  
class4	1662	the clinical and pathologic features of four cases of benign mesenchymoma in which mature cartilage represented the predominant component are reported  
class4	1662	the distinctive histologic feature in all four cases was a lobular proliferation of cartilaginous tissue exhibiting a spectrum of hyaline cartilage  fibrocartilage  myxoid cartilage  and cartilage with ossification and even bone marrow formation  intimately associated with mature adipose tissue and vascular elements  
class4	1662	the localization of these tumors was in the proximity of a bone  but not attached to the periosteum or in continuity with a joint  
class4	1662	because these lesions may be mistaken for other cartilaginous neoplasms of soft tissue  recognition of this entity has potentially important diagnostic and therapeutic implications in that mutilating surgery may be avoided  
class4	1663	dentofacial development in long term survivors of acute lymphoblastic leukemia  a comparison of three treatment modalities  
class4	1663	ninety seven children who were diagnosed with acute lymphoblastic leukemia before 10 years of age and treated with chemotherapy alone  chemotherapy plus 1800 cgy cranial irradiation  rt   or chemotherapy plus 2400 cgy rt were evaluated for effects of therapy on dentofacial development  
class4	1663	all patients were seen at least 5 years postdiagnosis  
class4	1663	dental abnormalities were determined from panoramic radiographs  and craniofacial evaluations were made from lateral cephalometric radiographs  
class4	1663	ninety one  94   of all patients and 41  100   of patients younger than 5 years of age at diagnosis had abnormal dental development  
class4	1663	the severity of these abnormalities was greater in children who received treatment before 5 years of age and in those who received rt  
class4	1663	observed dental abnormalities included tooth agenesis  arrested root development  microdontia  and enamel dysplasias  
class4	1663	craniofacial abnormalities occurred in 18 of 20  90   of those patients who received chemotherapy plus 2400 cgy rt before 5 years of age  
class4	1663	mean cephalometric values of this group showed significant deficient mandibular development  
class4	1663	the results of this study suggest that the severity of dentofacial developmental abnormalities secondary to antileukemia therapy are related to the age of the patient at the initiation of treatment and the use of cranial rt  
class4	1664	clinical and prognostic assessment of patients with resected small peripheral lung cancer lesions  
class4	1664	one hundred fifteen patients with small  less than or equal to 2 cm in diameter  peripheral lung cancer lesions underwent surgical treatment in the department of surgery  the research institute for chest diseases and cancer  tohoku university  miyagi prefecture  japan  
class4	1664	the authors investigated several prognostic factors of these cases  
class4	1664	the 5 year survival rate of these 115 patients was 70   
class4	1664	various factors such as histologic type  nodal involvement  pleural involvement  pathologic stage  and curativity of the operation were revealed to affect survival significantly  
class4	1664	in patients with and without nodal involvement  there was no significant difference between the survival rate of patients with lung cancer lesions smaller than 2 cm and those with lesions 2 1 to 3 cm  
class4	1664	however  the rate of lymph node metastasis was significantly different in the group with lesions smaller than 2 cm compared with those with lesions 2 1 to 3 cm  21  versus 43   respectively   
class4	1665	choroid plexus tumors in the breast cancer sarcoma syndrome  
class4	1665	choroid plexus neoplasms are rare epithelial tumors of the central nervous system  
class4	1665	a carcinoma of the choroid plexus occurred in a child from a family with the breast cancer sarcoma syndrome  li fraumeni or sbla syndrome   an inherited condition characterized by the development of diverse neoplasms  sarcoma  breast cancer  brain tumors  leukemia  adrenal cortical carcinoma  and others   
class4	1665	choroid plexus carcinomas were identified in two kindreds previously reported with the syndrome  
class4	1665	the literature contains reports of choroid plexus neoplasms occurring in families and in individuals with multiple primary tumors  
class4	1665	choroid plexus neoplasm may be a manifestation of the inherited proclivity to tumor development in the breast cancer sarcoma syndrome  
class4	1666	fallopian tube cancer  the roswell park experience  
class4	1666	sixty four patients with primary fallopian tube cancer treated at roswell park memorial institute from 1964 to 1987 underwent retrospective clinicopathologic review  
class4	1666	in 40 patients fallopian tube cancer was the only primary  but in 24 patients primary fallopian tube cancer was part of a multifocal upper genital tract malignancy  
class4	1666	of the 40 patients with unifocal fallopian disease  the median survival was 28 months  
class4	1666	only 15  of patients were alive and disease free with follow up ranging from 22 to 141 months  median  90 5 months   
class4	1666	survival was not associated with stage of disease  tumor histology  grade  or depth of invasion in this series  
class4	1666	fourteen patients who received cisplatin based chemotherapy were evaluable for response  
class4	1666	three patients  21   responded  two complete and one partial  
class4	1666	twelve patients without clinical evidence of disease underwent second look procedures  ten laparotomy and two laparoscopy  
class4	1666	four of ten second look laparotomies were negative  
class4	1666	secondary debulking was done in three of four patients with gross disease  one of which had a negative third look laparotomy  
class4	1666	negative laparotomy  second look or third look  was associated with improved survival  p   0 016   
class4	1666	one of the two laparoscopies was negative  but the patient recurred  
class4	1666	in the remaining 24 patients cancer of the fallopian tube was part of a multifocal upper genital tract malignancy  
class4	1666	in 12 patients tubal disease was invasive  and in 12  it was in situ  
class4	1666	separate primaries occurred in the ovaries  n   20   uterus  n   7   and cervix  n   2   
class4	1666	this represents 1 3  of ovarian malignancies treated at roswell park memorial institute during the study period  
class4	1666	fallopian tube cancer seems as virulent as ovarian cancer with few long term survivors  
class4	1666	it is frequently associated with other sites of upper genital tract malignancy  
class4	1666	second look laparotomy is an important predictor of survival  
class4	1666	second look laparoscopy may be useful if positive  
class4	1667	true hermaphrodite with bilateral ovotestes  bilateral gonadoblastomas and dysgerminomas  46 xx 46 xy karyotype  and a successful pregnancy  
class4	1667	the first case  to the authors  knowledge  is reported of a true hermaphrodite with bilateral ovotestes  bilateral gonadoblastomas and dysgerminomas  a 46  xx 46 xy karyotype  and a successful pregnancy  
class4	1667	the true hermaphroditism was diagnosed during infancy  
class4	1667	the patient was subsequently found to have a gonadoblastoma and a microscopic dysgerminoma in the gonad diagnosed as an ovotestis and excised during infancy  
class4	1667	the successful pregnancy occurred when the patient was 29 years old  
class4	1667	a year later a large gonadal tumor affecting the remaining gonad was excised  
class4	1667	the gonad was found to be an ovotestis  and the tumor was a dysgerminoma arising from a gonadoblastoma  
class4	1667	this case further emphasizes the malignant potential of the y chromosome in patients with abnormal gonads  
class4	1668	extrahepatic metabolism of morphine occurs in humans  
class4	1668	the pharmacokinetics of morphine was studied in six patients in whom a radiologic localization of an insulinoma was to be performed under general anesthesia  
class4	1668	sampling was done in the peripheral artery  the mesenteric vein in five of the six patients  the hepatic vein  and the peripheral vein  as well as in urine  
class4	1668	hepatic blood flow was estimated by an indocyanine green infusion technique at the end of the radiologic procedure  
class4	1668	morphine terminal half life was 92     9 minutes  total body clearance was 1260 ml min 1  and the hepatic extraction ratio was 0 65     0 11  
class4	1668	no concentration gradient was observed between the artery and the superior mesenteric vein  showing that no gut wall metabolism of morphine occurred  
class4	1668	the total body clearance exceeded the hepatic clearance by 38   
class4	1668	it was concluded that the extrahepatic extraintestinal clearance of morphine probably occurred through the kidney  
class4	1669	insulin like growth factor binding protein secretion by breast carcinoma cell lines  correlation with estrogen receptor status  
class4	1669	breast tumor cell lines have been shown to secrete several distinct polypeptide growth factors  although conflicting results exist for the insulin like growth factors  igfs   
class4	1669	in contrast a limited number of breast tumor cell lines have definitely been shown to secrete the high affinity igf binding proteins  igfbps  that modify igf actions  
class4	1669	to characterize the types of igfbps that are secreted by breast tumor cell lines  conditioned medium was collected from seven separate tumor cell lines  three of which were estrogen receptor  er  negative  and four of which were er positive  
class4	1669	all three of the er negative cell lines  mda 231  mda 330  and hs578t  secreted binding proteins of 49 000 and 43 000 mr  igfbp 3  as well as 29 000  igfbp 1  and 24 000 mr  
class4	1669	in contrast  all four er positive cell lines secreted 34 000  igfbp 2  or 24 000 mr forms  and none secreted the 49 000 and 43 000 or 29 000 mr forms  
class4	1669	bt 20  a cell line that is positive for er messenger rna  mrna  but negative for er protein  secreted predominantly a 34 000 mr protein  
class4	1669	the amount of total igfbp activity released in 24 h ranged between 0 4 and 5 6 nm equivalents of igfbp 1  and there was no significant difference between the er positive and negative cell lines  
class4	1669	the mcf 7 cells that produced predominantly 34 000 and 24 000 mr forms showed a 1 8 fold increase in igfbp secretion after estrogen stimulation  
class4	1669	immunoblotting and a specific ria for igfbp 1 showed that only the er negative lines mda 330  mda 231  and hs578t secreted this form  
class4	1669	northern blotting analysis for the mrna encoding this protein showed that both mda 330 and mda 231 contained a single 1 6 kilobase mrna species that hybridized with an igfbp 1 complementary dna  cdna  probe  
class4	1669	immunoblotting analysis of the other cell lines showed that only the 34 000 mr form secreted by the er positive cell lines reacted with igfbp 2 antisera  
class4	1669	exposure of the conditioned media from the three er negative cell lines to n glycanase revealed that the 49 000 and 43 000 mr forms of igfbp were glycosylated and therefore probably represent igfbp 3  
class4	1669	we conclude that er negative cell lines secrete three forms of igfbps  igfbp 1  igfbp 3  and a 24 000 mr form  
class4	1669	in contrast  the er positive cell lines secrete predominantly igfbp 2 and the 24 000 mr form but do not secrete igfbp 3 or 1  abstract truncated at 400 words   
class4	1670	a simple and sensitive microtiter plate estrogen bioassay based on stimulation of alkaline phosphatase in ishikawa cells  estrogenic action of delta 5 adrenal steroids  
class4	1670	we have developed an estrogen bioassay using the ishikawa human endometrial adenocarcinoma cell line growing in 96 well microtiter plates  
class4	1670	alkaline phosphatase enzyme activity  alkp  in these cells is markedly stimulated by estrogens  and this enzyme can be easily quantified in situ using a chromogenic substrate  
class4	1670	these cells are very sensitive to estrogens  estradiol induces alkp at levels as low as 10  12  m  
class4	1670	antiestrogens completely block the action of estradiol  
class4	1670	various estrogens stimulate alkp with potencies comparable to those achieved in vivo  
class4	1670	the induction of alkp is specific for estrogens  no other type of steroid  including androgens  progestins  mineralocorticoids  or glucocorticoids produce this effect  
class4	1670	the stimulation of alkp in ishikawa cells is specific for estrogens  is highly reproducible and sensitive  and permits large numbers of samples to be assayed with ease  
class4	1670	we have used this assay to investigate the estrogenic action of the adrenal delta 5 3 beta hydroxysteroids  
class4	1670	while pregnenolone is inactive  dehydroepiandrosterone and its sulfate ester induce alkp slightly  
class4	1670	however  the c19 steroid  5 androstene 3 beta  17 beta diol is considerably more estrogenic in this assay  although it stimulates ishikawa alkp with a potency of 1 30 000 that of estradiol  
class4	1670	the stimulation by 5 androstene 3 beta 17 beta diol is inhibited by antiestrogens  but it is not blocked by the delta 5 3 beta hydroxysteroid isomerase dehydrogenase inhibitor  cyanoketone  or by the aromatase inhibitor  4 hydroxy androstenedione  
class4	1670	thus  neither conversion to a delta 4 3 ketone nor aromatization is required for the action of this unusual estrogen  
class4	1671	alterations in opioid parameters in the hypothalamus of rats with estradiol induced polycystic ovarian disease  
class4	1671	the distribution and density of selectively labeled mu   delta   and kappa opioid binding sites were examined by in vitro radioautography in the hypothalamus of normal  estradiol valerate  ev  injected  and estradiol  e2  implanted female rats  
class4	1671	hypothalamic beta endorphin concentration was also examined by ria in these three groups of animals  
class4	1671	quantitative analysis of film radioautographs demonstrated a selective increase in mu opioid binding in the medial preoptic area of ev treated  but not of e2 implanted rats  
class4	1671	however  both these estrogenized groups exhibited a reduction in the density of delta opioid binding in the suprachiasmatic nucleus  
class4	1671	statistically significant changes between either estrogenized groups were not observed for kappa opioid binding  
class4	1671	results on the hypothalamic concentration of beta endorphin indicated a marked reduction in ev injected animals with respect to controls  
class4	1671	in contrast  the e2 implanted animals exhibited beta endorphin concentrations similar to controls  
class4	1671	the present results confirm the increase in opioid receptor binding previously reported in the hypothalamus of ev treated rats and further demonstrate that this increase is confined to the medial preoptic area and exclusively concerns mu opioid receptors  
class4	1671	the concomitant reduction in beta endorphin levels observed in the same group of animals suggests that the observed increase in mu opioid binding could reflect a chronic up regulation of the receptor in response to compromised beta endorphin input  
class4	1671	given the restriction of this effect to the site of origin of lhrh neurons and the demonstrated inhibitory role of opioids on lhrh release  it is tempting to postulate that such up regulation could lead to the suppression of the plasma lh pattern that characterizes polycystic ovarian disease in the ev treated rat  
class4	1672	rapid inactivation and phosphorylation of pyroglutamyl peptidase ii in y 79 human retinoblastoma cells after exposure to phorbol ester  
class4	1672	pyroglutamyl peptidase ii  ec 3 4 19     a membrane bound metalloproteinase  is a highly specific trh degrading enzyme  
class4	1672	exposure of y 79 human retinoblastoma cells to 12 0 tetradecanoyl phorbol 13 acetate  tpa  decreased the activity of this enzyme in a time  and concentration dependent manner  ic50 5 x 10  9  m   
class4	1672	after 15 min of tpa treatment  only 10  of pyroglutamyl peptidase ii activity remained  
class4	1672	tpa treatment did not affect the activity of the cytosolic enzyme pyroglutamyl peptidase i  ec 3 4 19 3  or the membrane bound enzyme dipeptidyl peptidase iv  ec 3 4 19 3   
class4	1672	pretreatment of the cells with the protein kinase c inhibitors h 7 or sphingosine prevented the inactivation of pyroglutamyl peptidase ii by tpa  
class4	1672	the time course of the tpa mediated effect paralleled the time course of translocation and activation of protein kinase c in this cell line  
class4	1672	immunoblot analysis demonstrated that inactivation of pyroglutamyl peptidase ii was not due to dissociation or internalization of this enzyme molecule  
class4	1672	incubation of tpa activated y 79 cell membranes with gamma  32p  atp followed by immunoprecipitation revealed a time dependent phosphorylation of a 48 kilodalton subunit of pyroglutamyl peptidase ii  
class4	1672	these studies indicate that the phorbol ester effect is mediated by protein kinase c  and reveal a mechanism of potentiation of the action of trh at its target sites  
class4	1673	squamous cell carcinomas often produce more than a single bone resorption stimulating factor  role of interleukin 1 alpha   
class4	1673	several cultured human squamous cell carcinoma cell lines  scc 4  scc 12b2  scc 12f2  ec gi 10  and ben  and one normal keratinocyte line  epy 1  were investigated for the production of bone resorption stimulating activity  brsa   
class4	1673	conditioned medium  cm  from each of the six cell lines stimulated bone resorption in neonatal mouse calvariae in culture  
class4	1673	the brsa of scc 12f2 and ec gi 10 was inhibited completely by antibody to interleukin 1 alpha  il 1 alpha   whereas the brsa in cm from the ben  scc 4  scc 12b2  and epy 1 cell lines was only partially inhibited by anti il 1 alpha  
class4	1673	addition of indomethacin to the calvarial cultures also partially inhibited the brsa from ec gi 10  scc 4  scc 12b2  and epy 1 cells  the brsa from ben and scc 12f2 cells was inhibited completely by indomethacin  
class4	1673	camp production by calvariae was determined after a 60 min incubation with cm  
class4	1673	cm from ec gi 10  ben  scc 4  and epy 1 stimulated camp production by bone  
class4	1673	preincubation of cm from ben  ec gi 10  scc 4  and epy 1 cells with two antisera against pth related protein  pthrp  one specific for two pthrp  1 141   the other recognizing both pthrp  1 40  and pthrp  1 141   completely inhibited the camp stimulating activity  
class4	1673	using specific enzyme linked immunosorbent assays for il 1 alpha and il 1 beta  il 1 alpha was measured in cm of the scc 4  scc 12b2  scc 12f2  and epy 1 cell lines  
class4	1673	il 1 beta was undetectable  less than 0 1 ng ml  in cm from all cell lines  
class4	1673	our findings indicate that the brsa secreted by scc 12f2 cells can be accounted for largely or entirely by il 1 alpha  while the activity produced by scc 12b2 includes il 1 alpha and another unknown factor s   
class4	1673	the brsa produced by ec gi 10  ben  scc 4  and epy 1 cells includes both il 1 alpha and pthrp  
class4	1673	we conclude that il 1 alpha may be a more prevalent and biologically significant component of the brsa produced by sccs than previously recognized  
class4	1674	autoradiographic evaluation of monoclonal antibodies  access to melanoma associated antigens in melanoma xenografts  
class4	1674	autoradiography of nude mice bearing human malignant melanoma xenografts was performed to characterize the distribution pattern of radioiodinated anti melanoma monoclonal antibodies  moab  and fragments in macroscopic tumor nodules  
class4	1674	non uniformity of radioactivity distribution was seen in all moab xenograft combinations  
class4	1674	the predominant patterns were marked deposition of radioactivity either in the periphery of nodules or in sharply delimited intra tumoral foci  
class4	1674	these patterns were generated by limitations in the accessibility of melanoma tissue rather than gross necrosis or heterogeneity of antigen expression  
class4	1674	computer aided densitometry of autoradiograms was used to elaborate the difference of accumulation in intra tumoral hot spots versus cold areas  
class4	1674	it was found that increasing uniformity was achieved by increasing the dose of moab  i e   intact igg  injected  whereas a reduction in the size of moab  igg greater than f ab  2 greater than fab  showed no such effect  
class4	1675	ability of circular extrachromosomal dna molecules to carry amplified mycn proto oncogenes in human neuroblastomas in vivo  
class4	1675	amplification of the proto oncogene mycn  also known as n myc  in neuroblastomas has been shown to correlate with both disease stage and prognosis  yet little is known about the dna structures that carry amplified mycn genes in neuroblastomas in vivo  
class4	1675	we have used dna irradiation and pulsed field gel electrophoresis to analyze mycn amplification structures in eight neuroblastomas from separate patients  four primary tumors and four metastatic lesions exhibiting mycn amplification   
class4	1675	six of the eight neuroblastomas  three primary tumors and three metastatic lesions  exhibited mycn dna irradiation profiles consistent with the presence of circular extrachromosomal dna amplification structures  
class4	1675	five neuroblastomas possessed amplification structures within the size range of double minute chromosomes  and one contained smaller dna circles  
class4	1675	two neuroblastomas exhibited mycn dna irradiation patterns consistent with larger  presumably chromosomal  amplification structures  
class4	1675	multiple sizes of dna circles were observed in the neuroblastomas of four different patients  implying in vivo multimerization of amplification structures  
class4	1675	the presence of circular mycn amplification structures in six of eight neuroblastomas examined suggests that circular dna molecules are important structures in in vivo gene amplification  
class4	1676	history of cigarette smoking and risk of leukemia and myeloma  results from the adventist health study  
class4	1676	the risks of leukemia and myeloma associated with cigarette smoking were evaluated in a cohort study of 34 000 seventh day adventists  
class4	1676	although seventh day adventists do not smoke by church proscription  many are adult converts who smoked cigarettes prior to their baptism into the church  
class4	1676	in comparison with those who never smoked  ex smokers experience a relative risk of 2 00  95  confidence interval   1 01 3 95  for leukemia and 3 01  95  confidence interval   1 13 8 05  for myeloma  
class4	1676	risks increased in a dose response fashion with increasing numbers of cigarettes smoked daily for both leukemia  trend p    009  and myeloma  trend p    005   
class4	1676	also  the risks of both leukemia and myeloma increased with the total duration of cigarette smoking  
class4	1676	the cigarette smoking leukemia relationship was strongest for myeloid leukemia  for which ex smokers experienced a relative risk of 2 24  95  confidence interval   0 91 5 53   
class4	1676	these data lend support to the hypothesis that cigarette smoke may induce malignant degeneration in bone marrow and its products  
class4	1677	glycolysis as primary energy source in tumor cell chemotaxis  
class4	1677	the energy requirements via glycolytic pathways were directly measured in migrating tumor cells  
class4	1677	motility in the metastatic human melanoma cell line a2058  stimulated by insulinlike growth factor i  igf i   depends on glycolysis in the presence of glucose as its principal source of energy  
class4	1677	motility in glucose free medium was 75  reduced and utilized mitochondrial respiration  inhibited by oligomycin   
class4	1677	with increasing  physiologic  glucose concentrations  there was a dramatic shift to anaerobic glycolysis as the energy source and 93  elimination of the oligomycin inhibition of motility  
class4	1677	oxamate  an inhibitor of glycolysis  inhibited motility at all glucose concentrations  
class4	1677	co2 production from glycolysis and from the hexose monophosphate shunt was measured in migrating tumor cells  
class4	1677	the time course and glucose dose dependence of glycolytic co2 production correlated directly with motility  
class4	1677	in contrast  mitochondrial co2 production was inversely related to glucose concentration  
class4	1677	a monoclonal antibody for the igf i receptor inhibited both motility and glycolytic co2 production  indicating that both processes are receptor mediated  
class4	1678	influence of organ environment on extracellular matrix degradative activity and metastasis of human colon carcinoma cells 
class4	1678	orthotopic implantation of human colon carcinoma cells is useful for studying the behavior of metastatic subpopulations  
class4	1678	we observed that the parental line and variants of human colon carcinoma km12 cells were all tumorigenic following implantation into the subcutis or cecal wall of balb c nude mice  
class4	1678	their ability to metastasize to distant organ sites varied  however  with the site of growth  
class4	1678	subcutaneous  sc  tumors did not produce visceral metastases  whereas cecal tumors metastasized to the regional mesenteric lymph nodes and to the liver  
class4	1678	to examine the influence of organ environment on the extracellular matrix degrading activity of the tumors  we inoculated human colon carcinoma cells into the subcutis or cecal wall and after 7 weeks isolated and cultured the tumors in serum free medium  
class4	1678	the conditioned media of sc tumors contained very low levels of type iv collagenase  gelatinase  and heparanase  heparan sulfate specific endo beta d glucuronidase   whereas the media of the cecal wall tumors contained high levels of both  
class4	1678	zymograms of the media revealed that the intracecal human colon carcinomas secreted more than three times the amount of latent and active forms of 92 kd type iv collagenase than did the sc tumors  
class4	1678	moreover  only the conditioned media of intracecal tumors contained latent and active forms of 64 kd type iv collagenase  
class4	1678	histochemical analysis using rabbit antiserum raised against the synthetic peptides of 72 kd procollagenase type iv showed type iv collagenase in the intracecal tumors  human colon carcinoma growing sc  however  were not stained significantly  
class4	1678	these results suggest that factors in the organ environment may affect production and secretion of tumor extracellular matrix degrading enzymes  and these factors may modify the metastatic behavior of human colon carcinoma cells in nude mice  
class4	1679	bolus versus infusion regimens of etoposide and cisplatin in treatment of non small cell lung cancer  a study of the north central cancer treatment group 
class4	1679	in an effort to test clinically the hypothesis that the duration of cellular exposure to etoposide  vp 16  and cisplatin  cddp  is an important determinant of cytotoxicity  we performed a phase iii randomized trial comparing an outpatient bolus regimen of combined vp 16 and cddp with a sequential infusion over 72 hours of these same two drugs  
class4	1679	all patients had stage iv non small cell lung cancer  and survival was the primary end point  
class4	1679	of 113 patients randomly allocated to the study  108 were assessable for response  survival  and toxicity  
class4	1679	a major response was observed in 20  37   of 54 patients on the bolus regimen and in 16  30   of 54 patients receiving infusion therapy  
class4	1679	the median time to progression was 61 and 88 days for bolus and infusion therapy  respectively  
class4	1679	the median survival time was 148 and 157 days  respectively  p    71   
class4	1679	study results were not consistent with the possibility that infusion therapy could be associated with a 50  improvement in median survival  i e  
class4	1679	from 5 months to 7 1 2 months  
class4	1679	toxicity was primarily myelosuppression and was significantly greater with the infusion regimen  
class4	1679	we conclude that infusion therapy as tested in this protocol with vp 16 and cddp does not offer any advantage in response rate  time to disease progression  or survival as compared with bolus therapy  
class4	1679	in addition  infusion therapy is associated with a greater degree of neutropenia and more treatment related deaths  
class4	1680	mechanism of antitumor activity of tumor necrosis factor alpha with hyperthermia in a tumor necrosis factor alpha resistant tumor  
class4	1680	cells from a radiation induced fibrosarcoma  rif 1  are exceedingly resistant to tumor necrosis factor alpha  tnf alpha  in vitro  
class4	1680	we tested whether the addition of mild hyperthermia  42 5 degrees c  30 minutes  could enhance tnf alpha activity against rif 1 tumors growing in syngeneic hosts  c3h mice   
class4	1680	tnf alpha was administered intratumorally  
class4	1680	tumor cell killing essentially was not measurable following tnf alpha  hyperthermia  or a combination of the two  
class4	1680	single modality treatments also had no effect on tumor growth delay or on the x ray dose  given 24 hours after the primary treatment  required to sterilize 50  of the tumors  
class4	1680	the combination of tnf alpha and hyperthermia  however  resulted in a marked increase in tumor doubling time and a highly significant reduction in the x ray dose required to sterilize the tumors  
class4	1680	syngeneic lymph nodal lymphocytes and blood leukocytes did not appear to mediate the action of tnf alpha on rif 1 cells in vitro  
class4	1680	necrosis and hemorrhage were the most prominent histopathological alterations in the treated tumors  
class4	1680	electron microscopic studies 6 hours after therapy showed increased damage to capillary endothelial cells and accumulation of neutrophils in the capillaries of tumors treated with tnf alpha with or without heat  suggesting that neutrophils may mediate the endothelial cell injury  
class4	1680	these observations indicate a greater than additive tumoricidal effect of tnf alpha with hyperthermia  
class4	1680	furthermore  they support the concept that the interaction between the two agents damages the vasculature  compromising the microcirculation and ultimately causing ischemic tumor necrosis  
class4	1681	segregation analysis of breast cancer from the cancer and steroid hormone study  histologic subtypes 
class4	1681	the segregation pattern of breast cancer in white families from the cancer and steroid hormone study was investigated  
class4	1681	families were categorized into four groups based on the histologic type of breast cancer in the probands ductal cancer  lobular cancer  adenocarcinoma  and medullary cancer  
class4	1681	the ductal cancer sample was further split into a premenopausal proband and a postmenopausal proband subset  
class4	1681	results for six complex segregation analyses are presented  the findings suggest heterogeneity in the transmission of breast cancer  
class4	1681	for all analyses  there was no evidence for a multifactorial component in the mixed model  ie  a major locus plus other transmission  genetic and or cultural  
class4	1681	interpretation of the medullary cancer  adenocarcinoma  and lobular cancer analyses does not permit discrimination among the major locus models  
class4	1681	segregation of breast cancer in the entire ductal sample was consistent with autosomal recessive transmission  
class4	1681	in the ductal subanalyses  a recessive gene was sufficient to explain the breast cancer distribution when the proband had postmenopausal breast cancer  
class4	1681	in contrast  when the proband had premenopausal breast cancer  the transmission model was consistent with a dominant major gene  with sporadic cases of disease  
class4	1682	results of stereotactic brachytherapy used in the initial management of patients with glioblastoma  
class4	1682	recent studies have shown a survival benefit for patients with recurrent glioblastomas treated with stereotactic brachytherapy  
class4	1682	on the basis of these encouraging results  we began a prospective study in 1987 to evaluate the use of brachytherapy in patients with newly diagnosed glioblastoma  
class4	1682	patients were considered eligible for this study if they met the following criteria  karnofsky performance status 70  or greater  tumor size not greater than 5 cm in any dimension  a radiographically well delineated  supratentorial lesion not involving the ependymal surfaces  and pathologically confirmed glioblastoma  
class4	1682	we treated 35 such patients between 1987 and 1990 with stereotactic brachytherapy as part of their initial therapy  
class4	1682	the treatment protocol involved surgery  partial brain external beam radiotherapy  59 4 gy in 33 fractions   and stereotactic brachytherapy with temporary high activity iodine 125 sources giving an additional 50 gy to the tumor bed  
class4	1682	chemotherapy was not used in the initial management of these 35 patients  
class4	1682	to compare our results with those obtained in a matched control group  we identified 40 patients with glioblastoma treated with surgery and external radiotherapy  with or without chemotherapy  between 1977 and 1986 at our institution  
class4	1682	these patients had clinical and radiographic characteristics that would have made them eligible for the brachytherapy protocol  
class4	1682	survival rates at 1 and 2 years after diagnosis were 87  and 57   respectively  for patients receiving brachytherapy versus 40  and 12 5   respectively  for the controls  p less than  001   
class4	1682	we conclude that stereotactic brachytherapy improves the survival of patients with glioblastoma when it can be incorporated into the initial treatment approach  
class4	1682	unfortunately  only about one in four patients with glioblastoma are suitable candidates for brachytherapy at the time of initial presentation  
class4	1683	lipolytic factors associated with murine and human cancer cachexia  
class4	1683	we have identified a lipolytic factor in extracts of a cachexia inducing murine carcinoma  mac16  that shows characteristics of an acidic peptide and appears to be composed of three fractions of apparent molecular weights corresponding to 3 kd  1 5 kd  and 0 7 kd  as determined by exclusion chromatography  
class4	1683	material with identical chromatographic and molecular weight characteristics was also present in the serum of patients with clinical cancer cachexia but absent from normal serum  even under conditions of starvation  
class4	1683	the mac16 lipid factor  when injected into animals bearing the non cachexia inducing tumor mac13  was capable of inducing weight loss without a significant reduction in food intake  
class4	1683	similar lipolytic material  although in lower concentration  was also found in the mac13 tumor extracts  
class4	1683	these findings suggest that cachexia may arise from the enhanced expression of a lipolytic factor associated with tumor cells  
class4	1684	effects of fudr on primary cultured colon carcinomas metastatic to the liver  
class4	1684	hepatic arterial infusion of fluorodeoxyuridine  fudr  has demonstrated efficacy in the treatment of metastatic colorectal carcinoma of the liver  
class4	1684	in this study  the direct cytotoxic effect of fudr was measured on ten metastatic and two primary site colorectal carcinomas in a primary culture assay system  
class4	1684	overall  clinically achievable concentrations of fudr  0 4 to 4 microm  induced partial cell kill in 75  of tumors  including a greater than 50  reduction in viable tumor cell number in only two tumors and less than 50  in the remaining seven  
class4	1684	total cell kill was not observed in any tumor  
class4	1684	three tumors were resistant to these fudr concentrations  
class4	1684	tumor sensitivity correlated with the size of the tumor growth fraction  
class4	1684	increasing the exposure time to fudr from 3 to 7 days approximately doubled the magnitude of the response  
class4	1684	5 flurouracil and cisplatin  at clinically achievable concentrations  were more toxic to metastatic tumor cells than fudr  
class4	1684	because of the limited chemosensitivity of metastatic colorectal tumor cells to fudr in vitro  we postulate that other mechanisms besides direct cytotoxicity contribute to the clinical efficacy of fudr in vivo  
class4	1685	recurrence of resected esophagogastric adenocarcinoma  results of re resection  
class4	1685	isolated local recurrence following potentially curative resection for carcinoma of the esophagus or esophagogastric junction does not necessarily imply pending systemic disease and early demise  
class4	1685	while radiation alone or in combination with chemotherapy is standard treatment for such patients  resection is another available option  
class4	1685	resection may also be a consideration should localized disease persist after non operative therapy in the absence of metastases  
class4	1685	a 5 year retrospective review was performed examining 204 resections performed prior to 1989  
class4	1685	only 5 patients underwent resection of locally recurrent esophagogastric  eg  adenocarcinoma during this period  
class4	1685	no squamous carcinoma recurrences were resected  
class4	1685	one patient is well 15 months later while another died at 18 months of other causes without recurrence  
class4	1685	recurrence after re resection occurred at 8  11  and 24 months in the 3 other patients  
class4	1685	although there were no postoperative deaths  major complications occurred in 4 patients  
class4	1685	all 5 patients swallowed normally after operation  
class4	1686	cryoprobe as a  handle  for resection of metastatic liver tumors  
class4	1686	resection of metastatic liver tumors can be a difficult and risky procedure  
class4	1686	using a cryoprobe as a  handle  can greatly facilitate resection by providing a taut surface for transection and improving visualization of ductal and vascular structures  
class4	1686	in addition  this technique may decrease the risk of contaminating surrounding tissues with cancer cells  and may inhibit tumor recurrence within the margins of resection  
class4	1687	extended neck dissection  
class4	1687	from the time crile described radical neck dissection in 1906  this surgical procedure became popular in the management of metastatic cancer in the neck  
class4	1687	over the past two decades  the modified neck dissection has been effectively utilized for conservation of function and cosmesis while achieving the same oncologic goals  
class4	1687	however  there are several instances where the above standard procedures are not adequate for resection of malignant tumors  
class4	1687	although there is a definite trend toward conservation procedures  extended neck dissection is often necessary especially in patients with n2 and n3 disease  
class4	1687	apart from the standard structures removed in radical neck dissection  the other structures removed in extended neck dissection include skin  the digastric muscle  hypoglossal nerve  vagus nerve  sympathetic chain  ramus mandibularis  carotid artery  tracheo esophageal nodes  etc  
class4	1687	over the past seven years  we have performed 40 extended neck dissections  
class4	1687	all the patients had n2 or n3 disease in the neck  
class4	1687	nine patients had unknown primaries  
class4	1687	thirteen patients had their primary tumors in the oral cavity and 11 in the laryngopharynx  
class4	1687	five patients had primary tumor in the salivary glands and two patients had metastatic melanoma  
class4	1687	patients who underwent extensive skin excision had pectoralis myocutaneous flap reconstruction  
class4	1687	all patients received postoperative radiation therapy  
class4	1687	one patient died of cardiac problems 4 weeks after operation  
class4	1687	local control was achieved in 70   
class4	1687	the most difficult region for local control was the disease behind the mastoid process  and the most difficult problems were patients with involvement of the subdermal lymphatics  
class4	1687	our data suggests that there are definite situations where extended neck dissection is indicated with satisfactory local control of the nodal disease  
class4	1688	immune competent cells of regional lymph nodes in colorectal cancer patients  ii  immunohistochemical analysis of leu 7  cells  
class4	1688	distribution of leu 7  cells in cancer tissues and regional lymph nodes was immunohistochemically examined to estimate the role of nk cells in colorectal cancer patients  
class4	1688	leu 7  cells were rarely observed both in the primary and distant metastatic lesions  but the number of these cells was large in the germinal center of the lymph nodes  
class4	1688	studies of leu 7  cell population in the lymph node indicated that intermediate nodes in n0 and n1 groups showed significantly higher values than those in the control group  
class4	1688	comparative study of the population in identical patients revealed a significantly higher rate in the intermediate nodes than in the paracolic nodes both in n0 and n1 groups  
class4	1688	these data suggest that leu 7  cells might be related to the defense mechanism of regional lymph nodes against tumor  
class4	1689	gamma detecting probe and autoradiographic studies of radiolabeled antibody b72 3 in cx 1 colon xenografts  
class4	1689	nude mice bearing cx 1 colon tumors were injected with 50 microci 125i labeled monoclonal antibody  mab  b72 3  
class4	1689	radioactivity in tumors was studied with the gamma detecting probe  gdp  on days 1  3  7  and 10 after mab injection  
class4	1689	on each day  two mice were sacrificed and sections were examined with autoradiography  arg   immunoperoxidase methods  imp   and routine stains  
class4	1689	mean probe counts showed increasing tumor to background ratios and arg demonstrated a progressive increase in radionuclide in the tumors  
class4	1689	the distribution of 125i was primarily around the vascular spaces on day 1  but by day 3 and progressively it appeared in tumor gland lumina and necrotic areas  
class4	1689	a regional correlation was shown between radionuclide in vascular spaces and its sequestration in tumor elements  
class4	1690	surgical wound infection and cancer among the elderly  a case control study  
class4	1690	surgical wound infection occurs in fewer than 5  of operations  
class4	1690	nevertheless  it represents the second most common type of hospital acquired infection and results in increased morbidity and mortality  
class4	1690	as with all nosocomial infections  the rate of surgical wound infection increases with age  
class4	1690	patients over 65 years of age run an approximately 15  risk of surgical wound infection  
class4	1690	two thirds of patients with invasive cancer other than non melanotic skin cancer are aged 65 years and over  
class4	1690	over half of them are treated surgically for their cancer  
class4	1690	cancer and other chronic diseases have been cited as possible causes of the increased risk of nosocomial infection among the elderly  
class4	1690	using the foothills hospital wound study data base as the sampling frame  we conducted a case control study of surgical wound infection and cancer among the elderly  
class4	1690	cancer was found not to be a risk factor for surgical wound infection  
class4	1690	the results are discussed in relation to the role of immunity in both disorders  
class4	1691	long survival and prognostic factors in hepatocellular carcinoma  
class4	1691	we studied survival and prognostic factors in all cases of hepatocellular carcinoma seen at a midwestern teaching hospital from 1947 through 1986  
class4	1691	of the 70 cases  56 were diagnosed during life and 14 at autopsy  
class4	1691	there were 47 males and 23 females with age at diagnosis ranging from 14 to 88  
class4	1691	median survival for the 56 patients diagnosed during life was 106 days  
class4	1691	only 11 patients lived longer than one year  
class4	1691	two patients were long survivors and presumed cured  one living 27 years after diagnosis and surgical treatment and the other 19 years  
class4	1691	cox regression model showed young age at diagnosis and low stage of disease at diagnosis to be significant predictors of long survival  
class4	1691	white patients survived nearly twice as long as black patients but the difference was not significant  
class4	1691	gender and year of diagnosis did not appear to be important determinants of survival  
class4	1691	pathologic material was still available for one of the two long survivors and the histology was that of fibrolamellar carcinoma of young adults  
class4	1692	carcinoid tumors  
class4	1692	the authors carried out a retrospective study of 32 patients  23 m  9 f  with carcinoid tumors who were diagnosed and treated at harlem hospital center  new york  from 1967 to 1988  
class4	1692	all the patients were black and the commonest sites were the ileum  28 1    rectosigmoid and rectum  21 9    and the appendix and lung  15 6  each   
class4	1692	metastasis correlated with site  size  and depth of the primary tumor and occurred in 12 patients  38    most frequently to the regional lymph nodes and liver  
class4	1692	carcinoid syndrome developed in 12 5   3 f  1 m   
class4	1692	surgical resection for cure or palliation was the mainstay of treatment  
class4	1692	overall 5 year survival rate was 66   and for those with metastases was 0   
class4	1692	the poorer survival rates are probably related to the socioeconomic status of our patient population  
class4	1692	the only observed racial difference compared to other series is the preponderance of males  and the disproportionately higher ratio of females with the carcinoid syndrome  
class4	1693	symptomatic pericardial effusion in breast cancer patients  the role of fluid cytology  
class4	1693	clinical and cytologic findings in 21 breast cancer patients with symptomatic pericardial effusion are presented  
class4	1693	the etiology of the pericardial effusion was definitely malignant  by cytology histology in 13 patients  62    and suspected malignant by cytology in 2 patients  9    
class4	1693	one patient  5   with definitely nonmalignant pericardial effusion by cytology was found to be histologically positive at autopsy  
class4	1693	in 5 patients  24   there was no histological cytological evidence of malignancy  radiation pericarditis could be the etiology in 4 of these 5 patients  
class4	1693	the median time from the diagnosis of breast cancer to the development of symptomatic pericardial effusion was 60 months  range  1 219 months   
class4	1693	ten patients developed cardiac tamponade  they were treated by either pericardiocentesis or pericardiectomy  
class4	1693	the mean survival of patients with negative cytology histology was 12 months  patients with suspicious cytology had a mean survival of 9 months  patients with malignant effusion  treated by pericardiectomy  had a mean survival of 22 3 months  while patients with malignant pericardial effusion  who were not subjected to surgery  had a mean survival of 4 7 months  only  
class4	1693	it is concluded that the etiology of symptomatic pericardial effusion in breast cancer patients is not always malignant  which emphasizes the role of fluid cytology in establishing definite diagnosis  
class4	1693	the survival probability is a function of the extent of extracardiac disease  among patients with malignant pericardial effusion those selected for pericardiectomy have a longer than average survival  
class4	1694	hemicorporectomy  a collective review  
class4	1694	hemicorporectomy or translumbar amputation has been described as the most revolutionary of all operative procedures  
class4	1694	frederick e  
class4	1694	kredel  who first voiced the concept of the operation in 1950  referred to it as halfectomy  
class4	1694	demonstration of his cadaver studies established the feasibility of the operation  
class4	1694	amputation is effected through the lower lumbar area of the body  
class4	1694	necessary life functions are preserved in the upper torso  
class4	1694	kredel envisioned hemicorporectomy as a curative operation for locally advanced cancer  limited to the pelvis  not encompassable by standard operative intervention  
class4	1694	additional indications are intractable decubitus ulcers with malignant change  particularly in paraplegics  pelvic organs  and bone infection with nonhealing fistulae  and crushing trauma to the pelvis  
class4	1694	the first hemicorporectomy operation was reported in 1960  
class4	1694	thirty four operations have been recorded in the world literature  
class4	1694	two heretofore unreported cases are added  raising the total to 36  
class4	1694	review of these 36 cases confirms the conviction that hemicorporectomy is a humane and ethical alternative to the suffering encumbered by advancing  painful  malodorous malignant disease not treatable by conventional means  
class4	1694	while cure rates are not substantial  the best results are reported in paraplegics with intractable decubitus ulcers with or without malignancy  
class4	1694	rehabilitation is prolonged and costly  
class4	1694	most survivors have been restored to preoperative occupations or other gainful employment  
class4	1695	the use of interferon alpha c in patients with metastatic renal cell carcinoma arising in a congenital solitary kidney  
class4	1695	three cases of renal cell carcinoma in a congenital solitary kidney are presented  
class4	1695	treatment with recombinant interferon alpha c was administered in two cases  
class4	1695	a subjective response occurred in one case  
class4	1695	the literature is reviewed with respect to treatment options and prognostic factors  
class4	1696	community lifestyle characteristics and risk of acute lymphoblastic leukaemia in children  
class4	1696	high rates of leukaemia in children and young people have been associated with features of community isolation and population growth  
class4	1696	incidence data collected by two specialist registries were used to compare incidence rates at ward level with relevant ward characteristics derived from routine census and ordnance survey data for england and wales  
class4	1696	an excess risk of childhood acute lymphoblastic leukaemia  all  was found for wards which are farthest from large urban centres  
class4	1696	the excess was greatest for wards of higher socioeconomic status and for children aged 1 7 years  the childhood peak   for which a two fold excess was seen  
class4	1696	these findings in general support the hypothesis that childhood leukaemia has an infectious aetiology  
class4	1697	matched group study of surgical resection versus cobalt 60 plaque radiotherapy for primary choroidal or ciliary body melanoma  
class4	1697	we report the results of a nonrandomized  matched group  survival and visual preservation study of patients with a choroidal or ciliary body melanoma managed by microsurgical resection of the tumor versus cobalt 60 episcleral plaque radiotherapy  
class4	1697	each treatment group consisted of 30 patients  
class4	1697	all patients were matched on a case by case basis in terms of tumor size  largest linear tumor dimension   location of the anterior tumor margin relative to the ora serrata  location of the posterior tumor margin relative to the equator  and age at the time of treatment  
class4	1697	although the estimated actuarial 5 year survival probability was slightly greater in the resection group  85 2   than in the cobalt plaque group  81 8    this difference was neither clinically impressive nor statistically significant  
class4	1697	in contrast  there was a substantially higher rate of early posttreatment severe visual loss in the resection group  p    0008  mantel haenszel test   
class4	1698	interleukin 2 immunotherapy in children  
class4	1698	immunotherapy with interleukin  il  2 possesses great potential in the treatment of immune mediated diseases and cancers  
class4	1698	however  only a few reports on a small number of children have appeared in the literature  
class4	1698	from march 1988 to march 1989  11 children and adolescents were treated with il 2  
class4	1698	they included 1 patient with hepatocellular carcinoma  1 with hepatoblastoma  6 with childhood atopic dermatitis  and 3 with juvenile rheumatoid arthritis  
class4	1698	the dosages ranged from 10 000 to 50 000 u kg every 8 hours by intravenous drip  
class4	1698	the following side effects were observed  anorexia  fever  and chillness  100    general malaise  82    irritability  64    diarrhea  100    nausea and vomiting  73    weight gain  82    edema  82    abdominal distension  73    oliguria  82    cough  91    dyspnea  27    pleural effusion  40    hypotension  82    skin eruption  82    oral ulcer  18    enlarged liver  73   liver function abnormalities  82    renal function impairment  36    electrolyte imbalance  73    anemia  91    thrombocytopenia  54    leukopenia  18    and eosinophilia  73    
class4	1698	immunologically  numbers of natural killer cells were increased and natural killer and lymphokine activated killer cell activities were augmented after il 2 treatment  
class4	1698	there was a tendency for serum levels of il 2 and receptor il 2 to decrease  especially in patients with atopic eczema  
class4	1698	ten patients  91   completed one course  9 to 12 days  of therapy  and the remaining patient interrupted the treatment because of intolerable adverse effects  
class4	1698	clinically  complete remission for 3 months was obtained in 1 juvenile rheumatoid arthritis patient  transient improvement  2 to 6 weeks  in all atopic dermatitis patients  minor response in the hepatoblastoma patient  and no response in the patient with hepatocellular carcinoma  
class4	1699	congenital abnormalities of the lymphatic system  a new clinical classification  
class4	1699	the numerous clinical presentations of congenital abnormalities of the lymphatic system in children and the confusing terminology used to describe their pathologic diagnoses impede the physician s understanding of the condition  
class4	1699	the clinical classification based on the actual symptoms of the congenital problems we have presented here should help the physician identify the specific abnormality and a potential treatment  
class4	1699	future research should concentrate on the specific causes and the treatment of these congenital abnormalities  
class4	1700	tissue specific transformation by epidermal growth factor receptor  a single point mutation within the atp binding pocket of the erbb product increases its intrinsic kinase activity and activates its sarcomagenic potential  
class4	1700	avian c erbb is activated to a leukemia oncogene following truncation of its amino terminal  ligand binding domain by retroviral insertion  
class4	1700	the insertionally activated transcripts encode protein products that have constitutive tyrosine kinase activity and that can induce erythro leukemia but not sarcomas  
class4	1700	we have found that a single point mutation within the atp binding pocket of the tyrosine kinase domain in this truncated molecule can increase the ability of this oncogene to induce anchorage independent growth of fibroblasts in vitro and fibrosarcoma formation in vivo  
class4	1700	associated with this increased transforming potential is a corresponding increase in the kinase activity of the mutant erbb protein product  
class4	1700	the mutation  which converts a valine to isoleucine at position 157 of the insertionally activated c erbb product  is at a residue that is highly conserved within the protein kinase family  
class4	1700	to our knowledge  this is the first demonstration of a point mutation in the atp binding pocket that activates a tyrosine kinase  
class4	1701	v ha ras transgene abrogates the initiation step in mouse skin tumorigenesis  effects of phorbol esters and retinoic acid  
class4	1701	experimental carcinogenesis has led to a concept that defines two discrete stages in the development of skin tumors   i  initiation  which is accomplished by using a mutagen that presumably activates a protooncogene  and  ii  promotion  which is a reversible process brought about most commonly by repeated application of phorbol esters  
class4	1701	we have created a transgenic mouse strain that carries the activated v ha ras oncogene fused to the promoter of the mouse embryonic alpha like  zeta globin gene  
class4	1701	unexpectedly  these animals developed papillomas at areas of epidermal abrasion and  because abrasion can also serve as a tumor promoting event in mutagen treated mouse skin  we tested these mice for their ability to respond to phorbol ester application  
class4	1701	within 6 weeks virtually all treated carrier mice had developed multiple papillomas  some of which went on to develop squamous cell carcinomas and  more frequently  underlying sarcomas  
class4	1701	we conclude that the oncogene  preinitiates  carrier mice  replacing the initiation mutagenesis step and immediately sensitizing them to the action of tumor promoters  
class4	1701	in addition  treatment of the mice with retinoic acid dramatically delays  reduces  and often completely inhibits the appearance of promoter induced papillomas  
class4	1701	this strain has use in screening tumor promoters and for assessing antitumor and antiproliferative agents  
class4	1702	multisurface method of pattern separation for medical diagnosis applied to breast cytology  
class4	1702	multisurface pattern separation is a mathematical method for distinguishing between elements of two pattern sets  
class4	1702	each element of the pattern sets is comprised of various scalar observations  
class4	1702	in this paper  we use the diagnosis of breast cytology to demonstrate the applicability of this method to medical diagnosis and decision making  
class4	1702	each of 11 cytological characteristics of breast fine needle aspirates reported to differ between benign and malignant samples was graded 1 to 10 at the time of sample collection  
class4	1702	nine characteristics were found to differ significantly between benign and malignant samples  
class4	1702	mathematically  these values for each sample were represented by a point in a nine dimensional space of real variables  
class4	1702	benign points were separated from malignant ones by planes determined by linear programming  
class4	1702	correct separation was accomplished in 369 of 370 samples  201 benign and 169 malignant   
class4	1702	in the one misclassified malignant case  the fine needle aspirate cytology was so definitely benign and the cytology of the excised cancer so definitely malignant that we believe the tumor was missed on aspiration  
class4	1702	our mathematical method is applicable to other medical diagnostic and decision making problems  
class4	1703	embryonic stem cell virus  a recombinant murine retrovirus with expression in embryonic stem cells  
class4	1703	the expression of moloney murine leukemia virus and vectors derived from it is restricted in undifferentiated mouse embryonal carcinoma and embryonal stem  es  cells  
class4	1703	we have developed a retroviral vector  the murine embryonic stem cell virus  mesv   that is active in embryonal carcinoma and es cells  
class4	1703	mesv was derived from a retroviral mutant  pcc4 cell passaged myeloproliferative sarcoma virus  pcmv   expressed in embryonal carcinoma cells but not in es cells  
class4	1703	the enhancer region of pcmv was shown to be functional in both cell types  but sequences within the 5  untranslated region of pcmv were found to restrict viral expression in es cells  
class4	1703	replacement of this region by related sequences obtained from the dl 587rev retrovirus results in mesv  a modified pcmv virus that confers g418 resistance to fibroblasts and es cells with similar efficiencies  
class4	1703	expression of mesv in es cells is mediated by transcriptional regulatory elements within the 5  long terminal repeat of the viral genome  
class4	1704	glucocorticoids locally disrupt an array of positioned nucleosomes on the rat tyrosine aminotransferase promoter in hepatoma cells  
class4	1704	transcriptional activation by steroid hormones is often associated with the appearance of a dnase i hypersensitive site resulting from a local alteration of the nucleoprotein structure of the promoter  
class4	1704	for the mouse mammary tumor virus long terminal repeat  a viral promoter under glucocorticoid control  a model has been proposed  the appearance of the hormonodependent dnase i hypersensitive site reflects the displacement of a single precisely positioned nucleosome associated with the glucocorticoid responsive elements  
class4	1704	to determine if such a mechanism is of general relevance in transcriptional activation by steroid hormones  we have investigated the nucleosomal organization of the rat tyrosine aminotransferase promoter over a 1 kilobase region that contains the glucocorticoid regulatory target  
class4	1704	this region displays a hormonodependent dnase i hypersensitive site  
class4	1704	in the absence of hormone  micrococcal nuclease digestion of nuclei demonstrates the presence of positioned nucleosomes  with cutting sites centered around positions  3080   2900   2700   2800   2255  and  2040  
class4	1704	treatment of the cells with dexamethasone induces a disruption of the chromatin structure over a relatively short stretch of dna  approximately positions  2400 to  2650  that overlaps two nucleosomes  
class4	1704	these observations suggest a strong similarity in the role of chromatin structure in glucocorticoid dependent transcriptional activation of mouse mammary tumor virus and tyrosine aminotransferase promoters  
class4	1705	mapping chromosome band 11q23 in human acute leukemia with biotinylated probes  identification of 11q23 translocation breakpoints with a yeast artificial chromosome  
class4	1705	translocations involving chromosome 11  band q23  are frequent recurring abnormalities in human acute lymphoblastic and acute myeloid leukemia  
class4	1705	we used 19 biotin labeled probes derived from genes and anonymous cosmids for hybridization to metaphase chromosomes from leukemia cells that contained four translocations involving band 11q23  t 4 11  q21 q23   t 6 11  q27 q23   t 9 11  p22 q23   and t 11 19  q23 p13   
class4	1705	the location of the cosmid probes relative to the breakpoint in 11q23 was the same in all translocations  
class4	1705	of the cosmid clones containing known genes  cd3d was proximal and pbgd  thy1  srpr  and ets1 were distal to the breakpoint on 11q23  
class4	1705	hybridization of genomic dna from a yeast clone containing yeast artificial chromosomes  yacs   that carry 320 kilobases  kb  of human dna including cd3d and cd3g genes  showed that the yacs were split in all four translocations  
class4	1705	these results indicate that the breakpoint at 11q23 in each of these translocations occurs within the 320 kb encompassed by these yacs  whether the breakpoint within the yacs is precisely the same in the different translocations is presently unknown  
class4	1706	vaccination against tumor cells expressing breast cancer epithelial tumor antigen  
class4	1706	ninety one percent of breast tumors aberrantly express an epithelial tumor antigen  eta  identified by monoclonal antibody h23  
class4	1706	vaccinia virus recombinants expressing tumor antigens have considerable promise in the active immunotherapy of cancer  and we have evaluated the potential of vaccinia recombinants expressing the secreted  s  and cell associated  transmembrane  t  forms of h23 eta to elicit immunity to tumor cells expressing eta  
class4	1706	tumorigenic ras transformed fischer rat fibroblast lines fr s and fr t  expressing the s or t form of h23 eta  respectively  were constructed for use in challenge experiments  
class4	1706	expression of h23 eta in these lines was confirmed by western blotting and immunofluorescence  
class4	1706	when challenged by subcutaneous seeding of tumor cells  97   fr s  and 91   fr t  of syngeneic fischer rats rapidly developed tumors that failed to regress  
class4	1706	vaccination with recombinant vaccinia virus expressing eta t prior to challenge prevented tumor development in 82  of animals seeded with fr t cells but in only 61  of animals seeded with fr s  
class4	1706	the vaccinia recombinant expressing the s form was a less effective immunogen  and vaccination protected only 29 30  of animals from developing tumors upon challenge with either fr s or  t cells  
class4	1706	the increased immunogenicity of the recombinant expressing eta t was reflected in elevated levels of eta reactive antibody in vaccinated animals  confirming that secreted antigens expressed from vaccinia virus are less effective immunogens than their membrane associated counterparts  
class4	1707	recognition by elam 1 of the sialyl lex determinant on myeloid and tumor cells  
class4	1707	endothelial leukocyte adhesion molecule 1  elam 1  is an endothelial cell adhesion molecule that allows myeloid cells to attach to the walls of blood vessels adjacent to sites of inflammation  
class4	1707	elam 1 recognizes the sialyl lewis x  sialyl lex  determinant  neuac alpha 2 3gal beta 1 4 fuc alpha 1 3 glcnac   a granulocyte carbohydrate also found on the surface of some tumor cell lines  
class4	1707	binding of myeloid cells to soluble elam 1 is inhibited by a monoclonal antibody recognizing sialyl lex or by proteins bearing sialyl lex  some of which may participate in humoral regulation of myeloid cell adhesion  
class4	1707	stimulated granulocytes also release an inhibitor of elam 1 binding that can be selectively adsorbed by monoclonal antibody to sialyl lex  
class4	1708	head and neck paragangliomas  a clinicopathologic study with dna flow cytometric analysis  
class4	1708	a total of 11 head and neck paragangliomas were the subject of pathologic study  including histologic  immunohistochemical  and dna flow cytometric analyses  
class4	1708	we cannot absolutely predict aggressive clinical behavior using histologic parameters alone  but we can use such parameters to segregate patients into low risk and high risk groups  
class4	1708	several trends were observed in the current study  
class4	1708	tumors with higher s phase fractions  g2 m fractions  or aneuploid cell populations tended to behave  aggressively   the presence of sustentacular cells in the primary tumors cannot be used as an absolute indicator of tumor metastatic potential  as two metastatic paragangliomas in this study contained sustentacular cells in both the primary and metastatic lesions  
class4	1708	dna ploidy status cannot be used as an absolute prognostic parameter as the two metastatic tumors were composed of diploid primary and metastatic lesions  
class4	1708	the three tumors with aneuploid cell populations showed  aggressive  histologic and clinical features  but the length of the follow up period for these cases is too limited to draw any conclusions  
class4	1708	although no absolute criteria can be used at present to gauge aggressiveness  close follow up of these patients is essential  especially if pathologic findings suggest an  aggressive  course  ie   malignant  histology  higher s phase fractions  g2 m fractions  aneuploid cell populations  or decreased sustentacular cell density   
class4	1709	breast cancer  the military s experience at wilford hall usaf medical center  
class4	1709	we reviewed the experience with breast cancer at wilford hall usaf medical center for the years 1978 through 1988  
class4	1709	a total of 868 cases were identified in the wilford hall tumor registry  overall 5 year and 10 year survivals were 63  and 39   respectively  
class4	1709	infiltrating ductal carcinoma represented the principal histologic category  
class4	1709	the other predominant variants included invasive lobular carcinoma  lobular carcinoma in situ  and ductal carcinoma in situ  
class4	1709	until recently  most of these patients  90   had modified radical mastectomy as their definitive surgical therapy  with chemotherapy reserved primarily for patients with advanced disease  
class4	1710	pheochromocytoma and acute myocardial infarction  
class4	1710	when a pheochromocytoma is manifested as an acute myocardial illness  diagnosis may be difficult to make  
class4	1710	if the tumor is suspected early enough  a workup can be done while the complications of the myocardial illness are being controlled  as in our case   
class4	1710	the tumor can then be expeditiously removed before any further problems develop  
class4	1710	the case presented here underscores the importance of maintaining a high index of suspicion for a pheochromocytoma in any patient who has an unexpected myocardial event  
class4	1711	endometriosis of the abdominal wall  
class4	1711	endometriosis of the abdominal wall typically occurs as a painful mass in a lower abdominal incision from previous cesarean section or hysterectomy  
class4	1711	most patients are young and in their active reproductive years  
class4	1711	the histologic diagnosis requires a combination of either endometrial like glands  endometrial stroma  or hemosiderin pigment  
class4	1711	the diagnosis must be considered in any woman with an abdominal wall mass and a history of transabdominal gynecologic surgery  
class4	1711	wide excision offers the best chance to prevent recurrence  
class4	1712	unilateral hydrocephalus in adults  
class4	1712	the authors report 14 cases of unilateral hydrocephalus in adults  
class4	1712	headache was the most common presenting symptom  
class4	1712	unilateral hydrocephalus was documented in each patient with computed tomography scans  magnetic resonance imaging was also used in seven patients in the latter part of the series  
class4	1712	unilateral hydrocephalus was caused by tumor  seven patients   venous angioma  one patient   ependymal cyst  one patient   postinflammatory gliosis  one patient   and was idiopathic in four patients  
class4	1712	the primary surgical treatment was craniotomy with fenestration of the septum pellucidum  which relieved symptoms in eight of nine patients for whom long term follow up data were available  
class4	1713	pedunculated giant lipoma of the esophagus  
class4	1713	a patient with a giant lipoma of the esophagus presented with progressive dysphagia and odynophagia  fever  and recurrent melena  
class4	1713	two years previously  when the symptoms were less pronounced  it had been misdiagnosed as achalasia  
class4	1713	after surgical removal of the lipoma  the patient became symptom free  
class4	1714	peritoneal mesothelioma  an unusual cause of esophageal achalasia  
class4	1714	secondary esophageal achalasia due to malignancy is a rare condition  only 53 such cases have been reported to date  
class4	1714	sixty two percent of the cases were due to gastric adenocarcinoma  
class4	1714	mesothelioma of the peritoneum is an uncommon neoplasm  
class4	1714	the usual presenting symptoms are abdominal pain  abdominal mass  or abdominal distention  
class4	1714	the patient we are reporting had peritoneal mesothelioma which presented with dysphagia and weight loss  in addition to the radiological and manometric picture of achalasia  
class4	1714	secondary achalasia was suspected clinically  and was confirmed by computed tomography and laparotomy  
class4	1714	the diagnosis of peritoneal mesothelioma was made only by histopathological examination  
class4	1714	we are not aware of any other report documenting the association of peritoneal mesothelioma and achalasia  
class4	1715	multifocal gastric carcinoma arising from hyperplastic and adenomatous polyps  
class4	1715	this paper is a presentation of the unusual case of a 61 yr old woman operated on for multiple gastric cancers  
class4	1715	two of the cancers were found in the hyperplastic polyps and one in the adenoma  
class4	1715	apart from cancers that arose from these polyps  there were four separate polypoid or flat gastric carcinomas and three other hyperplastic polyps with no signs of malignancy  in this case  
class4	1715	the presentation is followed by a detailed discussion focusing on the possible development of carcinoma in gastric hyperplastic polyps in view of the data from the literature  
class4	1716	synchronous diffuse well differentiated lymphocytic lymphoma and gastric adenocarcinoma presenting as splenomegaly and iron deficiency anemia  
class4	1716	diffuse well differentiated lymphocytic lymphoma  d wdll  and chronic lymphocytic lymphoma  cll  represent closely related neoplasms which may have indolent courses  
class4	1716	dating back more than one century  reports of associated second primary malignancies continue to intrigue clinicians  
class4	1716	a case of synchronous d wdll and gastric adenocarcinoma  presenting as splenomegaly and iron deficiency anemia  is presented  
class4	1716	the case and literature are reviewed  
class4	1717	primary leiomyoma of the liver  
class4	1717	a 30 yr old woman with right upper quadrant abdominal pain was found to have a hepatic leiomyoma  
class4	1717	this is the youngest patient in whom this rare tumor has been found  
class4	1717	the diagnostic approach toward gastrointestinal leiomyomata is emphasized  including the role of immunohistochemistry  
class4	1718	liver abscess complicating intratumoral ethanol injection therapy for hcc  
class4	1718	we report a patient who developed multiple liver abscesses and sepsis caused by lactobacilli after the percutaneous intratumoral injection of ethanol for hepatocellular carcinoma  
class4	1718	we diagnosed the liver abscess at an early stage because of a the finding of gas on ultrasound and computed tomography  
class4	1718	blood cultures grew gram positive rods  which were of the lactobacillus species  
class4	1718	the patient responded to the administration of antibiotics  and his hepatic tumors have not recurred in the 7 months since treatment  
class4	1718	this is the first report of liver abscess following percutaneous ethanol injection therapy  
class4	1719	failure to limit quantities of benzodiazepine hypnotic drugs for outpatients  placing the elderly at risk  
class4	1719	purpose  the long term use of benzodiazepine hypnotics by the elderly is associated with serious side effects  and prescriptions of large quantities of these agents allow such use  
class4	1719	therefore  we determined the quantities of these agents prescribed to outpatients in our veterans administration teaching hospital  and the relationship of patient age to total number of doses prescribed per prescription  
class4	1719	patients and methods  pharmacy and patient records related to 655 consecutive prescriptions for triazolam  halcion  and flurazepam  dalmane  were reviewed  
class4	1719	only 266  41   of the prescriptions were for 30 or fewer doses  while 178  27   were written for 180 or more doses  
class4	1719	results  thirty six percent of prescriptions for patients aged 65 years or older were for 180 or more doses  compared with 24  for those aged 45 to 64 years old  and 16  of the prescriptions for patients less than 45 years old  p less than 0 0001   
class4	1719	in a multivariate analysis controlling for six other factors related to the total number of doses prescribed  patients aged 65 years or older were still more likely to receive a prescription for 180 or more doses  relative risk 1 9  95  confidence interval 1 3  2 8   
class4	1719	conclusion  we conclude that inappropriately large quantities of benzodiazepine hypnotics were commonly prescribed  and that patients aged 65 years or older were at greatest risk for receiving such prescriptions  
class4	1720	lack of correlation of clinical breast examination with high risk histopathology  
class4	1720	purpose  routine breast examination frequently finds differences in palpable density and palpable nodularity  but it is not known if these differences correlate with the presence of high risk histopathology  
class4	1720	patients and methods  to test for a relationship between clinical breast examination and histopathology  we devised separate  4 point scales of clinical density and nodularity and validated these scales by repeat examinations 4 or more months apart in 199 separate breasts  the scale was the same or within 1 point on repeat examination 87  of the time for density and 90  for nodularity   
class4	1720	we then used these two clinical scales to compare density and nodularity to histopathology of breast tissue at the margins of segmental resections in 60 women undergoing breast conserving treatment of primary breast cancer  
class4	1720	in cases such as these  a large sample of  normal  tissue is intentionally removed when the wide excision is done to obtain negative margins  
class4	1720	histopathology at the margins was graded according to the consensus panel of the american college of pathology  as might be expected in women with previous cancer  some higher risk histopathology was found in 37  of cases  
class4	1720	a relationship was sought using spearman s rank correlation coefficient  
class4	1720	results  neither clinical breast density  rho   0 16  nor clinical breast nodularity  rho   0 01  related to the presence of high risk histopathology in the underlying tissue  
class4	1720	interestingly  breast nodularity increased with age  rho   0 28   and clinical density and nodularity were inversely related  rho    0 28   
class4	1720	conclusion  we conclude that neither clinical breast density nor nodularity correlates with histopathology and that it is unlikely that a larger study would find a clinically useful correlation  
class4	1720	therefore  a clinical examination should not be used to decide that high risk histopathology is likely to be present in an individual woman s breast  
class4	1721	role of systemic therapy in advanced non small cell lung cancer  
class4	1721	increasing evidence supports the investigation of chemotherapy in patients with non small cell lung cancer  nsclc   
class4	1721	randomized studies in patients with stage iv disease have shown increased survival in chemotherapy treated patients compared to best supportive care and indicate the ability of chemotherapy to alter the natural history of this disease  
class4	1721	randomized studies involving adjuvant and neoadjuvant chemotherapy have also shown encouraging results  
class4	1721	these studies and results of recent pilot studies utilizing neoadjuvant chemotherapy and concomitant chemoradiotherapy indicate a potential benefit from the use of chemotherapy in patients with nsclc and call for its continued intensive investigation in clinical trials  
class4	1722	the role of attitudes  beliefs  and personal characteristics of italian physicians in the surgical treatment of early breast cancer  
class4	1722	the influence of italian physicians  attitudes  beliefs  and personal characteristics on medical decision making is examined in the case of surgical treatment of early breast cancer  
class4	1722	responses to a mail survey of 657 physicians from different specialties were analyzed comparing doctors recommending a radical procedure  9   to those preferring a conservative procedure for younger patients only  25    and those considering conservative surgery the treatment of choice regardless of patients  age  66    
class4	1722	the findings suggest that the likelihood of physicians  preferring a conservative procedure is influenced by their specialty and the extent to which they feel that a patient should have a role in the treatment decision more than by differences in the beliefs of treatment outcomes  
class4	1722	only preferences of the small group indicating radical surgery as the sole admissible treatment can be accounted for by ignorance or distrust of results of recent trials  
class4	1722	these findings suggest that other than scientific factors guide many doctors in their decision making  they may help to explain why the diffusion of research results into clinical practice is often disappointingly slow  
class4	1723	characteristics of duodenal wall gastrinomas  
class4	1723	fifteen patients with duodenal wall gastrinomas  dwgs  and the zollinger ellison syndrome have been treated since 1960  
class4	1723	in 6 of 11 patients  dwgs were recognized at operation and totally excised  
class4	1723	in four patients  the tumor was subsequently found in the proximal duodenum of the surgical specimens  
class4	1723	in 12 patients  dwgs were single and lymph node metastases were present in 8  
class4	1723	in three patients  dwgs were multiple and lymph node metastases were present in two  
class4	1723	all dwgs were submucosal and all were located in the first or second portions of the duodenum except one found in the fourth portion  
class4	1723	tumor size ranged from 1 to 15 mm  and nine were less than 5 mm  
class4	1723	of 12 patients with single dwgs  9 have remained eugastrinemic after resection  mean follow up  5 5 years   
class4	1723	none of the patients with multiple dwgs became eugastrinemic after surgery  
class4	1723	dwgs are characteristically single  small or microscopic  submucosal  located in the proximal duodenum  rarely metastasize to the liver  and are usually curable by surgical resection  
class4	1724	glucagonoma syndrome is an underdiagnosed clinical entity  
class4	1724	glucagonomas  considered among the rarest of the islet cell neoplasms  produce a well defined clinical syndrome characterized by necrolytic migratory erythema  diabetes mellitus  glossitis  anemia  and weight loss  
class4	1724	this report describes seven patients with glucagonoma treated at our institution  
class4	1724	all seven had the characteristic dermatologic manifestations  present from 1 to 6 years prior to diagnosis  
class4	1724	five patients had extensive disease at the time of initial operation  three of whom underwent aggressive cytoreductive surgery  whereas the other two had biopsy only  
class4	1724	the remaining two patients presented with a single nodule each  underwent distal pancreatectomy and splenectomy  and remain free of disease 2 and 6 years postoperatively  
class4	1724	earlier recognition of the distinctive physical findings peculiar to this syndrome should increase survival  
class4	1724	aggressive cytoreductive surgery results in prolonged remission  
class4	1725	perioperative blood transfusion adversely affects prognosis of patients with stage i non small cell lung cancer  
class4	1725	it has been speculated that blood transfusion might adversely affect prognosis in cancer patients by immunosuppression  
class4	1725	to avoid the confounding affect of advanced disease  we tested this hypothesis in 117 patients with stage i non small cell lung cancer  
class4	1725	mean and median follow up were 49 7 months and 47 months  respectively  
class4	1725	patients who died during the postoperative period were not included  
class4	1725	perioperative transfusion was defined as administration of whole blood or packed cells within 30 days of operation  
class4	1725	the overall cumulative 5 year disease free survival rate was 67   
class4	1725	in patients with transfusion  it was 53  and in patients without transfusion it was 81   p   0 0055   
class4	1725	a multivariate analysis was performed that included patient age  race  sex  cell type  extent of operation  pneumonectomy versus lobectomy segmentectomy   operative blood loss  admission hematocrit  discharge hematocrit  and the presence or absence of perioperative transfusion  
class4	1725	the only variable that significantly correlated with 5 year disease free survival was the presence or absence of perioperative transfusion  p   0 0278   and this effect was not related to the number of transfusions  
class4	1725	retrospective analysis of long term results of patients surviving curative operation for stage i lung cancer shows that any perioperative transfusion significantly worsens the patient s prognosis and suggests very strongly that this association is due to an adverse effect of the transfusion rather than the transfusion serving as a marker for another risk factor  
class4	1726	continent ileocolonic urinary reservoirs for filling and lining the post exenteration pelvis  
class4	1726	pelvic exenteration has a high complication rate due  in large part  to the extensive raw surfaces and dead space it creates  
class4	1726	numerous techniques have been used to control this space and line these surfaces  but none  to date  has proven to be a reliable solution  
class4	1726	we investigated the use of continent ileocolonic urinary reservoirs as a new  flap  to fill and line the pelvis in 17 patients  and found that our historical complication rate of 44  for pelvic exenteration was reduced to 18   
class4	1726	these reservoirs appear to be an improved method of managing the post exenteration pelvis  
class4	1727	selective nonoperative management of patients referred with abnormal mammograms  
class4	1727	screening mammography provides a means of detecting clinically occult breast carcinoma  but the question of whether all abnormal mammograms require biopsy remains unanswered  
class4	1727	we retrospectively reviewed records of 214 women referred over an 8 year period for abnormal mammograms  
class4	1727	they were selectively assigned to biopsy or mammographic follow up based on specific mammographic criteria  
class4	1727	of 114 women initially observed mammographically  2 were later found by biopsy to have carcinoma  
class4	1727	initial assignment to mammographic observation delayed the recommendation for biopsy 3 and 12 months  respectively  in these patients  but no effect on outcome was documented  
class4	1727	because they have benign lesions by clinical and mammographic criteria  102 women  53   have been spared biopsy  they continue to be monitored closely  
class4	1727	we believe these data support the use of a selective approach to biopsy based on specific mammographic criteria  
class4	1728	when is polypectomy sufficient treatment for colorectal cancer in a polyp  
class4	1728	eighty seven patients with a carcinoma in a polyp were reviewed over a 12 year period  
class4	1728	ten histologic criteria were analyzed for an association with the presence of residual carcinoma  
class4	1728	four factors were identified as having prognostic value  size greater than 1 5 cm  sessility  cancer of at least 50  of the adenoma volume  and invasive carcinoma  
class4	1728	polypectomy alone is adequate treatment unless the carcinoma invades deeper to the muscularis mucosa and is associated with one or more of these characteristics  
class4	1729	multimodal therapy in locally advanced breast carcinoma  
class4	1729	among 879 patients treated for breast cancer between 1975 and 1984  advanced disease was found in 125  14    
class4	1729	a subgroup of 34  4   presented with untreated locally advanced disease without demonstrable distant metastases at the time of diagnosis  stage iiib   t4abed  nx 2 mo   
class4	1729	during the first 5 years  1975 through 1979   17 patients were treated primarily with sequential radiotherapy and chemotherapy  group a   
class4	1729	from 1980 to 1984  group b   the management consisted of four courses of induction multi drug chemotherapy followed primarily by mastectomy and additional chemotherapy  
class4	1729	the mean follow up for the most recent group  group b  is 48 months  
class4	1729	follow up was complete  
class4	1729	while the local disease control rate was the same for both groups  76    the survival was remarkably different  
class4	1729	group a patients experienced a median survival of 15 months  and only one survived 5 years  
class4	1729	in group b  the median survival was 56 months with nine patients  53   alive between 40 and 76 months  seven  41   of whom are 5 year survivors  
class4	1729	while the overall mortality of patients with inflammatory breast cancer was greater in both groups when compared with the group with noninflammatory disease  the survival of patients in group b was better than in group a for both inflammatory and noninflammatory cancers  p less than 0 01   
class4	1729	estrogen receptor  nodal  and menopausal status did not influence survival  
class4	1729	these data suggest that neoadjuvant chemotherapy improves survival for patients with stage iiib breast carcinoma and delays the establishment or progression of distant metastases  
class4	1729	mastectomy is an important component in the treatment of this disease  
class4	1730	outpatient percutaneous central venous access in cancer patients  
class4	1730	a 1 year experience of percutaneous subclavian catheterization in outpatients with cancer was reviewed to document reliability  safety  and cost  
class4	1730	there were 763 catheter insertions attempted with prospective documentation of complications in 664 consecutive patients  
class4	1730	catheter insertion was successful in 722 attempts  95    
class4	1730	there were only 13 pneumothoraces  2    
class4	1730	thirty catheters required repositioning  4    
class4	1730	the average catheter duration was 191 days  range  0 to 892 days   
class4	1730	fifty six catheters  8   were removed because of suspected infection  
class4	1730	documented catheter sepsis occurred in 21 patients  3    catheter site infection occurred in 8 patients  1    
class4	1730	thus  only 0 22 infections per catheter year occurred during this 382 catheter year experience  
class4	1730	the estimated cost of catheter insertion was  562  which is one third the estimated cost for tunneled catheters   1 403  and for reservoir devices   1 738   
class4	1730	in our experience  percutaneous subclavian catheterization is a reliable  cost effective method compared with tunneled or reservoir devices  with an equivalent incidence of catheter related infections  
class4	1730	the cornerstone of our success with this program is a staff dedicated to catheter care and intensive patient education  
class4	1730	in centers where a large number of patients require central venous access  percutaneous catheterization should be the technique of choice  
class4	1731	kaposi s sarcoma of the rectum in patients with the acquired immunodeficiency syndrome  
class4	1731	we retrospectively reviewed eight patients with biopsy proven anorectal kaposi s sarcoma  ks  treated between 1984 and 1989 at san francisco general hospital  
class4	1731	all patients were homosexual men with the acquired immunodeficiency syndrome  aids   
class4	1731	the average age was 34 years  
class4	1731	three patients had primary rectal ks without metastases  
class4	1731	five patients had disseminated ks with lesions throughout the alimentary tract  viscera  skin  or local lymph nodes  
class4	1731	three patients were treated with radiation or chemotherapy  
class4	1731	five patients had disseminated ks with lesions throughout the alimentary tract  viscera  skin  or local lymph nodes  
class4	1731	three patients were treated with radiation or chemotherapy  
class4	1731	five patients with advanced aids received no specific treatment for anorectal ks  
class4	1731	follow up ranged from 1 month to 5 years  
class4	1731	three of the untreated patients and the three patients treated with chemotherapy or radiotherapy were alive 1 month to 5 years after diagnosis  
class4	1731	aggressive surgical treatment of anorectal ks is not indicated  
class4	1732	caesarean section in a patient with haemoglobin sc disease and a phaeochromocytoma  
class4	1732	the anaesthetic management of a patient with haemoglobin sc disease for lower segment caesarean section and excision of a phaeochromocytoma is described  
class4	1732	the patient was given a general anaesthetic for the surgical procedure after exchange transfusion had achieved an haemoglobin a concentration of greater than 50   
class4	1732	a live infant was delivered and a suprarenal phaeochromocytoma was excised during a 6 5 hour procedure  
class4	1732	the patient s postoperative recovery was uneventful  
class4	1733	tyrosine kinase and control of cell proliferation  
class4	1733	the usefulness of phosphotyrosine antibodies for the detection of physiologically regulated or deregulated tyrosine kinases is discussed in this report  
class4	1733	this rather rare enzymatic activity is shared by receptors for some polypeptide growth factors and by the products of class 1 oncogenes  
class4	1733	the antibodies are able to detect proteins phosphorylated on tyrosine in fibroblasts stimulated with growth factors such as egf and pdgf  
class4	1733	the major phosphorylated protein species are the receptors themselves  which undergo phosphorylation only after the addition of the exogenous factor and only transiently  
class4	1733	phosphotyrosine antibodies were able to detect the products of the retroviral class 1 oncogenes  which are endowed with deregulated tyrosine kinase activity  
class4	1733	in fact  in these cases a constitutive phosphorylation of the relevant proteins was observed  which occurred continuously and independently of the presence or lack of exogenous ligands  
class4	1733	a tyrosine kinase constitutively activated in human gastric carcinoma cells was detected by p tyr antibodies  
class4	1733	this molecule has been characterized at the molecular level  and the mechanisms responsible for its enzymatic activation have been investigated  
class4	1733	the question of whether the tyrosine kinase identified is responsible for the induction and the maintenance of the transformed phenotype in gastric carcinomas remains to be answered  
class4	1733	it is reasonable to suggest that this might be the case by analogy with other situations such as class 1 oncogenes activated by transduction by retroviruses  abnormal expression of egf receptors  or deregulated activity of c abl encoded proteins in chronic myelogenous leukemia and acute lymphoblastic leukemia  
class4	1733	thus  the search for deregulated kinases by means of phosphotyrosine antibodies seems to be useful for identifying new activated oncogenes in clinical oncology  
class4	1734	gene amplification in human lung cancer  the myc family genes and other proto oncogenes and growth factor genes  
class4	1734	the development of human lung cancer may require multiple genetic deletions affecting a number of chromosomes  e g   1  3  11  13  and 17  
class4	1734	these genetic aberrations may induce the activation of proto oncogenes  c jun  ras  c raf1  and the loss of tumor suppressor genes  p53   
class4	1734	some of the activated proto oncogenes and tumor suppressor genes are more selectively expressed or absent in small cell lung cancer  l myc  c myb  c scr  rb gene  or non small cell lung cancer  c erbb 2  c sis  c fes   
class4	1734	these genes may thus be of importance for selection of differentiation pathway  
class4	1734	the c myc oncogene is frequently amplified in small cell lung cancer cell lines in a much higher frequency than in vivo  
class4	1734	this indicates that c myc seems to be related to tumor progression and a relatively late event in the lung cancer development  
class4	1734	the uncontrolled production of multiple growth factors has been identified in human lung cancer cell lines  
class4	1734	these factors can promote and inhibit the proliferation via paracrine and autocrine loops via specific receptors  
class4	1734	the products from some of the activated proto oncogenes  c sis  c erbb 2  are sequences homologous to a certain growth factor  pdgf  and a receptor  egf  identified in lung cancer  
class4	1734	the production and action of these growth factors may be of major importance for further activation of proto oncogenes via intracellular signal transduction and specific oncogenic activation leading to further tumor progression  
class4	1735	the ras oncogenes in human lung cancer  
class4	1735	the three well characterized genes of the ras gene family h ras  k ras  and n ras  code for closely related 21 kd proteins that have a role in the transduction of growth signals  
class4	1735	the ras proteins acquire transforming potential when a point mutation in the gene leads to replacement of an amino acid in one of the critical positions 12  13  or 61  
class4	1735	overexpression of the normal protein  usually associated with gene amplification  can have similar effects  
class4	1735	the detection of mutationally activated ras genes has been facilitated by the development of oligonucleotide hybridization assays that allow the identification of each possible mutation at the critical sites  
class4	1735	employment of the polymerase chain reaction has greatly increased the sensitivity of these assays  
class4	1735	studies of human lung cancer have shown that adenocarcinoma is the only subtype associated with ras mutations  
class4	1735	these occur in about 30  of primary tumors  
class4	1735	in almost all cases  the mutation is present in codon 12 of the k ras gene  
class4	1735	no mutations have been observed to date in tumors of nonsmokers  suggesting that the mutation may result from exposure to carcinogenic ingredients of tobacco smoke  
class4	1735	amplifications of ras genes were shown to be very uncommon in clinically early stages of lung cancer  
class4	1735	analysis of the clinical data of patients who were operated on for adenocarcinoma of the lung shows that k ras mutations are not associated with particular histologic characteristics of the tumors or with specific presenting features  
class4	1735	patients with k ras mutations  however  had significantly worse survival than did those without an activation  
class4	1736	progression through the cell cycle  an overview  
class4	1736	tissues in adults can be maintained at constant mass or they can increase or decrease in size because of imbalances of synthetic and degradative processes acting at the cellular and molecular levels  
class4	1736	some size changes are caused by physiologic conditions to which the tissue must adjust  
class4	1736	alternatively  the balance may be distorted in favor of net tissue increase in pathologic situations such as cancer  
class4	1736	strict regulatory mechanisms are required to keep proliferation responsive to the organism s needs  these mechanisms may be defective in disease  
class4	1736	net tissue proliferation requires repeated rounds of cell duplication in excess of that necessary to counterbalance cell death  
class4	1736	duplication of a cell requires a net doubling of its every molecule and structure  
class4	1736	the myriad of molecular events required for cell proliferation such as dna duplication and its partitioning at mitosis are tightly regulated in normal cells  
class4	1736	one may conceive of two classes of molecules  those required for  housekeeping   which constitute the cell s structural and functional machinery  and those such as growth factors  their receptors  and second messengers involved in signal transduction responsible for regulating the activities of the housekeeping molecules  
class4	1736	these molecular events and the cascade of processes that control them can be organized within the sequence of the cell cycle  
class4	1736	in this brief overview  we illustrate these issues with a few examples taken from very recent discoveries of novel proteins that appear to have major regulatory roles  
class4	1736	most of these results have been obtained with mammalian fibroblasts  but some have originated with discoveries made using two very different yeasts  
class4	1737	the beta type transforming growth factor  mediators of cell regulation in the lung  
class4	1737	an increased interest in the role of growth factors in the regulation of processes concerning normal and pathologic lung physiology has spurred a flurry of research in this area  
class4	1737	peptide growth factors are known to control not only cell proliferation but other events such as differentiation  chemotaxis  and matrix deposition as well  
class4	1737	the transforming growth factor beta  tgf beta  family of regulatory peptides serves as a prime example to illustrate the multiplicity of effects elicited by peptide growth factors in various lung derived cell types  
class4	1737	at present  the tgf beta family consists of at least 17 proteins and  based on sequence analysis  they can be divided into two groups  a cluster that shows very high sequence similarity to tgf beta 1  the closely related group  and a cluster that shows weaker sequence similarity to tgf beta 1  the distantly related group  
class4	1737	the purpose of this brief review is to summarize the salient features of tgf beta structure and regulatory abilities of the closely related group  
class4	1737	in addition  we will outline the evidence suggesting a role for tgf beta in normal lung development and physiology  
class4	1737	emphasis will be placed on studies with the closely related members tgf beta 1 and tgf beta 2 because  until recently  purified protein was available only for these two proteins  
class4	1738	genetic strategies of tumor suppression  
class4	1738	the evaluation of the cancer cell is a complex multigene process  
class4	1738	tumor suppressor genes that are lost or inactivated  as well as genes that are overexpressed  play key roles in tumor progression  
class4	1738	the identification of overexpressed genes has been expedited by the presence of transforming genes in some animal retroviruses  
class4	1738	however  tumor suppressor genes have been difficult to identify and isolate because of their loss or inactivation during tumorigenesis  
class4	1738	by a variety of methods  summarized in this review  a few tumor suppressors have been cloned and characterized  and many more have been recognized indirectly  
class4	1738	the general finding at this time is that the same tumor suppressors  and oncogenes  are found associated with many different tumors  that several different altered genes are found typically in the same tumors  and that other oncogenes and tumor suppressor genes seem to be characteristically altered in particular tumor types as well  
class4	1738	functions of tumor suppressor genes include the control of normal cell activities such as proliferation and differentiation as well as senescence  which is a special kind of differentiation in which cells lose their ability to divide  
class4	1738	the genetic basis of senescence and identification of genes involved in overcoming senescence  leading to immortalization  i e   indefinite growth potential   are important areas of current investigation  
class4	1738	our laboratory is engaged in senescence immortalization studies as a result of our discovery that normal human mammary epithelial cells can be immortalized by dna of the human papilloma virus  
class4	1738	these new studies are summarized here  
class4	1739	cell to cell communication and the control of growth  
class4	1739	growth of transformed cells is inhibited by cell to cell communication with normal cells  
class4	1739	this communication is regulated by certain oncogenes that alone or in cooperation can block the communication  
class4	1740	src expression in small cell lung carcinoma and other neuroendocrine malignancies  
class4	1740	the proto oncogene c src codes for two tyrosine kinases  pp60c src and pp60c srcn  
class4	1740	the latter protein appears to be exclusively expressed in neurons and neuronally differentiated tumors  
class4	1740	in cell lines derived from neuroblastoma and small cell lung carcinoma  src expression correlates positively with neuroendocrine differentiation  
class4	1740	however  pp60c srcn is expressed only in highly differentiated neuroblastomas  
class4	1740	although c src expression in neuroendocrine tumors probably reflects and is the result of the differentiation stage at which the tumors have been arrested  high c src expression and kinase activities in non neuroectodermal tumors  e g   colon carcinoma  breast carcinoma  might instead be a part of the malignant phenotype and contribute to the development of these tumors  
class4	1741	internists  practices in health promotion and disease prevention  a survey  
class4	1741	objective  to estimate internists  use of disease prevention and health promotion activities  and to explore demographic  professional  behavioral  psychological  cognitive  and organizational factors associated with the use of such practices  
class4	1741	design  mail survey  
class4	1741	setting and subjects  a sample of 2610 members and fellows of the american college of physicians  acp  participated in the study  
class4	1741	they engaged in patient care activities more than 20 hours per week and were stratified by gender and region  
class4	1741	they lived in four geographic areas of the united states  northeast  southeast  central  and west   comprising 21 acp regions  
class4	1741	measurements  a questionnaire requesting background information as well as information about personal health  record keeping  use of immunizations  pneumococcal  influenza  tetanus  hepatitis b   use of screening tests and procedures for detecting cancer  breast examination  papanicolaou smear  stool occult blood test  and other diseases  electrocardiograms  cholesterol level tests  chest radiographs   and behavioral counseling to promote health  in the areas of smoking  exercise  and alcohol and seat belt use   
class4	1741	main results  internists used effective preventive interventions less frequently and ineffective practices more frequently than experts recommend  
class4	1741	internists  use of health promotion and disease prevention activities is associated with habit  attitude  and a lack of adequate knowledge  
class4	1741	younger physician age  general internal medicine practice  and personal health promotion and disease prevention practices were strongly associated with more appropriate use of recommended practices  p less than 0 01   
class4	1741	conclusions  internists  use of disease prevention and health promotion activities falls short of expert recommendations  
class4	1741	programs to improve the delivery of preventive services might be aimed at improving physicians  personal health practices  might be directed toward patients  and might include the development of effective systems to remind physicians  
class4	1742	cerebrospinal fluid neopterin in human immunodeficiency virus type 1 infection  
class4	1742	we evaluated cerebrospinal fluid  csf  concentrations of neopterin  a putative marker of activated macrophages  in 97 subjects infected with human immunodeficiency virus type 1 who had a spectrum of neurological complications  
class4	1742	the highest csf neopterin concentrations occurred in those with neurological opportunistic infections  primary central nervous systems lymphoma  and acquired immunodeficiency syndrome  aids  dementia complex  
class4	1742	in general  the csf concentration of neopterin was independent of csf cell count and blood brain barrier disruption to albumin  
class4	1742	in the patients with aids dementia complex  csf neopterin concentrations correlated with severity of disease and decreased in conjunction with clinical improvement following treatment with zidovudine  
class4	1742	these results suggest that csf neopterin  although not disease specific  may be useful as a surrogate marker for the presence of aids dementia complex and its response to antiviral therapy  
class4	1743	lymphoproliferative disorders associated with carbamazepine  
class4	1743	carbamazepine induced lymphoproliferative disorders are relatively rare  
class4	1743	a 32 year old woman developed cervical lymphadenopathy while taking carbamazepine  
class4	1743	histologic evaluation of the lymph node biopsy specimen demonstrated near total effacement of the nodal architecture by a population of pleomorphic immunoblasts  
class4	1743	the predominant cell population expressed cd3  cd2  cd5  and cd4  while results of testing for cd8 were negative  
class4	1743	on the basis of the morphologic and immunohistologic features  a diagnosis of high grade  non hodgkin s lymphoma  t cell immunoblastic type  was made  
class4	1743	despite the fact that aggressive behavior is usually associated with immunoblastic lymphomas  the patient has done well for 33 months after cessation of carbamazepine in the absence of chemotherapeutic treatment  
class4	1743	the clinical features of this patient s illness  therefore  suggest that it is best regarded as a so called pseudolymphoma  
class4	1744	image cytophotometric dna analysis of atypical hyperplasias and intraductal carcinomas of the breast  
class4	1744	with the use of image analysis  dna content was quantified on paraffin embedded tissue sections of 25 atypical hyperplasias and 35 intraductal carcinomas of the breast by comparison of integrated gray levels of feulgen stained control and ductal cell nuclei  
class4	1744	the mean full peak  g0 g1  control cell dna histogram coefficient of variation was 5 5   
class4	1744	dna aneuploidy was more common in intraductal carcinomas compared with atypical hyperplasias  71  of intraductal carcinomas vs 36  of atypical hyperplasias  and correlated with a lack of cytologic  nuclear  and architectural differentiation  63  moderate vs 93  poor and 38  cribriform vs 82  solid   
class4	1744	in addition  multiple dna stemlines were observed in 40  of intraductal carcinomas  
class4	1744	we conclude that  1  some atypical hyperplasias demonstrate abnormal dna content consistent with neoplastic transformation   2  aggressive forms of intraductal carcinoma are more frequently associated with dna content abnormalities  and  3  frequent dna stemline heterogeneity in intraductal carcinoma supports the hypothesis that multiple genetic events occur in the development of mammary intraepithelial neoplasia  
class4	1745	enhanced expression of c myc and h ras oncogenes in letterer siwe disease  a sequential study using colorimetric in situ hybridization  
class4	1745	tissues from two patients with disseminated histiocytosis x  letterer siwe disease  in which histiocytosis x cells exhibited histologic and cytologic features of malignancy were evaluated by in situ hybridization with the use of biotinylated nucleic acid probes to c myc and h ras oncogenes  
class4	1745	enhanced expression of these oncogenes was observed in mononucleated and multinucleated cells of histiocytosis x in the terminal proliferative phase but not in the early quiescent phase of letterer siwe disease in both patients  
class4	1745	our findings indicate that deregulation of c myc and h ras in histiocytosis x are late events that likely confer a selective growth advantage to histiocytosis x cells  
class4	1746	lack of prognostic value of nucleolar organizer region enumeration in transitional cell carcinoma of the bladder  
class4	1746	enumeration of silver stained nucleolar organizer regions is of limited use in grading transitional cell tumors of the bladder  
class4	1746	we attempted in this article to establish whether or not such a technique would be helpful in predicting the prognosis of such tumors within rather than between grades  
class4	1746	in the study population of 11 high grade transitional cell carcinomas of the bladder  no correlation was found between clinical outcome and mean nucleolar organizer region count  
class4	1747	bilateral familial carotid body paragangliomas  report of a case with dna flow cytometric and cytogenetic analyses  
class4	1747	a case study of bilateral familial carotid body paragangliomas with dna flow cytometric and cytogenetic analyses is presented  
class4	1747	analysis of tumor cell nuclear dna content by flow cytometry revealed aneuploid cell populations in both tumors  
class4	1747	standard cytogenetic analysis  giemsa banding technique used  of the right carotid body paraganglioma showed no evidence of numerical or structural abnormalities  
class4	1747	we describe parameters currently used to  predict  biological behavior in these tumors  
class4	1748	hepatic cyst associated with peutz jeghers syndrome  
class4	1748	a solitary hepatic cyst  associated with peutz jeghers syndrome  is described  
class4	1748	to our knowledge  this association has not been previously reported  
class4	1748	a developmental anomaly or hamartomatous nature of this lesion is suggested  
class4	1748	knowledge of this association may be helpful in the clinical diagnosis of this benign entity  
class4	1749	soft tissue tumor with abnormal amianthoid collagen fibers  
class4	1749	electron microscopic examination of a solitary soft tissue tumor from the face demonstrated large areas with abnormal amianthoid collagen fibers in the neoplasm  
class4	1749	the lesion was classified as a benign neoplasm of myofibroblasts and tentatively named a myofibroblastoma  
class4	1749	the significance of the amianthoid collagen fibers is unknown  
class4	1749	normal native collagen fibers were found in some parts of the neoplasm  
class4	1750	extramedullary hematopoiesis in a bronchial carcinoid tumor  an unusual complication of agnogenic myeloid metaplasia  
class4	1750	a case of bronchial carcinoid tumor with foci of extramedullary hematopoiesis is presented  
class4	1750	the patient had a 6 year history of agnogenic myeloid metaplasia and hepatosplenomegaly  
class4	1750	all three hematopoietic cell lines were represented in different areas of the bronchial tumor  
class4	1750	to our knowledge  this is the first case of extramedullary hematopoiesis described in a bronchial carcinoid and only the fourth report of hematopoietic cells in a neoplasm of otherwise unrelated origin  
class4	1750	the pathogenesis of this uncommon finding is discussed and the literature is reviewed  
class4	1751	cholangiocarcinoma in association with multiple biliary microhamartomas  
class4	1751	the rarity of cholangiocarcinoma occurring in von meyenburg complexes is well appreciated  
class4	1751	we describe the case of a 35 year old man found to have cholangiocarcinoma in association with multiple biliary microhamartomas of the liver  
class4	1751	areas of ductal proliferation and atypia within the bile duct hamartomas suggest malignant transformation to cholangiocarcinoma  
class4	1752	acquired childhood aphasia  outcome 1 year after onset  
class4	1752	the effects of the variables age at onset  cause  severity and bilaterality of lesion  and type of aphasia on course and outcome were investigated in a group of 28 aphasic children  
class4	1752	analysis of spontaneous speech and tests of auditory verbal comprehension were used to determine the presence of aphasia  
class4	1752	the severity of the cerebral lesion was assessed using a rating scale for computed tomographic scans  
class4	1752	most of the children had not recovered completely 1 year after onset  
class4	1752	recovery was significantly different according to etiological categories  
class4	1752	complete recovery was seen in the majority of traumatic cases  
class4	1753	morphine induced transactivation of hiv 1 ltr in human neuroblastoma cells  
class4	1753	infection by human immunodeficiency virus  hiv  is followed in many cases by a clinically quiescent or latent phase that appears to continue as long as host antiviral defense is intact  
class4	1753	this has raised the possibility that certain host susceptibility factors  i e   environmental cofactors  might influence the progression of the disease  
class4	1753	in this study we demonstrate that morphine can function to activate hiv ltr cat fusion gene  hiv long terminal repeat chloramphenicol acetyltransferase  when transfected into undifferentiated human sh sy5y neuroblastoma cells  
class4	1753	the stimulatory effect of morphine is amplified in sh sy5y cells that have been induced to differentiate first with phorbol 12 myristate 13 acetate  pma  and is much less in cells differentiated with retinoic acid  ra   
class4	1753	morphine does not appreciably activate hiv ltr cat expression in human molt 3 and other t cells  
class4	1753	morphine activation of hiv ltr cat in the sh sy5y cells is not reversible by naltrexone and appears to involve a fos jun signaling system  
class4	1753	our results suggest that narcotics such as morphine may lead to activation of latent hiv infection  
class4	1753	this may be particularly important in tissues  such as brain  which can host latent hiv infection and which is uniquely damaged in patients with acquired immunodeficiency syndrome  aids  as evidenced by neuronal degeneration and dementia  
class4	1753	we also predict that these findings may have important implications for the pathogenesis of aids  particularly in opiate drug abusers  
class4	1754	shear stress induces not only platelet aggregation but also platelet tumor cell interaction  
class4	1754	to investigate the interaction between platelets and tumor cells under well defined flow conditions  the effect of tumor cells on platelet aggregation induced by shear stress was studied using a cone and plate viscometer adapted for measuring transmitted light intensity  
class4	1754	aggregation was markedly enhanced by hmv 1 cells in a cell number dependent fashion under shear stress of 12 dyne cm2  
class4	1754	enhancement was not observed at a high shear stress of 108 dyne cm2  
class4	1754	a monoclonal antibody against gpiib iiia  7e3 completely abolished enhancement of aggregation by hmv 1  
class4	1754	apyrase had similar inhibitory effects  
class4	1754	scanning electronmicroscopy showed that direct contacts of platelets with hmv 1 cells could be demonstrated when platelet platelet interaction was inhibited by 7e3 or apyrase  
class4	1754	these results may indicate that  at a shear stress of 12 dyne cm2  direct contacts of platelets and hmv 1 cells may trigger enhancement of platelet aggregation  
class4	1755	palliative treatment of bile duct tumoral compression by an endoprosthesis  clinical results  
class4	1755	the palliative therapy of stenoses of the biliary tract is a difficult choice  
class4	1755	because percutaneous or endoscopic drainage methods are fraught with complications  an endoprosthesis for surgical intubation of the biliary tract has been developed  
class4	1755	thirty patients were treated by this method  
class4	1755	after choledochotomy  the endoprosthesis is positioned surgically above the sphincter of oddi  thereby avoiding ascending cholangitis  
class4	1755	twenty nine patients  13 with gallbladder cancer  11 with cholangiocarcinomas  5 with metastases  presented with neoplastic compression  and one patient had an early postoperative stricture with loss of substance after right hepatectomy for hepatic metastases  
class4	1755	the operative mortality was 3 3   one pulmonary complication   
class4	1755	resolution of jaundice was obtained in all but two patients  and pruritus always resolved  
class4	1755	the mean survival time for the patients with cholangiocarcinoma was 12 2 months and 6 33 months for those with gallbladder cancer  
class4	1755	indices of satisfaction  bismuth s method  were 71   gallbladder cancer   93 5   hilar cholangiocarcinoma   and 92   metastatic compressions   
class4	1755	this new type of surgical endoprosthesis is an alternative in the palliative treatment of neoplastic hilar compression because it is well tolerated  has a low rate of operative mortality or morbidity  and affords an acceptable quality of life for the patients  
class4	1756	basic studies on a new material for inducing antitumor immune cells  
class4	1756	recently  adoptive immunotherapy for cancer with lymphokine activated killer  lak  cells has been widely used experimentally  
class4	1756	the therapy has several problems  including difficulty in handling  sterilization  and time consumption  
class4	1756	to solve these problems  new materials able to induce antitumor immune cells were investigated  
class4	1756	pokeweed mitogen  pwm  and pwm conjugated materials  cmc 1  could induce strong killer cells by short term stimulation of human peripheral blood lymphocytes  pbl   
class4	1756	the induced killer cells showed a wide killing spectrum in vitro against human tumor cell lines  mkk 1  prmi4788  nbt 2  zr 7530  h 1  hela  kb  hmv 1  pc 10  c 1   
class4	1756	human pbl stimulated for a short time by cmc 1 also showed a tumoricidal effect on tumor bearing  mkn 1  mkn 45  nude mice  
class4	1756	these results suggest that cmc 1 may solve the problems with currently used lak therapy and may provide easily applicable extracorporeal immunotherapy for cancer  
class4	1757	protection of the small intestine against irradiation by means of a removable prosthesis  
class4	1757	in radiation therapy of tumors  several techniques are used to prevent injury of the intestinal loops  
class4	1757	their purpose is to drive the intestine out of the external beam  
class4	1757	understanding the disadvantages they present  a temporary prosthesis which effectively protects the small bowel  and is easy to remove  has been developed  
class4	1757	the device is a 600 to 1 000 ml  silicone rubber  expandable balloon  
class4	1757	when implanted in the pelvis or retroperitoneal cavity  and filled  this balloon displaces the intestinal loops out of the pelvic irradiation field  
class4	1757	it may remain either filled or empty between each irradiation session  
class4	1757	due to its particular elliptical shape  once empty  the balloon can be removed through a 3 cm incision under local or peridural anesthesia at the completion of radiotherapy  
class4	1757	eleven patients with recurrent  8  or primary  3  cancer have been implanted  
class4	1757	the protective effect has been evaluated on successive biologic tests  performed during treatment  
class4	1757	no problem related to the prosthesis  no alteration of the biologic tests  nor bowel injury have been observed after several months follow up  
class4	1757	this device is suitable for preventing intestinal complications during therapy  allowing a higher dose of radiations in some cases  
class4	1758	large loop excision of the transformation zone  lletz  compared to carbon dioxide laser in the treatment of cin  a superior mode of treatment  
class4	1758	a series of 199 patients with histologically confirmed cervical intraepithelial neoplasia  cin  grade ii or iii were allocated by hospital number to receive out patient treatment by carbon dioxide laser vaporization or large loop excision of the transformation zone  lletz   
class4	1758	all patients received local anaesthesia  
class4	1758	the women in the lletz group experienced less post operative haemorrhage  less discomfort  operative time was greatly reduced  and histological material was available for confirmation of the diagnosis  
class4	1758	there was no significant difference in recurrence of cin after treatment between the two groups  
class4	1758	at 6 month follow up  recurrence rates of 8 2   cin ii  and 7 5   cin iii  were observed in the laser group and 5   cin ii  and 5 3   cin iii  in the lletz group  
class4	1758	further advantages of lletz are reduced capital expenditure and no hazard to the eyesight of the surgeon  but laser treatment is preferable in patients with widespread vaginal involvement  
class4	1759	the relationship of  high risk  mammographic patterns to histological risk factors for development of cancer in the human breast  
class4	1759	in the uk trial for the early detection of breast cancer in nottingham  119 women were identified as having fibrocystic change with epithelial hyperplasia or in situ carcinoma  
class4	1759	their mammograms were classified according to wolfe s criteria and the corresponding histology for each patient was classified for degrees of epithelial hyperplasia  atypia and in situ neoplasia using page s criteria  
class4	1759	a control population of patients presenting for breast screening was used to represent the general population  
class4	1759	no correlation was found between the four mammographic wolfe patterns  n1  p1  p2 and dy and histological evidence of epithelial hyperplasia  atypia or in situ carcinoma  
class4	1759	a further study was carried out to determine histological features of wolfe pattern  using radiological examination of resected breast tissue  
class4	1759	the variation in wolfe pattern was related to the distribution of fibrous and adipose tissue in the breast interlobular stroma and appeared to have no relationship to epithelial parenchymal content  
class4	1759	this information does not support the hypothesis that radiographic densities of p2 and dy patterns correspond to high risk epithelial proliferation  
class4	1760	lack of late skin necrosis in man after high dose irradiation using small field sizes  experiences of grid therapy  
class4	1760	out of a total of 437 patients with superior vena caval syndrome or advanced malignancy  given single dose grid radiotherapy  four survived to 7 years  
class4	1760	the dose to the skin under each of the 77 holes in the grid was approximately 58 gy  
class4	1760	the lack of skin necrosis in the total of 308 skin circles of 1 cm diameter among these survivors  compared with known necrosis rates in larger irradiated areas  implies that there is a marked field size effect for late necrosis in small areas of irradiated skin  
class4	1761	preoperative cytology and mammography in patients with single duct nipple discharge treated by surgery  
class4	1761	microdochectomy has been the routine management for single duct nipple discharge  
class4	1761	our review of 176 consecutive patients surgically treated between 1975 and 1988 revealed eight patients with in situ carcinomas and seven with infiltrative carcinomas  
class4	1761	seventeen patients had multiple papillomas  two had atypical hyperplasia and two had atypical epitheliosis  
class4	1761	case selection for surgery has recently been advocated  
class4	1761	in our study  nipple discharge cytology was helpful in 67 per cent of cases with underlying malignant pathology  
class4	1761	mammography was found to be unreliable  alerting suspicion in only two of 15 cases  
class4	1762	microdochectomy for discharge from a single lactiferous duct  
class4	1762	microdochectomy for persistent discharge from a single lactiferous duct was performed in 162 women  
class4	1762	invasive or in situ ductal carcinoma was diagnosed in 16 patients  10 per cent   none of whom had a palpable lump  
class4	1762	the discharge was blood stained in 14 of these women and in two it was clear  
class4	1762	mammography was performed in 15 of these 16 patients and was abnormal in only five  
class4	1762	three patients had atypical ductal hyperplasia  one of whom subsequently developed an invasive ductal carcinoma  
class4	1762	microdochectomy for persistent discharge from a single lactiferous duct is curative and gives a diagnosis of the cause  
class4	1762	it remains the treatment of choice whether the discharge is blood stained or clear  
class4	1763	fine needle aspiration biopsy in the diagnosis and management of fibroadenoma of the breast  
class4	1763	cytological and histological biopsies were obtained on 75 breast lumps clinically diagnosed as fibroadenomas  
class4	1763	of these  95 per cent of lesions were benign  
class4	1763	in 51  68 per cent  confirmed as fibroadenomas histologically  cytology was benign in 78 per cent  but inadequate for diagnosis in 16 per cent  
class4	1763	the remaining 24 lesions included three breast cancers and one lymph node with hodgkin s disease  
class4	1763	in this group cytology was inadequate for diagnosis in 54 per cent  including one breast cancer  
class4	1763	no lesion with benign cytology was subsequently shown to be malignant  
class4	1763	the study supports the view that clinical diagnosis and cytology are accurate in the diagnosis of benign breast disease of this type  
class4	1763	breast cancer may rarely present with the clinical features of a fibroadenoma and too few lesions have been studied to assess fully the performance of cytological biopsy in detecting these small mobile lesions  
class4	1763	a non excisional policy should therefore include prolonged follow up and repeat biopsy  
class4	1764	reduced psychological morbidity after breast conservation  
class4	1764	psychological morbidity was compared in 52 patients treated by mastectomy and 67 patients treated by lumpectomy for early breast cancer  
class4	1764	an informal counselling service was provided for all patients  
class4	1764	morbidity was measured at 6  9 and 12 months after surgery with two self rating scales  the general health questionnaire and the leeds depression and anxiety scales  
class4	1764	there was a significant excess of severe depression in the mastectomy group  
class4	1764	in contrast to the findings of previous research  this result suggests that breast conservation reduces psychological morbidity  
class4	1765	impaired polymorphonuclear leucocyte function in patients undergoing hepatectomy  adenylate energy charge and superoxide anion production in relation to hepatic mitochondrial redox state  
class4	1765	patients undergoing hepatectomy have an increased susceptibility to infection  
class4	1765	we therefore studied the energy metabolism of the polymorphonuclear leucocyte  pmn   focusing on energy charge and function  especially superoxide anion  o2   generation  in relation to the hepatic mitochondrial redox state  
class4	1765	by labelling the pmn adenine nucleotide pool with radioactive adenine and by superoxide dismutase inhibitable reduction of ferricytochrome c  the energy charge and o2  production was measured in 18 patients with hepatoma  non cirrhotic  seven  cirrhotic  11  undergoing hepatectomy  
class4	1765	their arterial ketone body ratios  kbrs   reflecting the hepatic mitochondrial redox potential  were above 0 7 before operation  
class4	1765	after surgery  the 18 patients were divided into two groups  group a  kbr greater than 0 7  n   10  and group b  kbr less than 0 7  n   8  
class4	1765	the energy charge and o2  release in group b decreased significantly from preoperative values  p less than 0 001 and p less than 0 01 respectively  and when compared with group a  p less than 0 05 and p less than 0 01 respectively   
class4	1765	these results suggest that impaired hepatic energy metabolism  kbr less than 0 7  in hepatectomized patients leads to impaired energy charge and o2  production in the pmns  
class4	1766	regional chemotherapy for colorectal liver metastases  a phase ii evaluation of targeted hepatic arterial 5 fluorouracil for colorectal liver metastases  
class4	1766	the results of systemic chemotherapy in patients with liver metastases from colorectal cancer remain dismal  
class4	1766	regional chemotherapy has been advocated as a method of improving the delivery of cytotoxic drugs to tumour  while minimizing systemic toxicity  
class4	1766	the use of vasoactive agents to redistribute arterial blood flow towards tumour  and of biodegradable microspheres to slow tumour blood flow  have also been suggested as methods of further improving tumour exposure to drug  
class4	1766	we present 21 patients who received intrahepatic arterial chemotherapy for colorectal liver metastases  
class4	1766	combined treatment  angiotensin ii  albumin microspheres and 5 fluorouracil  was administered 4 6 weekly  and bolus 5 fluorouracil was given in the intervening weeks  
class4	1766	toxicity was minimal  
class4	1766	responses were seen in seven patients  
class4	1766	fewer than half of the deaths were from liver metastases  a quarter of the patients died from non cancer related causes  
class4	1766	survival was prolonged in the treated group compared with historical controls  
class4	1766	these results suggest that this regimen has activity in patients with colorectal liver metastases  
class4	1767	hepatic metastases from colorectal carcinoma  impact of surgical resection on the natural history  
class4	1767	from 1960 to 1987  1209 patients with colorectal liver metastases were recorded  and followed until 1 january 1990  
class4	1767	in 242 cases the diagnosis was based on external imaging  whereas 967 patients had operative confirmation and staging of their liver disease  
class4	1767	three groups of patients were analysed  group 1 involved 921 cases  of whom 902 were deemed non resectable whereas 19 could not be unequivocally classified  
class4	1767	only 21 patients lived for longer than 3 years  seven survived for 4 years  but there were no 5 year survivors  
class4	1767	group 2 comprised 62 highly selected patients who at laparotomy demonstrated resectable metastatic spread confined to the liver  but this was not treated mainly because of a formerly different therapeutic approach  
class4	1767	these patients had a significantly longer median survival time  14 2 versus 6 9 months   but also failed to achieve 5 year survival  
class4	1767	the 226 patients forming group 3 underwent hepatic resection with intent to cure  
class4	1767	nine of them had minimal macroscopic disease left  and 34 with all gross tumour removed had positive margins  
class4	1767	survival of patients with these 43 eventually non radical resections followed an identical course as in group 2  median survival 13 3 months  maximum 42 months   
class4	1767	of the 183 patients with potentially curative resection ten died after surgery  5 5 per cent   
class4	1767	actuarial 5 and 10 year survival rates in the remaining 173 patients were 40 and 27 per cent with 25 and seven patients alive at respective periods of time  
class4	1767	until 1 january 1990  64 patients remained free from recurrent disease for up to 24 years  
class4	1767	in three patients the tumour status at death was unclear  
class4	1767	the other 106 patients developed definite cancer relapse  
class4	1767	nevertheless they demonstrated a prolongation of survival time by a median of 1 year when compared with the 43 non radically resected patients or the 62 untreated patients with resectable liver only metastases  and accomplished a maximum survival time of 8 years  
class4	1767	radical excision of colorectal secondaries to the liver therefore offers effective palliation  and in a small number the chance of a cure  
class4	1768	extended hepatectomy for hepatocellular carcinoma  
class4	1768	the results of extended hepatectomy in 25 patients with hepatocellular carcinoma performed over a 16 year period have been reviewed  analysed and compared with those of 144 patients who underwent lesser liver resection  
class4	1768	five left and 20 right extended hepatectomies were performed for tumours ranging from 3 to 20 cm in diameter  
class4	1768	seventeen  68 per cent  of the patients had non cirrhotic livers  
class4	1768	the major postoperative complications were  haemorrhage in five cases  major bile duct injury in three  subphrenic abscess in two  liver failure in one and wound dehiscence in one  
class4	1768	the 30 day  operative  mortality rate was 12 per cent and the median survival duration  including operative mortality  was 9 7  range 0 2 32 1  months  
class4	1768	the survival rate was 46 per cent at 1 year  33 per cent at 2 years and 22 per cent at 3 years  
class4	1768	the morbidity  mortality and survival data of extended hepatectomy were comparable with the results of lesser hepatic resections for hepatocellular carcinoma  
class4	1768	we conclude that extended hepatectomy is a worthwhile operation for large hepatocellular carcinomas and a viable alternative to liver transplantation  
class4	1769	vastus lateralis myocutaneous flap for reconstruction of defects around the groin and pelvis  
class4	1769	we present our experience using the vastus lateralis myocutaneous flap for the repair of defects around the groin and pelvis  
class4	1769	it is a relatively new technique  with many advantages over other flaps used in this area  though it has limitations  
class4	1769	the history  anatomy and surgical technique of raising the flap are described and clinical cases are discussed  
class4	1769	the importance of patient selection is highlighted  
class4	1770	association between extent of colonic mucosal sialomucin change and subsequent local recurrence after curative excision of primary colorectal cancer  
class4	1770	two interrelated studies were carried out to determine whether extent of sialomucin change adjacent to a primary colorectal carcinoma predicted local tumour invasiveness and risk of local recurrence  
class4	1770	in the first  depth of tumour penetration was correlated with the length of the sialomucin band adjacent to 72 primary colorectal cancers  
class4	1770	there was a significant  p less than 0 05  increase in sialomucin band length adjacent to tumours invading adjacent structures compared with those which had not  mann whitney u test   although there was no overall correlation between depth of penetration  duke s classification or degree of differentiation  kruskal wallis test   
class4	1770	a sialomucin band of greater than 3 cm was associated with a 70 per cent probability of adjacent structure  t4  invasion  
class4	1770	these observations were then tested prospectively in a second study involving 256 patients to determine whether the presence of a greater than 3 cm sialomucin band could predict local recurrence  
class4	1770	presence of a greater than 3 cm sialomucin band was a significant  x2   7 12  d f  
class4	1770	  1  p less than 0 001  and independent predictor of local but not distant recurrence  
class4	1770	in addition both the interval to local recurrence and survival were significantly shorter if a greater than 3 cm sialomucin band was present  
class4	1770	however the accuracy of greater than 3 cm sialomucin band as a predictive test for local recurrence was only 70 per cent  
class4	1770	the extent of sialomucin adjacent to a primary colorectal cancer does provide a crude assessment of tumour invasiveness and risk of local recurrence  
class4	1771	intraluminal pressure adjacent to left colonic anastomoses  
class4	1771	a cumulative total of 89 h of pressure data was acquired from both sides of a left colonic anastomosis in 15 patients over a median period of 7 postoperative study days  
class4	1771	patients had a colonic ileus lasting 3 10 days and during this proximal and distal inactivity the intraluminal pressure remained within 6 mmhg of atmospheric pressure  
class4	1771	after recovery of activity  pressures proximal to the anastomosis in excess of 10 mmhg occurred during less than 1 per cent of the recording time  
class4	1771	distal peak pressures were significantly elevated with respect to the proximal site  p less than 0 001   
class4	1771	two thirds of the distal pressures recorded were between 10 and 20 mmhg and 98 per cent were less than 50 mmhg  the peak distal pressure was 90 mmhg  
class4	1771	four patients had distal repetitive tonic contractions creating a pressure difference across the anastomosis with a mean of 20 mmhg and a peak of 45 mmhg  
class4	1771	each contraction persisted for 15 20 min  
class4	1771	intraluminal pressures are unlikely to play a role in anastomotic dehiscence  
class4	1772	thallous chloride uptake and dna profile in parathyroid adenomas  
class4	1772	thallium isotope scintigraphy is used to localize parathyroid adenomas but the mechanism underlying the technique is poorly understood  
class4	1772	while larger adenomas are reliably localized the results are less certain for small tumours  
class4	1772	this study explores the relationship between cellular dna profile and thallium uptake  localization accuracy  in 24 parathyroid adenomas  
class4	1772	the dna profile was assessed using flow cytometry and standard subtraction thallium scintigraphy was performed before surgery  
class4	1772	fifteen of the 24 adenomas demonstrated excessive mitotic activity and 13 of these glands were accurately localized  
class4	1772	of the remaining nine glands  only five were localized accurately  p less than 0 01  chi 2 test including yates  correction   
class4	1772	this difference in thallium uptake could not be accounted for on the basis of gland weight  
class4	1772	thallium localization of parathyroid adenomas is related to mitotic activity  
class4	1772	this may explain some of the limitations of this technique  
class4	1773	the importance of calcium regulation in toxic cell injury  studies utilizing the technology of digital imaging fluorescence microscopy  
class4	1773	the regulation of ions within the cell is of critical importance in both acute and chronic toxicology  
class4	1773	recently  new methods have been developed for measuring such changes in living cells and correlating them with studies of structure  function  and biochemistry  
class4	1773	a major revolution has occurred from the linkage between the computer and the light microscope  which has resulted in the use of digital imaging fluorescence microscopy and video intensification microscopy coupled with image analysis  
class4	1773	these methods have already yielded much additional information and it is anticipated that their further application by pathologists and toxicologists will continue to uncover the important role of ion deregulation and toxic cell injury  
class4	1774	esophageal adenocarcinoma in a patient with surgically treated achalasia  
class4	1774	although squamous cell carcinoma of the esophagus occurs with increased incidence in primary achalasia  esophageal adenocarcinoma has been considered rare in this condition  
class4	1774	we report a patient with long standing achalasia in whom adenocarcinoma of the esophagus occurred many years after heller esophagomyotomy  presumably related to barrett s esophagus complicating gastro esophageal reflux disease  
class4	1775	cathepsins d and e in normal  metaplastic  dysplastic  and carcinomatous gastric tissue  an immunohistochemical study  
class4	1775	immunohistochemical distributions of cathepsins d and e were determined in normal mucosa  metaplastic  dysplastic  and cancerous lesions of the human stomach  
class4	1775	cathepsins d and e were localised in the foveolar epithelium and parietal cells of the normal gastric mucosa  but their intracytoplasmic distributions were different   cathepsin e distribution was even and diffuse in the cytoplasm while cathepsin d was found in coarse intracytoplasmic granules  
class4	1775	chronic inflammation and ulcer did not influence the distribution of these enzymes  
class4	1775	no positive staining was obtained in the incomplete type of intestinal metaplasia  dysplasia  and well differentiated adenocarcinoma  
class4	1775	tumour cells of signet ring cell carcinoma and poorly differentiated adenocarcinoma cells  however  gave strong and diffuse stainings for cathepsins d and e in the cytoplasm  
class4	1775	the results suggest that the distribution of cathepsins d and e is related to each specialised function of the foveolar epithelium and the parietal cells  and that their disappearance is associated with development of well differentiated adenocarcinoma from intestinal metaplasia  
class4	1776	microspectrophotometric dna analysis in ulcerative colitis with special reference to its application in diagnosis of carcinoma and dysplasia  
class4	1776	the deoxyribonucleic  dna  content was measured by microspectrophotometry in 100 specimens from 60 patients with ulcerative colitis  including six patients in whom the colitis was associated with carcinoma  
class4	1776	some 23 of 30  77   specimens of dysplastic tissue showed aneuploidy or polyploidy  whereas 50 of 53  94   specimens of non dysplastic tissue showed diploidy  
class4	1776	the difference was statistically significant  p less than 0 001   
class4	1776	polyploidy was often observed in non dysplastic mucosa from patients who had carcinoma or dysplasia  
class4	1776	in the non dysplastic patients all samples of inflamed tissue showed diploidy  
class4	1776	some 10  of samples without inflammation  however  also showed polyploidy  
class4	1776	a good correlation was found between the frequency of polyploid cells and the grade of dysplasia  
class4	1776	microspectrophotometric measurement of dna content proved useful in the assessment and diagnosis of dysplasia in ulcerative colitis and could be considered for screening high risk patients  
class4	1777	role of upper gastrointestinal investigations in a screening study for colorectal neoplasia  
class4	1777	should patients with positive faecal occult blood screening tests who are free of colorectal neoplasia undergo upper gastrointestinal investigation  altogether 16 985 faecal occult blood tests were completed in a group of 18 818 asymptomatic patients  45 75 years  offered screening at two yearly intervals  
class4	1777	a total of 447  2 6   were positive and underwent large bowel investigations  
class4	1777	no neoplastic disease was identified in 283  63   of them  
class4	1777	fourteen  5   also underwent gastroscopy for upper gastrointestinal symptoms  benign conditions were identified in five and a gastric carcinoma in one  
class4	1777	no further investigations were instituted in the remaining 269 subjects who have now been followed up for a median period of 5 years  2 8 years   
class4	1777	five have been referred for benign upper gastrointestinal conditions  but none for upper gastrointestinal malignancy  
class4	1777	thirty one subjects have died   one from gastric cancer  a patient who had undergone a previous partial gastrectomy for a duodenal ulcer and who had persistent upper gastrointestinal symptoms   
class4	1777	the remaining deaths were unrelated to the upper gastrointestinal tract  
class4	1777	nineteen people who have left the trial area have been monitored for the development of malignant disease  none have presented with upper gastrointestinal malignancy  
class4	1777	these data support the view that upper gastrointestinal investigations need not be performed routinely in this group of subjects  but may be reserved for those with relevant symptoms  
class4	1778	role of ultrasound guided fine needle aspiration biopsy in the diagnosis of hepatocellular carcinoma  
class4	1778	in 170 cases of hepatocellular carcinoma  ultrasound showed a high sensitivity in identifying focal liver lesions  
class4	1778	fine needle aspiration biopsy guided by ultrasound yielded a pathological diagnosis in the majority of cases  
class4	1778	the advantages of this technique  its high diagnostic yield and low cost  render the older technique of blind percutaneous biopsy using a coarse needle obsolete  
class4	1778	laparoscopy retains its essential role in selected cases  
class4	1778	complementary use of fine needle aspiration biopsy under ultrasound guidance and laparoscopy assures the highest rate of diagnostic accuracy in hepatocellular carcinoma  
class4	1778	we confirm the poor sensitivity of alpha fetoprotein  
class4	1779	stomal adenocarcinoma in crohn s disease  
class4	1779	malignant change occurring at the site of a stoma in two patients with proved crohn s disease is described  
class4	1779	patients with ulcerative colitis have an increased risk of colonic malignancy and crohn s disease is also associated with both small and large bowel carcinoma  
class4	1779	most previous reports of stomal carcinoma have been associated with ulcerative colitis although crohn s disease seems to carry a greater risk of associated small bowel carcinomas  
class4	1779	this is the first report of stomal carcinoma complicating crohn s disease  
class4	1779	epithelial dysplasia is associated with gastrointestinal carcinomas in both ulcerative colitis and crohn s disease and a dysplasia carcinoma sequence has been suggested as the origin of these tumours  
class4	1779	in both our patients with stomal adenocarcinoma  dysplasia was identified in adjacent tissues  which suggests a similar mechanism  
class4	1779	malignant change should be suspected if epithelial dysplasia is discovered in a biopsy specimen from the mucosa of an ileostomy in crohn s disease  and this risk is increased if the dysplasia is of a high grade  
class4	1780	squamous carcinoma in the liver  
class4	1780	squamous carcinoma of the liver has only rarely been reported  
class4	1780	we present a case which highlights not only the difficulties in diagnosis but also how it can closely mimic sclerosing cholangitis  
class4	1781	function after amputation  arthrodesis  or arthroplasty for tumors about the knee  
class4	1781	we studied the function of twenty two patients who had had a malignant skeletal tumor adjacent to the knee  
class4	1781	an above the knee amputation was done in seven  a resection arthrodesis  in nine  and a replacement arthroplasty  in six  
class4	1781	the patients all walked at a similar speed  sixty one to sixty six meters per minute   which is slower than normal  eighty meters per minute   
class4	1781	they all walked with comparable efficiency at three velocities  the mean consumption of oxygen was 0 210 milliliter per kilogram of body weight per meter at free velocity  0 215 milliliter per kilogram of body weight per meter when they walked 25 per cent faster  and 0 211 to 0 240 milliliter per kilogram of body weight per meter when they walked 50 per cent faster  
class4	1781	the three groups of patients and a normal control group consumed oxygen at similar rates  
class4	1781	the patients who had had an amputation were very active  and they were the least worried about damaging the affected limb  but they had difficulty walking on steep  rough  or slippery surfaces  
class4	1781	the patients who had had an arthrodesis had a more stable limb and performed the most demanding physical work and recreational activities  but they had difficulty sitting  
class4	1781	the patients who had had an arthroplasty led sedentary lives and were the most protective of the limb  but they were the least self conscious about the limb  
class4	1782	the van nes tibial rotationplasty  a functionally viable reconstructive procedure in children who have a tumor of the distal end of the femur  
class4	1782	twelve patients who had a malignant tumor of the distal end of the femur were treated with a van nes tibial rotationplasty  
class4	1782	the survival rates were comparable with those for above the knee amputees and patients who had an endoprosthetic replacement  
class4	1782	the results of functional testing showed that these patients performed as well as those who had endoprosthetic replacement and better than those who had above the knee amputation  
class4	1782	rotationplasty is therefore a favorable alternative to amputation or endoprosthetic replacement  either as a primary or as a salvage procedure  
class4	1783	insulin like growth factor i expression by tumors of neuroectodermal origin with the t 11 22  chromosomal translocation  a potential autocrine growth factor  
class4	1783	expression of insulin like growth factor i  igf i  mrna by some tumor cell lines of neuroectodermal origin has been described  
class4	1783	to further explore the significance of igf i mrna expression in these tumors  a more extensive analysis was performed  
class4	1783	most  9 of 10  neuroectodermal tumor cell lines with a t 11 22  translocation  primitive neuroectodermal tumor  pnet   ewing s sarcoma  esthesioneuroblastoma  expressed igf i mrna  whereas 0 of 15 cell lines without the translocation  pnet  neuroblastoma  expressed igf i  
class4	1783	furthermore  inasmuch as all neuroblastoma  12 of 12  cell lines examined expressed igf ii rna  the pattern of igf expression could distinguish between these closely related tumors  
class4	1783	chp 100  a pnet cell line with the t 11 22  translocation  was shown to secrete both igf i protein and an igf binding protein  igfbp 2  
class4	1783	this cell line also expressed the type i igf receptor mrna  and blockade of this receptor by a monoclonal antibody  alpha ir3  inhibited serum free growth  
class4	1783	these data demonstrate that igf i expression is a property of neuroectodermal tumors with a t 11 22  translocation and that interruption of an igf i autocrine loop inhibits the growth of these tumor cells  
class4	1784	metabolic effects of cachectin tumor necrosis factor are modified by site of production  cachectin tumor necrosis factor secreting tumor in skeletal muscle induces chronic cachexia  while implantation in brain induces predominantly acute anorexia  
class4	1784	we have developed a murine model of wasting by injecting intracerebrally cells which continuously secrete h cachectin tnf  cho tnf  to   a  determine the effects of cachectin tnf produced continuously in the central nervous system  cns   and  b  compare the metabolic effects of cachectin tnf secreting tumor in the brain to the cachexia caused by cho tnf tumor in peripheral tissue  im   
class4	1784	intracerebral cho tnf tumors produced increased serum h cachectin tnf levels with lethal hypophagia and weight loss  mean survival time of 11 d   these changes were not observed in association with nonsecretory control brain tumors  
class4	1784	the metabolic consequences of intracerebral cachectin tnf production were indistinguishable from acute  lethal starvation  whole body lipid content was decreased significantly but protein was conserved  
class4	1784	although intramuscular cachectin tnf secreting tumors caused similar increases of serum h cachectin tnf levels  profound anorexia did not develop  wasting developed after a longer period of tumor burden  50 d  with classical signs of cachexia  i e   anemia and depletion of both protein and lipid   
class4	1784	these studies provide a reproducible animal model of site specific cytokine production and suggest that  regardless of serum levels  cachectin tnf produced locally in brain influences both the rate of development of wasting and its net metabolic effects  
class4	1785	active specific immunotherapy in patients with melanoma  a clinical trial with mouse antiidiotypic monoclonal antibodies elicited with syngeneic anti high molecular weight melanoma associated antigen monoclonal antibodies  published erratum appears in j clin invest 1991 feb 87 2  757  
class4	1785	in two clinical trials the mouse antiidiotypic monoclonal antibody  mab  mf11 30  which bears the internal image of human high molecular weight melanoma associated antigen  hmw maa  was administered by subcutaneous route without adjuvants to patients with stage iv malignant melanoma on day 0  7  and 28  
class4	1785	additional injections were administered if anti antiidiotypic antibodies were not found or their titer decreased  
class4	1785	in the first phase i trial with 16 patients the initial dose was 0 5 mg per injection and escalated to 4 mg per injection  
class4	1785	neither toxicity nor allergic reactions were observed despite the development of anti mouse ig antibodies  
class4	1785	minor responses were observed in three patients  
class4	1785	in a second clinical trial mab mf11 30 was administered to 21 patients at a dose of 2 mg per injection  since this dose had been shown in the initial study to be effective in inducing anti antiidiotypic antibodies  
class4	1785	two patients were inevaluable  in the remaining 19 patients  the average duration of treatment was 34 wk  
class4	1785	in this trial as well  neither toxicity nor allergic reactions were observed  
class4	1785	17 of the 19 immunized patients increased the levels of anti mouse ig antibodies and 16 developed antibodies that inhibit the binding of antiidiotypic mab mf11 30 to the immunizing anti hmw maa mab 225 28  
class4	1785	one patient increased the level of anti hmw maa antibodies  
class4	1785	one patient achieved a complete remission with disappearance of multiple abdominal lymph nodes for a duration of 95 wk  
class4	1785	minor responses were observed in three patients  
class4	1785	these results suggest that mouse antiidiotypic mab that bear the internal image of hmw maa may be useful reagents to implement active specific immunotherapy in patients with melanoma  
class4	1786	occurrence of human papillomavirus type 16 dna in cutaneous squamous and basal cell neoplasms  
class4	1786	sixty eight cutaneous squamous cell neoplasms  in situ and invasive  and 26 basal cell carcinomas from 89 patients were analyzed for dna sequences homologous to the human papillomavirus  hpv  types found predominantly in the genital tract  
class4	1786	thirty six  53   of the squamous cell neoplasms contained hpv dna as detected by filter or in situ hybridization analysis  
class4	1786	the frequency of detection of hpv dna was dependent on the site of the lesion  
class4	1786	of 40 genital squamous cell neoplasms  penile  vulvar  and perianal   27  68   had detectable hpv dna  
class4	1786	in 25 of these  the hpv type was 16 or hpv 16 related  which was similar to the results for the squamous cell neoplasms of the finger  hpv dna in 9 of 11 tumors with hpv 16 in seven   
class4	1786	none of 16 squamous cell neoplasms from sites other than the genital tract or the finger had detectable hpv dna  
class4	1786	hpv dna was detected in one of the 26 basal cell carcinomas  4    
class4	1786	we conclude that  for cutaneous epithelial malignancies  hpv 16 is restricted to squamous cell neoplasms of the genital tract and finger  
class4	1786	these data are consistent with venereal transmission of hpv 16 to the periungual region and suggests a role for this virus in the evolution of squamous cell carcinoma at this site  
class4	1787	spitz nevi in black children  
class4	1787	four black children with spitz nevi are presented  
class4	1787	the initial clinical diagnosis was pyogenic granuloma for three patients  
class4	1787	one child had two spitz nevi  
class4	1787	histologic examination revealed melanocytic dendritic hyperplasia in all cases  
class4	1788	ocular melanoma in families with dysplastic nevus syndrome  
class4	1788	five families with the dysplastic nevus syndrome  in each of which one member had ocular melanoma  are reported  
class4	1788	these five families were examined within a 3 year period in one medical center  
class4	1788	to date only five other families with such a combination have been reported  
class4	1788	we suggest a causal relation between ocular melanoma and the familial dysplastic nevus syndrome  
class4	1789	polypoid melanoma  a virulent variant of nodular melanoma  report of three cases and literature review  
class4	1789	we report the cases of three patients with polypoid melanoma  
class4	1789	in no case was there microscopic evidence of melanoma cell invasion below the papillary dermis  
class4	1789	in the polypoid variant of nodular melanoma  melanoma cells accumulate in large volume above the skin s surface  
class4	1789	this increase in tumor volume encourages dislodgment of melanoma cells that are carried to superficial lymphatic vessels without invading the reticular dermis  this feature differentiates polypoid melanoma from the nonpolypoid nodular variant  
class4	1789	although polypoid melanoma is considered the most malignant form of melanoma  our findings  albeit limited to three cases  suggest that early diagnosis and prompt surgical excision may provide a favorable 5 year survival rate  
class4	1790	photopheresis for the treatment of cutaneous t cell lymphoma  
class4	1790	we investigated the use of extracorporeal chemotherapy  photopheresis  in eight patients with cutaneous t cell lymphoma  
class4	1790	initially described by edelson et al  
class4	1790	for the treatment of erythrodermic cutaneous t cell lymphoma  we have expanded the treatment to include patients with extensive patch plaque disease as well as tumor stage disease  
class4	1790	four of five patients with erythrodermic stage disease had either a complete or a partial clinical remission with photopheresis alone  
class4	1790	one patient with extensive patch plaque disease continued to have a partial clinical remission of 7 months  duration with photopheresis alone  
class4	1790	of the two patients with tumor stage disease  one remained without evidence of clinical disease at 10 months with photopheresis alone  whereas the second patient had a partial clinical remission of 5 months with a combination of local radiation therapy followed by monthly photopheresis  
class4	1790	the skin biopsy specimen obtained from the patient with tumor stage disease in complete clinical remission did not show cutaneous t cell lymphoma  
class4	1790	we conclude that photopheresis is an effective modality alone or in combination with adjunctive therapy for erythroderma  extensive patch plaque disease  and some tumor stage disease  
class4	1791	causes of death in the elderly and their changing pattern in hisayama  a japanese community  results from a long term and autopsy based study  
class4	1791	the causes of death for the elderly were prospectively studied in hisayama  japan  a rural community  
class4	1791	we compared 1 621 subjects  aged 40 years or over  recruited in 1961  and 2 053 subjects recruited in 1974  
class4	1791	each cohort was studied in a follow up that lasted 10 years  they had autopsy rates of 82 1  and 86 1  during each 10 year period  respectively  
class4	1791	the most common causes of death for those aged 70 years or over were cerebrovascular disease  malignant neoplasms  and pneumonia  
class4	1791	deaths due to cerebrovascular disease tended to decrease in the recent cohort  but the proportion of decline was more prominent in cases aged 40 to 69 years  
class4	1791	there was a sex difference in the changing pattern of mortality from heart diseases including ischemic heart disease  
class4	1791	deaths by both heart diseases and ischemic heart disease increased in the more recent cohort of aged women  whereas they decreased in the aged men  
class4	1791	pneumonia was an important cause of death for the elderly in both cohorts  
class4	1791	deaths due to  senility  were rare  being only 1  of the deceased aged 70 or over  
class4	1791	with prolonged lifespan  especially for women  the impact of atherosclerosis and its related disorders on the recent japanese aged population appears to have increased  
class4	1792	leukocyte larceny  spurious hypoxemia confirmed with pulse oximetry 
class4	1792	leukemic patients with extremely high white blood counts may exhibit the phenomenon of leukocyte larceny  in which white blood cells metabolize plasma oxygen in arterial blood gas samples  abg  producing a spuriously low oxygen tension  
class4	1792	we report the case of a leukemic patient with a white blood count in excess of 500 000 in whom multiple abgs documented hypoxemia out of proportion to his clinical picture  
class4	1792	pulse oximetry was used to confirm higher hemoglobin oxygen saturation to establish the leukocyte larceny  
class4	1793	blepharospasm oromandibular dystonia associated with a left cerebellopontine angle meningioma  
class4	1793	blepharospasm oromandibular dystonia is characterized by the presence of spasms of the orbicularis oculi  blepharospasm  and of the lower facial or oromandibular muscles  
class4	1793	a patient with this syndrome is presented in which a left cerebellopontine angle meningioma appeared to act as a triggering mechanism for the development of this disorder  
class4	1793	on the basis of this report  we recommend that physicians search for this tumor in patients with this disorder  
class4	1794	a randomized trial of the effect of three non steroid anti inflammatory agents in ameliorating cancer induced fever  
class4	1794	paraneoplastic fever is well known  and is not an uncommon problem in daily practice  
class4	1794	in an effort to ameliorate tumour induced fever we randomized 48 patients to receive three different non steroid anti inflammatory drugs  naproxen  500 mg d 1   indomethacin  75 mg d 1  or diclophenac sodium  75 mg d 1   
class4	1794	all patients had solid tumours  and microbial infection had been excluded  
class4	1794	all three drugs were equally effective in bringing the temperature down to normal for a period of 30 33 d  
class4	1794	naproxen had the most rapid effect  
class4	1794	in cases of fever relapse with the first drug  when the other two drugs were given instead  both proved equally effective  
class4	1794	no side effects were observed  
class4	1794	we conclude that naproxen  indomethacin and diclophenac sodium are equally effective in ameliorating paraneoplastic fever  
class4	1794	in relapse  a second drug given subsequently can be effective as well  
class4	1795	castanospermine vs  its 6 o butanoyl analog  a comparison of toxicity and antiviral activity in vitro and in vivo  
class4	1795	inhibitors of glycoprotein processing  such as castanospermine  1 6 7 8 tetrahydroxyoctahydroindolizine   have been shown previously to inhibit human immunodeficiency virus type 1  hiv 1  with acceptable toxicity in cultured human cells  
class4	1795	in prior experiments  we have tested the toxicity and antiviral efficacy of castanospermine in mice infected with the rauscher murine leukemia virus  rlv   
class4	1795	when compared with 3  azido 3  deoxythymidine  azt  zidovudine   castanospermine was less effective and more toxic  
class4	1795	since the 6 o butanoyl analog of castanospermine was previously found to have a more favorable activity profile than the parent compound against hiv 1 in cultured cells  we compared the antiviral efficacy of both compounds in parallel in vitro and in vivo in the rlv system  
class4	1795	plaque formation in the xc assay was inhibited with a 50  inhibitory concentration  ic50  of 2 4 microm for the 6 o butanoyl analog of castanospermine  as compared to 9 microm for castanospermine  
class4	1795	for both compounds  concentrations resulting in significant cytotoxicity were about ten times higher  
class4	1795	both compounds significantly decreased hiv 1 env induced syncytium formation in a novel in vitro assay  
class4	1795	in rlv exposed mice  the 6 o butanoyl analog showed no advantage over the parent compound  both curves for toxicity as well as antiviral efficacy were super imposable  
class4	1795	we conclude that the 6 o butanoyl analog of castanospermine as well as castanospermine itself are active antiviral agents in mice and that prolonged oral administration is tolerable  
class4	1795	however  in comparison to azt  their antiviral activity profiles are less favorable  
class4	1796	incidence of polymyositis dermatomyositis  a 20 year study of hospital diagnosed cases in allegheny county  pa 1963 1982  
class4	1796	the incidence of hospital diagnosed polymyositis dermatomyositis  pm dm  among residents of pittsburgh and allegheny county  pa was determined from 1963 to 1982  
class4	1796	medical records of all allegheny county hospitals were searched for patients diagnosed pm dm  and each accepted case was reviewed and verified by a physician  according to specified criteria  
class4	1796	direct age adjusted incidence rates were computed for race and sex  as new cases million population year  with the 1970 allegheny county population as the standard  
class4	1796	one hundred seventy seven cases were identified during this 20 year survey for a total annual incidence of 5 5 million population  
class4	1796	incidence more than tripled during 1973 1982 compared to the first decade of study  with the greatest increase occurring in black women  
class4	1796	overall  the female to male incidence ratio was 2 2 1  but during the childbearing years  ages 15 44  this ratio increased to greater than 5 1 in both races  
class4	1796	detection of pm dm is increasing  as shown by temporal trends  
class4	1796	although our series has significantly more adult pm and less dm and overlap cases than other published studies  annual incidence is similar to that reported in other locales  
class4	1797	bladder outlet obstruction due to pelvic lipoma  computerized tomography  magnetic resonance imaging and radiographic evaluation  
class4	1797	we report an unusual case of long standing bladder outlet obstruction due to pelvic lipoma in a 31 year old white man  
class4	1797	the mass was evaluated by plain film  computerized tomography and magnetic resonance imaging  
class4	1797	the differential diagnosis of fat containing extraperitoneal pelvic masses is discussed  
class4	1798	adenocarcinoma of the urachus associated with elevated levels of ca 125  
class4	1798	adenocarcinoma of the urachus is a rare genitourinary tumor with a poor prognosis  
class4	1798	the treatment of choice is en bloc surgical resection  although combination therapy with surgery and chemotherapy has been used with mixed results  
class4	1798	we describe a 69 year old woman with adenocarcinoma of the urachus and elevated serum levels of ca 125 tumor marker  
class4	1798	she was treated with resection plus 5 fluorouracil  doxorubicin and mitomycin  alternating with platinum based chemotherapy  
class4	1798	the serum ca 125 level decreased precipitously after the operation and became normal after 2 months of chemotherapy  
class4	1798	the patient remained free of disease 1 year postoperatively  
class4	1798	serum ca 125 may be a useful tumor marker for urachal carcinoma and adjuvant chemotherapy may be effective in treating the disease  
class4	1799	unresectable calcified bladder tumor  hemiacidrin irrigation as an adjunct to resection  
class4	1799	radiographic calcification of urothelial malignancies is an uncommon finding  
class4	1799	to our knowledge  calcification of transitional cell carcinoma of the bladder preventing transurethral resection has not been reported previously  
class4	1799	we report a case of an initially unresectable radiopaque bladder tumor and discuss the successful  conservative management with continuous bladder irrigation with hemiacidrin followed by complete transurethral resection  
class4	1800	rectourethral fistula caused by kaposi s sarcoma  
class4	1800	a 35 year old man with the acquired immunodeficiency syndrome related complex was evaluated for a persistent urethral discharge  pneumaturia and watery diarrhea  
class4	1800	radiographic and endoscopic procedures established the diagnosis of a rectourethral fistula  
class4	1800	perineal exploration and excision of the fistula revealed the pathological diagnosis of kaposi s sarcoma  
class4	1800	the differential diagnosis of an acquired rectourethral fistula and the significance of kaposi s sarcoma are discussed  
class4	1801	adenocarcinoma of the prostate in a 41 year old man with xxy karyotype and chronic lymphocytic leukemia  report of a case  
class4	1801	we report a case of adenocarcinoma of the prostate in a 41 year old man with 47xxy karyotype  klinefelter s syndrome  and chronic lymphocytic leukemia  
class4	1801	the increased incidence of malignancy in individuals with klinefelter s syndrome has been well documented for certain neoplasms  
class4	1801	adenocarcinoma of the prostate has not been reported previously in a patient with klinefelter s syndrome and a 47xxy karyotype  
class4	1801	absence of mosaicism was confirmed by peripheral lymphocyte  skin fibroblast  bone marrow cell and spleen stroma fibroblast cultures  
class4	1801	chronic lymphocyte leukemia  especially the t cell cytotoxic suppressive variant  may additionally add to an immunological deficit  
class4	1801	since carcinoma of the prostate  klinefelter s syndrome and chronic lymphocytic leukemia are common  the lack of a previous report is interesting  
class4	1801	etiological aspects are discussed  
class4	1802	exaggerated venous mural hypertrophy in association with metastatic adenocarcinoma of the prostate  
class4	1802	a 61 year old black man presented with metastases to the right groin 5 years after 125iodine treatment for a well differentiated primary prostatic adenocarcinoma  
class4	1802	medium sized veins within and immediately adjacent to the neoplasm showed marked mural thickening due to hypertrophy and hyperplasia of the inner circular and outer longitudinal muscles  
class4	1802	there was no histological evidence of radiation effect in the stroma or in the tumor cells  
class4	1802	we could find no report in the literature of such changes associated with metastatic carcinoma  
class4	1803	end stage renal disease serum contains a specific renal cell growth factor  
class4	1803	end stage renal disease  esrd  kidneys display abnormal growth characterized by a continuum of cystic disease  adenoma and carcinoma  
class4	1803	this study evaluates the hypothesis that serum of patients with esrd contains increased amounts of a growth factor which specifically induces proliferation of renal cells  
class4	1803	esrd sera compared to sera from normal controls induced a two to three fold increase in the proliferative rate of renal cell carcinoma cell lines and normal kidney explants compared to cell lines from other sites  
class4	1803	the increased proliferative activity of esrd sera on renal cells was paralleled by an increase in cytosolic free calcium  
class4	1803	the growth factor activity was encoded by a polypeptide of between 15 and 30 kd  
class4	1803	the activity of esrd sera on renal cells was not mimicked or inhibited by epidermal growth factor  basic fibroblast growth factor and platelet derived growth factor indicating that the renal cell specific growth factor activity in esrd is different from these factors  
class4	1804	cytotoxic effects of high energy shock waves in different in vitro models  influence of the experimental set up  
class4	1804	high energy shock waves  electromagnetically generated  siemens lithostar  were studied for their effects in vitro on different  tumor  cell types  
class4	1804	cells were exposed to the shock waves as a single cell suspension or as a cell pellet on the bottom of a test tube  
class4	1804	in both cases  a dose dependent direct cytotoxicity  established by trypan blue dye exclusion  was observed after treatment with 1000 or 2000 shock waves  
class4	1804	also  the antiproliferative capacity as determined by clonogenic potential  double layer soft agar  and growth rate  plastic  were affected in this way  
class4	1804	however  comparing the results after treatment in suspension or pellet  a discrepancy was evident  
class4	1804	the cell lines showed a different susceptibility in pellet vs  
class4	1804	suspension  
class4	1804	also the differential sensitivity of the cell types varied in these two treatment models  
class4	1804	furthermore the outcome depended on the cell concentration  direct cytotoxicity in a cell suspension was more pronounced at higher cell concentrations  while in a pellet this was increased by decreasing the number of cells  
class4	1804	finally  no shock wave induced cytotoxicity could be seen after fixation of cells in gelatine or by placing the pellet on a bottom layer of gelatine  
class4	1804	pressure measurements revealed no adequate explanation for this phenomenon  
class4	1804	these results indicate that in vitro effects depend on the way cells are exposed to the shock waves and can be greatly influenced by changing the conditions of the microenvironment  
class4	1804	therefore  precise descriptions of the experimental set up and careful interpretations of their outcome are obligatory  
class4	1805	surgical management and prognosis of renal cell carcinoma invading the vena cava  
class4	1805	a total of 44 patients with renal cell carcinoma and vena caval tumor thrombus underwent surgical resection  
class4	1805	of these patients 27 had primary tumor confined within gerota s fascia  negative lymph nodes and no distant metastases  stage t3cn0m0   
class4	1805	patients who underwent extraction of a mobile tumor thrombus from the vena cava had a 69  5 year survival rate  median 9 9 years  but patients with tumor thrombus directly invading the vena cava had a 26  5 year survival rate  median 1 2 years   which improved to 57   median 5 3 years  if the involved vena caval side wall was resected successfully  
class4	1805	of these patients 17 had renal cell carcinoma with vena caval thrombus as well as extrafascial extension  regional lymphadenopathy or distant metastases  and the 5 year survival rate was less than 18  in all groups  median survival less than 0 9 years   
class4	1805	prognosis was determined by the pathological stage of the renal cell carcinoma and by the presence or absence of vena caval side wall invasion but not by the level of tumor thrombus extension  
class4	1805	patients with incomplete resection of localized renal cell carcinoma with tumor thrombus do not survive any longer than those with extensive cancer  positive lymph nodes or distant metastases  
class4	1805	however  when partial venacavectomy establishes negative surgical margins then survival markedly improves  
class4	1806	progression of stage t1 bladder tumors after intravesical bacillus calmette guerin  published erratum appears in j urol 1991 apr 145 4  840  
class4	1806	of 221 patients with superficial bladder tumors  stages ta  tis and t1  treated by transurethral resection and an initial 6 week course of intravesical bacillus calmette guerin  bcg  195 were evaluated after 3 months for local response  
class4	1806	of these patients 17  8 7   had a stage t1 tumor  of whom 14  82   subsequently had muscle invasion  7   uncontrolled local disease  6  or metastasis  1   
class4	1806	the median interval to progression was 8 4 months  which was significantly  p   0 0001  less than among the other 178 patients with a nonstage t1 lesion or no tumor found at 3 months  of whom 44  25   had progression  median more than 5 years   
class4	1806	these data suggest that patients with stage t1 tumor 3 months after bcg therapy require additional therapy other than simple tumor resection and meticulous followup  
class4	1807	results of contemporary radical cystectomy for invasive bladder cancer  a clinicopathological study with an emphasis on the inadequacy of the tumor  nodes and metastases classification  
class4	1807	we reviewed 261 patients who underwent a radical operation at a single institution as definitive treatment of invasive bladder cancer to evaluate the survival and accuracy of the tumor  nodes and metastasis system in characterizing the prognosis  
class4	1807	between january 1979 and june 1987 the 261 evaluable patients underwent 1 stage radical cystectomy with pelvic node dissection and urinary diversion  
class4	1807	no chemotherapy and or radiation therapy was given before or after the operation  
class4	1807	the postoperative mortality rate was 1 8   
class4	1807	the over all staging error between clinical and pathological stages was as high as 44   
class4	1807	the over all actuarial 5 year survival rate was 54 5   
class4	1807	the 5 year survival rates were 75  for stage pt1  63  for stage pt2  31  for stage pt3 and 21  for stage pt4 disease  
class4	1807	a significant difference in the survival  p less than 0 002  was observed in stage pt3 by dividing tumors confined within the bladder wall  pt3a  50   from those extending throughout the bladder wall  pt3b  15    
class4	1807	a careful evaluation of transitional cell involvement of the prostate in stage pt4a cancer led to the identification of 2 different patterns  1  contiguous when a bladder tumor extended directly into the prostate through the bladder wall and 2  noncontiguous when a bladder tumor and a transitional cell carcinoma of the prostate were found simultaneously  
class4	1807	these patterns had completely different  p less than 0 05  survival rates  6 versus 37    
class4	1807	the patients with high grade tumors had a worse prognosis in comparison with those with grades 1 and 2 tumors  41 versus 56   p less than 0 005   
class4	1807	the over all 5 year survival of patients with positive nodes was 4  in comparison with 60  of those without nodal involvement  p less than 0 001   
class4	1807	despite current optimal surgical treatment  nearly 50  of all patients with invasive bladder cancer continue to die  
class4	1807	the need for a modification of the current tumor  nodes and metastasis tumor classification to provide the clinician a more reliable staging system for planning treatment modalities is indeed mandatory  
class4	1808	total bladder replacement using detubularized sigmoid colon  technique and results  
class4	1808	we performed total bladder replacement with a detubularized segment of sigmoid colon in patients after cystoprostatectomy  
class4	1808	the surgical technique and long term results in 27 patients are reported  
class4	1808	this neobladder configuration compared favorably with other neobladder types regarding ease of construction  
class4	1808	the surgical complications were acceptable  
class4	1808	initial reservoir function was good but improved further with time  
class4	1808	after 1 year the capacity averaged 600 cc  pressures during filling and at capacity were low  average 12 and 16 cm  
class4	1808	water  and emptying was satisfactory  residual urine 4 to 80 cc   
class4	1808	all patients were continent during the day and 67  were continent at night without excessive voiding habits  
class4	1808	nighttime incontinence was further resolved in 2 patients by using the ams 800 artificial sphincter around the bulbous urethra  
class4	1808	the detubularized sigmoid is an excellent neobladder configuration after cystoprostatectomy  
class5	1809	osteoma of the middle ear  report of a case  
class5	1809	osteomas of the middle ear are rare  
class5	1809	we report a case of a 7 year old boy with osteoma originating from the pyramidal eminence  combined with congenital cholesteatoma  
class5	1809	the osteoma and cholesteatoma were successfully removed by tympanomastoidectomy  
class5	1809	the long process of the incus and the superstructure of the stapes disappeared  
class5	1809	the body of the incus was sculpted and used as a columella  
class5	1809	histopathologically  the osteoma was much the same as an external auditory canal osteoma  
class5	1809	the possibility of a primary congenital origin of this neoplasm is suggested  
class5	1810	replacement of an aortic valve cusp after neonatal endocarditis  
class5	1810	septic arthritis developed in a neonate after an infection of her hand  
class5	1810	despite medical and surgical treatment endocarditis of her aortic valve developed and the resultant regurgitation required emergency surgery  
class5	1810	at operation a new valve cusp was fashioned from preserved calf pericardium  
class5	1810	nine years later she was well and had full exercise tolerance with minimal aortic regurgitation  
class5	1811	chondrosarcoma of bone in children  
class5	1811	chondrosarcoma of bone rarely occurs in children  
class5	1811	this report analyzes the clinicopathologic features in a series of 47 patients with conventional chondrosarcoma who were less than 17 years of age  
class5	1811	of the 47 cases  14 were from the mayo clinic files  and 33 were from our consultation files  
class5	1811	most of the lesions occurred in the trunk and upper ends of the long bones  with the humerus being the most frequent skeletal site  
class5	1811	twelve of the 47 tumors were secondary  
class5	1811	the radiographic findings were the same as those seen in adult chondrosarcoma  
class5	1811	pathologically  the tumors were low grade  
class5	1811	en bloc resection is the treatment of choice because of the high incidence of local recurrence with lesser surgical margins  
class5	1811	prognosis in childhood chondrosarcoma is no different from that in adult chondrosarcoma  
class5	1811	none of the patients with follow up data had metastasis  
class5	1812	klinefelter s syndrome with anomalous origin of left main coronary artery 
class5	1812	klinefelter s syndrome is a rare entity  
class5	1812	even rarer is an anomalous origin of the left main coronary artery  
class5	1812	for both conditions to occur in the same patient is hence exceedingly rare  
class5	1812	reported here is a never previously reported case of a coronary congenital anomaly in a patient with klinefelter s syndrome together with the proper angiographic approach  
class5	1813	the importance of calcium ions for in vitro malignant hyperthermia testing  
class5	1813	intracellular ca   levels in skeletal muscle are elevated during the in vitro contracture response of muscle from subjects with malignant hyperthermia  
class5	1813	the role of ca   in the bathing medium and the consequences of substitution of sr   for ca   in the response to agents associated with malignant hyperthermia were examined  
class5	1813	when ca   was omitted from the bathing medium the contractures induced in human vastus lateralis by halothane  three per cent  or succinylcholine  50 mm  were reduced by 80 and 100 per cent  respectively  while contractures induced by caffeine  8 mm  were only reduced by 50 per cent  
class5	1813	substitution of ca   by another divalent cation  sr    completely restored contractures induced by caffeine  but only partially restored contractures induced by halothane or succinylcholine  to 50 and 30 per cent of ca     containing medium  respectively   
class5	1813	mepacrine  10 microm  was effective in antagonizing contractures by caffeine  whereas verapamil and nifedipine  10 microm  were not  
class5	1813	these results support an essential role for extracellular ca   not fulfilled by sr   in contracture induction by halothane and succinylcholine  but not by caffeine  
class5	1814	intertrochanteric corrective osteotomy in slipped capital femoral epiphysis  a long term follow up study of 26 patients  
class5	1814	the results of intertrochanteric corrective osteotomy in a series of 26 hips with moderate to severe chronic slipped capital femoral epiphysis are reported from follow up studies in 1976 and 1986  
class5	1814	in hips with a slippage of less than 40 degrees  ten hips   arthrosis was present in one hip  
class5	1814	in the remaining 16 cases in which slippage exceeded 40 degrees  osteoarthrosis was present in 15  even though correction was adequate  
class5	1814	from these observations it can be concluded that intertrochanteric corrective osteotomy does not prevent degeneration in cases with the most severe slip  
class5	1814	on the basis of the present observations on treated and untreated cases  the authors advocate treatment by fixation without realignment  accepting the deformity in moderate and severe chronic slips  
class5	1814	rotational osteotomy may be considered in the event of hip joint contracture  
class5	1815	five year postoperative results of cemented femoral arthroplasty in patients with systemic bone disease  
class5	1815	to determine whether bone cellular abnormality affects the results of cemented femoral arthroplasty  21 patients had biopsies of the iliac crest and femoral cortex at the time of surgery  
class5	1815	roentgenographic and histomorphometric studies were used to characterize fibrous membrane formation  cancellous bone  calcar resorption  and bone turnover  
class5	1815	patients with high bone turnover and decreased femoral thickness and density before surgery were at risk of developing calcar resorption and cancellous diaphyses  conditions that weaken proximal stem support and lead to early failure  
class5	1815	these findings suggest that noncemented stems may be indicated in this group  
class5	1815	another group  osteoporotic patients  suffered from osteoblastic insufficiency  which may be the indication for the use of cemented stems rather than noncemented stems  which require bony ingrowth  
class5	1816	trochanteric fractures  influence of reduction and implant position on impaction and complications  
class5	1816	a review of roentgenograms and charts was made of 532 trochanteric fractures treated by the sliding screw technique  
class5	1816	according to evans  modified classification  65  of the fractures were unstable  
class5	1816	there was no breakage or bending of implants  
class5	1816	twenty  3 8   reoperations were performed because of technical complications or nonunion  
class5	1816	the singh index revealed more unstable fractures and technical complications in hips with grades 1 3 than in hips with grades 4 6  
class5	1816	reoperation was more frequent if the screw tip was within 8 mm from the subchondral line in the superolateral quadrant or in the anteroproximal quadrant than if the screw ended farther from the subchondral line  
class5	1816	fifty five  10 8   of the lag screws migrated 2 mm or more  
class5	1816	postoperatively  the neck shaft angle decreased more in unstable fractures than in stable fractures  
class5	1816	the decrease in neck shaft angle was less when the proximal fragment impinged medially on the shaft fragment  
class5	1816	unstable fractures with this type of reduction also impacted less than hips with anatomic reduction or medial reduction of the shaft fragment  
class5	1816	weight bearing did not significantly influence the degree of impaction  
class5	1817	the influence of joint line position on knee stability after condylar knee arthroplasty  
class5	1817	using a special knee testing device  ten knees obtained at autopsy were subjected to varus valgus  anterior posterior  and flexion rotation analysis in the intact state and after total knee arthroplasty  
class5	1817	the ten knees showed no significant change in stability after knee replacement when the joint line was maintained in its natural position  
class5	1817	when the femoral component was repositioned 5 mm proximally and 5 mm anteriorly  a significant increase in laxity occurred during midflexion  
class5	1817	when the joint line was shifted 5 mm distal and 5 mm posterior to its anatomic location  significant tightening occurred in midrange of motion  
class5	1817	coupled rotation of the tibia with knee flexion was decreased after surgery in all knees with no specific relationship to joint line position  
class5	1817	coupled rotation with varus valgus testing  however  remained within the normal range through the first 30 degrees of flexion only when the joint line was restored to its normal anatomic position  
class5	1817	stability in condylar knee arthroplasty is in part dependent on position of the joint line  
class5	1817	surgical techniques that rely on restoring the flexion and extension gap without regard to joint line position may result in alteration of varus valgus or anterior posterior displacement in midrange flexion  
class5	1818	pediatric spondyloarthropathies  
class5	1818	seronegative spondyloarthropathies in childhood are often misdiagnosed as juvenile rheumatoid arthritis  but recognition of their distinct clinical manifestations and unique underlying pathophysiologies can aid in making a proper diagnosis  
class5	1818	ankylosing spondylitis  reiter s syndrome  psoriatic arthritis  and the arthritis associated with inflammatory bowel disease are arthritides most often found in young adults  but they may also be present in children  
class5	1818	extraarticular manifestations include inflammation of the eyes  skin  gastrointestinal tract  and genitourinary tract associated with inflammation of the entheses  
class5	1818	the proper diagnosis will allow for treatment regimens that differ from those usually used for juvenile rheumatoid arthritis  
class5	1818	early diagnosis and treatment often lead to an early recovery and a return to normal daily activities  
class5	1819	the relationship between bone morphogenetic protein and neoplastic bone diseases  
class5	1819	the monoclonal antibody against bovine bone morphogenetic protein was used for demonstration of bone morphogenetic protein  bmp  in neoplastic bone diseases  
class5	1819	the avidin biotin peroxidase complex method demonstrated that bmp mainly exists in the cytoplasm of tumor cells of osteosarcoma and chondrosarcoma  
class5	1819	immunostaining showed that a majority of osteosarcomas and all of the chondrosarcoma cells contained a large quantity of bmp  
class5	1819	conversely  none of the fibrosarcomas showed positive staining  
class5	1819	thus  it was possible to differentiate osteosarcomas from fibrosarcomas by immunostaining  
class5	1819	in fibrous dysplasia of bone  bmp was abundant in the fibrocellular tissue that had osteogenic activity  
class5	1819	in contrast  fibrous tissue of ossifying fibroma showed weak positive staining  only the osteoblasts rimming the bone showed a positive reaction  
class5	1819	immunostaining showed that bmp was also detected in other neoplastic bone diseases such as osteoma  chondroma  and other tumors  
class5	1820	the influence of growth hormone on the reversibility of articular cartilage degeneration in rabbits  
class5	1820	growth hormone has chondrogenic affects on normal as well as on damaged articular cartilage  
class5	1820	in this study  the influence of growth hormone is investigated on early degenerative changes in the articular cartilage in 72 new zealand white rabbits  
class5	1820	cartilage lesions were created in femoral condyles using an immobilization model  
class5	1820	cartilage damage was assessed using biochemical  histologic  and biomechanical criteria  
class5	1820	growth hormone had no influence on prevention of immobilization abnormalities but had a significant affect on healing of established lesions  
class5	1821	effects of corticosteroids on mechanical strength of intervertebral joints and vertebrae in dogs  
class5	1821	dogs with hyperadrenocorticism had a higher incidence of intervertebral joint disease  i e   disc protrusion or spondylosis  
class5	1821	in comparing cases of hyperadrenocorticism with age  and breed matched controls with hypothyroidism  the incidence was significantly greater than expected  
class5	1821	this was not seen  however  in beagle dogs in which the incidence was already high and attributed to chondrodystrophoid tendencies in this breed  
class5	1821	to investigate the pathogenesis of this association and its possible relationship to steroid induced osteopenia  adult dogs were given a placebo  prednisone  or prednisone plus calcium for six months  
class5	1821	torque testing of intervertebral joints revealed a consistent trend of lower force to failure in both prednisone treated groups  but the difference was not statistically significant  
class5	1821	in these dogs with mild to moderate hyperadrenocorticism  compression tests of intact vertebral bodies were not significantly different  but blocks of trabecular bone cut from the vertebral bodies failed at significantly lower compressive forces in both prednisone treated groups compared with controls  
class5	1821	histomorphometric evaluation of lumbar vertebral trabecular bone revealed that the percentage of bone volume was not significantly decreased in the prednisone treated groups  
class5	1821	nor was there any difference in the thickness or porosity of vertebral end plates  which might contribute to weakening of intervertebral ligamentous insertions  
class5	1822	biomechanical comparison of single  and double pin fixation for acute slipped capital femoral epiphysis  
class5	1822	biomechanics of pin fixation for acute slipped capital femoral epiphysis  scfe  was studied in an in vitro immature canine model  
class5	1822	acute scfe were created in 24 paired femurs  
class5	1822	the paired specimens were pinned with either one or two pins and loaded to failure  
class5	1822	strength and stiffness of the paired limbs were expressed as percentages of the loads necessary to create the initial scfe in the intact specimen  
class5	1822	strength and stiffness were equivalent statistically for the intact physis and the fractured physis fixed with two pins  
class5	1822	single pinning was only 83  as strong and 78  as stiff as the intact physeal plate  
class5	1822	double pin fixation is recommended over single pin fixation for acute scfe  
class5	1822	these data  however  should not be extrapolated to the clinical situation of fixation for chronic scfe  
class5	1823	results of treatment of tibial and femoral osteomyelitis in adults  
class5	1823	from january 1  1971  to december 31  1985  425 patients with chronic osteomyelitis of the femur or tibia were seen at the authors  institution  
class5	1823	the success rate in this recent experience was 84 4  compared with 50 9  in the authors  results published in 1970  
class5	1823	a classification of chronic osteomyelitis is as follows   1  hematogenous osteomyelitis   2  osteomyelitis in united fractures  fracture with union    3  osteomyelitis in nonunion  fracture with nonunion   and  4  postoperative or posttraumatic osteomyelitis in which bone was not fractured  
class5	1823	for management of the scarring of surrounding soft tissue  there has been a change to excision of the scarred tissue and reliance on muscle flap  free tissue transfer  or closure of soft tissues without irrigation with antibiotic solution  
class5	1823	in recent years  free microvascular osseous grafts have permitted more aggressive resection of the involved osseous tissue  
class5	1823	the predominance of gram negative organisms and penicillin resistant staphylococcus aureus and the occurrence of methicillin resistant s  
class5	1823	aureus continue  
class5	1824	ocular complications of rheumatic diseases of childhood  
class5	1824	the association between inflammatory ocular and articular disease is a strong one  although the pathogenesis of this relationship is obscure  
class5	1824	for the physician or surgeon caring for children with chronic arthritis  awareness of the risk of chronic asymptomatic anterior uveitis is essential if early diagnosis  treatment  and prevention of visual impairment are to be accomplished  
class5	1824	this is particularly true for children with pauciarticular onset juvenile rheumatoid arthritis or psoriatic arthritis  
class5	1824	acute symptomatic anterior uveitis is characteristic of disorders such as ankylosing spondylitis  
class5	1824	whereas this disease is initially more unpleasant for the child  it has a good long term prognosis  
class5	1825	combined laminoplasty and posterolateral fusion for spinal canal surgery in children and adolescents  
class5	1825	spinal deformities  especially kyphosis and instability  after laminectomy for tumors and other diseases  are major clinical problems  
class5	1825	since 1981  combined laminoplasty and posterolateral fusion for the prevention of postlaminectomy spinal deformities was performed on eight male and two female patients aged two to 26 years  average  13 9 years   
class5	1825	the follow up period was from six months to seven years and three months  average  three years and five months   
class5	1825	two patients died six and ten months postoperatively because of brain metastases  astrocytoma  and lung metastases  neuroblastoma   respectively  
class5	1825	good alignment with no instability of the cervical or thoracic spine was obtained for all patients  including the two who died  
class5	1825	laminoplasty combined with posterolateral fusion was found to be very effective in preventing the development of spinal deformities after spinal canal surgery for spinal cord tumors or other diseases in children and adolescents  
class5	1826	comparison of quantitative sensory threshold measures for their association with foot ulceration in diabetic patients  
class5	1826	we compared the accuracy of cutaneous pressure perception threshold measurements with that of other sensory threshold measurements for detecting diabetic foot ulcer patients  
class5	1826	three hundred fourteen non insulin dependent diabetic patients were studied  of whom 91 had either a current foot ulcer or a history of foot ulceration  
class5	1826	foot ulcer patients had much higher pressure perception thresholds at the hallux than those without foot ulcers  mean     se 4 63     0 05 vs  
class5	1826	3 54     0 04 u  p less than 0 001   
class5	1826	the magnitude of association was higher than that for vibration thresholds and markedly greater than those for cool and warm thresholds  
class5	1826	pressure thresholds were highly accurate for identifying foot ulcer patients  
class5	1826	at a threshold level of 4 21 u  the sensitivity was 0 84  with a specificity of 0 96  
class5	1826	at similar sensitivities for vibration and thermal thresholds  specificities were lower  
class5	1826	foot ulceration and cutaneous pressure perception threshold are strongly associated  
class5	1826	pressure threshold measurements are extremely accurate and perform at least as well as other quantitative sensory tests in identifying foot ulcer patients  
class5	1826	assessment of the foot pressure threshold may have promise as a simple and inexpensive method for detecting diabetic patients at risk for foot ulcers  
class5	1827	measuring vibration sensations with graduated tuning fork  simple and reliable means to detect diabetic patients at risk of neuropathic foot ulceration  
class5	1827	to find a simple and reliable means to measure vibration sensations  189 diabetic patients and 88 control subjects were tested at different sites with a graduated tuning fork  
class5	1827	within test variation at big toes reached 8 4  in diabetic patients vs  
class5	1827	2 2  in control subjects  
class5	1827	mean contralateral variation was 7 5  in diabetic patients vs  
class5	1827	2 5  in control subjects  
class5	1827	tuning fork sensations were inversely correlated with duration of diabetes  whereas no correlation was found with hba1c levels or the severity of retinopathy  
class5	1827	ninety nine  52   patients had vibratory sensation at big toes of less than 99th percentile of normal values for age  
class5	1827	in addition  51  of the patients with clinical symptoms at extremities  n   67   70  of the patients without tendon reflexes  n   50   and 75  of the patients with abnormal nerve conduction velocities  n   60  also had low vibration sensations  
class5	1827	all patients with lower limb injuries  n   7  had values at big toes of less than 2  
class5	1827	altogether  the graduated tuning fork represents a simple and reliable alternative to quantitate vibration sensations  
class5	1827	long term follow up of asymptomatic patients will indicate whether these abnormalities reflect underlying neuropathy  
class5	1827	patients with abnormal values at screening will necessitate additional investigations and special foot care education programs  
class5	1828	chiari pelvic osteotomy for osteoarthritis  the influence of the torn and detached acetabular labrum  
class5	1828	we assessed the results of chiari pelvic osteotomy in 64 hips with early osteoarthritis in terms of acetabular labral detachment detected pre operatively by arthrography  
class5	1828	at an average follow up of four years  assessment by the merle d aubigne score showed 83  excellent or good results  
class5	1828	these satisfactory results were achieved in only half the cases with a detached labrum  but in nearly all cases with normal or torn acetabular labra  
class5	1828	other factors such as the acetabular index  the level and angle of osteotomy  and the displacement following osteotomy did not affect the results  
class5	1828	chiari pelvic osteotomy is a worthwhile procedure for early osteoarthritis in selected cases  but a detached acetabular labrum increases the risk of clinical failure  
class5	1829	the incidence of deep vein thrombosis after cementless and cemented knee replacement  
class5	1829	the incidence of deep vein thrombosis in 244 patients who had total knee replacement has been studied  
class5	1829	in 120 the prosthesis was cemented and in 124 it was cementless  
class5	1829	in all cases the replacement was primary and a porous coated prosthesis with a porous coated central tibial stem was used  
class5	1829	deep vein thrombosis was diagnosed by venography  and pulmonary embolism by perfusion scanning  
class5	1829	the incidence of deep vein thrombosis in the cementless knees  23 8   and in the cemented  25   was approximately the same  
class5	1829	the only significant predisposing factors for deep vein thrombosis in both groups were obesity  prolonged postoperative immobilisation  previous venous disease and hyperlipidaemia  
class5	1830	external fixation for type iii open tibial fractures  
class5	1830	an analysis of 51 type iii open tibial fractures treated by external skeletal fixation is presented  
class5	1830	the fractures are subdivided according to the classification of gustilo  mendoza and williams  1984  into types iiia  iiib and iiic  
class5	1830	the different prognoses of these fracture subtypes is examined  
class5	1830	the use of the hoffmann and hughes external fixators in the management of type iii open tibial fractures is presented and it is suggested that the prognosis is independent of the type of fixator used  
class5	1831	mechanism of the pivot shift  
class5	1831	the mechanism of the pivot shift was investigated by analysing movements under valgus torque in 29 fresh cadaveric knees  
class5	1831	the movements were measured in three dimensions  using biplanar photography  when all the ligaments were intact  and then after the ligaments were sequentially divided  
class5	1831	when only the anterior cruciate ligament was sectioned  the pivot shift occurred in seven out of 20 knees examined  
class5	1831	in the other 13  though the pivot shift was not observed  an abnormal internal rotation occurred at between 10 degrees and 50 degrees of flexion  
class5	1831	division of the iliotibial tract in addition to division of the anterior cruciate ligament stopped the pivot shift  as the tibia remained internally rotated throughout the range of flexion  
class5	1831	the axis of rotation of the pivot shift was located at the medial collateral ligament  which was kept tight by the applied valgus torque  
class5	1831	the sudden movement in the pivot shift was caused by a complex interaction between the geometry of the knee and the valgus torque applied  
class5	1832	healing of non vascularised diaphyseal bone transplants  an experimental study  
class5	1832	four different experiments were performed to study the healing of a large  non vascularised  diaphyseal  bone segment in adult cats  
class5	1832	in the first experiment  a 4 cm segment of tibia with its periosteum was excised and replaced in its bed  
class5	1832	the other experiments were similar  except that in the second  the periosteum of the segment was removed  in the third its medullary canal was blocked with a silastic rod  and in the last group the segment was isolated from its muscle bed by a silastic sheet  
class5	1832	the reparative processes were quantified by estimating the resorption index  the cortical new bone formation index  the callus encasement index  and the osteocyte count  
class5	1832	bone resorption and apposition occurred in the segment even when the periosteum was absent or the medullary canal was blocked  with osseous union at both ends by eight to 12 weeks  provided the segment was not isolated from its muscle bed  
class5	1832	thus  the muscle bed played a significant role in these reparative processes  
class5	1833	the management of the painful first metatarsophalangeal joint in the older patient  arthrodesis or keller s arthroplasty  
class5	1833	we report a prospective randomised trial comparing keller s arthroplasty and arthrodesis of the first metatarsophalangeal joint for the management of symptomatic hallux valgus and hallux rigidus in the older patient  
class5	1833	in 81 patients  110 feet   with a minimum of two years follow up  both procedures gave a similar degree of patient satisfaction and symptom relief  
class5	1833	the incidence of metatarsalgia was also similar  
class5	1833	as there were no obvious advantages to arthrodesis  and since six out of 50 arthrodesed toes required revision  we suggest that keller s arthroplasty is the better operation in these patients  
class5	1834	neonatal osteomyelitis  
class5	1834	thirty four neonates with osteomyelitis were reviewed  
class5	1834	the hip  19  was the most common site involved  
class5	1834	swelling and pseudoparalysis were the most significant local signs  
class5	1834	radiographic abnormalities  such as metaphyseal rarefaction and or joint subluxation were found on the initial radiographs in 18 of the 19 hips involved  
class5	1834	all patients were treated with antibiotics and all infections involving joints were drained surgically  
class5	1834	good results were achieved in 75  of all sites and in 68  of hips  
class5	1835	ultrasound guided aspiration for transient synovitis of the hip  
class5	1835	we reviewed 15 children with transient synovitis of the hip who had aspiration of an effusion under local anaesthesia with ultrasound guidance  
class5	1835	there were no significant complications  aspiration was useful for diagnosis and gave considerable symptomatic relief  
class5	1835	we discuss the role of ultrasound in diagnosis and treatment  
class5	1836	surgical treatment for severe slipping of the upper femoral epiphysis  
class5	1836	we have used a modified technique of cervical osteotomy to treat a consecutive series of 23 patients with chronic slip of the upper femoral epiphysis  
class5	1836	it has been successful in correcting both moderate and severe deformities with a low incidence of avascular necrosis  comparable to that seen after subtrochanteric osteotomies  
class5	1836	we describe the operative details and discuss the features which make cervical osteotomy technically superior to intertrochanteric and subtrochanteric procedures  
class5	1837	transient cyst like cortical defects following fractures in children  medullary fat within the subperiosteal haematoma  
class5	1837	asymptomatic cyst like cortical defects appearing after fractures in children have been occasionally reported  
class5	1837	typically  these defects appear during fracture consolidation  within the newly formed subperiosteal bone  proximal to the fracture line  do not enlarge  and progressively disappear  
class5	1837	we have previously shown a fatty density on ct scan within the early cortical defect  
class5	1837	we now present two additional cases in which early ct scans appeared to confirm that these transient cortical defects may consist of fat  and probably result from the inclusion of medullary fat within the subperiosteal haematoma  
class5	1838	open transpedicular biopsy of the vertebral body  
class5	1838	we describe a method of obtaining a biopsy from the body of a vertebra by an open transpedicular route  
class5	1838	this minimises the danger of contamination of tissue planes and spaces  
class5	1839	the modified schollner costoplasty  
class5	1839	the modified schollner costoplasty is a cosmetic procedure for the correction of rib prominence deformity in scoliosis  
class5	1839	we present the results of the procedure in 21 patients who had previously undergone spinal fusion for scoliosis  
class5	1839	we found the procedure to be well tolerated without major complications  
class5	1839	objective cosmetic improvement was achieved in all but one case  
class5	1839	all but one patient considered the procedure to have been of cosmetic benefit  
class5	1840	a surgical approach to the cervicothoracic spine  
class5	1840	we describe a method for approaching the lower cervical and upper thoracic spine  the brachial plexus and related vessels  
class5	1840	the method involves the elevation of the medial corner of the manubrium  the sternoclavicular joint  and the medial half of the clavicle on a pedicle of the sternomastoid muscle  
class5	1840	we have used this exposure in 17 cases with few complications and good results  
class5	1840	its successful performance requires high standards of anaesthesia  surgical technique and postoperative care  
class5	1841	operative and conservative treatment of moderate spondylolisthesis in young patients  
class5	1841	we made a retrospective study of 149 children and adolescents with moderate spondylolisthesis  slip less than or equal to 30    77 treated by fusion and 72 conservatively at an average follow up of 13 3 years  
class5	1841	both groups were fully comparable with regard to age at diagnosis  sex distribution  46  girls   and mean slip  
class5	1841	the patients who were treated operatively had more pain before treatment and showed more initial progression of the slip  
class5	1841	they had better clinical results and less pain at latest review  but the total progression of the slip over the whole follow up showed no statistical differences between the two groups  
class5	1841	patients with a pseudarthrosis after attempted fusion had had a longer period of postoperative pain  but at the latest review had no more pain than those with sound fusion  
class5	1841	none of those treated conservatively came to fusion later and the long term results in 18 patients who had refused the advised operation were no worse than those for other conservatively treated patients  
class5	1841	our results suggest that a moderate grade of spondylolisthesis in adolescents usually has a benign course  
class5	1841	it seems that spontaneous segmental stabilisation occurs as a result of degeneration of the disc at the level of the slip  
class5	1842	lumbar intervertebral disc prolapse in teenage twins  a case report and review of the literature  
class5	1842	we report the cases of teenage twin girls presenting within months of each other with severe symptoms from lumbosacral disc prolapses  requiring laminectomy in one and chemonucleolysis in the other  
class5	1842	ct scans showed similarities in spinal configuration  including the presence of disc bulges at the l4 5 level  
class5	1842	this suggests a strong hereditary factor in prolapse of intervertebral discs  but a review of the literature showed little information on that aspect  
class5	1843	radiographic appearances in lumbar disc prolapse  
class5	1843	the pre operative lumbar spine radiographs of 200 consecutive patients who had undergone discectomy for prolapsed intervertebral disc were reviewed  
class5	1843	prolapse was recognized as bulging or sequestration of the disc with consequent root compromise  
class5	1843	measurement of the lumbar level of the interiliac line was shown to correlate with the level of disc prolapse and the incidence of transitional vertebrae at the lumbosacral junction was significantly higher than normal  
class5	1843	a pathological value for the lumbosacral angle could not be identified  
class5	1844	autoantibodies to the hla b27 sequence cross react with the hypothetical peptide from the arthritis associated shigella plasmid  
class5	1844	we previously reported elevated serum antibody levels to a peptide representing the hla b27 polymorphic region  b27 peptide  in hla b27    ankylosing spondylitis  as  patients  
class5	1844	a plasmid  phs 2  isolated from arthritogenic shigella flexneri strains had been shown to encode an amino acid sequence homologous to hla b27  
class5	1844	rabbit antibody to this sequence  phs 2 peptide  strongly cross reacted with b27 peptide and  to a much lesser extent  with klebsiella nitrogenase peptide  
class5	1844	serum antibody levels to phs 2 peptide were studied in 160 spondylarthropathy patients  
class5	1844	12 of 115  10 4   as patients  2 of 45  4 4   patients with reiter s syndrome or reactive arthritis as well as 6 of 147  4 1   normal controls were shown to have elevated anti phs 2 peptide antibodies  
class5	1844	antibody levels to b27 and phs 2 peptides were significantly correlated in 134 hla b27    patients  r   0 333  p less than 0 001   
class5	1844	13 of 15 affinity purified anti b27 peptide antibodies from patients strongly cross reacted with phs 2 peptide  whereas only 3 weakly cross reacted to nitrogenase peptide  
class5	1844	leucine appeared to be a critical residue for this cross reaction  
class5	1844	as patients  anti b27 peptide antibodies reacted with hla b27 transfected l cells  
class5	1844	these results may suggest that phs 2 peptide more efficiently  mimics  b27 peptide than does nitrogenase peptide  
class5	1844	involvement of phs 2 in pathogenesis of spondylarthropathy through molecular mimicry mechanisms requires further study  
class5	1845	scleroderma and l tryptophan  a possible explanation of the eosinophilia myalgia syndrome  
class5	1845	scleroderma developed in six women who were taking l tryptophan  
class5	1845	fasciitis and morphea were most common  but one patient had pleural effusion  hypertension  and signs of cardiac and kidney failure  
class5	1845	in five patients the biopsy findings were characteristic of scleroderma  the sixth patient had crohn s disease and developed fasciitis  her biopsy specimen showed inflammatory arteritis  
class5	1845	all patients  conditions improved after cessation of their l tryptophan intake  initiation of corticosteroid therapy  or both  
class5	1845	these findings confirm previous data that show altered tryptophan kynurenine metabolism in some patients with scleroderma and fasciitis  particularly with tryptophan loading  
class5	1846	dermatoses associated with sterile lytic bone lesions  
class5	1846	in recent years several dermatoses  palmoplantar pustulosis  acne fulminans  and sweet s syndrome  have been associated with sterile lytic bone lesions  
class5	1846	this article discusses the clinical  laboratory  and histologic findings of these disorders and postulates a common mechanism underlying the bone lesions  
class5	1847	the restorative and surgical technique for the full maxillary subperiosteal implant  
class5	1847	the edentulous atrophic maxilla represents one of the most challenging implant restorative opportunities  
class5	1847	when prescribed within the appropriate diagnostic range and performed by a highly skilled and experienced practitioner  the full maxillary subperiosteal implant is a predictable solution for the patient with an edentulous atrophic maxilla  
class5	1848	regenerating bone in clinical periodontics  
class5	1848	bone autografts and allografts  various alloplastic materials  and guided tissue regeneration are used to reconstruct lost periodontal tissues  
class5	1848	this paper focuses on controversies related to these therapeutic modalities as well as their role in periodontal regeneration  
class5	1849	imidazole salicylate versus piroxicam in the treatment of arthrosis in elderly patients  a double blind clinical and endoscopic trial  
class5	1849	the clinical efficacy and gastroduodenal tolerability of imidazole salicylate  imidazole 2 hydroxybenzoate  itf 182   a new synthetic drug with an anti inflammatory action  was evaluated endoscopically in comparison with those of piroxicam in elderly patients suffering from osteoarthrosis  
class5	1849	of the 41 patients entering the trial  only 38 completed the protocol  6 men and 32 women  mean age  71  range  65 80 years   
class5	1849	after upper gastrointestinal endoscopy for the purpose of excluding gastric and duodenal mucosal lesions  the patients were allocated at random  according to a double blind  double dummy protocol  to treatment either with imidazole salicylate 750 mg three times daily or with piroxicam 20 mg once daily for a period of 4 weeks  
class5	1849	imidazole salicylate proved active in controlling a number of the pain symptoms caused by arthrosis  although its efficacy was inferior to that of piroxicam  
class5	1849	grade 2 gastric mucosal lesions were detected in 1 of 20 patients  5   treated with imidazole salicylate  lesions corresponding to grades 2  3  and 4 were found in 6 of 18  33   of those treated with piroxicam  p    034   
class5	1849	painful dyspepsia was reported by 15  of the patients in the imidazole salicylate group and by 28  of those in the piroxicam group  
class5	1849	on the basis of these results and under the experimental conditions adopted in this trial  the authors concluded that imidazole salicylate is characterized by good gastric tolerability and can thus be used in the treatment of rheumatic diseases in the elderly  
class5	1850	dermatomyositis  correlative mr imaging and p 31 mr spectroscopy for quantitative characterization of inflammatory disease 
class5	1850	magnetic resonance  mr  imaging and phosphorus 31 mr spectroscopy were used to examine four patients with dermatomyositis and five control subjects  
class5	1850	t2 weighted images of the thigh muscles of patients showed increased signal intensity  with focal and inhomogeneous involvement predominantly in the vastus lateralis and secondarily in the vastus intermedius and vastus medialis  
class5	1850	t1 and t2 values of the vastus lateralis in patients were significantly higher than those of the control subjects  
class5	1850	t1 values of the rectus femoris and biceps femoris with more generalized inflammation were moderately elevated but still significantly higher than those of the control subjects  
class5	1850	p 31 mr spectra of the quadriceps muscles were obtained during rest  during exercise at two graded levels  and in recovery  
class5	1850	concentrations of adenosine triphosphate and phosphocreatine  pcr  in the diseased muscles were 30  below normal values  and the inorganic phosphate pcr ratios were increased in the patients  muscles at rest and throughout exercise  
class5	1850	the t1 and t2 values as well as the p 31 metabolite data correlated with symptoms and clinical assessment  
class5	1851	cytomegalovirus induced osteomyelitis in a patient with the acquired immunodeficiency syndrome  
class5	1851	a 43 year old man with aids had a periodontal abscess  no fever  and normal findings on funduscopic examination  
class5	1851	three months later  the abscess area was debrided  and histologic examination of the tissue revealed osteomyelitis of the mandible  
class5	1851	within the area of osteomyelitis were numerous cells with inclusions typical of cytomegalovirus  cmv  infected cells  
class5	1851	funduscopic examination at that time revealed extensive cmv retinitis  
class5	1851	osteomyelitis should be added to the list of infections caused by cmv in patients with aids  
class5	1852	sagittal plane analysis in idiopathic scoliosis patients treated with cotrel dubousset instrumentation  
class5	1852	one hundred sixty patients with idiopathic scoliosis treated with cotrel dubousset instrumentation  cdi  underwent preoperative and postoperative sagittal plane analysis of the thoracic spine  thoracolumbar junction  and lumbar spine  
class5	1852	the data suggest that mild to moderate improvements in thoracic hypokyphosis are possible  
class5	1852	when crossing the thoracolumbar junction  reversal of rod bend and reversal of hooks on the derotation rod appear to provide the most physiologic sagittal contour  
class5	1852	cotrel dubousset instrumentation to the mid and distal lumbar spine can preserve and  at times  enhance lumbar lordosis  
class5	1853	long scoliosis fusion to the sacrum in adults with nonparalytic scoliosis  an improved method  
class5	1853	the first 17 adults with nonparalytic scoliosis having long fusion to the sacrum treated with the luque galveston technique were reviewed  
class5	1853	there were 3 men and 14 women  
class5	1853	their average age at the time of surgery was 47 years and the mean follow up period was 42 months  
class5	1853	there were no neurologic complications and no patient developed significant loss of lumbar lordosis  
class5	1853	fusion occurred in 88  of patients  
class5	1853	two patients developed pseudarthrosis  neither of whom had anterior fusion at the level of pseudarthrosis  
class5	1853	the best results occurred in patients who had two stage procedures  with initial anterior lumbar fusion to the sacrum without instrumentation followed by posterior segmental instrumentation with the galveston technique of fixation to the pelvis  
class5	1854	herniated intervertebral discs associated with unstable spinal injuries  
class5	1854	to examine the occurrence of traumatic herniated intervertebral discs associated with unstable spinal injuries  the authors reviewed the records of all patients with spinal cord level unstable spine injuries managed at their institution over a 26 month period  
class5	1854	ninety three patients were identified  
class5	1854	all patients had roentgenographic and computed tomographic  ct  evaluation  
class5	1854	magnetic resonance imaging was performed in 48 patients  and revealed the presence of a herniated intervertebral disc in 16  with the highest incidence being in the cervical spine  
class5	1854	in the patients who had only plain film and ct scans  no disc pathology was identified  
class5	1854	magnetic resonance imaging provides a noninvasive means of examining intervertebral disc damage in unstable spinal injuries that might otherwise be unidentified and result in spinal cord injury at the time of surgery  
class5	1855	high levels of inflammatory phospholipase a2 activity in lumbar disc herniations  
class5	1855	inflammation of neural elements is frequently mentioned clinically in association with lumbar radiculopathy  
class5	1855	mechanical embarrassment of neural elements by definable structural abnormalities is inadequate as a sole explanation of nerve injury in this condition  
class5	1855	the purpose of this study was to demonstrate whether an enzymatic marker for inflammation  phospholipase a2  could be identified in human disc samples removed at surgery for radiculopathy due to lumbar disc disease  
class5	1855	samples were assayed for phospholipase a2 activity  
class5	1855	the level of activity in the disc samples was compared with values obtained from other human tissues using the same assay  
class5	1855	specific activity  percent hydrolysis radiolabelled substrate  ranged from 238 to 1 014 5 nmol min mg  
class5	1855	mean activity for the human disc material was 568 7 nmol min mg  compared with 0 006 nmol min mg for human pmn  and 12 1 nmol min mg for inflammatory human synovial effusion  
class5	1855	the ph and cation related activity were identical to those demonstrated for phospholipase a2 inflammatory conditions  
class5	1855	human lumbar disc phospholipase a2 activity is from 20  to 100 000 fold more active than any other phospholipase a2 that has been described  
class5	1855	as the enzyme responsible for the liberation of arachidonic acid from cell membranes  phospholipase a2 is the rate limiting step in the production of prostaglandins and leukotrienes  
class5	1855	these data establish biochemical evidence of inflammation at the site of lumbar disc herniations  
class5	1856	high lumbar disc degeneration  incidence and etiology  
class5	1856	three hundred seventy nine consecutive magnetic resonance images  mris  with dual echo images of the entire lumbar spine were reviewed by the authors  
class5	1856	all 379 patients presented with back pain and or leg pain  they were interviewed and examined  
class5	1856	pain drawings were completed by all  
class5	1856	there were 42 patients  11 1   with disc pathologies involving t12 l1  l1 2  and or l2 3 levels  
class5	1856	six patients  1 6   had isolated disc degeneration and or herniations limited only to these high lumbar segments  
class5	1856	the remaining 36 patients had degenerative changes of the higher discs with variable involvement of the lower lumbar discs  
class5	1856	out of 12 spondylolistheses of l5 on s1  7 had high disc pathologies at one or more levels presenting as skipped lesions  more severe high disc lesions were noted in grade ii slips  
class5	1856	isolated high disc degeneration is often associated with pre existing abnormalities such as end plate defects  scheuermann s disease  limbus vertebra  and so forth  and stressful cumulative work activities such as in construction workers  airplane mechanics  and so forth  
class5	1856	high disc degeneration was noted above or below previous fractures  
class5	1856	high disc involvement with diffuse changes in lower lumbar spine was more commonly found in ascending fashion in older age groups  and in patients who have had previous lower lumbar spine surgeries  prior fusions in particular  
class5	1856	our findings suggest that altered mechanics are associated with the high lumbar disc pathologies  
class5	1857	the natural history of lumbar intervertebral disc extrusions treated nonoperatively  
class5	1857	the purpose of this study was to evaluate the natural history of morphologic changes within the lumbar spine in patients who sustained lumbar disc extrusions  
class5	1857	all patients in this study were treated nonoperatively for radicular pain and neurologic loss  
class5	1857	the following questions were addressed  1  does perithecal or perineural fibrosis result when extrusions are not removed surgically  and 2  do disc extrusions spontaneously resolve  and  if so  how rapidly  the study population consisted of 11 patients with extrusions and radiculopathy  
class5	1857	all patients were successfully treated nonoperatively  
class5	1857	all had a primary complaint of leg pain and all had positive straight leg raising reproducing their leg pain at less than or equal to 60 degrees  
class5	1857	additionally  87  had muscle weakness on a neurologic basis in a root level distribution corresponding to the site of disc pathology  
class5	1857	computed tomographic  ct  examinations were obtained on all patients at the inception of treatment  
class5	1857	these studies were compared with follow up mri studies  
class5	1857	the initial ct scans were evaluated for the following criteria  disc size and position  thecal sac effacement  nerve root enlargement or displacement  and evidence of central or intervertebral canal stenosis  
class5	1857	in addition to the pathomorphology evaluated on the ct scans  follow up mri studies also evaluated disc hydration at the herniated and contiguous levels  and the presence of perithecal or perineural fibrosis  
class5	1857	the following grading system was used to evaluate change in fragment size on the follow up studies  grade 1 0 to 50  decrease in size  grade 2 50 to 75  decrease in size  grade 3 75 to 100  decrease in size  
class5	1858	metabolic bone disease in lumbar pseudarthrosis  
class5	1858	pseudarthrosis occurs in many patients who undergo lumbar spine fusion and it has been suggested that abnormalities of bone metabolism contribute to it  
class5	1858	the authors evaluated 47 patients with pseudarthrosis for metabolic bone disease  
class5	1858	symptomatic patients with pseudarthrosis underwent metabolic bone evaluation  
class5	1858	abnormal results of laboratory tests were found in 7 patients  14 9    3 low or borderline 1 25 dihydroxy vitamin d3  2 elevated 24 hour urine calcium  and 2 low serum testosterone  
class5	1858	none of these abnormalities correlated with other clinical findings  
class5	1858	bone density was low in 14 of 24 patients in whom it was measured  
class5	1858	low values did not correlate with smoking or abnormal laboratory values  
class5	1858	metabolic bone abnormalities do not appear to play a frequent or significant role in pseudarthrosis after attempted lumbar spine fusion  
class5	1859	lumbar discography followed by computed tomography  refining the diagnosis of low back pain  
class5	1859	two hundred fifty patients with low back pain who underwent lumbar discography followed by computed tomography  ct  are the subject of this prospective study  
class5	1859	in 93  of the patients  these combined imaging techniques provided additional useful diagnostic information that affected patient management and the selection of treatment alternatives  
class5	1859	lumbar discography followed by ct proved valuable in determining the significance of equivocal or multiple level abnormalities  determining the type of disc herniation  defining surgical options  and evaluating the previously operated spine  
class5	1859	in 94  of patients who had surgery  ct discography correctly predicted the type of disc herniation as protruded  extruded  sequestrated  or internally disrupted  
class5	1859	computed tomography discography may be more sensitive that magnetic resonance imaging  mri  in the early stages of disc degeneration because 18 of 177 discs with a normal t2 weighted image were discographically abnormal and the ct discogram revealed annular tears or radial fissuring  
class5	1859	the radiographic morphology of the normal herniated and degenerative lumbar discs shown by ct discography gives unique insight into the pathogenesis of disc degeneration  
class5	1859	the complications that followed the 750 discograms were one case of urticaria and one disc space infection  
class5	1859	even with the availability of high resolution ct and mri  lumbar discography remains the only pain provocation challenge to the lumbar disc  
class5	1860	a multicenter analysis of percutaneous discectomy  
class5	1860	this study was performed to evaluate a group of patients undergoing percutaneous discectomy  
class5	1860	all patients had a single level unilateral l4 5 or l5 s1 disc herniation documented on either computer tomographic  ct  scan  myelogram  and or magnetic resonance imaging  mri   
class5	1860	average follow up after percutaneous discectomy was 16 8 months  range  2 46 months   
class5	1860	the average hospitalization time was 1 7 days  range  1 5 days   
class5	1860	only 21 patients  55   were able to return to work after the procedure  
class5	1860	thirteen patients ultimately underwent surgical discectomy for continued symptoms after the procedure  
class5	1860	the additional 4 patients did not undergo surgical discectomy and never returned to work  
class5	1860	of those 25 percutaneous discectomy patients who did not undergo surgical discectomy  there was significantly more pain  residual weakness  and numbness compared with the patients undergoing surgical discectomy  
class5	1860	the results of this study clearly indicate that percutaneous discectomy does not appear to be as predictable or successful a treatment modality as surgical discectomy  
class5	1861	tryptophan induced eosinophilia myalgia syndrome 
class5	1861	eight patients who became ill while taking tryptophan had myalgia  fatigue  rash  fever  edema  alopecia  arthralgias  diminished joint motion  skin tightening  muscle cramping  and distal paresthesias  
class5	1861	three had shortness of breath  and one had pulmonary hypertension  
class5	1861	laboratory abnormalities included peripheral eosinophilia  leukocytosis  thrombocytosis  raised erythrocyte sedimentation rate  and elevated serum levels of aldolase  lactate dehydrogenase  and liver enzymes  
class5	1861	of 4 chest radiographs  3 were abnormal  
class5	1861	of 5 skin and muscle biopsies  4 showed sclerosis or mixed inflammatory cell infiltration of the dermis  subcutis  and fascia  
class5	1861	eosinophils were often present  but vasculitis was absent  
class5	1861	muscle inflammation was minimal  
class5	1861	we conclude that the  eosinophilia myalgia syndrome  is related to the ingestion of tryptophan and that abnormalities in the secretion of lymphokines may be important in its pathogenesis  
class5	1862	disc space infection  a case report with mri diagnosis  
class5	1862	vertebral disc space infection is an uncommon cause of back pain  
class5	1862	physical findings may be unimpressive and laboratory evaluation may only disclose an elevated erythrocyte sedimentation rate  
class5	1862	magnetic resonance imaging is particularly useful  since it reveals abnormalities earlier than plain radiographs and is more precise than bone scan  
class5	1863	factors influencing the development of metabolic bone disease in primary biliary cirrhosis  
class5	1863	the prevalence  type  and factors that may influence the development of bone disease in primary biliary cirrhosis  have been investigated in 20 consecutive patients  who  in addition to liver function tests and mineral and vitamin d metabolism studies  were submitted to a transiliac bone biopsy after tetracycline double labeling for quantitative histomorphometric examination  
class5	1863	intestinal calcium absorption was also assessed in 16 patients  
class5	1863	seven patients  35   had reduced bone volume and were considered osteoporotic  
class5	1863	three also had bone mineralization impairment  but did not have criteria for osteomalacia  
class5	1863	bone formation was depressed in 15 patients  and bone resorption was low or normal in 19 cases  
class5	1863	eroded surfaces were reduced in all osteoporotic patients  
class5	1863	duration of primary biliary cirrhosis was significantly longer in patients with osteoporosis  6 3     0 6 yr  than in those without osteoporosis  2 6     0 6  p   0 004   
class5	1863	moreover  osteoporosis was more prevalent in postmenopausal women  and in those who had intestinal calcium malabsorption  which was present in 80  of osteoporotic patients but in only 18  of nonosteoporotic patients  p   0 03   
class5	1863	osteoporosis and mineralization bone impairment were unrelated to the severity of cholestasis  
class5	1863	25 hydroxyvitamin d was significantly lower in those patients with intestinal calcium malabsorption  
class5	1863	the results of this study indicate that osteodystrophy in primary biliary cirrhosis is characterized mainly by  low turnover  osteoporosis  which is related to the duration of the liver disease  postmenopausal condition  and calcium malabsorption  
class5	1864	phenotypic heterogeneity in osteogenesis imperfecta  the mildly affected mother of a proband with a lethal variant has the same mutation substituting cysteine for alpha 1 glycine 904 in a type i procollagen gene  col1a1   
class5	1864	a proband with a lethal variant of osteogenesis imperfecta  oi  has been shown to have  in one allele in a gene for type i procollagen  col1a1   a single base mutation that converted the codon for alpha 1 glycine 904 to a codon for cysteine  
class5	1864	the mutation caused the synthesis of type i procollagen that was posttranslationally overmodified  secreted at a decreased rate  and had a decreased thermal stability  
class5	1864	the results here demonstrate that the proband s mother had the same single base mutation as the proband  
class5	1864	the mother had no fractures and no signs of oi except for short stature  slightly blue sclerae  and mild frontal bossing  
class5	1864	as a child  however  she had the triangular facies frequently seen in many patients with oi  
class5	1864	on repeated subculturing  the proband s fibroblasts grew more slowly than the mother s  but they continued to synthesize large amounts of the mutated procollagen in passages 7 14  
class5	1864	in contrast  the mother s fibroblasts synthesized decreasing amounts of the mutated procollagen after passage 11  
class5	1864	also  the relative amount of the mutated allele in the mother s fibroblasts decreased with passage number  
class5	1864	in addition  the ratio of the mutated allele to the normal allele in leukocyte dna from the mother was half the value in fibroblast dna from the proband  
class5	1864	the simplest interpretation of the data is that the mother was mildly affected because she was a mosaic for the mutation that produced a lethal phenotype in one of her three children  
class5	1865	postpartum osteomyelitis caused by group b streptococcus  
class5	1865	postpartum infections caused by group b streptococci are generally limited in scope  
class5	1865	we report a case of vaginal colonization with group b streptococcus that progressed in the postpartum period to osteomyelitis that necessitated total hip replacement  
class5	1865	the patient had no risk factors predisposing to streptococcal osteomyelitis  
class5	1865	an altered immune status in pregnancy and intrapartum bacteremia may be involved in the pathogenesis of this infection  
class5	1866	magnetic resonance imaging of radiation optic neuropathy  
class5	1866	three patients with delayed radiation optic neuropathy after radiation therapy for parasellar neoplasms underwent magnetic resonance imaging  
class5	1866	the affected optic nerves and chiasms showed enlargement and focal gadopentetate dimeglumine enhancement  
class5	1866	the magnetic resonance imaging technique effectively detected and defined anterior visual pathway changes of radionecrosis and excluded the clinical possibility of visual loss because of tumor recurrence  
class5	1867	early facial reanimation following radical parotid and temporal bone tumor resections  
class5	1867	a retrospective study of 35 patients who underwent early facial reanimation following extirpative parotid and temporal bone surgery requiring facial nerve sacrifice was performed  
class5	1867	regional facial reanimation performed immediately or within several days included 16 patients who underwent temporalis muscle transposition and 27 who underwent gold weight or eyespring lid reanimation with lower lid tightening  
class5	1867	simultaneous nerve grafts or nerve crossover procedures were performed in 22 patients  
class5	1867	the authors  favored approaches to facial reanimation are discussed  with an emphasis on the value of early reanimation using properly selected techniques  
class5	1868	mandibular reconstruction with composite microvascular tissue transfer  
class5	1868	microvascular free tissue transfer has provided a variety of methods of restoring vascularized bone and soft tissue to difficult defects created by tumor resection and trauma  
class5	1868	over 7 years  26 patients have undergone 28 free flaps for mandibular reconstruction  15 for primary squamous cell carcinoma of the floor of the mouth or tongue  7 for recurrent tumor  and 6 for other reasons  lymphangioma  1   infection  1   gunshot wound  1   and osteoradionecrosis  3    
class5	1868	primary reconstruction was performed in 19 cases and secondary in 9  
class5	1868	all repairs were composite flaps including 12 scapula  5 radial forearm  3 fibula  2 serratus  and 6 deep circumflex iliac artery  
class5	1868	mandibular defects included the symphysis alone  7   symphysis and body  5   symphysis body ramus condyle  2   body or ramus  13   and bilateral body  1   
class5	1868	fourteen patients had received prior radiotherapy to adjuvant or curative doses  
class5	1868	eight received postoperative radiotherapy  
class5	1868	all patients had initially successful vascularized reconstruction by clinical examination  28  and positive radionuclide scan  22 of 22   
class5	1868	bony stability was achieved in 25 of 26 patients and oral continence in 24 of 26  
class5	1868	one complete flap loss occurred at 14 days  
class5	1868	complications of some degree developed in 22 patients including partial skin necrosis  3   orocutaneous fistula  3   plate exposure  1   donor site infection  3   fracture of reconstruction  1   and fracture of the radius  1   
class5	1868	microvascular transfer of bone and soft tissue allows a reliable reconstruction  despite previous radiotherapy  infection  foreign body  or surgery  in almost every situation in which mandible and soft tissue are absent  
class5	1868	bony union  a healed wound  and reasonable function and appearance are likely despite early fistula  skin loss  or metal plate or bone exposure  
class5	1869	reconstruction of mandibular defects in irradiated patients  
class5	1869	in this prospective study  mandibular reconstruction using titanium plates was evaluated in 31 patients treated between july 1988 and january 1990  
class5	1869	sixteen patients had prior surgery  13 had prior radiotherapy  
class5	1869	in 11 patients  prior radiation and surgery had failed  
class5	1869	sixteen patients received postoperative radiotherapy either in standard or accelerated fractions  
class5	1869	twelve patients had complications of either intraoral  8   extraoral  5   or combined  1  plate exposure or fistula formation  2   
class5	1869	factors significantly related to complications were poor nutrition  accelerated radiation  and recurrence  
class5	1869	sixty one percent of all patients healed uneventfully  
class5	1869	when patients with complications secondary to recurrence who subsequently died were excluded  the success rate was 73   
class5	1869	only one patient had an unacceptable result that produced a cosmetic and functional deformity despite secondary repair  
class5	1870	predicting the severity of cocaine associated rhabdomyolysis  
class5	1870	study objectives  the syndrome of rhabdomyolysis associated with cocaine use has been recently described  but the incidence  severity  risk factors  and complications are unknown  
class5	1870	this study sought to describe the spectrum of the syndrome and identify clinical features of patients at risk  
class5	1870	design  retrospective case series with analysis of common clinical features  
class5	1870	setting  medical emergency department of an urban teaching hospital serving an indigent population  
class5	1870	types of participants  ed patients with acute cocaine intoxication and a serum creatine kinase  all mm  of more than 500 u l  8 3 ukat l  who were admitted for in hospital management  
class5	1870	measurements and main results  twenty nine patients  representing 5  of cocaine related patient visits  were identified over 20 months  
class5	1870	patients were divided into three groups  mild  characterized by anxiety  tachycardia  diaphoresis  dyspnea  or chest pain  moderate  characterized by delirium  agitation  fever  leukocytosis  or an elevated serum creatinine  and severe  characterized by seizure  coma  hypotension  arrhythmia  or cardiac arrest  
class5	1870	there was a significant association between the rating system for level of intoxication and the severity of rhabdomyolysis and its complications  p less than  01   
class5	1870	patients at highest risk for complications of rhabdomyolysis were those in the moderate or severe groups  
class5	1870	conclusion  this classification system may be useful for the management of patients with acute cocaine intoxication  predicting those patients in whom aggressive therapy should be initiated in the ed to minimize the complications of rhabdomyolysis  
class5	1871	treatment of postmenopausal osteoporosis with high doses of synthetic calcitriol  a randomized controlled study 
class5	1871	objective  to study the efficacy of synthetic 1 25 dihydroxyvitamin d3  calcitriol  in the treatment of osteoporosis  
class5	1871	design  two year  double blind  randomized clinical trial  
class5	1871	setting  university medical center  
class5	1871	patients  fifty postmenopausal women with vertebral fractures recruited by referral  
class5	1871	intervention  calcium intake was adjusted to 25 mmol d  1000 mg d  at baseline  
class5	1871	patients were then randomized to treatment with either calcitriol or placebo  
class5	1871	during the study  calcium intake was reduced to 15 mmol d  600 mg d  and the dose of calcitriol was adjusted to maintain serum calcium less than 2 74 mmol l  less than 11 0 mg dl  or urine calcium less than 9 96 mmol d  less than 400 mg d   
class5	1871	measurements and main results  after 2 years  the mean dose of calcitriol in the treated group was 0 62 micrograms d  
class5	1871	bone mineral density of the spine increased 1 94  with calcitriol therapy and decreased 3 92  with placebo  p   0 001   
class5	1871	total body calcium increased 0 21  with calcitriol therapy and decreased 1 85  with placebo  p   0 004   
class5	1871	patients receiving placebo had significant decreases in spine density  p   0 0007  and total body calcium  p   0 0004   
class5	1871	there were no differences in vertebral fracture rates between the groups  
class5	1871	renal function studies were not statistically different between the groups after 2 years  
class5	1871	conclusion  the treatment of postmenopausal osteoporotic women with synthetic calcitriol for 2 years was associated with increases in spine density and total body calcium  
class5	1871	no adverse effects on renal function were seen after long term calcitriol therapy  
class5	1872	an unusual cause of thoracic mass  
class5	1872	a previously well 10 year old boy presented with scoliosis  a mass in the chest wall  and a pleural effusion  
class5	1872	chest radiography showed the triad of chronic consolidation  pleural effusion  and rib periostitis  
class5	1872	investigations confirmed thoracic actinomycosis  
class5	1872	tissue spread was evaluated by computed tomography  
class5	1872	it was successfully treated with benzylpenicillin  which was later replaced by clindamycin  
class5	1873	eosinophilia myalgia syndrome  recognition of a distinct clinicopathologic entity 
class5	1873	the eosinophilia myalgia syndrome is a newly described disorder related to the ingestion of l tryptophan containing products  
class5	1873	its presentation may mimic other disorders characterized by eosinophilia and muscle pain and or weakness  but can be differentiated by certain characteristic laboratory and pathologic findings  
class5	1873	we report two such cases  describe their features  and review similar syndromes  
class5	1874	eosinophilia myalgia syndrome associated with l tryptophan ingestion  analysis of four patients and implications for differential diagnosis and pathogenesis 
class5	1874	four patients fulfilling the case definition for eosinophilia myalgia syndrome are described  including one whose disease began in 1986  
class5	1874	each displayed a variety of symptoms  one suffered principally from myalgia and recovered spontaneously on discontinuation of l tryptophan therapy  one exhibited progressive sclerodermiform skin changes  neuropathy  and myopathy  a third had prominent neuromuscular disease and sclerodermiform skin changes  and the fourth experienced profound weight loss  an axonal polyneuropathy  and perivascular lymphoid infiltrates simulating a lymphoma  
class5	1874	evidence of t cell activation was present in peripheral blood and affected tissues during the clinically active progressive phase of disease  
class5	1874	among other manifestations pleural effusion  cutaneous vasculitis  joint contractures  and bloody diarrhea were observed  
class5	1874	a history of l tryptophan ingestion should be sought in patients with myalgia  fatigue  or the above outlined symptoms  
class5	1875	congenital myopathy and cardiomyopathy with identical ultrastructural changes  
class5	1875	a 7 day old girl with congenital hypotonia and unexplained episodes of bradycardia had a broad spectrum of similar skeletal muscle and myocardial degenerative ultrastructural abnormalities  
class5	1875	ultrastructural studies showed obliteration of cross striations  myofilament disorganization  streaming  smearing  clumping  and zigzag z band deformities  
class5	1875	a decrease in glycogen  mitochondria  and t tubular system occurred in the regions showing z band abnormalities of both skeletal muscle and myocardium  
class5	1875	concurrent structural cardiomyopathy should be considered in patients with congenital myopathies  particularly with unexplained cardiac conduction abnormalities or contractile insufficiency  
class5	1875	ultrastructural evaluation of skeletal and cardiac muscle may be necessary to define such disorders  
class5	1876	unusual cause of  piriformis muscle syndrome   
class5	1876	the piriformis muscle syndrome is a controversial  clinical  syndrome primarily characterized by signs and symptoms of sciatic nerve compression at the region of the piriformis muscle as it passes through the greater sciatic notch  
class5	1876	the syndrome is often referred to  however  cases are rarely reported  and it is generally an uncommon diagnosis  
class5	1876	of those cases reported  the incidence is six times more frequent in females than in males  and is typically temporally related to minor pelvic or buttock trauma  
class5	1876	we describe a case of a 40 year old woman presenting with signs and symptoms suggestive of piriformis muscle syndrome following a gynecologic procedure performed in the dorsal lithotomy position  
class5	1876	electromyographic findings were consistent with this clinical entity  
class5	1876	operative exploration  however  revealed the source of neural compression to be a pseudoaneurysm of the inferior gluteal artery adjacent to the piriformis muscle  
class5	1876	the diagnostic features of this clinical syndrome are discussed  
class5	1877	imbalance between the mechanisms of activation and inhibition of metalloproteases in the early lesions of experimental osteoarthritis  
class5	1877	levels of tissue inhibitor of metalloproteases  timp  and plasminogen activator  pa  plasmin were measured and the distribution of pa was studied by immunohistochemical techniques in cartilage and synovium samples from dogs subjected to sectioning of the anterior cruciate ligament of their right knees and sham operation of their left knees  controls   
class5	1877	twenty three animals were divided into 3 groups and killed at 2  4  or 8 weeks after surgery  
class5	1877	the levels of pa and plasmin were found to be significantly elevated in the osteoarthritic  oa  knee cartilage and synovium at all times after surgery  except for levels of pa in the oa cartilage at 2 weeks  
class5	1877	there was a positive correlation between the levels of pa and plasmin in the synovial membrane  r   0 64  p less than 0 001   
class5	1877	in oa knees  the presence of high levels of total and active collagenase was detected in cartilage and in synovium  
class5	1877	the levels of these 2 forms of collagenase showed a positive correlation both in cartilage  r   0 65  p less than 0 001  and in synovium  r   0 77  p less than 0 001   
class5	1877	the levels of timp in cartilage from oa and sham operated knees were similar  
class5	1877	although the timp level was increased in the oa synovium  it was found only in trace amounts in cartilage  
class5	1877	immunohistochemical studies revealed that both forms of pa  urokinase type pa and tissue type pa  and timp were present in oa tissues  
class5	1877	in the synovium  they were found mainly in monocyte macrophages  synovial lining cells  and blood vessel cells  
class5	1877	in oa cartilage  pa was present only at the superficial level in chondrocytes and in cartilage matrix  whereas timp was present in chondrocyte lacunae throughout the full thickness of the cartilage  
class5	1877	timp was also detected in the superficial level of cartilage from sham operated knees  
class5	1877	the results of this study indicate that in oa tissues  there are conditions that favor the synthesis and activation of metalloproteases  
class5	1877	pa and plasmin are likely to play an important role in the physiologic activation of metalloproteases  although they are probably not the only system involved in this process  
class5	1877	the lack of increased timp levels in the oa cartilage  in the presence of increased metalloprotease activity  is also a possible contributing factor in the enzymatic degradation of this tissue  
class5	1878	cellular immune response toward human articular chondrocytes  t cell reactivities against chondrocyte and fibroblast membranes in destructive joint diseases  
class5	1878	articular cartilage is one of the major targets in destructive joint diseases in humans  
class5	1878	we studied cellular immune reactions against cartilage cell surface membranes  because it has recently been suggested that these represent possible antigenic structures  based upon the observation of autoantibodies with this specificity in certain joint diseases  
class5	1878	a striking t cell reactivity toward chondrocyte membranes was found both in blood and synovial tissue from patients with rheumatoid arthritis  
class5	1878	this reactivity was strongly dependent on the presence of monocytes and had all the characteristics of an antigen driven process  
class5	1878	clonal analysis demonstrated high precursor frequencies in peripheral blood t cells that were reactive against chondrocyte membranes  
class5	1878	this response to chondrocyte membranes greatly exceeded the t cell stimulation induced by membranes from other sources such as fibroblasts or epithelial cells  
class5	1878	in contrast to patients with rheumatoid arthritis  individuals with osteoarthritis showed a strong peripheral blood and synovial fluid t cell response not only to chondrocyte membranes  but also to fibroblast membrane material  
class5	1878	however  there was no reactivity to epithelial cell membranes  
class5	1878	normal donors generally did not show significant responses to any membrane preparation  
class5	1878	these data indicate that there is a strong t cell reactivity toward chondrocyte membranes in destructive joint disorders  and this may significantly contribute to the pathogenetic processes that occur in these diseases  
class5	1879	relationship of glucocorticoid dosage to serum bone gla protein concentration in patients with rheumatologic disorders  
class5	1879	serum bone gla protein  bgp  measurements in 50 rheumatic disease patients receiving long term prednisone therapy revealed an inverse relationship  r    0 71  p less than 0 001  between serum bgp levels and prednisone dosage  
class5	1879	multiple regression analysis demonstrated significant relationships  r2   0 72  p less than 0 001  between serum bgp1 2 and prednisone dosage  dosage2  serum creatinine  age  and an age creatinine interaction  
class5	1879	this model predicts the suppression of serum bgp with low dosages of steroids and 50  suppression with dosages of 20 25 mg day  
class5	1880	specificity of antibodies to type ii collagen in rheumatoid arthritis  
class5	1880	to reassess the role of autoantibodies to type ii collagen in the pathogenesis of diseases  we studied antibodies from patients with rheumatoid arthritis  ra  and from patients with relapsing polychondritis for species specificity and collagen type specificity  using an improved enzyme linked immunosorbent assay  
class5	1880	antibodies were found in the sera of 15  of the ra patients and 50  of the relapsing polychondritis patients  as well as in the cartilage of 69  of the ra patients examined  
class5	1880	reaction with both homologous and heterologous type ii collagens was common  
class5	1880	analysis of 19 selected ra sera revealed that autoantibodies were generally associated with specific antibodies to some species of heterologous type ii collagen  
class5	1880	in contrast  antibodies found in 4  of the non ra controls were specific for either bovine or chick type ii collagen  
class5	1880	these findings indicate that autoantibody formation in ra and relapsing polychondritis may occur as a result of an immune response to heterologous type ii collagen  
class5	1880	however  since ra and relapsing polychondritis patient sera differed in their reactivity with the cyanogen bromide digested peptides  it is possible that the clinical manifestation of collagen autoimmunity might be influenced by the epitope specificity of the antibodies  
class5	1881	renal disease in chronic arthritis of childhood  a study of urinary n acetyl beta glucosaminidase and beta 2 microglobulin excretion  
class5	1881	urinalyses of randomly obtained samples from children with various types of chronic arthritis revealed proteinuria in 2 3  of patients  hemoglobinuria in 3 5   erythrocyturia in 4 1   and leukocyturia in 5 3   these frequencies are within the range found by screening school children  
class5	1881	however  raised urinary levels of n acetyl beta glucosaminidase and or beta 2 microglobulin  both sensitive measures of renal tubular damage  were found more frequently in children with chronic arthritis than in controls  p less than 0 0001   
class5	1881	abnormalities of either n acetyl beta glucosaminidase or beta 2 microglobulin excretion were associated with active arthritis as measured by physician global estimate of disease activity  with a polyarticular onset of juvenile rheumatoid arthritis  and with the use of slow acting antirheumatic drugs or the concurrent use of more than 1 nonsteroidal antiinflamtory drug  
class5	1881	abnormal renal tubular function appears to be common in chronic arthritis of childhood  
class5	1881	the long term consequences of this abnormality remain to be elucidated  
class5	1882	pseudotumor of the craniocervical junction during long term hemodialysis  
class5	1882	a systematic study of the upper cervical spine was performed using magnetic resonance imaging in 25 patients  15 men and 10 women  who had been undergoing hemodialysis for more than 10 years  
class5	1882	seven pseudotumors of the periodontoid soft tissue were disclosed  which were similar to the pannus recently described in rheumatoid arthritis  
class5	1882	bone cystic radiolucencies were observed in association with these pseudotumors in 5 patients  
class5	1882	the radiolucencies were located in the atlas  1 in the lateral mass and 1 in the anterior branch  and in the axis  3 in the odontoid process and 1 in the vertebral body   
class5	1882	no horizontal or vertical atlantoaxial subluxation was demonstrated  
class5	1882	these features were observed only in patients who had amyloid arthropathy  
class5	1882	they could be a frequent  yet thus far little recognized  feature of beta 2 microglobulin amyloidosis  
class5	1883	human immunodeficiency virus associated psoriasis  psoriatic arthritis  and reiter s syndrome  a disease continuum  
class5	1883	the presence of peripheral arthritis and hla a  b  c  dr  and dq antigens was evaluated prospectively in 18 caucasian men with human immunodeficiency virus associated psoriasis  
class5	1883	an asymmetric polyarthritis occurred in 32  of the patients and correlated with the presence of hla b27  
class5	1883	extensive clinical overlap between psoriatic arthritis  psoriasis  and reiter s syndrome was noted  
class5	1883	no significant excess of the hla antigens previously found to be associated with psoriasis was seen  which suggests that human immunodeficiency virus associated psoriasis per se may instead constitute another form of spondylarthropathy that is more closely related to reiter s syndrome  
class5	1884	intravenous pulse cyclophosphamide therapy in myositis and sjogren s syndrome  
class5	1884	we describe a patient with primary sjogren s syndrome who developed myositis  
class5	1884	the results of muscle pathologic analysis before and after treatment with monthly pulses of cyclophosphamide  intravenously   are presented  
class5	1885	alcohol and bone disease  
class5	1885	alcohol is considered to be an important risk factor for various bone diseases but recent studies have shown that moderate alcohol intake can be beneficial to bone structure  
class5	1885	alcohol decreases osteoblastic activity  leading to decreased bone formation and defective mineralization  
class5	1885	the changes reported in calciotropic hormones  mainly vitamin d and parathyroid hormone  are observed due in part to a deficient intestinal absorption of vitamin d and an inadequate synthesis of its hepatic metabolite  although greater emphasis has been given to dietary deficiencies or lack of exposure to sun  
class5	1885	the changes in parathyroid hormone are not consistent and since there is no greater incidence of hyperparathyroidism in alcoholic patients  it suggests that alcohol does not have a long term effect on the parathyroid glands  
class5	1885	alcohol increases calcitonin secretion acutely  calcitonin is an inhibitor of bone resorption and may be the mechanism by which moderate alcohol intake protects bone structure  
class5	1885	alcohol increases urinary calcium  magnesium and zinc excretion  
class5	1885	zinc deficiency has been postulated as a cause of oesteoporisis because it causes hypogonadism  
class5	1885	the decrease in the levels of the gonadal hormones and the increase of cortisol  observed in chronic alcoholics  may indirectly cause osteopenia and aseptic necrosis  
class5	1885	to these actions must be added the acidosis due to alcohol and the greater tendency of the alcoholic to fall  all of which influence bone changes and increase the incidence of bone fractures  
class5	1886	the effect of local deep microwave hyperthermia on experimental zymosan induced arthritis in rabbits  
class5	1886	the effect of local deep microwave hyperthermia  ldmwh  on normal and zymosan induced arthritis has been evaluated in 12 rabbits  24 joints   
class5	1886	ldmwh  four treatments to each joint  twice weekly for a period of 2 wk   was generated by an antenna operating at 915 mhz for 60 min  reaching an intraarticular temperature of 42 5     0 5 degrees c  
class5	1886	a surface cooling system was used with the microwave apparatus  
class5	1886	two weeks after the last treatment  all animals were sacrificed  
class5	1886	the application of ldmwh on normal joints induced a limited proliferation of the synovial lining cells with a minimal perivascular infiltration of mononuclear and neutrophil cells  
class5	1886	however  no histologic damage to the skin  muscles  bone  cartilage or bone marrow adjacent to the heated joints could be noted  
class5	1886	induction of zymosan arthritis  2 wk before ldmwh  was characterized by pannus formation and granulomatous reaction accompanied by fibrinoid deposits and disseminated necrotic foci in the synovial intima  
class5	1886	the ldmwh treatment on the examined arthritic joints brought about a reduction in the degree of granulomatous reaction concomitant with the appearance of some fibrocytes and fine collagen fibrils  
class5	1886	these findings suggest that ldmwh can be safely applied  even repeatedly  without morphologic evidence of damage to any normal mesenchymal tissue  
class5	1886	moreover  it reduces the inflammatory process in experimentally induced synovitis  
class5	1887	pivoting larynx  an unusual clinical observation at laryngoscopy  
class5	1887	rigid oesophagoscopy was planned in the investigation of a young patient with dysphagia  
class5	1887	during laryngoscopy for tracheal intubation an unusual pivoting manoeuvre was required to see the vocal cords  
class5	1887	although the initial diagnostic investigations were unhelpful  follow up directed at explaining the clinical observations led to an eventual diagnosis of anterior tubercles of c6  which explained the observation and accounted for the dysphagia  
class5	1888	extradural abscess following local anaesthetic and steroid injection for chronic low back pain  
class5	1888	a case is described of extradural abscess following extradural injection of local anaesthetic and steroid for the management of chronic low back pain  
class5	1888	the common signs and symptoms are reviewed  possible causes discussed and the association with diabetes stressed  
class5	1889	prediction of hip fracture in elderly women  a prospective study 
class5	1889	objective  to assess the relative importance of osteoporosis of the os calcis  cognisance  and mobility in the risk of subsequent fracture of the hip in elderly women  
class5	1889	design  prospective study of elderly women in residential care over two years  
class5	1889	setting  21 private or 38 local authority residential homes for the elderly and 4 geriatric hospitals in doncaster and hull  
class5	1889	subjects  1414 ambulant women aged over 69  in private or local authority residential care or geriatric care  
class5	1889	those who had had bilateral hip surgery were excluded  
class5	1889	main outcome measures  broad band ultrasonic attenuation  bua  index  clifton assessment procedures for the elderly test  for cognisance   and mobility on a six point scale  and fracture of the hip in the subsequent two year period  
class5	1889	results  73 women fractured their hip during the two years  
class5	1889	their mean age was not significantly different from that of the women who did not have a fracture  85 3  sd 5 6  v 83 9  6 3   p   0 07   but their mean bua index  40 3  19 3  v 50 9  22 2  db mh2   and score for cognisance  median 19  interquartile range 10 5 27 0  v 24  17 30   were significantly lower  both p less than 0 001   
class5	1889	these variables had independent associations with fracture of the hip  
class5	1889	women with fractures had a significantly lower score for the psychomotor component of the cognisance test  4 5  1 8  v 7  2 10   p less than 0 0025 and were significantly more mobile  1 1 3  v 3  1 6   p less than 0 02   
class5	1889	subdividing women according to high  medium  and low scores for bua index and cognisance testing disclosed a high risk group  118 women  with low bua index and cognisance score  whose incidence of fracture was 12 8   in the group at lowest risk  136 women  with high bua index and cognisance score  the incidence of fracture was only 1 5   relative risk 8 4  95  confidence interval  2 0 to 35 5   
class5	1889	further analysis showed that those most at risk were  additionally  most mobile but that less mobile women with good cognisance had a low incidence of fractures  regardless of the bua index   1 2   high index  v 0 9   low index   
class5	1889	conclusions  elderly women most at risk of sustaining hip fractures were those with low bua index  low cognisance test score  and high mobility  
class5	1889	improving bone strength and cognisance in elderly women may reduce their incidence of hip fracture  
class5	1890	the sulphated glycosaminoglycan levels in synovial fluid aspirates in patients with acute and chronic joint disease  
class5	1890	proteoglycan levels were measured in a series of synovial fluid samples from patients with acute and chronic joint diseases using a modified chemical dye binding method  
class5	1890	levels found in 50 miscellaneous inflammatory arthritis fluids  mean   173 2     90 9 micrograms ml  were higher than found in either 50 with rheumatoid arthritis  96 3     31 3 micrograms ml  or 50 with osteoarthritis  83 8     27 3 micrograms ml   
class5	1890	for comparison  proteoglycan levels were measured in 15 cadaver synovial fluids  98 9     44 2 micrograms ml  and 12 synovial fluids from patients with sports injury  163 7     79 4 micrograms ml   
class5	1890	patients were recruited into a trial where synovial fluid was aspirated as often as possible over a 6 month period during which the patients were followed using a number of well proven clinical parameters  
class5	1890	no correlation was found between the degree of joint destruction as measured by x ray damage and the concentration or total amount of proteoglycan in the synovial fluid  
class5	1890	in addition  there was no correlation between the level or total amount of proteoglycan and any clinical parameter of disease activity  
class5	1891	patients with arthritis and anti u1 rnp antibodies  a 10 year follow up  
class5	1891	five hundred and forty patients attending a rheumatology ward were screened for antinuclear antibodies  ana  by indirect immunofluorescence  ifl   
class5	1891	seventy had a significant titre of ana  
class5	1891	twenty three had u1 ribonucleoprotein antibodies  u1 rnp ab   
class5	1891	the clinical findings in u1 rnp ab positive patients were consistent with mixed connective tissue disease  mctd   
class5	1891	disease was more serious in the u1 rnp ab positive patients in terms of polyarthritis severity as well as mortality due to rheumatic disease  
class5	1891	thus  in this arthritis patient population  u1 rnp ab positivity predicted an aggressive disease characterized by an erosive arthritis  
class5	1892	diffuse idiopathic skeletal hyperostosis  dish  of the shoulder  a cause of shoulder pain  
class5	1892	shoulder pain is a common complaint and shoulder hyperostosis a frequent radiological condition  
class5	1892	however  little is known about the association between the clinical and radiological findings  
class5	1892	to evaluate the clinical relevance of shoulder hyperostosis we performed a controlled  blind study of 99 hospitalized probands with and without thoracospinal hyperostosis on lateral chest x rays  
class5	1892	the study included grading of the shoulder hyperostosis on the basis of three bilateral standard radiographs  assessing shoulder pain in a standardized way by an interviewer and recording extraskeletal causes of shoulder pain  
class5	1892	the prevalence of shoulder hyperostosis was doubled in probands with thoracospinal hyperostosis compared to controls  chi 2   5 90  p less than 0 025  n   99   
class5	1892	shoulder hyperostosis  irrespective of thoracospinal hyperostosis  predisposed to shoulder pain  40  versus 18   chi 2   4 06  p less than 0 05  n   74   
class5	1892	shoulder hyperostosis in combination with thoracospinal hyperostosis  shoulder dish  predisposed to shoulder pain to an even greater extent  46  versus 12   chi 2   6 64  p less than 0 01  n   47   
class5	1892	we conclude that shoulder hyperostosis is a radiological finding of potential clinical relevance  
class5	1893	a clinical epidemiological study in low back pain  description of two clinical syndromes  
class5	1893	in 100 patients with mainly chronic low back pain  lbp  signs and symptoms were evaluated prospectively and without preconceived expectation of particular findings  
class5	1893	two clinical syndromes were distinguished  both characterized by  typical local tenderness  and associated with specific clinical features  these syndromes  described previously in the literature but receiving scant attention  were named the greater trochanteric pain syndrome  trochanteric bursitis  and the iliac crest pain syndrome  iliolumbar syndrome   and occurred in 35  and 43  of the patients  respectively  
class5	1893	the recognition of these syndromes may enable us to study aetiology  prognosis  and therapy of lbp in more homogeneous groups of patients  
class5	1894	lesions of the mid shaft of the humerus presenting as shoulder capsulitis  
class5	1894	we describe three patients who presented with pain and restriction of movement at the shoulder suggestive of capsulitis  but proved to have lesions of the mid shaft of the humerus  
class5	1894	it is important to be aware of the possibility of this cause of a  frozen shoulder   since radiographs of the shoulder are usually cropped at the mid humerus and lesions at this level may easily be missed  
class5	1894	a radiograph of the entire humerus  or an isotope bone scan  may be more useful than repeated shoulder radiographs in patients whose shoulder symptoms do not respond to standard treatment  
class5	1895	abdominal wall pain  an alternative diagnosis  
class5	1895	the cause of abdominal pain need not necessarily reside in the viscera  the abdominal wall is another source of symptoms  
class5	1895	some causes of abdominal wall pain are obvious  e g  
class5	1895	hernias  but not so others such as nerve entrapment syndromes  
class5	1895	this review is concerned with causes of abdominal wall pain which  although common  may be easily overlooked  
class5	1896	cemented total knee arthroplasty for gonarthrosis in patients 55 years old or younger  
class5	1896	the results of 68 cemented total knee arthroplasties  tkas  in 50 patients with gonarthrosis who were 55 years old or younger at the time of surgery were reviewed  
class5	1896	these patients were operated on between 1979 and 1987 and were followed for an average of 6 2 years  
class5	1896	the average age of the patients was 50 years  
class5	1896	patients were evaluated by the hospital for special surgery knee score  
class5	1896	the average preoperative score was 53  and the average follow up score was 90  
class5	1896	overall  55 tkas were rated as excellent and 13 as good  
class5	1896	using the knee rating score advocated by the knee society  the average postoperative score was 92 for pain and 84 for function  
class5	1896	there were four successful reoperations for patellar component loosening  all in metal backed patellae  
class5	1896	the femoral and tibial components in these patients were intact  and at the follow up period  two knees were rated as excellent and two as good  
class5	1896	detailed roentgenographic evaluation demonstrated that 20  of tibial components had radiolucencies in at least one zone on the anteroposterior roentgenogram and in 11  on the lateral roentgenogram  
class5	1896	femoral radiolucencies occurred in only 2  of knees  
class5	1896	patellar radiolucencies in one or more zones occurred in 20  of knees that had not had patellar revision  
class5	1896	no complete or progressive radiolucencies at the bone cement interface were noted for any component  and no components were considered to be roentgenographically loose  
class5	1896	cemented tkas can achieve excellent long term results in patients younger than 55 years old with gonarthrosis of the knee  
class5	1896	these results compare with those obtained in published reports on older age groups  
class5	1897	total knee arthroplasty in diabetes mellitus  
class5	1897	a retrospective study was done of 59 total knee arthroplasties  tkas  in 40 patients diagnosed with diabetes mellitus  
class5	1897	the overall infection rate was 7   with an overall revision rate of 10  and an average follow up period of 4 3 years  
class5	1897	wound complications were present in 12  of the tkas  
class5	1897	the rate of deep joint infections in diabetic patients was statistically higher than the reported incidence of sepsis in nondiabetic patients  
class5	1897	therefore  maximum precautions should be taken for diabetic patients having tka to minimize both wound complications and joint sepsis  
class5	1898	bone loss in the distal anterior femur after total knee arthroplasty  
class5	1898	bone loss in the distal anterior femur in asymptomatic total knee arthroplasty  tka  patients has been noted roentgenographically and during revision surgery  
class5	1898	a retrospective roentgenographic review of 147 tka cases was carried out to document bone loss  
class5	1898	the influence that the mode of fixation  porous coated and cemented  and the implant design have on bone loss was examined  
class5	1898	the time of onset and the progression of bone loss were studied  
class5	1898	bone loss occurred in the distal anterior femur in the majority of cases reviewed  68    
class5	1898	the prevalence of bone loss was independent of the mode of fixation and the implant design  
class5	1898	by qualitative observation  roentgenographically detectable bone loss occurred within the first postoperative year and did not progress further  
class5	1898	previously three dimensional finite element analysis demonstrated that the replacement of the bearing surface of the femur with a stiff metallic implant reduces the stress in the distal anterior femur by at least one order of magnitude  
class5	1898	it is therefore speculated that the observed bone loss results from stress shielding  
class5	1898	the apparent lack of progression may reflect the development of a new remodeling equilibrium under the altered stress conditions  
class5	1898	the bone loss in the distal anterior femur described has not been implicated as a source of failure  
class5	1898	however  since the bone strength in the femoral region is compromised as it becomes osteopenic  bone failure may occur with longer periods of cyclic loading  
class5	1898	furthermore  as a result of bone loss  revision arthroplasty may be more difficult  
class5	1899	a sequential three step lateral release for correcting fixed valgus knee deformities during total knee arthroplasty  
class5	1899	an approach to mild  moderate  and severe fixed valgus deformities of the knee is described  
class5	1899	the sequential approach to soft tissue releases in the fixed valgus knee allows the surgeon to regain a neutral alignment in valgus deformities of up to 90 degrees  
class5	1899	an additional benefit of the approach is spontaneous correction of fixed external tibial rotation deformities  
class5	1899	using this approach  early and late stability allows the use of unconstrained knee implants  including those with mobile bearing elements  
class5	1900	anterior acromioplasty for treatment of the shoulder impingement syndrome  
class5	1900	between 1975 and 1979  anterior acromioplasty was performed in 65 patients with 66 involved shoulders  
class5	1900	the procedure appears to be safe and reasonably effective  
class5	1900	of the 65 patients in this study  50 had chronic tendon inflammation with fibrosis  and 16 also had a small supraspinatus tendon tear  
class5	1900	these 16 had rotator cuff repairs  
class5	1900	twenty six patients were also treated with distal clavicle excision  and seven had tenodesis of the long head of the biceps brachii  
class5	1900	the average age of the patients was 50 years  range  23 75 years   
class5	1900	all patients were followed for an average of eight years  range  three to 13 years   
class5	1900	at final evaluation  no or slight pain was present in 77  of the shoulders  39 of 50 without tendon tearing and 12 of 16 with tendon tearing and repair  
class5	1900	active shoulder abduction averaged 167 degrees  
class5	1900	ninety two percent returned to employment  including 18  with some job modification  
class5	1900	eighty six percent returned to recreational athletics  20  with some modification of activities  
class5	1900	seven patients had additional surgical treatment  
class5	1900	the progression of rotator cuff disease is not always prevented  but the need for subsequent shoulder treatment generally decreases  
class5	1901	humeral head retroversion in patients with unstable humeroscapular joints  
class5	1901	humeral head retroversion and shoulder rotation in both the frontal and scapular plane were studied in 34 patients with anterior glenohumeral instability  
class5	1901	twenty two patients had traumatic anterior shoulder dislocations and another 12 patients had nontraumatic dislocations with generalized joint laxity  
class5	1901	patients with traumatic recurrent dislocations had a smaller than normal retroversion angle in the unstable shoulder  
class5	1901	the angles were 26 degrees on the dominant side and 23 degrees on the nondominant side compared with 33 degrees and 29 degrees  respectively  in normal shoulders  
class5	1901	the stable contralateral shoulder joint was clinically and roentgenographically similar to the normal shoulder  
class5	1901	the patients with nontraumatic dislocations had increased rotation and smaller retroversion angles  irrespective of stability in the shoulder joint  
class5	1901	the retroversion angles were 18 degrees for unstable shoulders on the dominant side and 15 degrees on the nondominant side  
class5	1901	the retroversion angle of the stable contralateral joint in these patients was less in five of eight shoulders  
class5	1902	chondrosarcoma complicating total hip arthroplasty in maffucci s syndrome  
class5	1902	a 70 year old woman who was followed for 60 years for maffucci s syndrome required a total hip arthroplasty  tha  of the right hip for degenerative arthritis  
class5	1902	this did not relieve pain  
class5	1902	three years later  chondrosarcoma of the femur developed around the femoral component and was fatal  
class5	1902	the roentgenographic changes after the tha were incorrectly interpreted as being caused by infection  
class5	1903	total hip arthroplasties in patients younger than 45 years  a nine  to ten year follow up study  
class5	1903	eighty one cemented total hip arthroplasties in patients younger than 45 years were reviewed with an average 9 2 year follow up interval  
class5	1903	the results were compared with the same group previously reported at an average follow up time of 4 5 years  
class5	1903	clinically satisfactory results were 58  compared with 78  at 4 5 years  
class5	1903	the revision rate almost tripled to 33   
class5	1903	impending failure was present in 56  of those hips not yet revised  
class5	1903	in the first study  technique was a primary determinant of success  
class5	1903	in this report there was no influence of technique on the incidence of revision  
class5	1903	age did not influence revision rates either  with 35  in patients younger than 30 years and 32  in patients aged 30 45 years  
class5	1903	patients younger than 30 years had fewer satisfactory clinical results and a higher rate of impending failure  
class5	1903	as in the first study  the best results were obtained in patients with inflammatory collagen disease aged from 30 to 45 years  
class5	1904	giant cell reparative granuloma of the hand and foot bones  
class5	1904	giant cell reparative granuloma  gcrg  is an uncommon benign reactive intraosseous lesion  
class5	1904	it occurs in the skull  jaw  hand  foot  and facial bones and rarely in other skeletal sites  
class5	1904	it is a solitary  lytic  expanded lesion and infrequently may extend into the surrounding soft tissue  
class5	1904	histologically  it is composed of fibrous stroma with spindle shaped fibroblasts  multinucleated giant cells  and inflammatory mononuclear cells  
class5	1904	areas of hemorrhage are uniformly present  
class5	1904	it may be difficult to distinguish this entity from an aneurysmal bone cyst  giant cell tumor  or brown tumor of hyperparathyroidism because of roentgenographic and histologic similarities  
class5	1904	accurate diagnosis is essential for appropriate treatment  serum calcium  phosphorus  and parathyroid hormone levels should be measured  
class5	1904	curettage and bone graft are effective treatments for both primary lesions and recurrences  
class5	1904	second recurrences are rare  
class5	1905	primary inflammatory reaction in synovial fluid and tissue in rabbit immobilization osteoarthritis  
class5	1905	the kinetics and composition of the primary cellular inflammatory process were studied in the synovial fluid  sf  and synovial tissue  st  compartments of a rabbit knee immobilization osteoarthritis model  
class5	1905	immobilization induced rapid migration of neutrophils  59      26  of all cells  into sf in three days  which was accompanied by nonspecific esterase positive monocytes  71      8  of all mononuclear cells   
class5	1905	this finding suggests that non specific inflammation mediated by phagocytic leukocytes predominates the cellular response in the sf compartment  
class5	1905	in contrast  morphometric analysis of st proper showed an inflammatory mononuclear cell response  the intensity of which diminished over time during the study period from day 3  416     59 cells per 0 049 mm2 st tissue  through day 10  305     32 cells  to day 35  174     36 cells   
class5	1905	a dotlike t pattern alpha naphthyl acetate esterase  anae  was found in the t cell dependent areas of secondary lymphatic tissue in the spleen  enabling immunocytologic anae marker studies  
class5	1905	the st response in situ was predominated by tissue macrophage  though infiltrates rich in t lymphocytes were present in the immediate sublining stroma  
class5	1905	there was a significant correlation between the intensity of the sf cell response  total recovery  and the percentage of neutrophils  but there was no correlation between the intensity of the st response and the proportion of t lymphocytes  
class5	1905	these t cell accumulations together with the local proliferation of fibroblastlike lining cells and stromal fibroblasts suggest that the primary inflammatory cell response is not caused by either wear and tear or mechanically by cartilage fragments  
class5	1906	comparison of patellar resurfacing versus nonresurfacing in bilateral total knee arthroplasty  
class5	1906	twenty five patients who received bilateral total knee prostheses were studied to evaluate the advantages and disadvantages of patellar resurfacing  
class5	1906	only patients with advanced patellofemoral disease were included in the study  
class5	1906	in all patients  patellar resurfacing had been done in the right knee but not in the left knee  
class5	1906	the depuy porous coated implant was used in all cases  
class5	1906	subjective criteria were compared with objective criteria  which included range of motion  knee flexion and extension  and roentgenographic evaluation  
class5	1906	the findings in this study suggest that patellar resurfacing can offer the patient a superior knee with regard to pain relief and strength  
class5	1907	the inwardly pointing knee  an unrecognized problem of external rotational malalignment  
class5	1907	twelve patients with inwardly pointing knees had chronic knee pain and disability suggestive of patellofemoral subluxation  
class5	1907	none had responded well to conservative measures or surgical correction at the level of the soft tissues  
class5	1907	their pattern of limb alignment was studied roentgenographically and was found to differ significantly from the control group of 49 healthy young adults  
class5	1907	the deformities primarily related to the tibia were external tibial torsion  excess varus angulation of the tibial plateau  and varus knees  
class5	1907	angulation of the femoral condyles was normal and femoral anteversion did not appear to contribute significantly to the deformity  
class5	1907	surgery in seven cases  nine knees  was by derotation valgus maquet osteotomy of the tibia and lateral release realignment of the patellae  
class5	1907	outcome assessments after a three year follow up period  five knees  were excellent  
class5	1907	early results on the remaining cases were satisfactory  
class5	1908	late recurrence of varus deformity after proximal tibial osteotomy  
class5	1908	one hundred thirteen knees with medial gonarthrosis in 95 patients were treated by valgus producing proximal tibial osteotomy and followed clinically and roentgenographically for a minimum of five years  mean  6 3 years   
class5	1908	sixty four knees  57   were pain free or had only mild discomfort when walking  
class5	1908	the standing femorotibial angle decreased from a postoperative average of 9 3 degrees valgus to 7 8 degrees valgus at the final follow up examination  
class5	1908	the tendency for varus recurrence greater than 5 degrees and for medial  or lateral compartment arthritic progression was evaluated using the kaplan meier survival method  
class5	1908	varus recurred in 18   lateral compartment arthritic progression in 60   and medial compartment arthritic progression in 83  by nine years after surgery  
class5	1908	the probability of arthritic progression is much higher than the probability of significant varus recurrence in long term roentgenographic follow up studies of patients with valgus producing proximal tibial osteotomies  
class5	1909	two  to four year results of posterior cruciate sparing condylar total knee arthroplasty with an uncemented femoral component  
class5	1909	one hundred fourteen hybrid press fit condylar total knee arthroplasties  tkas  were reviewed an average of 2 8 years after surgery to determine if this method of implantation provided satisfactory results compared with conventional cemented tkas  
class5	1909	ninety three percent of the knees had good or excellent results  and 94  of the knees had at most only mild or occasional pain  
class5	1909	one knee with a metal backed patella was revised for mechanical failure of the patellar button  
class5	1909	roentgenographic analysis of the femoral component interface showed that 30  of knees had a radiolucent line in at least one zone  
class5	1909	however  none of the lines was wider than 1 mm  and none was about the central stem  
class5	1909	there were no signs of loosening about any of the components  
class5	1909	it was concluded that hybrid tka provides a good and predictable result that is comparable to cemented tka  
class5	1910	fetal imaging in the skeletal dysplasias  
class5	1910	second trimester diagnosis of fetal skeletal dysplasia is becoming increasingly common  
class5	1910	by careful examination of the fetus for skeletal mineralization  shape and size of long bones and cranium  and abnormalities of other organ systems  a definitive diagnosis can often be achieved by ultrasound  
class5	1910	fetal radiography is very helpful in giving more information about bone shape and mineralization as well as in confirming the diagnosis  
class5	1910	subsequent obstetric management should be dictated by the natural history of the disease  the parents  wishes  and the gestational age at diagnosis  
class5	1910	because many of these disorders have a high recurrence risk  genetic counseling and follow up are an important part of the management of these patients  
class5	1911	does alternate day cloprednol therapy prevent bone loss  a longitudinal double blind  controlled clinical study  
class5	1911	osteoporosis is a serious side effect of systemic treatment with steroids  
class5	1911	cloprednol  a synthetic glucocorticoid with an anti inflammatory potency twice that of prednisone  causes less calcium and nitrogen excretion than does prednisone in equipotent doses  
class5	1911	therefore a double blind study was undertaken comparing the effects of alternate day cloprednol and prednisone therapy on bone mineral density in 39 patients  cloprendol  13 men and 8 women aged 48 5     2 8 years  prednisone  9 men and 9 women aged 49 7     1 7 years  with lung diseases  
class5	1911	ten patients with asthma  9 men and 1 woman aged 37 8     3 7 years  inhaling daily beclomethasone served as control subjects  
class5	1911	trabecular and total bone density of the distal tibia and radius was determined quarterly during 1 year with a special purpose computed tomographic system  
class5	1911	initial mean trabecular bone density of the patients receiving cloprednol and prednisone was 17  below normal  
class5	1911	after a treatment period of 1 year  we found a loss of radial trabecular bone density  mean     sem  of 1 33      0 49  in the cloprednol group and 2 38      0 69  in the prednisone group  
class5	1911	in postmenopausal women  prednisone but not cloprednol therapy caused significant  p less than 0 01  trabecular bone loss  5 29      0 99  versus 0 70      0 65    
class5	1911	the control group lost 0 91      0 79   
class5	1911	loss of cortical bone was insignificant in all three groups  
class5	1911	in post menopausal women  1 year of alternate day cloprednol therapy was associated with significantly less bone loss than was prednisone therapy in equipotent dosages  
class5	1912	studies of the porcine intestinal calcitriol receptor in pseudo vitamin d deficiency rickets type i  
class5	1912	1  
class5	1912	calcitriol  1 25 dihydroxyvitamin d3  concentrations in plasma of humans and pigs with pseudo vitamin d deficiency rickets type i  pvdri  have been reported to be significantly lower than in normal subjects and animals  
class5	1912	sometimes  however  calcitriol concentrations are relatively high in these subjects and animals  50 80 pmol l  and nevertheless clinical symptoms of rickets develop  
class5	1912	we have studied whether or not the development of rachitic lesions in piglets with pvdri is due to altered binding properties of the intestinal calcitriol receptor in addition to the defective renal production of calcitriol  
class5	1912	pvdri piglets with clinical and biochemical symptoms of rickets  hypocalcaemia  increased activity of alkaline phosphatase  and with calcitriol concentrations in plasma of 83 7     4 2 pmol l  n   7  were used  
class5	1912	they were compared with unaffected piglets with normal calcitriol concentrations  178 0     17 7 pmol l  n   9   
class5	1912	2  
class5	1912	the equilibrium dissociation constant  kd  of the receptor in the pvdri piglets  0 31     0 05 nmol l  and in control piglets  0 33     0 05 nmol l  and the maximum binding capacity  bmax    674     103 and 719     122 fmol mg of protein  respectively  were not different  n   9   
class5	1912	3  
class5	1912	the association rate constant  kass  at 4 degrees c  0 15 x 10 7  and 0 24 x 10 7   mol l  1 min 1  and the dissociation rate constant  kdiss   0 40 x 10  3  and 0 48 x 10  3  min 1  half life of dissociation   24 1 and 28 9 h  respectively  were also not different between diseased and control piglets  
class5	1913	kyphoscoliosis and respiratory failure  a patient treated with assisted ventilation for 27 years  
class5	1913	a 62 year old woman had had kyphoscoliosis since age 12 years  
class5	1913	respiratory failure developed at age 35 years following a respiratory infection  
class5	1913	a tracheostomy was done and she required assisted ventilation using a respiratory  bird   
class5	1913	many attempts at weaning her from the ventilator were unsuccessful  
class5	1913	she has remained dependent on assisted ventilation for more than 27 years but has had a relatively comfortable and meaningful life  
class5	1913	in 1983  a left pleuroscopy was done related to recurrent pneumothorax and numerous small bullae were seen on the lung surface  
class5	1913	recent investigation using computed tomographic scanning has shown patchy areas of emphysema in both lungs  
class5	1913	emphysema is not a feature of kyphoscoliosis and it is suggested that intermittent positive pressure applied to the lung over long duration may cause the lung destruction of emphysema  
class5	1914	macrophage colony stimulating factor restores in vivo bone resorption in the op op osteopetrotic mouse  
class5	1914	the op op variant of murine osteopetrosis is a recessive mutation characterized by impaired bone resorption due to lack of osteoclasts  
class5	1914	cultured osteoblasts and fibroblasts from this mutant do not secrete m csf activity and resident macrophages are absent in bone marrow  
class5	1914	this failure has been related to a mutation within the m csf coding region  
class5	1914	we report now that the administration of recombinant human m csf  rhm csf  corrects in vivo the impaired bone resorption in this animal  
class5	1914	the treatment restores the bone marrow cavity virtually absent in the op op animal and induces the appearance of resorbing osteoclasts and of resident bone marrow macrophages  
class5	1914	this proves that the deficiency of m csf is the cause of the op op bone disorder and that this cytokine is directly or indirectly necessary for physiological osteoclastogenesis  the resulting bone resorption and for the establishment of bone marrow hemopoiesis  
class5	1915	soft tissue rheumatism of the upper extremities  diagnosis and management  
class5	1915	upper extremity tendinitis and bursitis are usually the result of repetitive microtrauma  probably resulting in disruption of fibers  
class5	1915	a focus of inflammation often occurs  producing pain  spasm  and disability  
class5	1915	with a careful history and physical exam  the diagnosis can be made  distinguishing soft tissue rheumatism from arthritis  
class5	1915	treatment consists of rest  heat or ice  and frequently  the use of non steroidal anti inflammatory drugs or injections to control the inflammatory response  
class5	1915	protection from repeated trauma may be beneficial in preventing recurrence  
class5	1916	calcium absorption in bone disease associated with chronic cholestasis during childhood  
class5	1916	fractional absorption of calcium was determined in 9 children aged 4 9 to 16 9 yr with chronic cholestatic liver disease to determine the role of calcium malabsorption in the development of metabolic bone disease  
class5	1916	radiological evidence of rickets was absent in all patients  but bone density  measured by single beam photon absorptiometry of the distal radius  was reduced in eight of nine subjects  
class5	1916	serum calcium and phosphorus concentrations were normal in all except one subject  
class5	1916	serum 25 hydroxyvitamin d concentration was decreased compared with controls in only one of nine patients  but serum 1 25 dihydroxyvitamin d concentrations were diminished in seven of nine subjects  
class5	1916	in all subjects  dietary calcium and phosphorus intakes were greater than 80  of the rda  
class5	1916	fractional absorption of calcium  determined by oral and intravenous administration of stable calcium isotopes  was similar in cholestatic compared with control subjects  37 1      12 5  vs  
class5	1916	34 0      16 4    
class5	1916	in the cholestatic subjects  calcium absorption correlated with serum 1 25 dihydroxyvitamin d  r   0 871  p less than 0 002  but not 25 hydroxyvitamin d concentrations  
class5	1916	calcium balance  assessed by the duplicate diet method  was positive in four of five subjects  
class5	1916	anthropometric measurements were performed to examine the relationship between nutritional status and bone mineral content  
class5	1916	heights of all subjects were less than or equal to the 10th percentile and fat stores and somatic protein stores were less than the 25th percentile in six of nine subjects  
class5	1916	we conclude that factors other than calcium malabsorption and decreased serum 25 hydroxyvitamin d concentration contribute to diminished bone mass in children with cholestatic liver disease  
class5	1917	results of treatment of displaced patellar fractures by partial patellectomy  
class5	1917	the results of partial patellectomy as a treatment for displaced patellar fractures were assessed retrospectively with use of clinical  radiographic  and isokinetic strength testing criteria  
class5	1917	forty patients who had been followed for an average of 8 4 years were studied  
class5	1917	in the extremity that had been operated on  the mean active range of motion was 94 per cent  the circumference of the thigh was 100 per cent  and the strength of the quadriceps was 85 per cent of these measurements in the contralateral extremity  
class5	1917	the over all result was rated as excellent in twenty patients  good in eleven  fair in six  and poor in three  
class5	1917	there was a significant statistical correlation between the type of fracture and the outcome  
class5	1917	the results of this study indicate that partial patellectomy can be an effective treatment for selected patellar fractures  
class5	1918	arthrometric evaluation of knees that have a torn anterior cruciate ligament  
class5	1918	we used the kt 1000 arthrometer to test the knees of 107 patients who had an acute tear of the anterior cruciate ligament  153 patients who had a chronic tear  and 141 control subjects  for a total of 401 individuals  
class5	1918	the three testing parameters were the extent of anterior translation at eighty nine newtons of force and at maximum manual force  and the compliance index  
class5	1918	the differences between the involved and the uninvolved knees were calculated  
class5	1918	at eighty nine newtons  all but one of the control subjects had anterior translation of ten millimeters or less  compared with 58 per cent of the patients who had a chronic tear  
class5	1918	at maximum manual force  all but two of the control subjects had translation of ten millimeters or less  compared with 20 per cent of the patients who had an acute or a chronic tear  
class5	1918	analysis of variance showed that the clinical diagnosis correlated well with the results for all tests  p less than 0 001   
class5	1918	however  when the uninjured knees of patients who had an acute or a chronic tear were compared with the knees of the control subjects  significant differences were noted  p less than 0 001 to 0 006   
class5	1918	in the patients who had a chronic tear  there was no relationship between the time from injury to operation and the extent of anterior translation  
class5	1918	the arthrometric test at maximum manual force was the strongest discriminant  it differentiated normal from abnormal knees  p less than 0 001  with high sensitivity  92 per cent   high specificity  95 per cent   and high positive predictive accuracy  the cut off point was eleven millimeters or less  
class5	1919	measurement of anterior posterior displacement of the knee  a comparison of the results with instrumented devices and with clinical examination  
class5	1919	thirteen subjects who had normal knees and fifteen patients who had a chronic rupture of the anterior cruciate ligament were tested in order to compare the measurements of tibiofemoral displacement as recorded by four commercial devices  the acufex knee signature system  the genucom knee analysis system  the medmetric kt 1000 arthrometer  and the stryker knee laxity tester  
class5	1919	anterior and posterior displacement were measured at forces of eighty nine newtons  twenty pounds  and 133 newtons  thirty pounds   
class5	1919	we found significant differences in reproducibility of measurement among the devices  
class5	1919	the acufex  medmetric  and stryker devices had more reproducible measurements  and they could be used to identify 80 to 90 per cent of the normal subjects and anterior cruciate deficient patients  
class5	1919	the genucom device had poorer reproducibility of measurement  and it tended to register greater differences in displacement between the right and left knees of normal subjects  
class5	1920	evaluation of an electrogoniometric instrument for measurement of laxity of the knee  
class5	1920	eight lower extremities from cadavera were tested for anterior posterior laxity in two positions before and after transection of the anterior cruciate ligament  
class5	1920	at critical points in the tests  electrogoniometric and radiographic measurements of tibiofemoral translation were compared  
class5	1920	by direct measurement  we determined the accuracy of the radiographic method to     0 4 millimeter  95 per cent  in measuring anterior posterior translations of the tibia with respect to the femur  
class5	1920	the electrogoniometer estimated displacement of the tibia with respect to the femur during the anterior drawer test to be 3 5     8 2 millimeters at 90 degrees of flexion of the knee and 11 1     16 1 millimeters at 30 degrees of flexion  
class5	1920	direct comparison of these measurements with those obtained by means of the radiographic technique showed that the electrogoniometer tended  on average  to overestimate the tibial translation  
class5	1920	the amount of overestimation was 0 7 millimeter for intact knees and 1 9 millimeters after sacrifice of the anterior cruciate ligament  
class5	1920	despite this small average error in measurement of tibial translation  the difference between individual electrogoniometric and radiographic measurements varied greatly  with a 95 per cent confidence limit of     5 5 millimeters  
class5	1920	the error of the electrogoniometric measurements varied with the angle of flexion of the knee during testing  both the accuracy and the reliability of the electrogoniometric measurements being greatly diminished at 30 degrees of flexion  
class5	1920	the electrogoniometric method also tended to overestimate tibial internal rotation  by an average of 10 5 degrees  and external rotation  by an average of 9 3 degrees   the reliability of these measurements was     6 9 degrees  
class5	1921	use of a knee brace for control of tibial translation and rotation  a comparison  in cadavera  of available models  
class5	1921	we assessed the relative restraints that are provided by fourteen currently available functional knee braces  using six limbs in cadavera  
class5	1921	the tests were made at 30 and 60 degrees of flexion of the knee  and a mechanical loading system applied loads that caused anterior posterior translation and internal external rotation  
class5	1921	the braces limited abnormal tibiofemoral displacements by 10 to 75 per cent in translation  there was more variation in rotation  
class5	1921	this study demonstrated that functional knee braces provide a restraining influence that may be beneficial in the control of abnormal displacements of the knee  but that the degree of restraint varies considerably  
class5	1922	hypertension after operative correction of club foot deformity  
class5	1922	severe hypertension occurred as a postoperative complication after correction of a club foot deformity in four children  seven feet  who were between the ages of two and three years and had no history of hypertension  
class5	1922	the hypertension subsided slowly after administration of antihypertensive medications or more rapidly after release of the correction that had been obtained operatively  
class5	1923	the lateral approach for operative release of post traumatic contracture of the elbow  
class5	1923	a lateral approach was used to release a post traumatic contracture of the elbow in seven patients  and the results were evaluated an average of thirty eight months postoperatively  
class5	1923	extension improved from an average flexion contracture of 45 degrees preoperatively to one of 12 degrees postoperatively  and the average point of maximum flexion increased from 116 degrees preoperatively to 129 degrees postoperatively  
class5	1923	the average arc of motion increased 46 degrees  
class5	1923	all patients began using a continuous passive motion device immediately after the operation  
class5	1923	there were no problems with wound healing or formation of heterotopic bone  
class5	1924	arthrodesis of the ankle with cancellous bone screws and fibular strut graft  biomechanical analysis  
class5	1924	the stability of an arthrodesis with two cancellous bone screws across the ankle joint was evaluated in eighteen ankles from fresh frozen cadavera  
class5	1924	tibiotalar motion was recorded in response to the following loading modes  medial lateral moment  plantar flexion dorsiflexion moment  and internal external tibial torque  
class5	1924	the series of loading tests was performed with two cancellous bone screws through the tibia into the talus and a lateral fibular strut graft fixed with a proximal and a distal screw  
class5	1924	the tests were repeated after the strut graft was removed  and again after it had been reapplied  
class5	1924	the amount of motion at the site of the arthrodesis was greatest with tibial torque and was least with medial lateral bending  this was true for specimens with or without a fibular strut graft  
class5	1924	removal of the strut graft allowed increased tibiotalar motion for all modes of loading  increases in motion were far greater for specimens of poor bone quality  
class5	1925	spondyloepiphyseal dysplasia of maroteaux  
class5	1925	the cases of four patients who had an unusual clinical entity of disproportionately short stature  referred to as spondyloepiphyseal dysplasia of maroteaux  are described  
class5	1925	in patients who have this syndrome  the abnormalities are confined to the musculoskeletal system  
class5	1925	the patients do not have corneal opacities or increased excretion of keratosulphate  
class5	1925	the mode of transmission appears to be autosomal dominant  
class5	1925	platyspondylysis is present but there are no anterior tongue like deformities of the vertebral bodies  
class5	1925	because of the presence of spondyloepiphyseal dysplasia and normal intelligence  and the lack of abnormalities at birth  this entity seems to mimic morquio syndrome  
class5	1925	however  unlike morquio syndrome  the disorder involves no biochemical abnormalities  
class5	1925	thus  the entity may be classified as new  
class5	1926	the patellofemoral joint after total knee arthroplasty without patellar resurfacing  
class5	1926	one hundred total knee replacements with a total condylar prosthesis and without patellar resurfacing were followed for a minimum of two years  
class5	1926	eighty four per cent of the knees were affected by osteoarthrosis  
class5	1926	graded according to the knee rating system of the hospital for special surgery  there were eighteen excellent  fifty three good  eighteen fair  and eleven poor results  
class5	1926	at the most recent follow up  twenty nine knees  29 per cent   nine of which were affected by rheumatoid arthritis  were still painful in the patellofemoral area  
class5	1926	the height and weight of the patient definitely influenced the amount of patellofemoral pain postoperatively  
class5	1926	small patients who had osteoarthrosis were exceptionally free of pain  regardless of sex  age  or level of activity  
class5	1926	it seems that the best approach to patellofemoral replacement includes resurfacing of the patella in all patients who have rheumatoid arthritis and in patients who have osteoarthrosis if they have preoperative patellofemoral pain  are more than 160 centimeters tall  weigh more than sixty kilograms  and have advanced changes in the patella at the time of the operation  
class5	1927	thyroid abnormalities in the mccune albright syndrome  ultrasonography and hormonal studies  
class5	1927	hyperthyroidism and goiter have been reported frequently in association with the mccune albright syndrome  mas   
class5	1927	to assess the prevalence and extent of thyroid abnormalities in girls with mas  we studied 19 patients  mean age  6 6     1      se  yr  mean bone age  9 5     1 yr  and 18 normal control girls  mean age  10 3     0 5 yr   
class5	1927	all patients appeared euthyroid when examined  1 was taking antithyroid medication  
class5	1927	ultrasonography revealed thyroid abnormalities in 7 patients  including generalized inhomogeneity  small  2 4 mm  and large  greater than 10 mm  hypoechoic regions  and echogenic nodule like regions  
class5	1927	repeat ultrasonography after intervals of 9 18 months showed enlargement of large hypoechoic regions in 2 patients  
class5	1927	in the patients with abnormal ultrasound findings  serum tsh was uniformly low or suppressed both at baseline and after administration of 7 micrograms kg trh  
class5	1927	the mean serum t3 level in this group was significantly higher than that in controls  2 9     0 2 vs  
class5	1927	2 3     0 1 nmol l  p less than 0 05   whereas mean serum t4  free t4  and t4 binding globulin levels did not differ from those of controls  
class5	1927	in the remaining 11 patients  thyroid ultrasonography was normal  and the serum levels of t3  t4  free t4  and tsh were normal  
class5	1927	bioassay showed no detectable thyroid stimulating activity in the plasma of the mas patients with suppressed tsh levels  
class5	1927	none of the patients became overtly thyrotoxic over 3 6 yr of observation  and their serum iodothyronine levels remained stable  
class5	1927	we conclude that thyroid dysfunction is common in girls with mas  but that it may be clinically occult and not rapidly progressive  
class5	1927	the thyroid dysfunction  like that of the ovaries  is associated with structural abnormalities in the gland itself  together with suppressed levels of the respective stimulating hormones  
class5	1928	mandibular osteomyelitis in a patient with sickle cell anemia  report of case  
class5	1928	a case is presented in which mandibular osteomyelitis and mental nerve paresthesia developed in a patient with sickle cell anemia  
class5	1928	this infection appeared to precipitate a sickle cell crisis  
class5	1928	the mechanisms for these patients  propensity to infection and the diagnosis and management of sickle cell osteomyelitis of the jaws are discussed  
class5	1929	musculoskeletal impairments and physical disablement among the aged  
class5	1929	this article summarizes the results of a longitudinal investigation of the progression of sight  hearing  and musculoskeletal impairments and their association with change in physical disability  in 10 adls among members of the massachusetts health care panel study  
class5	1929	the findings confirm widely held clinical beliefs that specific types of musculoskeletal decrement are an important cause of physical disability among older persons  
class5	1929	decrement in hand function is a significant musculoskeletal impairment influencing limitations in basic adl  and progression of instrumental adl dysfunction is influenced by progression of lower extremity impairments  
class5	1929	progression of sight and hearing impairments was not associated with change in physical disability  
class5	1929	musculoskeletal impairments  one of the most prevalent and symptomatic chronic complaints of middle and old age  deserve increased attention from epidemiologists  disability researchers  and clinicians seeking ways to prevent disablement among the aged  
class5	1930	monosodium urate crystals stimulate phospholipase a2 enzyme activities and the synthesis of a phospholipase a2 activating protein  
class5	1930	eicosanoids are important mediators of the inflammatory response to monosodium urate crystals  msuc  that results in gout  
class5	1930	phospholipase enzymes cleave fatty acids from membrane phospholipids  and this is thought to be the rate limiting step in eicosanoid production  
class5	1930	to understand better the mechanism of eicosanoid production in this disease  we stimulated human peripheral blood neutrophils and monocytes with msuc and measured phospholipase enzyme activities  
class5	1930	msuc stimulated both intracellular and secretory phospholipase a2 enzyme activities in a time and concentration dependent manner  
class5	1930	specificity was observed  as phospholipase c activities were not affected  
class5	1930	pretreatment with colchicine  but not aspirin  indomethacin  allopurinol  or islet activating protein  abrogated the enhanced phospholipase a2 activities  
class5	1930	we have recently isolated and characterized a phospholipase a2 activating protein termed plap from synovial fluid from patients with rheumatoid arthritis  and from murine and bovine cell lines  
class5	1930	plap was detected in gouty synovial fluid by immunodot blotting and elisa assays and expressed the same characteristics as plap identified from other sources  
class5	1930	to examine the role of plap in msuc induced phospholipase a2 stimulation  we treated cells with msuc and observed an increase in immunoreactive plap  
class5	1930	this response also could be blunted by colchicine  but not other drugs  
class5	1930	both phospholipase a2 and plap induced production by human monocytes of pge2 and leukotriene b4 by neutrophils  
class5	1930	these findings suggest that phospholipase a2 activation in response to msuc requires an intact microtubule structure  and that phospholipase a2 and plap may be important modulators of at least a portion of the gouty inflammatory response  
class5	1931	a distinctive triad of malformations of the central nervous system in the meckel gruber syndrome  
class5	1931	a distinct triad of central nervous system  cns  malformations  prosencephalic dysgenesis  occipital exencephalocele and rhombic roof dysgenesis  was present in seven cases of the meckel gruber syndrome examined at autopsy  
class5	1931	we compared our findings with those previously described  
class5	1931	microcephaly  sloping forehead  posterior occipital exencephalocele  cerebellar hypoplasia  chiari malformation  hydrocephalus  polymicrogyria  arhinencephaly  holoprosencephaly and anencephaly constituted a broad spectrum of the reported cns anomalies  
class5	1931	few reports contained a comprehensive description of the observed cns malformations  
class5	1931	in those reports  and in our cases  features of prosencephalic dysgenesis included agenesis of olfactory bulbs and tracts  arhinencephaly   hypoplasia of optic nerves and chiasm  agenesis of corpus callosum  fused thalami or complete holoprosencephaly  
class5	1931	the occipital encephalocele has consisted of a displacement of rhombic roof elements  including caudal third ventricle  cerebellar vermis and fourth ventricle  extruded through an enlarged posterior fontanelle rather than through an occipital cranium bifidum and is thus more precisely labeled an exencephalocele  
class5	1931	different degrees of dysgenesis of posterior fossa structures  described by some as a variant of dandy walker cyst with features of a chiari malformation  were often associated with this occipital exencephalocele  
class5	1931	this pattern of cns anomalies represents a triad of malformations probably associated with defective ventral induction of the developing cns by the prechordal mesoderm  
class5	1932	limited precision of lumbar spine dual photon absorptiometry by variations in the soft tissue background  
class5	1932	the estimation error due to variations in soft tissue baseline in lumbar bone mineral content  bmc  measured by dual photon absorptiometry  dpa  was calculated with a new method of automatic baseline subtraction  
class5	1932	in water phantom measurements  the s d  
class5	1932	of the soft tissue  st  baseline matched closely  r   0 98  to the random error  calculated using 44 kev and 100 kev count rates and the directly determined baseline variations  
class5	1932	in 21 volunteers and in 70 patients with osteoporosis  the st variations were larger than the expected random error  revealing a source of error related to the inhomogeneity of soft tissue  
class5	1932	the estimation error in bmc caused by st variations was 0 7  in healthy subjects  mean bmc 40 5 gha  and 1 5  in patients  mean bmc   26 4 gha   
class5	1932	these results indicate that st related errors are an important limit to the precision of lumbar dpa measurements  
class5	1933	evaluation of anterior maxillary alveolar ridge resorption when opposed by the transmandibular implant  
class5	1933	fifteen edentulous patients with complaints regarding denture comfort and or function were treated with the transmandibular implant  
class5	1933	all patients were restored with conventional maxillary dentures opposed by implant supported removable prostheses  
class5	1933	two to 4 years after surgery  these patients were evaluated for vertical and horizontal maxillary bone loss with a radiographic analysis developed by the authors  
class5	1933	with this technique  attention was focused on vertical alveolar ridge resorption in the anterior maxilla  
class5	1933	although the sample size was small  the findings from this study indicate that vertical bone loss in the anterior maxilla does occur when a maxillary denture is opposed by an implant supported overdenture  
class5	1933	comparison of these results with a previous study that evaluated anterior maxillary resorption when a complete maxillary denture opposed natural mandibular anterior teeth and a distal extension removable partial denture demonstrated no statistically significant difference  
class5	1934	rhabdomyolysis and acute renal failure associated with cocaine abuse  
class5	1934	cocaine abuse has emerged as a major public health problem among young adults  
class5	1934	illicit use of cocaine has been associated with an increasing array of medical complications  
class5	1934	both traumatic and nontraumatic rhabdomyolysis  often complicated by acute renal failure  has recently been described following cocaine abuse  
class5	1934	the present report describes our experience with 15 such patients and serves to further define the spectrum of muscle injury associated with cocaine abuse ranging from the incidental finding of elevated serum levels of muscle enzymes to acute renal failure  
class5	1934	those patients who developed renal failure experienced more severe rhabdomyolysis in association with trauma  seizures or hyperpyrexia  
class5	1935	indirect revascularization of the lower extremity by means of microvascular free muscle flap  a preliminary report  
class5	1935	we describe the treatment of a patient with end stage peripheral vascular disease and ischemic ulceration of the lower extremity in whom an obliteration of the distal arterial bed precluded conventional arterial reconstruction  
class5	1935	a nonhealing dorsal foot ulcer was debrided  and soft tissue reconstruction was accomplished by the free microsurgical transfer of a muscle flap to the distal lower extremity  
class5	1935	arterial inflow to this free flap was provided by a contralateral reversed saphenous vein graft from the proximal arterial tree of the leg  
class5	1935	this procedure resulted in a healed wound  stable coverage  and limb salvage  
class5	1935	the patient also noted complete relief of rest pain and improvement in his claudication symptoms  
class5	1935	a follow up arteriogram was done 2 months after surgery  
class5	1935	contrast injection directly into the artery of this flap showed new blood vessel growth from the muscle flap into the foot with anastomoses of these  new vessels  to the patient s native circulation  
class5	1935	this experience suggests that limb salvage may be possible by the free microvascular transplantation of a muscle flap onto the limb in selected patients whose limbs are deemed  nonreconstructible    
class5	1936	diclofenac associated hepatotoxicity 
class5	1936	diclofenac sodium  a phenylacetic acid derived nonsteroidal anti inflammatory drug  nsaid  recently released in the united states  was associated with the development of significant hepatitis in seven patients  with one associated death  
class5	1936	signs and symptoms developed within several weeks of initiation of drug use and generally resolved 4 to 6 weeks following discontinuation of use of the drug  
class5	1936	the only patient rechallenged with the drug developed a recurrence of her hepatic abnormalities  
class5	1936	in one patient  fatal  fulminant hepatitis developed despite early withdrawal of the drug  
class5	1936	review of the european literature disclosed three additional fatalities associated with diclofenac therapy  
class5	1936	it is unclear whether the incidence of hepatotoxicity is higher with this drug compared with other nonsteroidal anti inflammatory drugs  
class5	1936	careful patient monitoring is advised  and prompt discontinuation of the drug is suggested when signs or symptoms of liver disease develop  
class5	1937	polymyositis  a case history approach to the differential diagnosis and treatment  
class5	1937	a wide range of conditions can mimic polymyositis  
class5	1937	thus  diagnosing this condition can be a challenge  
class5	1937	although no single criterion is diagnostic of polymyositis  the following criteria have been proposed and widely used   1  symmetric proximal muscle weakness   2  characteristic violaceous rash on the hands  elbows  and knees   3  increased muscle enzymes in the serum   4  characteristic electromyographic findings  insertional activity  fibrillation potentials  motor unit potentials of increased frequency and decreased duration  and normal conduction velocity in nerves   and  5  muscle biopsy specimen with characteristic inflammatory and myopathic changes  
class5	1937	although polymyositis primarily involves muscle  up to 20  of patients may have extramuscular problems  
class5	1937	the main treatment for polymyositis is high dose corticosteroids  
class5	1937	in corticosteroid resistant patients  methotrexate is often effective  
class5	1937	in this report  case histories are presented to highlight the usefulness and the limitations of the common diagnostic criteria for polymyositis  
class5	1938	electrophysiological spectrum of inclusion body myositis  
class5	1938	we present electrodiagnostic data on 30 patients with inclusion body myositis  ibm  in order to better delineate its electrophysiological features  
class5	1938	comprehensive electromyography  emg  and nerve conduction studies  ncs  were performed in all cases  
class5	1938	twelve patients had single fiber electromyography  sfemg   
class5	1938	emg showed abundant short small motor unit potentials  mup  with fibrillations and positive sharp waves in 56 6  of patients  and a mixed pattern of large and small mup in 36 7   
class5	1938	in 6 7   only  neurogenic  features were seen  
class5	1938	ncs were slow in 33 3   
class5	1938	sfemg revealed a mildly abnormal jitter and a slightly increased fiber density  
class5	1938	ibm demonstrates a heterogeneous emg profile  
class5	1938	a pattern of large and small mup is highly suggestive of ibm but is seen in only about one third of cases  
class5	1939	central changes in hypothyroid myopathy  a case report  
class5	1939	a muscle biopsy from a patient with hypothyroid myopathy showed striking central changes  
class5	1939	 cores  were seen in most type 1 fibers with oxidative enzyme preparations  
class5	1939	electron microscopy of these areas revealed z disc streaming  myofilament disruption  and absent mitochondria  
class5	1939	the myopathy rapidly improved with thyroxine treatment  
class5	1939	this biopsy is of interest  as numerous  cores  have not previously been reported in hypothyroid myopathy  
class5	1940	quantitative electromyography in polymyositis  a reappraisal  
class5	1940	manual analysis of motor unit action potentials  muaps  was performed in 33 patients with polymyositis of whom 16 were studied in the acute stage and 17 in the chronic stage  
class5	1940	contrary to common description of  myopathic potentials  as being of low amplitude  short duration  and polyphasic shape  the quantitated study revealed no difference as to amplitude of short duration muaps in patients and normal subjects though short duration muap and short duration polyphasic potentials were 4 and 3 times  respectively  more common in patients than in controls  
class5	1940	although the mean duration of muaps usually was significantly shorter in polymyositis than in controls  the average scatter of muaps duration was the same in the 2 groups  
class5	1940	the average incidence of polyphasic muaps was 4 times higher in patients than in controls  as was the incidence of those of long duration  
class5	1940	to avoid misinterpretation of emg findings due to an excess of polyphasic muaps  a greater number of individual potentials than usually recommended should be collected allowing a valid estimate of the mean duration of muaps of simple configuration  
class5	1941	the little women of loja  growth hormone receptor deficiency in an inbred population of southern ecuador  
class5	1941	background and methods  
class5	1941	laron type dwarfism  which is characterized by the clinical appearance of isolated growth hormone deficiency with elevated serum levels of growth hormone and decreased serum levels of insulin like growth factor i  igf i   has been described in approximately 50 patients  
class5	1941	this condition is caused by a deficiency of the cellular receptor for growth hormone  and it is transmitted as an autosomal recessive trait  as indicated by an equal sex distribution and a high rate of consanguinity in affected families  
class5	1941	we studied 20 patients  19 females and 1 male  2 to 49 years of age   from an inbred spanish population in southern ecuador  who had the clinical features of laron type dwarfism  
class5	1941	results  
class5	1941	seventeen patients were members of two large pedigrees  
class5	1941	among the 13 affected sibships  there were 19 affected and 24 unaffected female siblings and 1 affected and 21 unaffected male siblings  
class5	1941	the patients  heights ranged from 10 0 to 6 7 sd below the normal mean height for age in the united states  
class5	1941	in addition to the previously described features  15 patients had limited elbow extensibility  all had blue scleras  affected adults had relatively short extremities  and all four affected women over 30 years of age had hip degeneration  
class5	1941	basal serum concentrations of growth hormone were elevated in all affected children  30 to 160 micrograms per liter  and normal to moderately elevated in the adults  
class5	1941	the serum level of growth hormone binding protein ranged from 1 to 30 percent of normal  igf i concentrations were low  less than or equal to 7 micrograms per liter in the children and less than or equal to 66 micrograms per liter in the adults  normal for ecuadorean women  98 to 238   
class5	1941	serum levels of igf ii and growth hormone dependent igf binding protein 3 were also low  
class5	1941	conclusions  
class5	1941	we describe an inbred population with a high incidence of growth hormone receptor deficiency resulting in a clinical picture resembling laron type dwarfism but differing principally in showing a marked predominance of affected females  
class5	1941	this population  of mediterranean origin  may be genetically related to other reported populations with laron type dwarfism  but with the genetic defect linked to a trait resulting in the early fetal death of most affected males  
class5	1942	characterization of a newly established malignant meningioma cell line of the human brain  iomm lee  
class5	1942	a permanent malignant meningioma  mm  cell line of the human brain designated  iomm lee  is reported  
class5	1942	this cell line was successfully established from the tumor of a 61 year old chinese man with repeated recurrent primary intraosseous malignant meningioma of the skull  
class5	1942	it has been subcultured for more than 60 passages during the past 30 months  
class5	1942	the doubling time of cultured cells is approximately 62 hours  
class5	1942	tumorigenicity in athymic nude mice  balb c nu nu  who develop multiple pulmonary metastases was observed  the doubling time of tumor volume in vivo is approximately 5 days  
class5	1942	karyotypic analysis revealed this cell line to be of human origin and near diploid  with a modal chromosome number of 49  
class5	1942	the mesenchymal tumor marker vimentin and intracytoplasmic microfilaments were identified in the cytoplasm of tumor cells by indirect immunohistochemical peroxidase anti peroxidase assays and immunogold ultrastructural localization by transmission electron microscopy  respectively  
class5	1942	scanning electron microscopy of cultured cells and xenografted tumors revealed ellipsoidal or carrot shaped tumor cells presenting a wrinkled surface with short sparse microvilli  
class5	1942	potential proliferating activity was determined by ki 67 monoclonal antibody  the ki 67 labeling index of cultured cells and xenografted tumors was approximately 36  and 30   respectively  
class5	1942	this newly established malignant meningioma cell line of the human brain may prove useful as a research model  
class5	1943	intradural herniation of a thoracic disc presenting as flaccid paraplegia  case report  
class5	1943	a case of intradural herniation of a thoracic disc in a patient with a flaccid paraplegia is described  
class5	1943	intradural herniation of a thoracic disc is considered a rare event  
class5	1943	a review of the relevant patient literature revealed 14 other reports involving 28 patients  
class5	1943	no other report has described a patient with an intradural thoracic disc herniation who developed a flaccid paraplegia  
class5	1944	a case of dyschondroplasia associated with brain stem glioma  diagnosis by stereotactic biopsy  
class5	1944	we present a 24 year old patient with multiple chondromas of both hands  the pelvis  the left leg  and an associated brain stem glioma  
class5	1944	there was no evidence of hemangioma or dyschromia  and the condition was diagnosed as ollier s disease  a special type of dyschondroplasia like maffucci s syndrome and kast s disease  
class5	1944	an increased overall risk for development of malignant skeletal and nonskeletal tumors is associated with maffucci s syndrome  
class5	1944	the risk of malignant degeneration is lower in ollier s disease  
class5	1944	a glioma in the pons and the right lobe of the cerebellum was found in this patient  
class5	1944	the literature describes an association with gliomas in only 12 cases of dyschondroplasia and an infratentorial localization in just one case  
class5	1944	signs of malignancy were histologically confirmed in 7 cases without significant preponderance of any one type  
class5	1944	our patient had a low grade brain stem astrocytoma with fibrillar and gemistocytic components  
class5	1944	a stereotactic serial biopsy made it possible to rule out malignant degeneration  
class5	1944	stereotactic brain tumor biopsy as a routine neurosurgical procedure is particularly valuable for deep space occupying processes and forms the basis for therapy  
class5	1944	in the present case  irradiation was not recommended  
class5	1945	radical osteoclastic craniectomy in sagittal synostosis 
class5	1945	we report our experience in the surgical treatment of sagittal synostosis using radical osteoclastic craniectomy in 60 consecutive patients  
class5	1945	after surgery in children aged 6 months or younger  group i   reossification usually started 2 weeks postoperatively and was complete within 6 months  resulting in an optimal skull contour  
class5	1945	in children aged 7 to 12 months  group ii   reossification was prolonged and lasted for 12 months or longer  
class5	1945	the skull contour normalized in its biparietal width and improved in sagittal diameter  remaining  however  slightly abnormal  
class5	1945	in children older than 12 months  group iii   the skull contour partly improved in the biparietal diameter but did not change in the sagittal direction  
class5	1945	reossification was incomplete with persistent pseudosutures  
class5	1945	enlarged frontal subarachnoid spaces were reversible or improved in all patients independent of age at the time of surgery  
class5	1945	we encountered no complications in our series  
class5	1945	in our opinion  radical osteoclastic craniectomy is the simplest  most efficient  and most physiologically sound method for the treatment of sagittal synostosis in patients up to 6 months of age  
class5	1945	this procedure allows the rapidly growing brain to form its skull vault  thus providing optimal cosmetic results  
class5	1945	in older children  osteoplastic morcellation procedures should be the treatment of choice  
class5	1946	maffucci s syndrome with bilateral cartilaginous tumors of the cerebellopontine angle  
class5	1946	maffucci s syndrome is characterized by the combination of multiple enchondromas  ollier s disease  and hemangiomatosis  
class5	1946	these hemangiomas develop in the subcutaneous tissue and form red blue tumors dispersed over the whole body  
class5	1946	intracranial involvement is rare  making a preoperative radiological diagnosis and differentiation from other tumors rather difficult  
class5	1946	the radiological characteristics and successful removal of the intracranial part of a chondrosarcoma of the cerebellopontine angle in a case of maffucci s syndrome are reported in this paper  
class5	1947	electron transfer flavoprotein  ubiquinone oxidoreductase  etf qo  deficiency in an adult  
class5	1947	a 19 year old woman with mild myopathic symptoms from age 6 and fasting intolerance presented with a reye like syndrome and a myopathy  
class5	1947	investigations disclosed a lipid storage myopathy  type ii glutaric acidemia  and carnitine deficiency in skeletal muscle  
class5	1947	riboflavin and carnitine treatment corrected the metabolic abnormalities and she improved clinically  
class5	1947	she later died from pulmonary complications secondary to aspiration  
class5	1947	subsequent studies established electron transfer flavoprotein  ubiquinone oxidoreductase  etf qo  deficiency  fibroblast etf qo activity was 2 9 mu mg  normal range is 14 1     3 8 mu mg  as the cause of her illness  
class5	1947	this is the first documented case of etf qo diagnosed in an adult  
class5	1948	eosinophilia myalgia syndrome  l tryptophan associated neuromyopathy   
class5	1948	histopathologic study of skeletal muscle biopsy in a patient with eosinophilia myalgia syndrome following l tryptophan use showed prominent lymphocytic perineuritis  neuritis  and perimysial fasciitis  
class5	1948	the presence of perineuritis and neuritis provides a histopathologic basis for clinical features of neuropathy in eosinophilia myalgia syndrome and occurred in conjunction with a fasciitis or interstitial myositis that was predominantly perimysial and focally endomysial  
class5	1949	psoriatic arthropathy of the temporomandibular joint  
class5	1949	a case of psoriatic arthritis of both temporomandibular joints is described with a brief review of the literature and discussion on the management of this condition  
class5	1949	to date  psoriatic arthritis has been successfully treated by conservative means  
class5	1949	in the case reported  surgical replacement of the condyles became necessary to eliminate pain and restore function  
class5	1950	quantitative evaluation of digital dental radiograph imaging systems  
class5	1950	two digital imaging systems  a video camera and analog to digital converter  and a charge coupled device linear photodiode array slide scanner  were tested for their suitability in quantitative studies of periodontal disease  
class5	1950	the information content in the original films was estimated  and digital systems were assessed according to these requirements  
class5	1950	radiometric and geometric performance criteria for the digital systems were estimated from measurements and observations  
class5	1950	the scanner based image acquisition  digitization  system had no detectable noise and had a modulation transfer function curve superior to that of the video based system  
class5	1950	the scanner based system was equivalent to the video based system in recording radiographic film densities and had more geometric distortion than the video based system  
class5	1950	the comparison demonstrated the superiority of the charge coupled device linear array system for the quantification of periodontal disease extent and activity  
class5	1951	cross sectional radiography for implant site assessment  
class5	1951	an accurate tomographic technique is described for acquisition of optimal cross sectional images of implant sites before implant surgery  
class5	1951	the described technique is applicable to tomographic systems equipped with a cephalometric head positioner  
class5	1951	this cross sectional tomographic technique was performed on a series of patients and the images of the first 20 patients subsequently evaluated  
class5	1951	the cross sectional images allowed for the characterization of the alveolar crest and visualization of anatomic structures in a buccolingual dimension while providing an accurate estimation of available vertical space from the crest  
class5	1952	heritability of symptoms in an experimental model of neuropathic pain  
class5	1952	male and female rats underwent transection and ligation of the sciatic and saphenous nerves  and the development of autonomy was monitored  
class5	1952	the deafferented animals were then interbred  always selecting males and females that expressed relatively high and  alternatively  relatively low levels of autotomy  
class5	1952	offspring were similarly operated and interbred  
class5	1952	by the sixth generation of selective breeding  lines were achieved in which autotomy was consistently high  ha  or consistently low  la   
class5	1952	there was no indication of sex linkage  
class5	1952	thermal and mechanical nocifensive responsiveness co selected with propensity to express autotomy following nerve injury  response thresholds were lower in ha than in la rats  
class5	1952	f1 hybrids formed by crossing homozygous ha and la animals showed low levels of autotomy  similar to la stock  
class5	1952	this indicates recessive inheritance of the autotomy trait  
class5	1952	backcrossing f1 hybrids onto the la line yielded a low autotomy phenotype in almost all cases  backcrossing f1 hybrids onto ha stock yielded about 50  high autotomy and 50  low autotomy  
class5	1952	these ratios are consistent with simple mendelian inheritance of a single gene  
class5	1952	taken together  the data suggest that autotomy is inherited as a single gene autosomal recessive trait  
class5	1953	adrenal medullary implants in the rat spinal cord reduce nociception in a chronic pain model  
class5	1953	previous work in this laboratory has indicated that the transplantation of adrenal medullary tissue into the subarachnoid space of the rat spinal cord can reduce pain sensitivity to acute noxious stimuli  particularly following stimulation by nicotine  
class5	1953	this most likely results from the stimulated release of opioid peptides and catecholamines from the transplanted chromaffin cells  
class5	1953	however  chronic pain models may more closely resemble human clinical pain  and the arthritic rat model has been used for screening potential therapeutic strategies  
class5	1953	the purpose of the present study was to assess the potential for adrenal medullary tissue implanted into the spinal subarachnoid space to alleviate chronic pain  
class5	1953	adrenal medullary tissue was implanted into adjuvant induced arthritic rats  and changes in body weight and vocalization responses were monitored over the 10 week course of the disease  
class5	1953	results indicate that the severe weight reduction normally associated with this inflammatory arthritis was attenuated by adrenal medullary  but not control  implants  
class5	1953	in addition  vocalizations were reduced in animals implanted with adrenal medullary  but not control tissue following nicotine stimulation  
class5	1953	this reduction was blocked by the opiate antagonist  naloxone  and partially attenuated by the alpha adrenergic antagonist  phentolamine  
class5	1953	together  these results suggest that the transplantation of adrenal medullary tissue into the subarachnoid space of the spinal cord may provide a local source of opioid peptides and catecholamines for the reduction of chronic pain  
class5	1954	thrombocytosis after pneumonia with empyema and other bacterial infections in children  
class5	1954	thrombocytosis is seen in association with many conditions  including infectious diseases  
class5	1954	we studied thrombocytosis after severe bacterial infections  particularly pneumonia with empyema in children  
class5	1954	a systematic survey of the phenomenon was conducted  
class5	1954	twenty seven children admitted for pneumonia with empyema were studied  
class5	1954	thrombocytosis  platelet counts greater than 500 x 10 3  microliters  was present in 92 5   
class5	1954	platelet counts reached their maximum at 15 1     3 7 days  range  7 to 25  and declined to normal after 3 weeks of illness  
class5	1954	compared with a healthy control group  significant thrombocytosis  but of lower incidence  was also noted in children with lobar pneumonia without pleural effusion  bacterial meningitis and osteomyelitis  
class5	1954	platelet functions were examined in seven of the children but no abnormalities were observed  
class5	1954	bone marrow aspiration of three children with pneumonia and empyema showed megakaryocytic hyperplasia  
class5	1954	we found no correlation between thrombocytosis  neutrophilia  fever  the clinical course  complications  prognosis or treatment  
class5	1954	neither thromboembolic nor hemorrhagic phenomena were observed  
class5	1955	young adults with special health care needs  prevalence  severity  and access to health services  
class5	1955	health care needs of disabled young adults and access to care are analyzed using the 1984 national health interview survey  a nationally representative sample of 10 394 randomly selected noninstitutionalized young adults aged 19 to 24  
class5	1955	in 1984  1 4 million young adults  almost 6   suffered from disabilities  
class5	1955	the leading cause of disability was diseases of the musculoskeletal system and connective tissue  
class5	1955	young adults living in poverty  in households where the family reference person had less than a high school education  and who were male were at elevated risk of disability  
class5	1955	disabled young adults made almost three times as many physician contacts and were hospitalized for close to six times as many days as nondisabled young adults  
class5	1955	one of every 5 disabled young adults was uninsured in 1984  
class5	1955	forty one percent of disabled hispanic 19  to 24 year olds and 51  of disabled young adults of other races were uninsured compared with 19  of whites and blacks  
class5	1955	research and financing policy implications are discussed  
class5	1956	the older adult  a comparative assessment  
class5	1956	thorough assessment of older men and women is a complex but vital part of their health care  
class5	1956	the ability to differentiate the changes owing to normal aging from those resulting from pathologic processes is necessary if their lives are to be as productive and enjoyable as they are prolonged  
class5	1956	each body system and function must be examined or tested with this difference in mind  
class5	1956	because aging occurs in different individuals at differing rates  a variety of functions may all be considered healthy or normal  
class5	1956	assessment findings must be viewed through the focus of the individual person as well as that of the population  
class5	1956	the nurse will find opportunities to use assessment skills for older adults in many settings  ranging from independent living arrangements to institutional residential areas  
class5	1956	in the community  social meeting places  day care facilities  meal sites  and shopping areas are but a few of the places where older adults may be found  alone or in groups  
class5	1956	assessment opportunities can be identified or structured in any milieu  
class5	1956	the setting itself  as well as the needs of the older adult s   will help to determine the complexity of the assessment activities  
class5	1956	the benefit to nursing of increased and expanded ability to assess the older adult is considerable  
class5	1956	the organized concern of science and health care with aging is a relatively recent phenomenon  
class5	1956	the older adults of today are unique  there are more of them than ever before  and they are living longer  
class5	1956	although their lives are not without health complications  they are  in a sense  role models for the rest of us  pathfinders in aging who can  if we observe them carefully  give us insight and direction for our own healthy aging processes and those of generations to come  
class5	1956	nursing is uniquely poised to use our caring methodology with the older adult  
class5	1956	the elderly are interested in their health and willingly cooperate with those whose assessments are knowledgeable and realistic  
class5	1956	nursing is challenged to develop and implement advanced and specialized ways to identify and meet their needs  
class5	1957	eosinophilia myalgia syndrome linked to tryptophan  
class5	1957	eosinophilia myalgia syndrome has been linked to ingestion of tryptophan  but the exact cause of this recently recognized syndrome is unclear  
class5	1957	as in other reported cases  the disease in the patient described here developed while she was taking tryptophan  
class5	1957	although eosinophilia resolved following glucocorticoid therapy  the disease in this patient continues to progress  
class5	1958	diastrophic dysplasia gene maps to the distal long arm of chromosome 5  
class5	1958	we have used polymorphic dna markers to map the gene for a clinically well characterized form of osteochondrodysplasia  diastrophic dysplasia  dd   an autosomal recessive disorder of unknown pathogenesis  
class5	1958	linkage was analyzed in 13 families with two or three affected sibs comprising a total of 84 individuals  
class5	1958	positive two point logarithm of odds  lod  scores were obtained between the dd locus and three polymorphic markers on chromosome 5  
class5	1958	the highest pairwise lod score estimate of 7 37 with zero recombination to locus d5s72 suggests very tight linkage  
class5	1958	there was no evidence of heterogeneity  
class5	1958	multipoint linkage analysis against the published order of the three loci gave the result centromere d5s84  dd  d5s72  d5s61 terminus with a four point lod score of 9 11  
class5	1958	the present findings place the dd locus distal to the gene for adenomatous polyposis coli on the distal part of the long arm of chromosome 5  
class5	1958	our results provide a basis for refining the map position of the dd locus followed by physical localization  isolation  and characterization of the gene  
class5	1959	fructose induced aberration of metabolism in familial gout identified by 31p magnetic resonance spectroscopy  
class5	1959	the hyperuricemia responsible for the development of gouty arthritis results from a wide range of environmental factors and underlying genetically determined aberrations of metabolism  
class5	1959	31p magnetic resonance spectroscopy studies of children with hereditary fructose intolerance revealed a readily detectable rise in phosphomonoesters with a marked fall in inorganic phosphate in their liver in vivo and a rise in serum urate in response to very low doses of oral fructose  
class5	1959	parents and some family members heterozygous for this enzyme deficiency showed a similar pattern when given a substantially larger dose of fructose  
class5	1959	three of the nine heterozygotes thus identified also had clinical gout  suggesting the possibility of this defect being a fairly common cause of gout  
class5	1959	in the present study this same noninvasive technology was used to identify the same spectral pattern in 2 of the 11 families studied with hereditary gout  
class5	1959	in one family  the index patient s three brothers and his mother all showed the fructose induced abnormality of metabolism  in agreement with the maternal inheritance of the gout in this family group  
class5	1959	the test dose of fructose used produced a significantly larger increment in the concentration of serum urate in the patients showing the changes in 31p magnetic resonance spectra than in the other patients with familial gout or in nonaffected members  thus suggesting a simpler method for initial screening for the defect  
class5	1960	hypodense eosinophils and interleukin 5 activity in the blood of patients with the eosinophilia myalgia syndrome  
class5	1960	the recent recognition of the eosinophilia myalgia syndrome  ems  associated with the ingestion of l tryptophan prompted an analysis of the peripheral blood eosinophil phenotypes and of the serum eosinophil hematopoietins in this disorder  
class5	1960	five patients with an illness characterized by the abrupt onset of aching skeletal muscles  edema  thickening and induration of the skin  and marked blood eosinophilia associated with l tryptophan ingestion provided eosinophils  serum  or both  for evaluation  
class5	1960	gradient sedimentation density analysis of the peripheral blood eosinophils from four of these patients revealed that 43     13   mean     sem  of the cells had converted to the abnormal  hypodense  sedimenting phenotype  
class5	1960	when normodense eosinophils from the reference donors were cultured for 3 days in medium supplemented with increasing concentrations of serum from the patients with ems  their viability increased in a dose dependent manner to 45   which was significantly augmented over the effect of normal serum  
class5	1960	this eosinophil viability sustaining activity was inhibited by 76     7   mean     sem  n   3  by the addition of anti interleukin 5  il 5  but not by neutralizing antibodies monospecific for either granulocyte macrophage colony stimulating factor  gm csf  or il 3  
class5	1960	il 5  an eosinophilopoietic factor  converts normodense peripheral blood eosinophils in vitro to a hypodense sedimenting form with extended viability and augmented biologic responses to activating stimuli  
class5	1960	thus  the presence of il 5 in the sera of patients with ems may contribute to the development and maintenance of the eosinophilia and may regulate the conversion of the peripheral blood eosinophils to the hypodense phenotype with augmented pathobiologic potential  
class5	1961	treatment of craniomaxillofacial fibrous dysplasia  how early and how extensive  
class5	1961	twenty eight craniomaxillofacial fibrous dysplasia patients were treated as early as the symptoms occurred  
class5	1961	the principles of surgical treatment were based on the zones of involvement  total excision of dysplastic bone of fronto orbital  zygoma  and upper maxillary origin  zone 1  and bone reconstruction primarily  conservative excision on hair bearing skull  zone 2   central cranial base  zone 3   and tooth bearing bones  zone 4   and optic canal decompression on patients with orbital dysplasia and decreasing visual acuity  
class5	1961	patients were followed for 1 to 11 years  average 5 3 years   
class5	1961	no recurrence or invasion of the fibrous dysplasia into the grafted bone was seen  
class5	1961	one patient had orthognathic maxillary osteotomy on the reconstructed maxilla 6 years after initial reconstruction  
class5	1961	five of 19 patients with alveolar dysplasia had a recurrence and were reshaped  
class5	1961	one patient had mandibular sagittal osteotomies to set back the prognathic  fibrous dysplasic mandible after three attempts at conservative shaving  
class5	1961	another patient with mandibular fibrous dysplasia had recurrence with pain and a hemimandibulectomy with successful immediate free vascularized iliac bone graft reconstruction  
class5	1962	the use of liposuction to contour cherubism  
class5	1962	yet another application of suction lipectomy equipment is presented to remove the pathologic tissue in cherubism  
class5	1962	owing to the variations of consistency of the material in this condition  this technique may not be successful in all patients  but it is certainly recommended when indicated  
class5	1963	estrogen therapy during menopause and the treatment of osteoporosis  
class5	1963	estrogen remains the single most effective agent in the treatment of menopausal symptoms and prevention of bone loss  
class5	1963	this article focuses on the use of estrogen therapy during menopause and the pharmacotherapy of osteoporosis  
class5	1963	risks and benefits of hormonal therapy and regimen selection for menopausal women are discussed  
class5	1963	the second section of the article focuses on current treatment strategies for osteoporosis  
class5	1964	tuberculous psoas muscle abscess following chemoprophylaxis with isoniazid in a patient with human immunodeficiency virus infection  
class5	1964	a 34 year old man with human immunodeficiency virus infection and disseminated mycobacterium avium and mycobacterium intracellulare infection developed a right psoas muscle abscess due to mycobacterium tuberculosis  
class5	1964	the abscess occurred 18 months after completion of a 12 month course of chemoprophylaxis with isoniazid that was given because of a positive reaction with purified protein derivative of tuberculin  
class5	1964	the adjacent vertebrae did not appear to be involved  
class5	1964	the abscess was drained with a percutaneously inserted catheter  and he received standard antituberculous chemotherapy  
class5	1964	three weeks into therapy  a second drainage with a catheter was required  
class5	1964	the isolation of two mycobacteria in this patient and the apparent failure of chemoprophylaxis with isoniazid are noted  
class5	1965	a case of group b streptococcal pyomyositis 
class5	1965	the group b streptococcus is an opportunistic pathogen that causes a variety of serious infections including bacteremias  puerperal sepsis  and neonatal meningitis  
class5	1965	group b streptococcal infections of muscle are rare  
class5	1965	we report here an unusual case of group b streptococcal pyomyositis  
class5	1965	pyomyositis arises predominantly from infections caused by staphylococcus aureus and  occasionally  streptococcus pyogenes  
class5	1965	because of the rarity of pyomyositis in temperate climates  the common lack of localizing signs or symptoms  and the frequently negative blood cultures  considerable delay often precedes the diagnosis of pyomyositis  in fact  the infection has been initially misdiagnosed as muscle hematoma  cellulitis  thrombophlebitis  osteomyelitis  or neoplasm  
class5	1965	diagnosis may be greatly aided by radiologic techniques that can demonstrate the sites of muscle enlargement and the presence of fluid collections  
class5	1965	the response to antibiotics is usually rapid  but resolution of the infection may require aspiration of deeply situated muscle abscesses  
class5	1965	this report describes a diabetic patient with an unusual presentation of pyomyositis that mimicked an acute abdomen  
class5	1966	group c streptococcal arthritis  case report and review  
class5	1966	streptococci account for approximately 15  20  of cases of nongonococcal septic arthritis  
class5	1966	the majority of these are due to group a streptococci  but group b and group g streptococci are being isolated more frequently  
class5	1966	we present a case of group c streptococcal arthritis and summarize nine additional cases reported in the literature  
class5	1966	the group c streptococci include the large colony of voges proskauer negative bacteria  streptococcus equi  streptococcus equisimilis  streptococcus zooepidemicus  and streptococcus dysgalactiae  as well as as the minute colony of voges proskauer positive streptococcus anginosus   streptococcus milleri   group c organisms  
class5	1966	any joint may become infected  but joints affected by preexisting rheumatologic abnormalities are more frequently involved  
class5	1966	bacteremia was documented in five of the 10 patients  
class5	1966	one patient had an associated pneumonia  and another patient had an associated acute aortic valve endocarditis  
class5	1966	none of the infections involved a prosthetic joint or an overlying cellulitis  associations reported for group g streptococcal arthritis  
class5	1966	surgical drainage of the infected joint was required in six of the 10 patients  
class5	1966	we concluded that the presence of two groups of organisms sharing the same lancefield group antigen necessitates the careful identification of isolates to determine potential clinical differences  
class5	1967	1990 volvo award in clinical sciences  lumbar spinal pathology in cadaveric material in relation to history of back pain  occupation  and physical loading  
class5	1967	the occurrence of symmetric disc degeneration  anular ruptures  end plate defects  vertebral body osteophytosis  and facet joint osteoarthrosis was examined radiographically and osteologically in 86 male cadavers for whom occupational  physical loading  and back pain histories were obtained from the men s families  
class5	1967	history of back pain and the parameters of spinal pathology were related to the highest and lowest degrees of physical loading  
class5	1967	in multivariate analyses  history of back injury was related to the occurrence of symmetric disc degeneration  anular ruptures  and vertebral osteophytosis  
class5	1967	symmetric disc degeneration was associated with sedentary work  and vertebral osteophytosis was related to heavy work  
class5	1967	history of back pain was related to occupational physical loading after control for the effects of the other covariates  
class5	1967	the results indicate that the least pathology stemmed from moderate or mixed physical loading  but the least back pain was associated with sedentary work  
class5	1968	1990 volvo award in experimental studies  anulus tears and intervertebral disc degeneration  an experimental study using an animal model  
class5	1968	an animal model was developed to test the hypothesis that discrete peripheral tears within the anulus lead to secondary degenerative changes in other disc components  
class5	1968	in 21 adult sheep  a cut was made in the left anterolateral anulus of three randomly selected lumbar discs  
class5	1968	the cut was parallel and adjacent to the inferior end plate  and had a controlled depth of 5 mm  
class5	1968	this left the inner third of the anulus and the nucleus pulposus intact and closely reproduced the rim lear lesion described by schmorl  
class5	1968	animals were randomly allocated to different groups in relation to the length of time interval between operation and death  varying from 1 to 18 months  
class5	1968	at death  the lumbar spine was cut into individual joint units and each disc sectioned into six parasagittal slabs  
class5	1968	after observation of the slabs under the dissecting microscope  two of the six slabs  the one containing the anulus lesion and a contralateral  were processed for histology  
class5	1968	the results of this study suggest that  despite the great care taken at operation to ensure that the inner anulus was left intact  progressive failure of the inner anulus was seen in all sheep and occurred in the majority of discs between 4 and 12 months after the operation  
class5	1968	although the outermost anulus showed the ability to heal  the defect induced by the cut led initially to deformation and bulging of the collagen bundles  and eventually to inner extension of the tear and complete failure  
class5	1968	these findings suggest that discrete tears of the outer anulus may have a role in the formation of concentric clefts and in accelerating the development of radiating clefts  
class5	1968	peripheral tears of the anulus fibrosus therefore may play an important role in the degeneration of the intervertebral joint complex  
class5	1969	osteoporosis and back pain in the elderly  a controlled epidemiologic and radiographic study  
class5	1969	the incidence of back pain was investigated in hip fracture patients  50 99 years of age  and in 70   75   and 81 year old controls from the same population  
class5	1969	the prevalence of vertebral fractures were evaluated from spinal radiographs  
class5	1969	eighty hip fracture patients and 103 controls  all between 70 and 75 years of age  were included in the radiographic study  
class5	1969	the incidence of back pain of the controls was twice that of the hip fracture patients  45 48  compared with 23 20   respectively  for both female and male subjects  
class5	1969	conversely  vertebral fractures were radiographically shown in 43  of the hip fracture patients and in 22  of the controls  
class5	1969	thus  the major explanation for longstanding back pain in the elderly does not appear to be related to spinal osteoporosis  
class5	1970	computer assisted tomography of scoliosis operated with or without harrington s rod  biomechanics aspects of the fusion  
class5	1970	forty eight cases of posterior vertebral arthrodesis for scoliosis  performed with or without instrumentation  were examined using computed tomography  ct  scanning to study the evolving fusion mass  
class5	1970	the authors observed that the fusion mass area is more voluminous in the cases performed without instrumentation than in the ones performed with instrumentation  and that 2 years after fusion the bone mass shows already a considerable increase  
class5	1970	for the cases operated with harrington s technique  the increase of the fusion mass is very slow and becomes considerable 5 years after operation  
class5	1970	in both series  the section of the fusion masses at the apex of the curve is asymmetric  with prevalence on the concave side   with an area of central resorption that shows the structure of a long bone  box section   
class5	1971	factors influencing the result of posterior spinal fusion in the treatment of adolescent idiopathic scoliosis  
class5	1971	sixty six consecutive patients with adolescent idiopathic scoliosis treated by posterior spinal fusion using harrington distraction compression instrumentation were followed for a minimum of 3 years  
class5	1971	initial surgical correction was satisfactory  but during the follow up period  mean 4 4 years  3 5 years   there was a loss of correction  
class5	1971	several factors  age  sex  the number of vertebrae in the fusions  and the use of cross wires  were important influences on correction  
class5	1971	a method of assessing the balance of a posterior spinal fusion is described that is useful when assessing radiographs  
class5	1972	the operative treatment of progressive early onset scoliosis  a preliminary report  
class5	1972	thirteen patients with progressive early onset scoliosis have been managed operatively in an attempt to achieve correction without bracing and to allow the spine to grow  
class5	1972	all had posterior segmental spinal instrumentation  ssi  without fusion and 9 of 13 had anterior apical growth arrest as a separate additional procedure  
class5	1972	at 2 year follow up  curve correction averaged 46   
class5	1972	patients who had anterior apical growth arrest and ssi without fusion had less curve deterioration than those who had ssi alone  
class5	1972	new methods are described for 1  measuring growth of the instrumented segment of the spine and 2  calculating the predicted growth of the instrumented segment  
class5	1972	eight of the 13 had more than 50  of predicted growth  three had 30 50  of predicted growth  and two had less than 30  of predicted growth  
class5	1972	operative treatment has been successful in the short term in all but the most malignant form of infantile idiopathic scoliosis  
class5	1973	an analysis of the effect of the zielke operation on s shaped curves in idiopathic scoliosis  a follow up study revealing some skeletal and soft tissue factors involved in curve progression  
class5	1973	this article analyzes the fate of s shaped idiopathic spinal curves during follow up in 18 patients having the zielke vds operation  
class5	1973	the spinal radiographs were evaluated by cobb angle  end vertebra angles  evas   vertebral rotation  and by a new method using the tilt of the surgically fused spinal block in the frontal plane  
class5	1973	spinal growth was measured  
class5	1973	using the conventional criterion for cobb angle progression  83  of the lower curves and 50  of the upper curves progress  
class5	1973	the use of evas shows that progression occurs mainly in the middle  thoracolumbar  segment of the spine  
class5	1973	curve progression occurs in the frontal plane without any significant change in vertebral rotation  
class5	1973	the progression of the upper curve cobb angle is not related to the progression of the cobb angle of the lower curve  but it is related to 1  tilt of the spinal block  2  growth of the spine below the block and 3  overall linear spinal growth  t1 s1   
class5	1973	progression of the upper eva of the upper curve is associated with skeletal immaturity  
class5	1973	the key features leading to curve progression after the zielke operation appear to be spinal asymmetry in the frontal plane  linear spinal growth  and concave lumbar muscle tether  myostatic contracture   
class5	1973	the surgical implications of the findings are outlined  
class5	1974	effects of rib elongation on the spine  i  distortion of the vertebral alignment in the rabbit  
class5	1974	elongation of one rib on the right side by 1 cm was achieved in two groups of adult rabbits of different age  by osteotomy and application of a metallic expander  
class5	1974	the procedure resulted in immediate deviation of the spine in the frontal and sagittal planes  with moderate scoliosis  convex to the left  and a significant decrease in the normal cervicothoracic lordosis and thoracolumbar kyphosis  
class5	1974	moreover  computed tomography  ct  scanning demonstrated rotation of vertebra about the longitudinal axis relative to the anterior midline of the body  and deviation of the spinous process toward the convex  left side  of the scoliotic deformity  
class5	1974	rib hump developed on the right side  that of the elongated rib  
class5	1974	these changes  which occurred simultaneously in the three planes  were less pronounced in the group of older animals  
class5	1974	two weeks after the operation  the distorted configuration of the spine remained unchanged  
class5	1974	the observed changes in the alignment of the vertebrae  changes that  except for their direction on the horizontal plane  resembled those associated with idiopathic scoliosis in man  support the earlier proposed link between the early stage of development of this condition and asymmetry of rib growth  
class5	1975	effects of rib elongation on the spine  ii  correction of scoliosis in the rabbit  
class5	1975	three intercostal nerves on the right side of growing rabbits were resected partially  
class5	1975	from 1 to 3 months later  moderate left convex thoracic scoliosis with rotation of vertebrae had developed  and the sagittal curvatures of the spine had diminished  
class5	1975	in one group of these animals  a mechanically produced increase of 1 cm in the length of one rib on the side of the convexity resulted in an immediate correction of the scoliotic deformity  an improvement that was still evident 3 weeks after the operation  
class5	1975	in two other groups of rabbits  a further resection of three intercostal nerves  this time on the left convex side  1 and 2 months after the first operation  resulted in regression of scoliosis or halted its progression  
class5	1975	these results further support a new concept in which the precipitating factor in the development of scoliosis is ascribed to asymmetric longitudinal growth of the ribs  
class5	1975	they also suggest that regulation of the rib length could be a promising approach to the effective correction of progressive scoliosis at an early stage in man  
class5	1976	congenital craniofacial anomalies of ophthalmic importance  
class5	1976	congenital craniofacial abnormalities frequently require ophthalmic evaluation and surgical management  
class5	1976	called upon to perform as part of the craniofacial team managing the often severely deformed craniofacial patient  the ophthalmologist must bring a basic knowledge of craniofacial syndromes and developmental anatomy  as well as clinical acumen to help preserve or improve ocular and adnexal function  
class5	1976	as an introduction to this area of ophthalmology  the clinical features  classification  appropriate facial embryology  assessment and surgical considerations of the various congenital craniofacial abnormalities are reviewed  
class5	1976	the expanding availability of craniofacial surgeons and surgical teams along with improved surgical results will ultimately require an increasing involvement by many more ophthalmologists in the evaluation and management of these congenital abnormalities  
class5	1977	hyperbaric oxygen therapy for necrotizing fasciitis reduces mortality and the need for debridements  
class5	1977	twenty nine patients with necrotizing fasciitis were treated from 1980 to 1988  
class5	1977	this study evaluates how the addition of hyperbaric oxygen  hbo  therapy to surgical treatment has affected mortality and the number of debridements required to achieve wound control in these patients  
class5	1977	two groups of patients were viewed  group 1  n   12  received surgical debridement and antibiotics only  group 2  n   17  received hbo  90 minutes at 2 5 atm  average 7 4 treatments  in addition to surgery and antibiotics  
class5	1977	both groups were similar in age  race  sex  wound bacteriology  and antimicrobial therapy  
class5	1977	body surface area affected was similar  however  perineal involvement was more common in group 2  53   than in group 1  12    
class5	1977	the admitting conditions of patients in group 1  non hbo  were diabetic  33   white blood cell count more than 12 000  50   and shock  8   
class5	1977	the admitting conditions of patients in group 2  hbo  were diabetic  47   white blood cell count more than 12 000  59   and shock  29   
class5	1977	although group 2 patients receiving hbo were more seriously ill on admission  mortality was significantly lower  23   compared to group 1  66    p less than 0 02   
class5	1977	in addition  only 1 2 debridements per group 2 patient were required to achieve wound control versus 3 3 debridements per group 1 patient  p less than 0 03   
class5	1977	the addition of hbo therapy to the surgical and antimicrobial treatment of necrotizing fasciitis significantly reduced mortality and wound morbidity  number of debridements  in this study  especially among nonclostridial infections  
class5	1977	we conclude that hbo should be used routinely in the treatment of necrotizing fasciitis  
class5	1978	estrogen prophylaxis  the u s  preventive services task force  
class5	1978	recommendation  although routine postmenopausal estrogen replacement is not recommended  estrogen therapy should be considered for asymptomatic women who are at increased risk for osteoporosis  who lack known contraindications and who have received adequate counseling about potential benefits and risks  
class5	1979	nutritional rickets  
class5	1979	nutritional rickets was diagnosed in 18 infants aged eight to 24 months  
class5	1979	clinical features included progressive leg bowing  poor linear growth  a diet deficient in vitamin d  seizures  and abnormal serum calcium  phosphate and alkaline phosphatase levels  
class5	1979	wrist radiographs and serum alkaline phosphatase levels were the most useful confirmatory tests  
class5	1979	breast milk may not contain enough vitamin d to protect infants  particularly dark skinned children and those living in cloudy  northern u s  
class5	1979	cities  from rickets after six months of age  
class5	1979	as breast feeding becomes more widely practiced  care is required to ensure that infants at high risk for rickets receive appropriate vitamin d supplementation  
class5	1980	mother daughter pairs  spinal and femoral bone densities and dietary intakes  
class5	1980	bone mineral density  bmd  of the lumbar spine  l1 l4  and femur  femoral neck  ward s triangle  and trochanter  was measured in 37 healthy  white mother daughter pairs by dual photon absorptiometry  
class5	1980	mothers and daughters were aged 52     7 and 25     4 y  mean     sd   respectively  
class5	1980	three day dietary intakes were evaluated  
class5	1980	significant correlations between mother daughter pairs for bmd of all lumbar and femoral areas  except for l2  r   0 26  p   0 054   indicated familial resemblances in bone mineralization  
class5	1980	total calcium intake was significantly correlated with three bmd values for the daughters  l2  femoral neck  and trochanter  but not for the mothers  
class5	1980	when mothers were classified as pre   n   20  or postmenopausal  n   17   correlation coefficients for bmd were higher for premenopausal mothers and their daughters and lower for postmenopausal mothers and their daughters  except for the trochanter  
class5	1980	the results suggest that the nature of inheritance of bone mass of women may have at least two components  one influencing the level of peak bone mass and one related to bone loss at menopause  
class5	1981	temporary loss of limb function secondary to soft tissue calcification in a patient with rhabdomyolysis induced acute renal failure  
class5	1981	a case of unusually severe soft tissue calcification with temporary loss of limb function in a patient with rhabdomyolysis induced acute renal failure  arf  is described  
class5	1981	a large dose of intravenous  iv  calcium was administered early in the hospital course to treat hypocalcemia  and hemodialysis  when initiated  was with a 1 75 mmol l calcium dialysate  
class5	1981	this case illustrates the danger of administering calcium supplementation and raises questions about the use of normal to high dialysate calcium concentration in the early stages of rhabdomyolysis induced oliguric arf  
class5	1981	calcium supplementation should be reserved for patients with clear clinical signs of hypocalcemia and dialysate calcium should be adjusted to prevent excessive positive calcium balance  
class5	1982	nucleus driven multiple large scale deletions of the human mitochondrial genome  a new autosomal dominant disease  
class5	1982	we studied several affected and one nonaffected individuals belonging to three unrelated pedigrees  
class5	1982	the pathological trait was an autosomal dominant mitochondrial myopathy due to large scale multiple deletions of the mitochondrial genome  
class5	1982	clinically  symptomatic patients had progressive external ophthalmoplegia  muscle weakness and wasting  sensorineural hypoacusia  and  in some cases  vestibular areflexia and tremor  
class5	1982	the muscle biopsies of all patients examined showed ragged red fibers  neurogenic changes  and a partially decreased histochemical reaction to cytochrome c oxidase  
class5	1982	multiple mtdna heteroplasmy was detected in the patients by both southern blot analysis and pcr amplification  whereas the unaffected individual had the normal homoplasmic hybridization pattern  
class5	1982	these findings confirm and add further details to the existence of a new human disease  defined clinically as a mitochondrial myopathy  genetically as a mendelian autosomal dominant trait  and molecularly by the accumulation of multiple  large scale deletions of the mitochondrial genome  that is due to impaired nuclear control during mtdna replication  
class5	1983	a controlled trial of intravenous immunoglobulin g in chronic fatigue syndrome 
class5	1983	purpose  currently  there is no established therapy for chronic fatigue syndrome  cfs   a recently defined illness that has been associated with a variety of immunologic abnormalities  
class5	1983	based on the hypothesis that a chronic viral infection or an immunoregulatory defect is involved in the pathogenesis of cfs  the therapeutic benefit of intravenous immunoglobulin g  iv igg  was evaluated in a group of patients with cfs  
class5	1983	additionally  serum immunoglobulin concentrations and peripheral blood lymphocyte subset numbers were measured at the outset of the study  and the effect of iv igg therapy on igg subclass levels was determined  
class5	1983	patients and methods  thirty patients with cfs were enrolled in a double blind  placebo controlled trial of iv igg  
class5	1983	the treatment regimen consisted of iv igg  1 g kg  or intravenous placebo  1  albumin solution  administered every 30 days for 6 months  
class5	1983	participants completed a self assessment form prior to each of the six treatments  which was used to measure severity of symptoms  functional status  and health perceptions  
class5	1983	patients were also asked to report adverse experiences defined as worsening of symptoms occurring within 48 hours of each treatment  
class5	1983	results  twenty eight patients completed the trial  
class5	1983	at baseline  all 28 patients complained of moderate to severe fatigue  and measures of social functioning and health perceptions showed marked impairment  
class5	1983	low levels of igg1 were found in 12  42 9    and 18  64 3   had low levels of igg3  
class5	1983	at the end of the study  no significant therapeutic benefit could be detected in terms of symptom amelioration or improvement in functional status  despite restoration of igg1 levels to a normal range  
class5	1983	major adverse experiences were observed in 20  of both the iv igg and placebo groups  
class5	1983	conclusion  the results of this study indicate that iv igg is unlikely to be of clinical benefit in cfs  
class5	1983	in addition to the ongoing need for placebo controlled trials of candidate therapies for cfs  an expanded research effort is needed to define the etiology and pathogenesis of this disorder  
class5	1984	a double blind  placebo controlled trial of intravenous immunoglobulin therapy in patients with chronic fatigue syndrome 
class5	1984	purpose  the chronic fatigue syndrome  cfs  is characterized by profound fatigue  neuropsychiatric dysfunction  and frequent abnormalities in cell mediated immunity  
class5	1984	no effective therapy is known  
class5	1984	patients and methods  forty nine patients  40 with abnormal cell mediated immunity  participated in a randomized  double blind  placebo controlled trial to determine the effectiveness of high dose intravenously administered immunoglobulin g  
class5	1984	the patients received three intravenous infusions of a placebo solution or immunoglobulin at a dose of 2 g kg month  
class5	1984	assessment of the severity of symptoms and associated disability  both before and after treatment  was completed at detailed interviews by a physician and psychiatrist  who were unaware of the treatment status  
class5	1984	in addition  any change in physical symptoms and functional capacity was recorded using visual analogue scales  while changes in psychologic morbidity were assessed using patient rated indices of depression  
class5	1984	cell mediated immunity was evaluated by t cell subset analysis  delayed type hypersensitivity skin testing  and lymphocyte transformation with phytohemagglutinin  
class5	1984	results  at the interview conducted by the physician 3 months after the final infusion  10 of 23  43   immunoglobulin recipients and three of the 26  12   placebo recipients were assessed as having responded with a substantial reduction in their symptoms and recommencement of work  leisure  and social activities  
class5	1984	the patients designated as having responded had improvement in physical  psychologic  and immunologic measures  p less than 0 01 for each   
class5	1984	conclusion  immunomodulatory treatment with immunoglobulin is effective in a significant number of patients with cfs  a finding that supports the concept that an immunologic disturbance may be important in the pathogenesis of this disorder  
class5	1985	prevalence and determinants of estrogen replacement therapy in elderly women  
class5	1985	to better understand which women use estrogen replacement therapy  we examined the prevalence and determinants of estrogen replacement therapy in 9704 nonblack women  age greater than or equal to 65 years  who participated in the multicenter prospective study of osteoporotic fractures  
class5	1985	overall  13 7  of women reported current use of oral estrogen  10 9  took estrogen alone and 2 8  took estrogen opposed by progestin  
class5	1985	four percent currently used parenteral estrogen compounds  
class5	1985	current use declined sharply with age from 17  at age 65 to 4  at age greater than or equal to 85  
class5	1985	the primary determinant of estrogen replacement therapy was the type of menopause  the odds of using estrogen replacement therapy in current users compared with never users were approximately five times higher in women with a surgical menopause  
class5	1985	estrogen use was more common among women who had higher levels of education and were less obese  
class5	1985	furthermore  estrogen replacement therapy users were more likely to drink alcohol and to participate in sports and recreation  
class5	1985	a diagnosis of osteoporosis was the major determinant of continued estrogen use  but only 24  of women with a diagnosis of osteoporosis used estrogen replacement therapy  
class5	1985	we conclude that only a small proportion of elderly women in the united states use estrogen replacement therapy  
class5	1985	selection factors for use of estrogen are evident and may introduce bias in studies of estrogen and disease  
class5	1985	in consideration of the distribution of these selection factors  estrogen users will tend to be at lower risk of coronary disease and possibly breast cancer but at greater risk for hip fractures  
class5	1986	orbital intramuscular schwannoma  
class5	1986	in an 8 year old girl with asymptomatic proptosis  computed tomographic scans showed a large medial orbital mass that contoured the globe anteriorly  bowed the optic nerve laterally  and extended posteriorly to the orbital apex  
class5	1986	t1 weighted coronal magnetic resonance images showed the mass to be a diffusely enlarged medial rectus muscle  
class5	1986	histopathologic examination of a medial rectus muscle biopsy specimen disclosed a multinodular  intramuscular schwannoma  separating and infiltrating normal skeletal muscle fibers  
class5	1986	the intramuscular location and multinodular configuration of this tumor  together with its occurrence in a child  distinguish it from previous orbital schwannomas  
class5	1987	pathogenesis of antigen induced arthritis in mice deficient in neutrophil elastase and cathepsin g  
class5	1987	the contribution of neutrophil derived elastase and cathepsin g to joint pathology has been examined in immune arthritis in the mouse  
class5	1987	neutrophils from beige mice are genetically deficient in lysosomal elastase and cathepsin g  but have normal levels of the acid hydrolases  beta glucuronidase  and n acetyl beta glucosaminidase  
class5	1987	the development of antigen induced arthritis in normal mice has been compared with that in beige mice  
class5	1987	the pattern of synovitis  both leukocyte accumulation and plasma leakage  were indistinguishable in normal and beige mice  
class5	1987	cartilage proteoglycan depletion was quantified by measuring the decrease in safranin o staining intensity  and this  too  was unaltered in mice lacking elastase and cathepsin g  
class5	1987	these results suggest that neutrophil elastase and cathepsin g do not contribute to these aspects of joint pathology in antigen induced arthritis in the mouse  
class5	1988	attenuation of suxamethonium myalgias  effect of midazolam and vecuronium  
class5	1988	we studied the incidence of fasciculations and postoperative myalgias in 100 female outpatients who had laparoscopy under thiopentone  n2o  isoflurane anaesthesia  
class5	1988	four groups of 20 patients each were pretreated with saline  group 1   tubocurarine 0 05 mg kg  group 2   vecuronium 0 006 mg kg  group 3   or midazolam 0 025 mg kg  group 4   followed by suxamethonium 1 5 mg kg  
class5	1988	group 5 received only vecuronium 0 1 mg kg as relaxant  no suxamethonium   
class5	1988	fasciculations were graded  and postoperative myalgias rated on the first and third postoperative days  
class5	1988	in groups 1 5 the incidence of fasciculations was 95  15  25  95 and 0   the incidence of myalgias on the first day after operation was 70  45  65  75 and 60   and on the third day after operation 20  5  20  20  and 5   respectively  
class5	1988	we conclude that pretreatment with vecuronium  but not midazolam  decreases the incidence of fasciculations after suxamethonium  p less than 0 05  and that in this patient population  postoperative myalgias appear to be unrelated to the use of suxamethonium  
class5	1989	clinical presentation of suspected malignant hyperthermia during anaesthesia in 402 probands  
class5	1989	as anaesthetists have become more aware of malignant hyperthermia the mortality rate has fallen  but concommitantly the number of dubious and aborted cases has increased  
class5	1989	all probands who developed a suspected malignant hyperthermia reaction during anaesthesia and subsequently underwent muscle biopsy were classified according to the clinical presentation  
class5	1989	a probability for malignant hyperthermia can be calculated  using the classification  for each type of clinical presentation  this varied from 0 96 to 0 07  
class5	1989	certain clinical features were found to be of more value as predictors than others  these included a high creative kinase and myoglobinuria  
class5	1989	the accuracy of prediction depends on a clear contemporaneous description of the clinical events  
class5	1990	erythromycin failure with subsequent pasteurella multocida meningitis and septic arthritis in a cat bite victim  
class5	1990	we report the case of a 75 year old woman who developed pasteurella multocida meningitis and septic arthritis while being treated for a cat bite wound infection with erythromycin  
class5	1990	review of the literature revealed that erythromycin has poor in vitro activity against this bacterium and has been associated with serious clinical failures  
class5	1990	we recommend that erythromycin not be prescribed for empiric therapy of established animal bite infections  
class5	1990	suggestions for optimal empiric therapy of animal bite infections and the differential diagnosis of severe cat bite associated sepsis are discussed  
class5	1991	gallium nitrate for advanced paget disease of bone  effectiveness and dose response analysis  
class5	1991	objective  to evaluate whether a brief course of treatment with gallium nitrate can reduce biochemical parameters of accelerated bone turnover in patients with advanced paget disease  
class5	1991	design  unblinded trial  decreasing dose schedules of gallium nitrate  
class5	1991	setting  university hospital with primary orthopedic and metabolic bone disease specialty  
class5	1991	patients  ten patients with advanced paget disease who had previously received conventional therapy consisting of calcitonin  etidronate  or mithramycin  
class5	1991	interventions  five patients were entered into each of three dose schedules  2 5 mg kg body weight per day by continuous intravenous infusion for 7 days  0 5 mg kg per day for 14 days by subcutaneous injection  and 0 25 mg kg per day for 14 days by subcutaneous injection  
class5	1991	several patients were treated with different dose schedules  
class5	1991	patients were followed until relapse  
class5	1991	results  fifteen courses of treatment were administered to ten patients  
class5	1991	reductions in serum alkaline phosphatase and urinary hydroxyproline excretion were observed after treatment with each dose schedule  
class5	1991	after treatment with high  intermediate  and low doses  the median maximum decreases in serum alkaline phosphatase activity were 49   39   and 18   respectively  
class5	1991	the median maximum decreases in urinary hydroxyproline excretion were 50   52   and 16   respectively  
class5	1991	the maximum decrease in urinary hydroxyproline excretion occurred within a median of 2 weeks from the start of treatment  whereas the maximum decrease in serum alkaline phosphatase activity occurred substantially later at a median of 6 weeks  
class5	1991	all treatment schedules were well tolerated  
class5	1991	response duration was highly variable  range  6 to 42 weeks   
class5	1991	conclusions  short term treatment with gallium nitrate can reduce biochemical parameters of disease activity in patients with advanced paget disease of bone  
class5	1991	larger trials using low dose intermittent treatment schedules are required to evaluate the safety and effectiveness of this therapy  
class5	1992	arachnoid granulation cerebrospinal fluid otorrhea  
class5	1992	a case report and review of the temporal bone  tb  collection in the department of otolaryngology at suny health science center in syracuse demonstrated the occurrence of arachnoid granulations  ags  in the posterior fossa surface of the tb and their role in cerebrospinal fluid  csf  otorrhea  
class5	1992	a large ag responsible for csf otorrhea in a 64 year old man was excised with soft tissue repair of the dural defect  
class5	1992	sixteen of 188 tbs  8 5   in the collection contained 24 ags ranging in size from 0 07 to 80 65 mm3  
class5	1992	nine ags  37   were small  less than 1 mm3  and did not demonstrate enlargement  
class5	1992	twelve  50   were of intermediate size  2 50 to 9 32 mm3   and three  13   were large  49 82 to 80 65 mm3   
class5	1992	the intermediate and large ags were associated with bone erosion and a high incidence of communication with a pneumatized mastoid complex  serous otitis media or meningitis   
class5	1992	these findings suggest that ags of sufficient size to produce bone erosion are the primary responsible lesions in adult onset spontaneous csf otorrhea  
class5	1993	prediction of acute renal failure after birth asphyxia  
class5	1993	twenty one babies of 34 41 weeks  gestational age with birth asphyxia  5 minute apgar score less than or equal to 5 or umbilical artery ph less than or equal to 7 2  were studied during the first two days of life to find out whether the urinary excretion of tubular markers of renal function is of value in the early diagnosis of acute renal failure  
class5	1993	urinary retinol binding protein  myoglobin  and n acetyl beta d glucosaminidase  nag   expressed as a ratio with urinary creatinine  were measured and excretion profiles repeated at 3 6 days in 15 infants and at 7 14 days in 11 infants  
class5	1993	plasma creatinine concentration  creatinine clearance  plasma myoglobin concentration  and fractional sodium excretion were measured where possible in asphyxiated infants  
class5	1993	control data were obtained from 50 healthy infants  28 gave urine samples alone  17 urine and blood  and five blood alone  
class5	1993	normal urinary values were derived from 17  25  and three infants  respectively  for the three time periods  
class5	1993	the number of control samples was limited for ethical reasons  
class5	1993	four asphyxiated infants had acute renal failure  group 1   four had tubular dysfunction without glomerular disturbance  group 2  and 13 had normal renal function  group 3   
class5	1993	group 1 were clearly identified by greatly increased urinary retinol binding protein  greater than 27 000 micrograms mmol creatinine  and myoglobin  greater than 1500 micrograms mmol creatinine  excretion measured in the first two days of life  
class5	1993	in control infants the range of excretion of retinol binding protein within the same time period was 3 to 967 micrograms mmol creatinine and urinary myoglobin was undetectable  
class5	1993	excretion of nag failed to discriminate between groups 1 and 2  
class5	1994	spontaneous resolution of bone mineral depletion in preterm infants  
class5	1994	fifteen preterm infants and 17 born at full term whose gestational ages ranged from 25 to 34 weeks and 38 to 42 weeks  respectively  were examined initially at postconceptional ages ranging from 38 to 44 weeks and subsequently at 46 to 71 weeks  
class5	1994	each examination included measurement of bone mineral content of the mid forearm by single photon absorptiometry  
class5	1994	for the preterm group  the mean  sd  value of bone mineral content at the first examination was 109 0  27 6  mg cm and was significantly lower than the corresponding value of 194 4  19 6  mg cm for the whole full term group  
class5	1994	the mean subsequent rate of mineral accretion in the preterm group was 8 70  4 60  mg cm week  the mean individual duration of observation being 9 7 weeks  
class5	1994	rate of mineral accretion for the full term group was independent of the duration of observation and averaged 1 60  2 20  mg cm week  
class5	1994	the difference between mean values of rate of mineral accretion in the preterm and full term groups was highly significant  
class5	1994	our results show that there is a phase of rapid mineral accretion starting at 40 weeks  postconception in preterm infants that substantially reduces the perinatal mineralisation deficit  
class5	1995	outcome after acute osteomyelitis in preterm infants  
class5	1995	eight cases of skeletal infection in preterm infants were studied  
class5	1995	all the infants were systemically unwell  with polymorpholeucocytosis  
class5	1995	diagnosis was by blood culture  and any radiographic changes were apparent at the time of presentation  
class5	1995	infection was often multifocal  with sites around the knee being most commonly affected  
class5	1995	staphylococcus aureus was the pathogen isolated in six of the eight cases  in these treatment with fusidic acid was effective and well tolerated  even at doses that were less than the recommended therapeutic minimum  
class5	1995	even with prompt diagnosis and aggressive treatment orthopaedic sequelae are common  
class5	1996	pheochromocytoma presenting as rhabdomyolysis and acute myoglobinuric renal failure  
class5	1996	we report the case of a previously healthy young woman who presented with the sudden onset of rhabdomyolysis and myoglobinuric renal failure  requiring hemodialysis for 3 weeks  
class5	1996	common causes of rhabdomyolysis were ruled out  as renal function returned  severe hypertension was noted and a pheochromocytoma was diagnosed  
class5	1996	we suggest that pheochromocytoma causes rhabdomyolysis and myoglobinuria via catecholamine mediated vasoconstriction and skeletal muscle ischemia  
class5	1997	the american college of rheumatology criteria for the classification and reporting of osteoarthritis of the hand  
class5	1997	clinical criteria for the classification of symptomatic idiopathic  primary  osteoarthritis  oa  of the hands were developed from data collected in a multicenter study  
class5	1997	patients with oa were compared with a group of patients who had hand symptoms from other causes  such as rheumatoid arthritis and the spondylarthropathies  
class5	1997	variables from the medical history  physical examination  laboratory tests  and radiographs were analyzed  
class5	1997	all patients had pain  aching  or stiffness in the hands  
class5	1997	patients were classified as having clinical oa if on examination there was hard tissue enlargement involving at least 2 of 10 selected joints  swelling of fewer than 3 metacarpophalangeal joints  and hard tissue enlargement of at least 2 distal interphalangeal  dip  joints  
class5	1997	if the patient had fewer than 2 enlarged dip joints  then deformity of at least 1 of the 10 selected joints was necessary in order to classify the symptoms as being due to oa  
class5	1997	the 10 selected joints were the second and third dip  the second and third proximal interphalangeal  and the trapeziometacarpal  base of the thumb  joints of both hands  
class5	1997	criteria derived using the  classification tree  method were 92  sensitive and 98  specific  
class5	1997	the  traditional format  classification method required that at least 3 of these 4 criteria be present to classify a patient as having oa of the hand  
class5	1997	the latter sensitivity was 94  and the specificity was 87   
class5	1997	radiography was of less value than clinical examination in the classification of symptomatic oa of the hands  
class5	1998	type xi collagen degrading activity in human osteoarthritic cartilage  
class5	1998	homogenates of 6 samples of human osteoarthritic cartilage were shown to degrade exogenous type xi collagen  
class5	1998	on sodium dodecyl sulfate polyacrylamide gel electrophoresis  the cleavage products generated by each homogenate were similar  and they were identical to those obtained by cleavage of the substrate with purified gelatinase  
class5	1998	enzyme activity  which was inhibited by edta  was greater in extracts of fibrillated osteoarthritic cartilage than in extracts of grossly normal cartilage from the same joint or in extracts of cartilage from joints with osteonecrosis  
class5	1998	activation with apma enhanced digestion  but breakdown was apparent in extracts of fibrillated osteoarthritic cartilage even without apma  
class5	1998	enzymatic degradation of type xi collagen could play a significant role in the turnover of articular cartilage in health and disease states  
class5	1999	a subluxing arthropathy associated with the anti jo 1 antibody in polymyositis dermatomyositis  
class5	1999	of 180 patients with polymyositis dermatomyositis  pm dm  seen at the university of pittsburgh and affiliated hospitals since 1975  21 of 100 tested positive for the anti jo 1 antibody  
class5	1999	sixteen of the 21 patients were women and 18 were white  
class5	1999	fifteen had adult pm  4 had myositis in overlap with scleroderma  and 2 had adult dm  
class5	1999	evidence of interstitial lung disease was found in 12 of 18 anti jo 1 positive patients  67    but in only 15 of 79 anti jo 1 negative patients  19    p less than 0 0002   
class5	1999	the 21 anti jo 1 positive patients were divided into 3 separate groups based on the observed articular findings  
class5	1999	four patients had a deforming  predominantly nonerosive arthropathy with subluxations of the distal interphalangeal joints  especially the thumbs  
class5	1999	eight patients had a nondeforming arthropathy primarily affecting the small joints of the hands  wrists  shoulders  and knees  
class5	1999	those with deformities had a longer duration of arthritis compared with those with nondeforming arthropathy  mean 14 5 years versus 3 3 years   
class5	1999	nine anti jo 1 positive patients had no joint arthropathy  
class5	1999	three of 4 patients with deformities have required articular reconstructive surgery for subluxation  with 2 having associated subcutaneous calcinosis  
class5	2000	igg and iga antibodies to the collagen like region of c1q in rheumatoid vasculitis  
class5	2000	we investigated the presence of igg and iga antibodies to c1q in serum samples from 80 patients with rheumatoid arthritis  ra   31 patients with rheumatoid vasculitis  and 80 healthy controls  
class5	2000	igg and iga antibodies to c1q  as measured by enzyme linked immunosorbent assay  were found in less than 5  of the sera from ra patients and from healthy controls  
class5	2000	in contrast  igg and iga antibodies to c1q were found in 29  and 61   respectively  of the sera from patients with rheumatoid vasculitis  
class5	2000	the occurrence of iga antibodies to c1q has not been previously demonstrated  
class5	2000	these results also demonstrate that igg antibodies to c1q do not occur exclusively in systemic lupus erythematosus patients  sera of patients with rheumatoid vasculitis frequently contain igg or iga antibodies to c1q  which contribute to immune complex formation  
class5	2001	interleukin 1 induced interleukin 6 is required for the inhibition of proteoglycan synthesis by interleukin 1 in human articular cartilage  
class5	2001	cartilage from normal controls  patients with osteoarthritis  and patients with rheumatoid arthritis produced no interleukin 6  il 6  in culture  
class5	2001	however  il 1 induced massive production of il 6  up to 135 ng ml  in cartilage from all 3 sources  in a dose dependent manner  in some cases  a peak value was reached   
class5	2001	the levels of induced il 6 were similar to those found in rheumatoid arthritis synovial fluid  
class5	2001	at il 1 concentrations that induced almost complete inhibition of proteoglycan  pg  synthesis  il 6 production could still be increased considerably  
class5	2001	exogenous il 6 inhibited pg synthesis by up to 25   
class5	2001	il 1 induced inhibition of pg synthesis was reversed by antibodies against recombinant human il 6  
class5	2001	these results suggest that il 6 is required for the il 1 induced inhibition of pg synthesis  
class5	2002	treatment of psoriatic arthritis with oral 1 25 dihydroxyvitamin d3  a pilot study  
class5	2002	we conducted a 6 month open label trial in which 10 patients with active psoriatic arthritis received 2 micrograms of oral 1 25 dihydroxyvitamin d3 daily  
class5	2002	statistically significant improvement was noted in the tender joint count and physician global impression  
class5	2002	of these 10 patients  4 had substantial  greater than or equal to 50   improvement  and 3 had moderate  greater than or equal to 25   improvement in the tender joint count  
class5	2002	two patients were unable to receive therapeutic doses because of hypercalciuria  
class5	2002	high dose vitamin d may be a useful therapeutic agent for psoriatic arthritis  
class5	2003	nontropical pyomyositis as a cause of subacute  multifocal myalgia in the acquired immunodeficiency syndrome  
class5	2003	we report a case of nontropical pyomyositis in a patient with acquired immunodeficiency syndrome and disseminated mycobacterium avium infection  in which severe myalgia was the presenting symptom over several weeks  
class5	2003	multifocal muscle lesions were identified by gallium scanning and magnetic resonance imaging techniques  
class5	2003	the epidemiology  possible pathogenesis  clinical features  diagnostic imaging  and therapy are reviewed  
class5	2003	early suspicion of nontropical pyomyositis in severely immunocompromised patients with  cryptic  myalgia is recommended  
class5	2004	outbreak of spontaneous staphylococcal arthritis and osteitis in mice  
class5	2004	staphylococcus aureus is the most common bacterial species found in association with nongonococcal bacterial arthritis in humans  
class5	2004	we present here the first description of spontaneous bacterial arthritis and osteitis in mice  
class5	2004	clinically  the most obvious findings were swelling and or ankylosis of hindpaws and nodose changes of the tail  
class5	2004	the prevalence of arthritis and osteitis ranged from 0  to greater than 50  of the mice studied  depending on the mouse strain  
class5	2004	the most prominent histopathologic feature of the arthritis was hypertrophy of the synovial tissue and destruction of cartilage and underlying bone  
class5	2004	most of the s aureus infected mice displayed an identical phage type  which was also the only s aureus phage type found in skin isolates from clinically healthy mice  
class5	2004	however  a few s aureus isolates were not typeable  indicating that an additional strain s  might cause bacterial arthritis in mice  
class5	2005	quantitative gamma ray computed tomography of the radius in normal subjects and osteoporotic patients  
class5	2005	a new design of gamma ray computed tomography  ct  scanner was used to measure bone density in 516 normal adults and in 116 female patients with osteoporotic fractures  
class5	2005	trabecular bone density  tbd  was measured for a core of the ultradistal radius  cortical bone mass per unit length  mls  and mass per unit volume  mvs  were computed for the radius shaft  
class5	2005	tbd  mls and mvs peaked at the age of about 40 in females and fell by 32   15  and 24   respectively  by the age of 65  
class5	2005	in males  tbd decreased from the third decade and mls and mvs peaked in the fourth decade  
class5	2005	the corresponding falls by 65 years were 20   6  and 7   
class5	2005	in patients with colles  fracture tbd and mls were reduced by 13  and 10   respectively  relative to age matched normal female subjects  
class5	2005	for patients with vertebral crush fracture the reductions relative to age matched normal females were 36   17  and 16  for tbd  mls and mvs  
class5	2005	in fracture patients the deficit in tbd was significantly greater than that for cortical bone but tbd was no better at discriminating normal and osteoporotic individuals because of its larger normal range  
class5	2005	we conclude that gamma ray ct may best be used for monitoring changes in bone rather than as a diagnostic screening tool  
class5	2006	l tryptophan implicated in human eosinophilia myalgia syndrome causes fasciitis and perimyositis in the lewis rat  
class5	2006	tryptophan associated eosinophilia myalgia syndrome  l trp ems  is a newly described syndrome which occurred in epidemic fashion in the united states in the summer and fall of 1989  
class5	2006	epidemiologic data has linked the syndrome to intake of l tryptophan  l trp  from one specific manufacturer  but the precise etiologic compound s  must be established by replication of the syndrome in an appropriate animal model  
class5	2006	in this study  implicated l trp  united states pharmacopeia  usp  grade l trp  or vehicle was administered by gavage in a blinded fashion for 38 d to female lewis rats at doses comparable with those ingested by patients who developed the eosinophilia myalgia syndrome  
class5	2006	animals receiving implicated l trp  but not those receiving usp grade l trp or vehicle  developed histologic signs consistent with fasciitis and perimyositis  specific pathologic features of human l trp ems  
class5	2006	peripheral blood eosinophilia was not observed  
class5	2006	hypothalamic corticotropin releasing hormone mrna levels were lower and plasma corticosterone levels tended to be lower in the animals that received implicated l trp  
class5	2006	plasma l kynurenine was higher in both l trp treated groups compared to the vehicle treated animals  
class5	2006	the female lewis rat is known to be susceptible to a wide variety of inflammatory diseases  
class5	2006	identification of specific inflammatory changes in this rat following exposure to implicated l trp indicates that this animal model will be important in subsequent investigations into the etiology  pathogenesis  and treatment of human l trp ems  
class5	2007	isolated congenital stapes ankylosis  surgical results in 32 ears and a review of the literature  
class5	2007	isolated congenital stapes ankylosis is described in 32 operated ears from 28 patients  
class5	2007	in 27 ears  a regular stapedectomy was performed  
class5	2007	in the remaining 5 ears  2 had stapes gushers  2 had bony stapedial tendons  and 1 had an aberrant facial nerve crossing the oval window  
class5	2007	the average individual hearing gain was 20 db  
class5	2007	the mean hearing gain for the 24 successful stapedectomies was 29 db  
class5	2007	in 24 of 32 ears  75    an essential hearing gain of at least 15 db fletcher s index hearing threshold could be achieved  
class5	2007	a fletcher s index not exceeding 30 db could be achieved in 19 of 32 ears  60    in spite of several cases with a sensorineural component in the hearing loss  
class5	2007	a review of the literature and overview of longer series with isolated congenital stapes ankylosis is presented  
class5	2008	repetitive strain injuries  how to deal with  the epidemic of the 1990s   
class5	2008	occupational trends  especially the mushrooming of computer use in the united states  have brought with them a virtual epidemic of repetitive strain injury of the upper limb  
class5	2008	what can you as a primary care physician do to stem the tide  in this article  the authors fill you in on treatment of the most common injuries as well as remark on the ramifications for business and industry  
class5	2009	hormone replacement therapy  how to select the best preparation and regimen  
class5	2009	hormone replacement therapy is a mainstay of preventive healthcare for the maturing female population  
class5	2009	estrogen deficiency that comes with menopause can have serious effects and is especially important in light of the increasing life expectancy of women  
class5	2009	various estrogen and progesterone preparations are available  and their best application requires understanding of the different potencies and metabolic effects  
class5	2009	daily maintenance therapy without a drug free interval is becoming the standard method of the 1990s  
class5	2009	no doubt the future will bring even better delivery regimens  
class5	2010	calvarial sutural abnormalities  metopic synostosis and coronal deformation  an anatomic  three dimensional radiographic  and pathologic study  
class5	2010	the purposes of this study were  1  to evaluate the histologic differences between synostotic versus deformational suture abnormalities and  2  to correlate these histologic findings with anatomic and three dimensional computed tomographic  ct  scans  
class5	2010	we examined three infants with premature metopic synostosis  one infant also had microcephaly trisomy 13 and curious overriding of the coronal sutures  
class5	2010	the three dimensional ct scans demonstrated obliteration of the metopic suture inferiorly  
class5	2010	histologic sections of this suture showed complete bony stenosis  
class5	2010	the same pattern was found in all three infants  including the two infants with trigonocephaly who did not have trisomy 13 or microcephaly  
class5	2010	in the trisomy 13 infant  the overlapped inferior coronal suture was obliterated on ct examination  
class5	2010	however  histologic sections in this region showed a merging of bone  there was no synostosis  
class5	2010	in summary  three dimensional ct re formation correlated with metopic suture histology  
class5	2010	 stenotic  fusion existed in all infants with trigonocephaly  those with normal and abnormal karyotypes  with and without microcephaly  
class5	2010	however  three dimensional ct re formation of the trisomic infant showed opacification of the coronal suture in the areas of greatest overlap  whereas histology revealed a curious bone remodeling pattern  possibly a precursor to  deformational  craniosynostosis  
class5	2011	the effect of early fronto orbital advancement on frontal sinus development and forehead aesthetics  
class5	2011	the frontal sinuses make an important contribution to normal forehead and glabellar contour  
class5	2011	this study was designed to test our clinical impression that early fronto orbital   frontal bone   advancement could have an adverse effect on frontal sinus development and consequently on forehead aesthetics  
class5	2011	a retrospective study was conducted on 11 patients who had undergone fronto orbital advancement and also had a long period of follow up at the institute of reconstructive plastic surgery at new york university  
class5	2011	the longitudinal cephalometric data were compared with unoperated controls  
class5	2011	with one exception  no patient who underwent bilateral fronto orbital advancement developed a frontal sinus  and all such patients had a flattened brow contour when compared with unoperated patients  of whom 82 percent developed at least one frontal sinus  
class5	2011	of the three patients who underwent unilateral fronto orbital advancement for plagiocephaly  flattened forehead   two developed a frontal sinus but only on the unoperated side and one developed bilateral frontal sinuses  
class5	2011	the two patients with unilateral frontal sinus development had a particularly obvious deformity resulting from normal glabellar projection on the unoperated side and a flattened contour on the operated side  
class5	2011	fronto orbital advancement affects forehead aesthetics and should be performed only in infant patients with moderate to severe deformities  
class5	2011	patients with plagiocephaly whose deformity is sufficiently severe to warrant surgery should preferably undergo bilateral fronto orbital advancement  by the technique described  rather than unilateral advancement in order to avoid the brow asymmetry that results from unilateral frontal sinus development  
class5	2012	arthritis  roles of radiography and other imaging techniques in evaluation  
class5	2012	imaging studies are performed on patients with arthritis for a variety of reasons  to determine whether an arthritic condition is present  to establish the specific diagnosis  to determine the extent of disease  to assess the activity of disease  to detect complications of disease  to evaluate progression of disease  to judge the efficacy of drug treatment  to help in selection of surgical candidates  to aid in the choice of surgical procedures  to size  design  or fabricate prostheses  and to identify complications of surgery  
class5	2012	conventional radiography is still the mainstay of all examinations in arthritic patients  
class5	2012	arthrography is best applied to evaluate complications of disease and of surgery  although it may be useful in disease detection and in determining the specific diagnosis  
class5	2012	nuclear medicine studies are best used to identify complications of surgery and may also be useful to assess disease activity or extent  
class5	2012	ultrasound is useful to detect dissecting synovial cysts and deep venous thrombosis  
class5	2012	the most valuable role of computed tomography is in the design and fabrication of prostheses and in evaluating complex anatomy of involved joints  
class5	2012	magnetic resonance imaging may be useful in early detection of articular cartilage damage and may assist in determination of the specific diagnosis  enhancement with contrast material may aid in assessment of disease activity  
class5	2013	association of vertebral end plate fracture with pediatric lumbar intervertebral disk herniation  value of ct and mr imaging  
class5	2013	a retrospective review of the radiologic findings in 31 patients less than 21 years old who underwent laminotomy for lumbar disk herniation revealed six cases of associated avulsion fracture of the vertebral end plate  a prevalence of 19   
class5	2013	all fractures were found in the 14 17 year old subgroup  six of 19   a prevalence of 32   
class5	2013	in four patients  plain radiographs did not reveal the fracture  
class5	2013	computed tomographic  ct  findings were diagnostic in all six cases  
class5	2013	magnetic resonance  mr  images  obtained in three patients  demonstrated the avulsed cortical fragment and what are assumed to be the attached sharpey fibers  
class5	2013	on sagittal mr images  these structures had a configuration with the appearance of a  y  or  7   
class5	2013	four of these six patients underwent bilateral laminotomies  
class5	2013	the need for more extensive surgical resection may not be apparent at plain radiography or myelography but can be predicted with ct and mr imaging  
class5	2014	focal fibrocartilaginous dysplasia associated with tibia vara  
class5	2014	focal fibrocartilaginous dysplasia of the tibia at the insertion of the pes anserinus  the expanded tendinous insertion of the gracilis  sartorius  and semitendinous muscles  is a rare unilateral lesion with a characteristic deformity of the proximal tibial metadiaphysis  
class5	2014	it is associated with unilateral tibia vara in toddlers  
class5	2014	three cases of this entity are described  and the radiologic features are presented  
class5	2014	recognition of this disease is important because the response to conservative therapy is excellent  
class5	2015	rotator cuff lesions  signal patterns at mr imaging  
class5	2015	the signal intensity patterns of rotator cuff lesions at magnetic resonance  mr  imaging were evaluated in 80 patients who had surgical correlation and in 13 asymptomatic individuals  14 shoulders   
class5	2015	six cadaver shoulders were examined with mr  and histologic correlation was obtained in four  
class5	2015	all studies were performed at 1 5 t with a flexible circular surface coil  
class5	2015	the accuracy of mr imaging in detection of full thickness cuff tears  31 patients  was 0 95 and of partial thickness tears  16 patients   0 84  
class5	2015	the most common and accurate pattern for full thickness cuff tears  22 of 31 tears  was a region of intense signal seen on t2 weighted images  
class5	2015	less often the torn region consisted of an extremely degenerated and attenuated tendon with moderate signal intensity or was obscured by low signal intensity scar  
class5	2015	the intense signal pattern on t2 weighted images was also accurate  although a less common finding  seven of 16 cases   in the diagnosis of partial tears  
class5	2015	tendinitis was recognized as focal or diffuse regions of increased signal intensity or a nonhomogeneous pattern of increased signal often associated with tendinous enlargement  
class5	2015	in some patients  manifestations of subacromial subdeltoid bursitis was present  
class5	2015	tendon degeneration was also manifested as regions of increased signal intensity  
class5	2015	some similarity and overlap of signal patterns of partial interstitial tears  tendinitis  and tendon degeneration are observed  
class5	2016	cystic rheumatoid arthritis  description of a nonerosive form  
class5	2016	in a study of patients with rheumatoid arthritis  ra   9   n   70  were found to have a cystic form  
class5	2016	at radiologic examination of these patients with cystic ra  the first abnormality seen consisted of periarticular intraosseous cysts without erosions  
class5	2016	the cysts were distributed symmetrically  most often located at the proximal side of the joints and predominantly around the proximal interphalangeal  metacarpophalangeal  and wrist joints of the hands and the first interphalangeal and metatarsophalangeal joints of the feet  
class5	2016	computed tomographic scans showed the peripheral intraosseous location of the cysts  
class5	2016	magnetic resonance images showed that the cysts may contain fluid  inflamed synovia  or both  
class5	2016	cysts can be an important feature in the diagnosis of ra and a supplement to the criteria of the american rheumatism association  
class5	2016	osteoporosis  joint space narrowing  and joint destruction occurred less frequently in patients with cystic ra than in patients with classic ra  
class5	2016	of the patients with cystic ra  54  were male  and 50  were seronegative  
class5	2016	this study is a supplement to and an enlargement on earlier descriptions of cyst predominance in ra  
class5	2017	magnetic resonance imaging and the nonoperative treatment of spinal epidural abscess  
class5	2017	this report describes three patients with spinal epidural abscess diagnosed by magnetic resonance imaging and treated nonoperatively  
class5	2017	prior to treatment  one patient was neurologically intact  one patient demonstrated a moderate neurological deficit  and one patient was severely paraparetic with loss of bladder and bowel control  
class5	2017	following identification of the pathogenic organism  antibiotic therapy was continued until the patients demonstrated clinical improvement and radiological resolution of the abscess  
class5	2017	all patients remained stable or improved neurologically  
class5	2017	analysis of 33 previously reported patients treated with antibiotics suggests that nonoperative treatment may be a reasonable alternative therapy under certain clinical conditions  
class5	2017	these include  1  identification of the pathogenic organism   2  a stable neurological condition   3  access to magnetic resonance imaging or computed tomography for potentially rapid reevaluation  and  4  appropriate neurosurgical consultation and nursing care  
class5	2017	nonoperative treatment may also be considered as a reasonable alternative for patients who have severe concurrent medical illness  
class5	2018	flurbiprofen versus diclofenac for the treatment of osteoarthritis of the knee  
class5	2018	seventy four patients were enrolled in this double blind  randomized single center study to evaluate the therapeutic effectiveness of 50 mg tid regimens of flurbiprofen or diclofenac sodium in patients with osteoarthritis of the knee  
class5	2018	by chance  the flurbiprofen patients had a significantly more advanced disease status at baseline than their diclofenac treated counterparts  
class5	2018	however  at subsequent follow up evaluations  both treatment groups experienced a significant reduction in disease severity regardless of the baseline differences  
class5	2018	no serious safety problems were associated with either investigational therapy  
class5	2018	the frequency of reported medical events were distributed equally between the flurbiprofen and diclofenac groups  
class5	2018	although the imbalance in disease severity between treatment groups made a rigorous statistical interpretation of the results very difficult  the data from this clinical trial tend to support the equiefficacy of 50 mg tid regimens of flurbiprofen versus diclofenac for treating osteoarthritis of the knee  
class5	2019	lymphoma presenting as a periorbital tumor  
class5	2019	lymphoma is a common tumor of the periorbital region  
class5	2019	facial radiographs may show a soft tissue mass  
class5	2019	radiologic differential diagnosis of orbital masses is difficult  
class5	2019	computed tomographic scanning with intravenous contrast medium is useful in diagnosing and staging neoplasms in this area  
class5	2020	determinants of vertebral mineral density in patients receiving long term glucocorticoid therapy  
class5	2020	this study addresses the impact of clinical and biochemical factors on the bone density of patients receiving glucocorticoid therapy  
class5	2020	vertebral mineral density was measured by quantitative computed tomography in 35 patients aged 17 to 77 years who had received therapeutic glucocorticoid drugs for 0 1 to 22 years  
class5	2020	the mean      sem  vertebral mineral density z score in the subjects was  1 7     0 2  
class5	2020	z score was unrelated to underlying diagnosis  sex  or age but was significantly related to the duration of previous steroid therapy  r     38  and to the total cumulative glucocorticoid dose  r     50   
class5	2020	the rate of change of bone density in 16 of these subjects followed up over a period of 12 months was  8 9  and was significantly greater in subjects taking more than 12 5 mg of prednisone per day  
class5	2020	bone loss was not influenced by sex  age  duration of previous steroid treatment  or diagnosis and was not predictable from biochemical measures of calcium metabolism  
class5	2021	muscle involvement in the scleroderma syndromes  
class5	2021	muscle involvement was identified in 14 patients with scleroderma or a connective tissue disease overlap syndrome with predominant features of scleroderma  
class5	2021	patients presented with symmetrical proximal weakness indistinguishable from other inflammatory myopathies  
class5	2021	creatine kinase and electromyography were useful to demonstrate muscle involvement  
class5	2021	muscle histopathology demonstrated primarily the vasculopathy of scleroderma or polymyositis in similar numbers of patients  
class5	2021	scleroderma vasculopathy and polymyositis generally occur without specificity to diffuse scleroderma  the calcinosis  raynaud s phenomenon  esophageal dysmotility  sclerodactyly  telangiectasia syndrome  or an overlap syndrome with arthritis  
class5	2021	polymyositis also occurs when the vasculopathy of scleroderma involves other organ systems  
class5	2022	the influence of renal function on diabetic foot ulceration  
class5	2022	we examined the effect of renal function on the formation  severity  and outcome of diabetic foot lesions  
class5	2022	information was collected from a retrospective hospital chart survey and analyzed by univariate and multivariate linear regression analysis  
class5	2022	creatinine clearance  peripheral neuropathy  and peripheral vascular disease were all found to be independently associated with formation of foot lesions  indicating that each of these acts by distinct biologic mechanisms  
class5	2022	renal function had no bearing on the severity of lesions or on their eventual healing  
class5	2022	we conclude that foot ulcers are more likely to develop in diabetic patients who also suffer from renal impairment  but they are no less likely to heal than are those in patients with normal renal function  
class5	2022	we further conclude that attempts to preserve functional limbs in these patients are justified  
class5	2023	the distribution of muscle weakness in upper motoneuron lesions affecting the lower limb  
class5	2023	to determine the distribution of weakness in the lower limb after upper motoneuron lesions the strength of 8 muscle groups was measured  
class5	2023	four groups of patients were studied  22 control subjects  16 patients with unilateral leg paresis  4 patients with severe unilateral paralysis and 5 patients with paraparesis  
class5	2023	in the testing posture  seated   patients with cerebral upper motoneuron lesions showed no selective loss of power in flexors or extensors on the contralateral side  
class5	2023	gravitational torques were included in the measurements  
class5	2023	however  proximal muscles  acting at hip and knee  were significantly less severely affected than more distal muscles  acting at ankle and hallux   
class5	2023	at any particular joint  physiological flexors and extensors were affected equally in both the hemiparetic and paraparetic subjects  
class5	2023	as in the upper limb  colebatch and gandevia  1989   the strength of muscles on the clinically unaffected side was reduced compared with control subjects  although no muscle groups were especially affected  
class5	2024	capacitive coupling as an adjunctive treatment for avascular necrosis  
class5	2024	the purpose of this study was to determine the effectiveness of capacitive coupling  a noninvasive method for applying electrical stimulation to biologic tissues  when used as an adjunct to decompression and grafting in the treatment of avascular necrosis  avn  of the femoral head  
class5	2024	it also compared the results of core decompression and grafting with nonoperative management  
class5	2024	forty patients with stages i iii avn of the femoral head were treated with core decompression and grafting  
class5	2024	all wore capacitive coupling units with electrodes placed over the femoral head continuously for six months  
class5	2024	one half of these units were active and one half were inactive  
class5	2024	patients were followed for two to four years  
class5	2024	results were determined by preoperative and postoperative harris ratings  quantitative roentgenographic measurements  and the number of hips that required total hip arthroplasty  tha   
class5	2024	after all evaluations were completed  patients were divided into stimulated and nonstimulated groups  
class5	2024	patients in both groups were similar regarding gender  etiology  and roentgenographic stage of involvement  
class5	2024	results were also compared to 55 hips previously treated symptomatically  without surgery or electrical stimulation  
class5	2024	there were no fractures  infections  or other significant complications in any of the hips operated on  
class5	2024	hips treated with decompression and grafting  both with and without electrical stimulation  were more satisfactory than hips treated symptomatically in regard to roentgenographic progression and the need for tha  
class5	2024	there was  however  no indication that the addition of capacitive coupling gave better results than decompression and grafting alone  
class5	2025	tissue changes around loose prostheses  a canine model to investigate the effects of an antiinflammatory agent  
class5	2025	the aseptically loosened prosthesis provided a means for investigating the in vivo and in vitro activity of the cells associated with the loosening process in seven dogs  
class5	2025	the cells were isolated and maintained in culture for sufficient periods of time so that their biologic activity could be studied as well as the effect of different agents added to the cells in vivo or in vitro  
class5	2025	the biologic response as determined by interleukin 1 and prostaglandin e2 activity paralleled the roentgenographic appearance of loosening and the technetium images and observations made at the time of revision surgery  
class5	2025	the correlation between clinical  roentgenographic  histologic  and biochemical loosening indicates that the canine model is suitable for investigating the mechanisms of prosthetic failure  
class5	2025	a canine model permits the study of possible nonsurgical therapeutic interventions with the ultimate hope of stopping or slowing the loosening process  
class5	2026	cementless total joint arthroplasty prostheses with titanium alloy articular surfaces  a human retrieval analysis  
class5	2026	surgical implants of titanium alloy  ti 6al 4v  have been found to be susceptible to abrasive wear  resulting in the well known phenomenon of metallosis  
class5	2026	in the presence of the acrylic debris generated by loose joint arthroplasty prostheses  this abrasive wear is greatly increased  
class5	2026	however  the bone loss seen in these cases has generally been presumed to be due to the osteolytic effects of particulate acrylic  not the alloy debris  which has generally been assumed to be biocompatible  
class5	2026	to examine the in vivo effects of titanium alloy wear without the added presence of acrylic debris  a comprehensive analysis was made of cementless human joint arthroplasty prostheses with ti 6al 4v alloy surfaces articulating on ultra high molecular weight polyethylene  uhmwpe   
class5	2026	specimens  including the prostheses  synovium  pseudocapsule and additional soft tissues  and periarticular bone  were retrieved from 22 hips and two knees  
class5	2026	specimens were examined by histologic techniques  energy dispersive x ray analysis  and electron microscopy  
class5	2026	serial sections of the implants were evaluated for tissue ingrowth  
class5	2026	tissues surrounding all joints implanted more than one year showed some degree of discoloration indicative of metallosis  whereas after two years the synovium was hypertrophic and villiform  
class5	2026	histologic evaluation showed good fixation by bony ingrowth in the vast majority of cases  although location and extent of ingrowth was dependent on numerous factors  
class5	2026	viability of ingrowth bone was established by fluorochrome labeling  
class5	2026	however  despite good biologic fixation  cavitary osteolysis of the bone surrounding the implants was frequently identified  
class5	2026	these lesions were filled with sheets of aggressive macrophages within a matrix of fibrous tissue and necrotic debris  
class5	2026	under polarized light the macrophages were found to be filled with alloy and polyethylene fragments of a characteristic size  
class5	2026	osteoblast mediated remodeling of bone was infrequently observed  
class5	2026	instead  the bone was resorbed along a front in contact with the granulomatous tissues filling the cystic lesions  
class5	2026	visible burnishing was observed on every articular surface  with a linear relationship between wear and time implanted  
class5	2026	by one year the surfaces were covered with a characteristic  scratch and gouge  pattern  similar on all sizes of femoral heads as well as the total knee prostheses  
class5	2026	this study demonstrates that the combination of ti 6al 4v alloy and uhmwpe  when used as a bearing surface combination in total joint arthroplasty prostheses  results in excessive wear of both metal and polymer  abstract truncated at 400 words   
class5	2027	making core decompression work  
class5	2027	meaningful assessment of a treatment modality for osteonecrosis  on  must take into account a number of factors   1  an accurate diagnosis   2  consistent staging of the disease process   3  understanding of the variability of the disease   4  consistent application of the treatment modality  or the surgical technique   and  5  a clear understanding of the goal of the treatment used  
class5	2027	this article reviews the important steps of a diagnostic algorithm that has been used to accurately diagnose and stage the disease process of on  
class5	2027	a consistent surgical technique with clearly defined goals is also outlined  
class5	2027	the results of two clinical studies that were based on these diagnostic and therapeutic philosophies and that assess the role of core decompression in the treatment of on are reviewed  
class5	2027	the first study compared core decompression to conservative management in a prospective randomized study of 55 hips  
class5	2027	decompression provided more predictable pain relief and changed the indications for further surgical intervention more consistently than did conservative management  
class5	2027	the second study represents a preliminary review of a ten year study of the decompression procedure  it showed that core decompression was particularly useful in stage i and stage ii on  
class5	2027	roentgenographic stabilization was most predictable for stage i hips  
class5	2027	core decompression can be a safe  effective  and predictable procedure in the treatment of stage i and stage ii on  
class5	2028	the effect of stem stiffness on femoral bone resorption after canine porous coated total hip arthroplasty  
class5	2028	bilateral noncemented total hip arthroplasty  tha  was produced in dogs to determine the effect of stem stiffness on stress related bone resorption  
class5	2028	two porous coated femoral implants of substantially different stiffnesses were designed for direct comparison  
class5	2028	one was manufactured from cobalt chromium  cocr  alloy  the other from titanium alloy  
class5	2028	the titanium stem was hollowed out to a wall thickness of 1 mm to further reduce its stiffness  
class5	2028	the cumulative stiffness differences were about 5 4 fold axially and 3 6 fold in bending and torsion  
class5	2028	staged bilateral tha was performed on eight dogs  
class5	2028	each dog received a stiff cocr stem on one side and a flexible titanium stem on the other  
class5	2028	after death  the femora were removed and processed for undecalcified thin section histology  
class5	2028	bone ingrowth and remodeling were quantified by computer aided image analysis and compared between stem designs  
class5	2028	all femoral specimens showed bone ingrowth fixation of both stiff and flexible stems along the implant length  
class5	2028	tetracycline labeling indicated active bone turnover in the femoral cortex and in regions of ingrowth  
class5	2028	however  gross differences in femoral bone remodeling were observed both roentgenographically and histologically  
class5	2028	femora with the flexible stems consistently showed much less bone resorption than those with the stiff stems  
class5	2028	quantitative analysis of paired cross sections indicated an average of 25  35  more cortical bone area in the femora with flexible stems  
class5	2028	severe resorption of the cortex in the midstem region occurred in three of the femora with the stiff stems but in none with the flexible stems  
class5	2028	stem stiffness strongly influences bone remodeling  
class5	2028	the flexible stem results in more uniform load transfer and less stress shielding  
class5	2029	acetabular dysplasia in the adolescent and young adult  
class5	2029	hip dysplasia is a major cause of osteoarthrosis in adults  
class5	2029	early aggressive osteotomy has the potential of preventing the development of arthritis  but carries with it significant risks  
class5	2029	the problem is further complicated because the surgeon has no means of quantifying the dysplastic deformity or of predicting what a particular combination of osteotomies would do to correct the deformity  
class5	2029	this study describes methods of quantifying hip joint geometry in three dimensions based on computed tomography and magnetic resonance studies  and of simulating pelvic osteotomy to correct the deformities  
class5	2029	the study analyzes 49 normal hip joints and 20 dysplastic hip joints  
class5	2029	the results show that the normal acetabulum is nearly a full hemisphere  which is anteverted 20 degrees and abducted 53 degrees  
class5	2029	the normal lateral center edge angle is 37 degrees  
class5	2029	the dysplastic acetabulum is not anterolaterally maldirected  as has been assumed  but is globally dysplastic  
class5	2029	analysis of the individual dysplastic hip joints showed a wide variability  
class5	2029	some patients were deficient globally  some anterolaterally  and some posterolaterally  
class5	2029	methods of analyzing a patient s hip joint  quantifying abnormalities  simulating surgery  and predicting results are demonstrated in a case example  
class5	2030	chylothorax after posterior spinal instrumentation and fusion  
class5	2030	chylothorax occurred in a 16 year old girl after posterior spinal fusion and instrumentation for idiopathic scoliosis  
class5	2030	nonoperative management  including chest tube drainage for 26 days and total parenteral nutrition  successfully treated this unusual complication after a posterior spinal fusion  
class5	2031	newer concepts in antimicrobial therapy  
class5	2031	advances in the treatment of infection have continued to increase both the length and quality of life  
class5	2031	unfortunately  many bacteria can readily adapt to their environment and develop a tolerance to the antimicrobial agents in widespread use  
class5	2031	during the recent past  the consumption of cephalosporins has increased so dramatically as to parallel the initial acceptance of penicillin  
class5	2031	organisms that are resistant to the cephalosporins will no doubt continue to thrive  especially within the susceptible host  
class5	2031	it is essential for the clinician to become familiar with the newest antimicrobial agents to more effectively treat modern infections  
class5	2032	peroneal nerve palsy after total knee arthroplasty  
class5	2032	the prognosis for peroneal palsy after total knee arthroplasty  tka  is poorly defined  
class5	2032	twenty six postoperative peroneal palsies occurred after 8998 tkas performed between 1972 and 1985  
class5	2032	eighteen patients had complete and eight had incomplete peroneal palsies  
class5	2032	twenty three had both motor and sensory deficits  and three had only motor deficits  
class5	2032	at an average of 5 1 years  range  one to 11 years  after arthroplasty  recovery was complete for 13 palsies and partial for 12  
class5	2032	complete recovery was more likely in those palsies that were incomplete initially  
class5	2032	patients with palsies that were initially partial had significantly higher knee scores than those with complete palsies  and patients whose eventual recovery was complete had significantly higher knee scores than those with incomplete recovery  
class5	2032	this new prognostic information should be useful for surgeons who encounter this unfortunate yet persistent complication of tka  
class5	2033	risk factors for the development of osteoarthrosis of the knee  
class5	2033	the roles of physical activity  both work and leisure time   obesity  and history of significant knee injury on the development of severe osteoarthrosis  oa  of the knee were evaluated  
class5	2033	a case control design compared 46 cases with a history of severe oa of the knee with 46 community controls matched for age and gender  
class5	2033	data were gathered with a self administered questionnaire  
class5	2033	the oa cases were 3 5 times more likely than controls to have been obese at 20 years of age  two to three times more likely than controls to have performed heavy work  and almost five times more likely than controls to have had a significant knee injury  
class5	2033	in contrast  leisure time physical activity was not significantly different in cases compared with controls  
class5	2033	obesity  significant knee injury  and long term heavy physical activity are important risk factors for the development of oa of the knee  
class5	2034	simplified two stage below knee amputation for unsalvageable diabetic foot infections  
class5	2034	a simplified two stage below knee amputation for unsalvageable diabetic foot infections was done on 19 limbs with 84  good results for healing  
class5	2034	the first stage was the standard below knee amputation with a long posterior flap in which the fascia and skin were closed in the central portion with the medial and lateral portions of the wound left open for drainage  
class5	2034	the second stage was delayed until closure of the open wounds three to seven days after the first stage  
class5	2034	wagner s classification of diabetic foot lesions was used to stratify these cases  
class5	2034	grades 3 and 4 foot infections had a uniformly good prognosis for healing with this surgical technique  
class5	2034	grade 5 foot infections had a poor prognosis for healing  especially if associated with renal failure and dialysis  even with an initial guillotine amputation  
class5	2035	bone fragility of the peripheral skeleton during fluoride therapy for osteoporosis  
class5	2035	bone fragility during fluoride therapy for osteoporosis was observed in 24  37 5   of 64 patients treated with sodium fluoride  calcium  and vitamin d for 2 5 years who developed episodes of lower limb pain during treatment  
class5	2035	eighteen  28   of these patients had clinical and roentgenographic features of 41 stress fractures and 12 new spinal fractures  
class5	2035	there were 26 periarticular  six femoral neck  three pubic rami  three tibia and fibula  one greater trochanter  and two subtrochanteric fractures  
class5	2035	vertebral fractures appeared first  then periarticular  then femoral neck  and lastly long bone shaft fractures  
class5	2035	all fractures were spontaneous in onset  
class5	2035	the peripheral fracture rate during treatment was three times that in untreated osteoporosis  
class5	2035	roentgenograms must be repeated at intervals of three to four weeks before the pathognomonic callus becomes visible  and the diagnosis can be made  
class5	2035	trabecular stress fractures tend to occur in the first 18 months of treatment  and cortical stress fractures occur after 30 months of therapy  
class5	2036	bipolar versus total hip arthroplasty for avascular necrosis of the femoral head  a comparison  
class5	2036	in a relatively small series of cases the results of bipolar prostheses in avascular necrosis were inferior to those of total hip arthroplasty  tha   
class5	2036	femoral loosening rates were not reduced by using bipolar prostheses  
class5	2036	tha produced more inferior results in avascular necrosis than in degenerative joint disease  
class5	2036	early results of noncemented tha for avascular necrosis were good but also must withstand the test of time  
class5	2036	a fixed noncemented acetabular component was preferable over a bipolar prosthesis for avascular necrosis of the femoral head  
class5	2037	histologic  biochemical  and ion analysis of tissue and fluids retrieved during total hip arthroplasty  
class5	2037	large amounts of metal and polyethylene debris and high ion readings are found in capsule and fibrous membranes of both loose titanium and cobalt chromium stems  
class5	2037	prostaglandin e2  interleukin 1  and collagenase levels are elevated when compared to control values with collagenase having the highest and most consistent elevations  
class5	2037	synovial fluid and blood ion readings were elevated in loose cemented and cementless stems made from both materials  
class5	2037	blood ion readings were not elevated in fixed stems  
class5	2037	fixed stems had much less particulate debris in soft tissues  
class5	2037	the data showed that failure of most metal hip stems was initially due to a mechanical cause  with high debris and ion counts occurring secondarily in capsule and fibrous membranes  
class5	2037	particulate debris and high ion readings are primarily a focal problem contained by the periprosthetic fibrous connective tissue encapsulation within the femoral canal and joint capsules  
class5	2037	no systemic problems were manifest in any of the patients examined and followed in this study  
class5	2038	perichondral grafting for cartilage lesions of the knee  
class5	2038	twenty five patients with 30 chondral lesions of the knee were treated with an autogenous strip of costal perichondrium  
class5	2038	the graft was fixed to the subchondral bone with tissucol  immuno  vienna   a human fibrin glue  
class5	2038	the leg was then immobilised for two weeks followed by two weeks of continuous passive motion  
class5	2038	weight bearing was permitted after three months  
class5	2038	the mean knee score  ranawat  insall and shine 1976  changed from 73 before operation to 90 one year after  in 14 patients evaluated after two years there was no decrease  
class5	2038	in 28 cases the defect was completely filled with tissue resembling articular cartilage  
class5	2038	we conclude that in most cases perichondral arthroplasty of cartilage defects of the knee gives excellent results  
class5	2039	osteotomy for osteoarthritis of the hip  a survivorship analysis  
class5	2039	we have reviewed 368 osteotomies carried out for osteoarthritis of the hip at the nuffield orthopaedic centre  
class5	2039	survivorship analysis showed that 10 years after osteotomy 47  had required no further surgery  and even after 20 years 23  had still not had a hip replacement  
class5	2039	hips with moderate arthritic change showed significantly better results than those with more severe degeneration  
class5	2039	osteotomies with varus angulation as well as medial displacement showed longer survival  
class5	2040	intra osseous pressure and oxygen tension in avascular necrosis and osteoarthritis of the hip  
class5	2040	the intra osseous pressure  po2  and pco2 were measured in 32 hips  21 patients  which were painful but showed no severe degenerative changes  
class5	2040	pre operative scintigraphy and radiography was performed in all patients  
class5	2040	thirteen hips showed early osteoarthritis  eight had early osteonecrosis  and 11 had no changes  
class5	2040	core biopsies were performed and the bone was examined histologically and graded for necrosis  
class5	2040	histologically  necrosis was present in 27 specimens  
class5	2040	scintigraphic findings did not correlate with the histological results but were more closely related to the radiographic findings  
class5	2040	the intra osseous pressure in hips with histological necrosis  mean 47 mmhg  was significantly higher than in hips without necrosis  mean 26 mmhg   
class5	2040	the po2 was lower in bone with histological necrosis  mean 44 mmhg  than in bone without  mean 71 mmhg   
class5	2040	po2 increased and intra osseous pressure decreased after decompression  
class5	2040	the results confirm that ischaemia plays a central role in the development of necrotic changes in bone  
class5	2040	histological necrosis was found in hips with radiographic signs of osteonecrosis and in those with osteoarthritis  
class5	2040	radiography  and scintigraphy are shown to be insensitive methods for differentiating between those disorders  
class5	2041	biomechanics of a double prosthetic ligament in the anterior cruciate deficient knee  
class5	2041	we have assessed the biomechanical properties of a  double bundle  prosthetic ligament replacing the anterior cruciate in cadaver knees  
class5	2041	we compared the results with those of single bundle  over the top  and  through the condyle  techniques  performing anterior drawer tests at 20 degrees and 90 degrees knee flexion  
class5	2041	the over the top reconstruction gave better anteroposterior stability at 20 degrees  while the through the condyle repair was more stable at 90 degrees  
class5	2041	the double bundle reconstruction gave practically normal anterior stability at both 20 degrees and 90 degrees  
class5	2042	development of the hip in multiple epiphyseal dysplasia  natural history and susceptibility to premature osteoarthritis  
class5	2042	we have determined the natural history of hip development in 42 patients with multiple epiphyseal dysplasia  med   
class5	2042	premature osteoarthritis was a frequent outcome and was almost inevitable before the age of 30 years in those with incongruent hips  
class5	2042	there were two types of immature hips  type i  the more severe form  had a fragmented and flattened ossific nucleus and acetabular dysplasia  was misshapen at skeletal maturity and osteoarthritic by 30 years of age  the milder type ii hip had a small  rounded  uniformly ossified nucleus and a more normal acetabulum  
class5	2042	type ii hips were well formed at maturity and were less prone to premature osteoarthritis  
class5	2042	considerable variations were noted in the manifestations of med between families but not within families  
class5	2042	the prognosis of a child s hip could be predicted  in sporadic cases from the type of immature hip  and in familial cases by also taking into account the outcome of affected relatives  
class5	2043	failed acromioplasty for impingement syndrome  
class5	2043	we evaluated 67 shoulders in 65 patients who had pain and dysfunction for more than two years after an initial acromioplasty for impingement syndrome without a rotator cuff tear  
class5	2043	in addition to a thorough history  physical examination  local anaesthesia injection and any other necessary investigations all patients had arthroscopic evaluation of the shoulder  
class5	2043	in 27 shoulders there had been diagnostic errors  and in 28 operative errors  only in 12 had the diagnosis and the operative procedure both been correct  
class5	2043	subsequent operative intervention in patients not receiving worker s compensation benefit had a 75  success rate  whereas in those receiving such benefits the success rate was only 46   
class5	2044	bone lysis in well fixed cemented femoral components  
class5	2044	we have reviewed 25 cases of focal femoral osteolysis in radiographically stable  cemented femoral implants  
class5	2044	in three hips retrieved at post mortem from two patients  we have been able to make a detailed biomechanical and histological analysis  
class5	2044	the interval between arthroplasty and the appearance of focal osteolysis on clinical radiographs ranged from 40 to 168 months  and in over 70  of the cases this did not appear until after five or more years  
class5	2044	few had significant pain and there was no relation to age  sex or original diagnosis  
class5	2044	the most common site for osteolysis were gruen zones 2 and 3 on the anteroposterior radiograph and zones 5 and 6 on the lateral radiograph  
class5	2044	in 15 cases  60    the area of osteolysis corresponded to either a defect in the cement mantle or an area of very thin cement  
class5	2044	the rate of progression of these lesions was variable  but to date only one has progressed to gross loosening of the femoral component  
class5	2044	the back scatter scanning electron microscopic examination of serial sections and biomechanical testing of the post mortem specimens demonstrated focal cement fracture around implants that were otherwise rigidly fixed  
class5	2044	in eight cases from which tissue was available  histology showed a histiocytic reaction with evidence of particulate polymethylmethacrylate  
class5	2044	we consider that this local fragmentation was the stimulus for local osteolysis in an otherwise stable cemented femoral component  
class5	2045	localised endosteal bone lysis in relation to the femoral components of cemented total hip arthroplasties  
class5	2045	four cases are described of localised endosteal bone lysis in the femur occurring in association with cemented femoral components that were not obviously  loose  radiologically  
class5	2045	in each  the area of lysis was shown at operation to be related directly to a region in which there was a local defect in the cement mantle surrounding the stem  
class5	2045	via the space between the stem and cement  such defects provide a route through which the contents of the joint cavity may reach the endosteal surface of the femur  subsequently leading to localised bone lysis  and later to frank loosening  
class5	2046	macrophages stimulate bone resorption when they phagocytose particles  
class5	2046	we investigated in vitro a mechanism by which particulate debris may induce bone resorption and cause implant loosening  
class5	2046	we first studied two standard particles  latex  which is considered to be inert  and zymosan  which is inflammatory  
class5	2046	macrophages that phagocytosed either particle became activated  and stimulated 15 times as much bone resorption as did control macrophages  
class5	2046	for activation to occur  100 times more latex than zymosan had to be phagocytosed  
class5	2046	we also found that bone cement and polyethylene particles activated macrophages in a similar manner  and that the necessary amounts of these were intermediate between those of latex and zymosan  
class5	2046	none of the particles were toxic  
class5	2046	it was concluded that implant loosening may result from bone resorption stimulated by mediators released by macrophages that have phagocytosed particles of bone cement or polyethylene  
class5	2047	tissue expanded radial forearm free flap in neck burn contracture  
class5	2047	neck contracture after burn injury can result in severe functional as well as aesthetic deformities  
class5	2047	contracture can recur even after wide and complete release and full thickness skin grafting  
class5	2047	recurrence is partly due to the inherent difficulties in both early postoperative immobilization and the required long term splinting  
class5	2047	when adjacent tissues are also burned  adequate local tissue for reconstruction may not be available  therefore  free tissue transfer may be necessary  
class5	2047	the large surface area that is required after adequate release may be provided by tissue expansion before free tissue transfer  
class5	2047	in the case presented the use of tissue expanded radial forearm free flap for the reconstruction of a recurrent neck contracture is described  
class5	2048	hearing loss due to cranio metaphysial dysplasia  
class5	2048	craniometaphysial dysplasia is a rare cause of conductive hearing loss  
class5	2048	it is a genetic disorder of bone due to decreased osteoclastic activity in the endosteal and periosteal regions of craniofacial and long bones  
class5	2048	the characteristic temporal bone abnormalities are attic fixation  abnormally shaped ossicles and obliterated foramina ovale  
class5	2048	computerised tomography is helpful in predicting operative findings  surgery should be reserved for those with a severe hearing loss  
class5	2049	magnetic and electrical stimulation of cervical motor roots  technique  site and mechanisms of excitation  
class5	2049	cervical motor roots and the brachial plexus were excited transcutaneously with magnetic  magstim  and electrical stimulation  elstim  applied dorsally over the spine and over the supraclavicular fossa  erb s point   
class5	2049	the compound muscle action potentials  cmaps  from the abductor digiti minimi  adm  and the biceps muscles  biceps  could be evoked with either stimulating technique in all 52 subjects tested  
class5	2049	with magstim over the spinous process c7  greater cmaps were obtained from adm  p less than or equal to 0 0001  paired t test  and biceps  p less than or equal to 0 005  when the inducing current in the coil as viewed from behind was clockwise for the right arm and vice versa  
class5	2049	elstim with the cathode over c7 t1 and the anode directed cranially provided greater cmaps from the adm  p less than or equal to 0 0001  and smaller cmaps from the biceps  p less than or equal to 0 01  than with the inverse polarity  
class5	2049	magstim of the cervical roots provided cmaps which were smaller from adm  p less than or equal to 0 0001   and greater from biceps  p less than or equal to 0 0001   than elstim  cathode c7 t1   whereas latencies did not differ significantly  p less than or equal to 0 3   
class5	2049	when comparing elstim and magstim applied over erb s point  the former yielded greater cmaps and 0 5 ms longer latencies from both the adm and biceps  p less than or equal to 0 001   
class5	2049	from these data and additional studies in four patients  including direct intraoperative root stimulation in one of them  it is concluded that elstim and magstim over the spine excite the motor roots at a similar site  that is  within a few cm outside the intervertebral foramina  
class5	2050	rigid spine syndrome with respiratory failure  
class5	2050	the pathogenesis and therapy of respiratory failure in the rigid spine syndrome are discussed in two cases who improved with respiratory assistance  
class5	2050	in both cases  the partial pressures of oxygen and carbon dioxide were reversed in arterial blood gas analysis and  vc was less than 30   
class5	2050	remission from respiratory failure has been obtained by the use of a ventilator during the night  
class5	2050	the cause of the respiratory failure in both cases was severe restrictive respiratory dysfunction due to extreme flattening of the chest and fixation of the thorax during respiration as a result of contracture of costovertebral joints  
class5	2050	all the previously reported cases of the rigid spine syndrome with respiratory failure died  
class5	2050	appropriate use of the ventilator can improve the prognosis  
class5	2051	sexually transmitted arthritis syndromes  
class5	2051	sexually transmitted infections may provoke a wide variety of rheumatic lesions  
class5	2051	disseminated n  
class5	2051	gonorrhoeae infection leads to septic arthritis  which may be rapidly destructive but which responds promptly to appropriate antibiotic therapy  
class5	2051	in contrast  both gonococcal and nongonococcal infections may lead to aseptic  reactive  arthritis or reiter s syndrome  
class5	2051	inheritance of hla b27 confers a relative risk of 30 to 50 times for the development of this condition  
class5	2051	the demonstration of c  
class5	2051	trachomatis antigen in joint material from a minority of patients suggests that direct interaction between microbial components and class i hla antigens in the joint may be central to the pathogenesis of this disease  
class5	2051	arthralgia and arthritis occur in up to 50  of individuals in the prodrome of hepatitis b infection  
class5	2051	joint symptoms may be accompanied by urticarial or cutaneous vasculitic lesions  especially on the legs  both features resolve with the onset of jaundice  
class5	2051	hepatitis b infection is also a major cause of necrotizing vasculitis  which may or may not be associated with overt hepatitis  
class5	2051	seronegative arthritis  including reiter s syndrome  psoriatic arthritis  and undifferentiated arthritis  a sjogren s like syndrome  vasculitis  and myopathies have been described in association with hiv infection  
class5	2051	it is clear that synovitis occurs in those patients despite the fact that hiv is present in immune cells within the joint during inflammatory arthritis and that both antigen presentation and lymphocyte responsiveness within the joint are impaired  
class5	2051	nevertheless  synovitis may occur in the presence of marked cd4 positive lymphocyte depletion  
class5	2051	rheumatic syndromes  including arthralgia  inflammatory arthritis  and neuropathic arthritis  may occur during any stage of congenital or acquired syphilis  
class5	2051	syphilitic synovitis responds well to antibiotic therapy  but neuropathic lesions cannot be treated effectively  
class5	2051	septic arthritis has rarely been described as a complication of disseminated mycoplasma or urea plasma infections  and joint lesions sometimes associated with erythema nodosum have also been reported in lymphogranuloma venereum and granuloma inguinale  
class5	2052	asymptomatic rhabdomyolysis of unknown etiology  
class5	2052	a 7 year old boy developed rhabdomyolysis with a peak creatine phosphokinase level of 261 400 iu l after his appendectomy  
class5	2052	these abnormalities occurred following a 2 3 day illness consisting of upper respiratory tract symptoms  fever  and abdominal pain mimicking acute appendicitis  
class5	2052	at the time of operation  a normal appendix was removed  and mesenteric lymphadenitis was noted  
class5	2052	the myoglobinuria and elevation of creatine phosphokinase were transient  and the patient remained asymptomatic  
class5	2052	we review various causes of right lower quadrant pain and rhabdomyolysis and address the roles of malignant hyperthermia and infectious agents  
class5	2052	the possible cause of the phenomena observed in this patient is discussed  
class5	2053	epiretinal membrane contracture associated with macular prolapse  
class5	2053	we treated two patients with annular epiretinal membranes that produced unusual macular morphologic characteristics  
class5	2053	contracture of the membranes caused herniation of macular tissue through a hole in the center of the membrane  
class5	2053	the membranes were removed surgically  and ultrastructural analysis disclosed cells with properties resembling myofibroblasts and apparent new vitreous collagen  
class5	2053	contracture of the cellular components probably produced tangential traction on the retina  which caused prolapse of the retinal tissue through a central defect in the membrane  
class5	2054	effects of 2  lignocaine on somatosensory evoked potentials recorded in the extradural space  
class5	2054	we have studied the effects of extradural administration of 2  lignocaine at the l3 4 interspace on somatosensory evoked potentials recorded in the cervical extradural space before corrective surgery for idiopathic adolescent scoliosis  
class5	2054	eight patients in whom the equivalent volume of 0 9  sodium chloride solution was administered into the lumbar extradural space acted as a control group  
class5	2054	lignocaine 2  resulted in a decrease in overall amplitude  but its main effect was a significant decrease in the amplitude of the second and third peaks  suggesting an action on the dorsal columns of the spinal cord  
class5	2054	a significant increase in latency was found in both the lignocaine and sodium chloride groups  
class5	2054	we conclude that the use of extradural 2  lignocaine in patients undergoing scoliosis surgery may interfere with the intraoperative monitoring of somatosensory evoked potentials  
class5	2055	the presence of autoantibody to recombinant lipocortin i in patients with psoriasis and psoriatic arthritis  
class5	2055	corticosteroids may mediate some of their anti inflammatory effects via induction of a specific 38 kda protein  lipocortin i  
class5	2055	anti lipocortin i antibodies  ala  were measured by enzyme linked immunosorbent assay  elisa  in 23 patients with plaque type psoriasis alone  nap   in 21 patients with psoriasis and arthritis  pa   and in 67 healthy controls  
class5	2055	only two of 23 nap patients had elevated ala  whereas six of 21 pa patients had raised levels of ala  p   0 2   
class5	2055	sero negative polyarthritis was the most common pattern of joint disease in those pa patients with elevated ala  4 6   
class5	2055	ala levels did not correlate with the extent or severity of cutaneous involvement  and are unlikely to be involved in the pathogenesis of cutaneous psoriasis  
class5	2056	aerobic work capacity in patients with chronic fatigue syndrome 
class5	2056	objective  to determine the aerobic work capacity of patients with the chronic fatigue syndrome and compare it with that of two control groups  and to assess the patients  perception of their level of activity before and during illness  
class5	2056	design  a symptom limited exercise treadmill test with on line gas analysis and blood sampling was used  
class5	2056	subjects were assessed by one investigator  who was blind to the group which they were in  
class5	2056	setting  department of medicine  royal victoria hospital  belfast  
class5	2056	subjects  13 patients  10 women  three men  who fulfilled the diagnostic criteria for chronic fatigue syndrome  
class5	2056	two control groups of similar age  sex  and body weight  13 normal subjects  10 women  three men  and seven patients  five women  two men  with the irritable bowel syndrome  
class5	2056	main outcome measures  aerobic work capacity as assessed by several variables such as length of time on treadmill  heart rate  and biochemical measurements  borg score  and visual analogue scores of perceived level of physical activity  
class5	2056	results  the patients with the chronic fatigue syndrome had a reduced exercise capacity compared with that of the other subjects  spending a significantly shorter time on the treadmill  
class5	2056	they had a significantly higher heart rate at submaximal levels of exertion and at stage iii exertion had significantly higher blood lactate concentrations  
class5	2056	using a borg score  they showed a significantly altered perception of their degree of physical exertion with a mean score of 8 2 compared with 6 6 and 5 3 for the normal subjects and patients with the irritable bowel syndrome respectively  
class5	2056	using a visual analogue scale they indicated that they had a greater capacity for activity before illness than had the patients with the irritable bowel syndrome  but the scores were not significantly different between the two groups  
class5	2056	both groups of patients indicated reduced activity at the time of testing  
class5	2056	normal controls and patients with the irritable bowel syndrome aspired to a greater level of activity than their current level  but the patients with the chronic fatigue syndrome aspired to a level similar to that which they had had before their illness  
class5	2056	conclusions  patients with the chronic fatigue syndrome have reduced aerobic work capacity compared with normal subjects and patients with the irritable bowel syndrome  
class5	2056	they also have an altered perception of their degree of exertion and their premorbid level of physical activity  
class5	2057	orbital compartment syndrome  direct measurement of orbital tissue pressure  1  technique  
class5	2057	many disorders of the orbit produce an increase in intraorbital pressure  which may result in the development of an orbital compartment syndrome and visual loss  
class5	2057	traditionally  orbital tension is assessed clinically by indirect means based on retrodisplacement of the globe  
class5	2057	the authors describe their experience with the  slit catheter  technique for direct tissue pressure measurement as applied to the orbit  
class5	2057	the preliminary results indicate that normal orbital pressure ranges from 3 0 to 6 0 mm hg  
class5	2057	in patients with graves  orbitopathy the values ranged from 7 0 to 15 0 mm hg  
class5	2057	the results suggest that the technique may have many exciting possibilities as a clinical research tool in orbital disease  and its use will result in better understanding of orbital compartment syndromes  
class5	2058	effects of a multidisciplinary management program on neurologically impaired patients with dysphagia  
class5	2058	dysphagia is a major problem in patients with neurologic disorders  
class5	2058	aspiration pneumonia and impaired nutritional status are consequences of dysphagia that result in high morbidity and mortality rates  
class5	2058	assessment and treatment of the dysphagic patient by a multidisciplinary team have been advocated but to date the effects of such an approach have not been demonstrated quantitatively  
class5	2058	this prospective study was conducted to determine if a dysphagia program would improve patients  caloric intake and body weight  decrease the instances of aspiration pneumonia  or improve patients  feeding ability  
class5	2058	patients were referred from a 26 bed neurology neurosurgery unit  
class5	2058	a time series design was utilized  
class5	2058	the control group consisted of 15 patients  mean age   46 1 years   managed according to the existing ward routine  
class5	2058	subsequently  nursing staff attended a dysphagia training program  
class5	2058	following this  the treated group of 16 patients   mean age   49 3 years  was assessed by the dysphagia team  using bedside and videofluoroscopic examinations to determine the specific swallowing disorder  
class5	2058	an individualized treatment program was designed for each patient  
class5	2058	the groups were compared on the basis of deviation from their baseline weight  deviation from ideal energy intake  and the incidence of aspiration pneumonia  
class5	2058	statistical analysis revealed that the groups were comparable in age  number of days on the study  and glasgow coma scale score  and that a significant weight gain and increase in caloric intake occurred in the treated group  
class5	2058	no incidence of aspiration pneumonia was reported in either group  
class5	2058	we speculate that this may have been influenced by the meticulousness of the care delivered in an acute unit as well as greater attention to prevention given in both groups  
class5	2059	the effects of parathyroid hormone  pth  and pth related peptide on osteoclast resorption of bone slices in vitro  an analysis of pit size and the resorption focus  
class5	2059	the mechanism whereby pth  a potent stimulator of bone resorption  may under certain circumstances exert anabolic effects on bone is not known  but it is possible that it involves reduction of the size of osteoclast resorption lacunae  
class5	2059	we have therefore made a detailed in vitro study of the effects of pth and pth related peptide  pthrp  on resorption by neonatal rat osteoclasts paying particular attention to the plan area of resorption pits  
class5	2059	in order to distinguish between increased resorption at a particular site and increased numbers of sites  we have used an eyepiece graticule to define a focus of resorption  namely an area occupying 1 116th of the bone slice  which may contain either one or several pits  
class5	2059	in addition we have studied the relationship between the number of pits in a resorption focus and the total area of bone resorbed at the focus  
class5	2059	we found that pth and pthrp  at doses between 2 x 10  10  m and 2 x 10  8  m  while exerting significant stimulatory effects on bone resorption  caused a reduction in the median plan area of pits  
class5	2059	an increase in the number of resorption foci was the primary stimulatory effect of pth and pthrp  occurring within 6 h in the case of pth  
class5	2059	however  the plan area of bone resorbed at a focus showed no significant increase  despite an increase in the number of pits per focus  because as more pits were formed at a focus  the pits were smaller  thus partially dissipating the stimulatory effect of pth on resorption  
class5	2059	these results are consistent with the activation of new remodeling sites by pth in vivo  
class5	2059	furthermore  the formation of smaller pits under the resorptive influence of pth may  together with the maintenance of coupling between formation and resorption  play a role in the preservation of cancellous bone recorded in cases of primary hyperparathyroidism and the anabolic effect of exogenous pth  
class5	2060	squamous cell carcinomas often produce more than a single bone resorption stimulating factor  role of interleukin 1 alpha   
class5	2060	several cultured human squamous cell carcinoma cell lines  scc 4  scc 12b2  scc 12f2  ec gi 10  and ben  and one normal keratinocyte line  epy 1  were investigated for the production of bone resorption stimulating activity  brsa   
class5	2060	conditioned medium  cm  from each of the six cell lines stimulated bone resorption in neonatal mouse calvariae in culture  
class5	2060	the brsa of scc 12f2 and ec gi 10 was inhibited completely by antibody to interleukin 1 alpha  il 1 alpha   whereas the brsa in cm from the ben  scc 4  scc 12b2  and epy 1 cell lines was only partially inhibited by anti il 1 alpha  
class5	2060	addition of indomethacin to the calvarial cultures also partially inhibited the brsa from ec gi 10  scc 4  scc 12b2  and epy 1 cells  the brsa from ben and scc 12f2 cells was inhibited completely by indomethacin  
class5	2060	camp production by calvariae was determined after a 60 min incubation with cm  
class5	2060	cm from ec gi 10  ben  scc 4  and epy 1 stimulated camp production by bone  
class5	2060	preincubation of cm from ben  ec gi 10  scc 4  and epy 1 cells with two antisera against pth related protein  pthrp  one specific for two pthrp  1 141   the other recognizing both pthrp  1 40  and pthrp  1 141   completely inhibited the camp stimulating activity  
class5	2060	using specific enzyme linked immunosorbent assays for il 1 alpha and il 1 beta  il 1 alpha was measured in cm of the scc 4  scc 12b2  scc 12f2  and epy 1 cell lines  
class5	2060	il 1 beta was undetectable  less than 0 1 ng ml  in cm from all cell lines  
class5	2060	our findings indicate that the brsa secreted by scc 12f2 cells can be accounted for largely or entirely by il 1 alpha  while the activity produced by scc 12b2 includes il 1 alpha and another unknown factor s   
class5	2060	the brsa produced by ec gi 10  ben  scc 4  and epy 1 cells includes both il 1 alpha and pthrp  
class5	2060	we conclude that il 1 alpha may be a more prevalent and biologically significant component of the brsa produced by sccs than previously recognized  
class5	2061	congenital abnormalities of the lymphatic system  a new clinical classification  
class5	2061	the numerous clinical presentations of congenital abnormalities of the lymphatic system in children and the confusing terminology used to describe their pathologic diagnoses impede the physician s understanding of the condition  
class5	2061	the clinical classification based on the actual symptoms of the congenital problems we have presented here should help the physician identify the specific abnormality and a potential treatment  
class5	2061	future research should concentrate on the specific causes and the treatment of these congenital abnormalities  
class5	2062	biomechanics of mammalian terrestrial locomotion  
class5	2062	mammalian skeletons experience peak locomotor stresses  force per area  that are 25 to 50  of their failure strength  indicating a safety factor of between two and four  
class5	2062	the mechanism by which animals achieve a constant safety factor varies depending on the size of the animal  
class5	2062	over much of their size  0 1 to 300 kilograms   larger mammals maintain uniform skeletal stress primarily by having a more upright posture  which decreases mass specific muscle force by increasing muscle mechanical advantage  
class5	2062	at greater sizes  increased skeletal allometry and decreased locomotor performance likely maintain stresses constant  
class5	2062	at smaller sizes  skeletal stiffness may be more critical than strength  
class5	2062	the decrease in mass specific muscle force in mammals weighing 0 1 to 300 kilogram indicates that peak muscle stresses are also constant and correlates with a decrease in mass specific energy cost of locomotion  
class5	2062	the consistent pattern of locomotor stresses developed in long bones at different speeds and gaits within a species may have important implications for how bones adaptively remodel to changes in stress  
class5	2063	physician documentation of diabetes care  use of a diabetes flow sheet and patient education clinic  
class5	2063	we assessed two interventions designed to improve the care of patients with diabetes mellitus by documenting the complications of their disease  
class5	2063	these were a flow sheet  included with outpatient medical records  and a weekly patient education clinic  in which a nurse educator provided individualized instruction to patients with diabetes  
class5	2063	physician compliance with recommendations of the national diabetes advisory board for diabetes care was measured before  n   45  and after  n   158  these interventions  
class5	2063	the numbers of referrals to ophthalmologists increased from 22  to 46   urinalyses increased from 58  to 77   and lower extremity examinations increased from 36  to 61   
class5	2063	nutrition education documentation increased from 51  to 69   and diabetes education documentation increased from 31  to 61   
class5	2063	these results suggest that a significant improvement in physicians  documentation of care of patients with diabetes can be achieved by using a flow sheet and a diabetes patient education clinic  
class5	2064	sternoclavicular septic arthritis due to haemophilus influenzae  
class5	2064	we have reported a case of septic sternoclavicular arthritis illustrating a rare complication of infection with a relatively common pathogen  haemophilus influenze  
class5	2064	early identification of the infecting organism and appropriate antibiotic therapy are essential to prevent further morbidity from the complications of this unusual pyoarthritis  
class5	2065	eosinophilic granuloma of the cervical spine  a case report and review of the literature  
class5	2065	this is a report of a case of eosinophilic granuloma involving the second cervical vertebra in a 33 year old woman  
class5	2065	there have been 32 case reports in the literature describing eosinophilic granuloma presenting as cervical spine disease  
class5	2065	due to its intimate relation to the central nervous system  the opportunity for neurological sequelae and neurosurgical intervention is common in cervical eosinophilic granuloma  
class5	2065	in this report a brief history of eosinophilic granuloma is reviewed and case histories from the literature with cervical spine involvement are summarized  
class5	2065	the therapeutic options are described and a recommended protocol for management is outlined  
class5	2066	avascular necrosis of bone  a common serious complication of allogeneic bone marrow transplantation  
class5	2066	purpose  to describe the incidence  presentation  clinical course  and management of avascular necrosis of bone following bone marrow transplantation  and to identify risk factors related to its development and outcome  
class5	2066	patients and methods  all patients developing avascular necrosis after transplantation between march 1974 and may 1988 were identified by means of the minnesota bone marrow transplant database and hospital records and included in analysis  
class5	2066	of 902 consecutive patients undergoing bone marrow transplantation  28 developed avascular necrosis of bone  
class5	2066	results  twenty eight of 642 allogeneic transplant recipients  10 4  by product limit estimate  developed avascular necrosis compared to zero of 260 autologous transplant recipients  
class5	2066	symptoms developed 1 to 62 months  median 12 months  after transplantation  
class5	2066	in the 28 patients a total of 91 joints were affected  mean 3 3 per patient  range one to eight joints   
class5	2066	the hip joint was most often involved  64  of patients   followed by knee  61    ankle  29    shoulder  21    and elbow  7    
class5	2066	initial standard radiographs were negative in 13 patients  while in nine patients  technetium 99 scans and or magnetic resonance imaging demonstrated changes of osteonecrosis before changes on routine radiographs  
class5	2066	almost all patients had received steroid prophylaxis and therapy for graft versus host disease  gvhd   
class5	2066	we observed a significant correlation between the total cumulative dose of steroids and number of joints involved  p less than 0 01   
class5	2066	a multivariate analysis  allogeneic transplant patients only  identified acute or chronic gvhd requiring steroid therapy  p   0 003   and increasing age  p   0 002  as significant and independent risk factors  
class5	2066	fourteen patients required surgery  including joint replacement in 11 patients  
class5	2066	in six of six patients  hip core decompression failed to halt disease progression  and total hip arthroplasty was subsequently required  
class5	2066	conclusion  avascular necrosis of bone is a frequent late complication of bone marrow transplantation  causing significant morbidity and often requiring surgery  diagnosis using conventional imaging techniques may be difficult and treatment remains inadequate  
class5	2067	reconstruction of the anterior cruciate ligament using allogeneic tendon  long term followup  
class5	2067	eighty four patients who underwent acl reconstruction with fresh frozen allogeneic tendon were reviewed and evaluated with subjective and functional rating scales  physical examinations  instrumented anterior drawer tests  isokinetic testing  and arthroscopy  
class5	2067	the average followup was 57 months  range  36 to 90 months  and the average age at operation was 22 years  range  16 to 37 years   
class5	2067	the subjective and functional results were rated as excellent in 48 patients  57    good in 31  37    and fair in 2  2    
class5	2067	three patients  3   experienced a retear of the acl  
class5	2067	physical examinations and instrumented anterior drawer tests showed that satisfactory anterior stability was restored in 88  of the patients  
class5	2067	isokinetic evaluations demonstrated that the extension torque of the involved knee recovered to a slightly lower level than that of the controls  although the flexion torque recovered to a level equivalent to that of the controls  
class5	2067	arthroscopic evaluations revealed that the allografts were elaborately remodeled  viable  and taut  
class5	2067	there was no sign of immunologic rejection at any time postoperatively  
class5	2067	additional extraarticular procedures  consisting of both pes anserinus transfer on the medial side and iliotibial band reinforcement on the lateral side  had no effect on the results  
class5	2068	shoulder arthroscopy  its role in evaluating shoulder disorders in the athlete  
class5	2068	we retrospectively reviewed 100 initial shoulder arthroscopies from a general sports medicine orthopaedic practice to determine if arthroscopy is helpful diagnostically and to see if specific lesions correlate well with specific diagnoses  
class5	2068	seventy two percent of the patients in the review had glenoid labral tears  
class5	2068	ninety two percent of patients who had a diagnosis of either recurrent anterior dislocation or recurrent anterior subluxation demonstrated a tear of the anterior inferior margin of the glenoid labrum  
class5	2068	sixty eight percent of patients with a diagnosis of impingement demonstrated tears at the superior margin of the labrum  
class5	2068	there was a significant difference between throwing and nonthrowing athletes  
class5	2068	partial rotator cuff tears were noted in 18 patients  the majority occurring in throwing athletes  
class5	2068	other abnormalities  such as degenerative joint changes and biceps tendon lesions  were also noted at the time of arthroscopy  
class5	2068	a large number of glenoid labral tears found at the time of arthroscopy appeared to be associated with conditions other than instability  which may or may not affect the throwing athlete  
class5	2068	there also appeared to be a high correlation between tears in the anterior inferior glenoid labrum and anterior instability  
class5	2068	arthroscopy enabled us to identify other significant information about the status of the biceps tendon or the undersurface of the rotator cuff  
class5	2068	these are areas in which problems might otherwise have been missed  
class5	2068	degenerative changes of the articular surface  not apparent on plain radiographs  may also be better evaluated arthroscopically  
class5	2069	incidence of cervical spinal stenosis in professional and rookie football players  
class5	2069	sagittal canal vertebral body ratios were measured on cervical spine lateral radiographs of 124 professional football players and 100 rookie football players  
class5	2069	a total of 894 levels were measured in 224 players  
class5	2069	thirty two percent  40  of the 124 professional football players  and 34  of the 100 rookies had a ratio of less than 0 80 at one or more levels from c3 to c6  
class5	2069	the 0 80 ratio has been considered indicative of cervical spinal stenosis  
class5	2069	this is the first time that the incidence of spinal stenosis  as determined by torg s ratio  has been demonstrated in a population of professional and rookie football players  
class5	2069	because one third of this population has cervical spinal stenosis as determined by the torg ratio  other factors should be considered in the evaluation of a player with a transient quadriplegic episode when making continued play decisions  
class5	2070	peripheral neuropathy associated with eosinophilia myalgia syndrome  
class5	2070	in 1989  the centers for disease control recognized the existence of an epidemic illness characterized by myalgia and eosinophilia in individuals taking preparations containing l tryptophan  
class5	2070	we evaluated 3 patients with eosinophilia myalgia syndrome who presented with subacute progressive neuropathies  
class5	2070	the neuropathies were predominantly motor and maximal in the lower extremities  
class5	2070	two patients were confined to a wheelchair and one was ventilator dependent and bedridden  
class5	2070	sensory loss predominantly involved small fiber modalities  
class5	2070	electrophysiological studies showed multifocal marked conduction slowing and conduction block indicating segmental demyelination  with associated axonal degeneration that was accentuated distally  
class5	2070	examination of sural nerve biopsy specimens demonstrated axonal degeneration in all 3 patients and perivascular infiltrates in 2  
class5	2070	levels of quinolinic acid  a neurotoxic metabolite of l tryptophan  were elevated in the cerebrospinal fluid in the 2 patients in whom it was measured  
class5	2070	the cause of the neuropathy is unknown but may include immune mechanisms or toxicity of eosinophils  l tryptophan  its metabolic products  or contaminants within l tryptophan preparations  
class5	2071	human immunodeficiency virus  hiv  associated myopathy  immunocytochemical identification of an hiv antigen  gp 41  in muscle macrophages  
class5	2071	in a patient with acquired immunodeficiency disease syndrome  aids  and muscle weakness  a muscle biopsy specimen disclosed degeneration of muscle fibers  regeneration  and focal endomysial mononuclear inflammation  
class5	2071	a conspicuous feature was the presence of perivascular macrophages within the endomysium that showed positive immunostaining for human immunodeficiency virus  hiv   gp 41  antigen  
class5	2071	hiv was not detected within myofibers  
class5	2071	our findings suggest an important role for the hiv infected macrophage in the pathogenesis of this myopathy  
class5	2072	effect of a pulsing electromagnetic field on metabolically derived osteoporosis in rats  a pilot study  
class5	2072	the literature suggests that a pulsating electromagnetic field  pemf  is effective against bone loss in disuse osteoporosis  
class5	2072	this study was conducted to evaluate the effects of pemf on metabolically derived osteoporosis in rats  
class5	2072	sixteen 5 month old female sprague dawley rats were divided into three groups  g 1 2 3   
class5	2072	g 1 was given a normal diet and no exposure to pemf  g 2 3 were oophrectomized and fed a low calcium diet for 8 months  and g 3 was also exposed for 24 hr day to pemf generated by applying a 15 hz  5 6 a peak to peak square wave to helmholtz coils  64 cm i d   200 turns coil   
class5	2072	the rats were sacrificed at 4  6  and 8 months  
class5	2072	skeletal changes were analyzed by measurements of acid extracted bone calcium and bone mineral content  bmc  using single photon absorptiometry  spa   
class5	2072	although all animals started at approximately the same weight  mean of 290 0 g   g 2 showed a more progressive increase  
class5	2072	while the mean weight after 8 months in g 1 was 350 0 g  and 352 5 g for g 3  that in g 2 was 400 0 g  
class5	2072	the calcium content of the femur in g 2 and g 3 at 8 months was lower than that of g 1  but there were no significant differences among the three groups  
class5	2073	prerandomization  an alternative to classic randomization  the effects on recruitment in a controlled trial of arthroscopy for osteoarthrosis of the knee  
class5	2073	possibly the greatest threat to the success of a randomized clinical trial is the inability to recruit an adequate number of subjects  
class5	2073	concern that the randomized clinical trial will adversely affect the physician patient relationship is the most common reason for physicians  reluctance to enroll patients in such trials  
class5	2073	we report a modification of a prerandomized design  first described by zelen  which was implemented in a randomized clinical trial of arthroscopy for patients who had osteoarthrosis of the knee  
class5	2073	the method was associated with a sixfold increase in the rate of accrual of patients as compared with the use of a classic randomization trial  
class5	2073	we propose the design as a potential solution to the problem of recruitment of subjects  particularly for clinical studies  
class5	2074	open fractures of the tibia in children  
class5	2074	forty one children who had forty two open fractures of the tibial metaphysis or diaphysis were studied retrospectively  
class5	2074	twelve fractures were type i  eighteen  type ii  six  type iiia  four  type iiib  and two  type iiic  according to the classification of gustilo et al  
class5	2074	all fractures were irrigated and debrided  and antibiotics were given for a minimum of forty eight hours after the injury  
class5	2074	twenty fractures were initially treated with external fixation and twenty two  with immobilization in a plaster cast  
class5	2074	three patients had an early infection of the wound  one of which was associated with osteomyelitis  all were successfully treated  
class5	2074	the average time to healing of the fracture was five months  range  two to twenty one months   
class5	2074	the time to union was related to the severity of the soft tissue injury  the pattern of the fracture  the amount of segmental bone loss  the occurrence of infection  and the use of external fixation  
class5	2074	there were six delayed unions  
class5	2074	four patients had an angular malunion of more than 10 degrees  which spontaneously corrected in three  
class5	2074	one patient who had a proximal metaphyseal diaphyseal segmental fracture had a progressive valgus deformity  
class5	2074	four patients who had a severe fracture that was treated with external fixation had more than one centimeter of tibial over growth  
class5	2074	there were no amputations  
class5	2074	the incidences of compartment syndrome  vascular injury  infection  and delayed union were similar to those reported for open tibial fractures in adults  
class5	2075	total hip arthroplasty with cement  a long term radiographic analysis in patients who are older than fifty and younger than fifty years  
class5	2075	the long term performance of a total of 712 charnley and sth prostheses was evaluated as a function of the patient s age  older than fifty years or younger than fifty years  and of the underlying disease  osteoarthrosis  rheumatoid arthritis  or avascular necrosis   
class5	2075	in patients who were older than fifty years  there were lower incidences of continuous cement bone radiolucency about the acetabular component  p   0 04   wear of the polyethylene acetabular cup  p   0 03   and resorption of the calcar  p   0 03   
class5	2075	however  larger percentages of younger patients had rheumatoid arthritis or avascular necrosis  
class5	2075	in the cohort of patients who had osteoarthrosis  the performance of the prosthesis did not differ significantly between older and younger patients  therefore we attributed the differences that were observed to the disease  that is  to rheumatoid arthritis or avascular necrosis  
class5	2076	hazards of internal fixation in the treatment of slipped capital femoral epiphysis  
class5	2076	we reviewed the records of 202 patients  308 hips  in whom a slipped capital femoral epiphysis had been fixed with pins or screws  
class5	2076	a serious complication that was directly related to the use of internal fixation developed in eighty hips  26 per cent   
class5	2076	the rate of complications in the 202 patients was 40 per cent  
class5	2076	in thirty six  18 per cent  of the 202 patients  an additional procedure was done to correct a pin related complication  
class5	2076	forty one hip joints had been penetrated by a pin  
class5	2076	other complications included avascular necrosis  fourteen hips   chondrolysis  nine   fracture  one   infection  one   further slippage  one   sciatic nerve injury  one   and breakage of a screw  eight   
class5	2076	ways of decreasing the incidence of complications of fixation were explored  
class5	2077	osteoarthrosis and congenital dysplasia of the hip in family members of children who have congenital dysplasia of the hip  published erratum appears in j bone joint surg  am  1991 feb 73 2  293  
class5	2077	four hundred and eight siblings  parents  and grandparents of seventy eight children from the new england area who had congenital dysplasia of the hip were evaluated  by clinical examination and by measurements of the acetabulum on pelvic radiographs  for the signs and sequelae of congenital dysplasia of the hip  
class5	2077	six siblings and four mothers  representing seven of seventy eight families  had been diagnosed with congenital dysplasia of the hip during childhood  
class5	2077	the other ninety one siblings were asymptomatic and had no radiographic evidence of dysplasia of the hip  
class5	2077	in the adults in these families  acetabular coverage  as measured by the center edge angle of wiberg  was no different from that in the control subjects  
class5	2077	there was no difference between the study group and the control subjects in the prevalence of osteoarthrosis of the hip or of osteoarthrosis that could be considered secondary to congenital dysplasia of the hip  
class5	2077	the results indicate that children born to families that have a history of congenital dysplasia of the hip have a greater prevalence of this problem compared with the general population  but also that examinations of the hip in newborns are effective in detecting congenital dysplasia of the hip in such families  
class5	2077	the greater prevalence of congenital disease of the hip among the siblings and mothers in these families is consistent with a multifactorial inheritance  
class5	2077	the fact that acetabular development in the family members who did not have congenital dysplasia of the hip was no different from that in the control subjects suggests that acetabular dysplasia  rather than being an inherited abnormality  is secondary to subluxation or dislocation  
class5	2078	failure of acetabular autogenous grafts in total hip arthroplasty  increasing incidence  a follow up note  
class5	2078	we reported previously on the application of an autogenous femoral head graft to the acetabulum during total hip arthroplasty for compensation of marked osseous deficiency in patients who had arthritis secondary to severe congenital dysplasia or dislocation of the hip  
class5	2078	an average of seven years postoperatively  the graft seemed to have been a successful adjunct to the arthroplasty  
class5	2078	five years later  to assess our long term results  we reviewed the findings in the same forty six hips  thirty seven patients  that we had studied previously  
class5	2078	an average of 11 8 years after the total replacement and use of the autogenous femoral head graft  nine hips  20 per cent  needed a second operation because the acetabular fixation had failed  
class5	2078	two had had a resection arthroplasty and seven  a complex revision  
class5	2078	in one additional hip  a resection arthroplasty was done for infection that had developed after operative reattachment of the greater trochanter  
class5	2078	in twelve of the remaining thirty six hips  there was definite radiographic evidence of acetabular loosening  
class5	2078	thus  the total incidence of loosening of the acetabular component was 46 per cent  twenty one hips   
class5	2078	the average time from the index operation to the first definite radiographic evidence that the fixation had failed was 6 4 years  range  2 9 to 12 7 years   
class5	2078	while we recognize that application of a bulk autogenous graft to the acetabulum is useful when the acetabular bone stock is extremely deficient  we no longer recommend the use of bulk corticocancellous autogenous grafts in other situations  
class5	2079	the molecular basis of hereditary 1 25 dihydroxyvitamin d3 resistant rickets in seven related families  
class5	2079	hereditary 1 25 dihydroxyvitamin d3  1 25 oh 2d3  resistant rickets  hvdrr  is an autosomal recessive disease caused by target organ resistance to the action of 1 25 oh 2d3  the active form of the hormone  
class5	2079	the defect in target cells is heterogenous and commonly appears to be a mutation in the gene encoding the vitamin d receptor  vdr   
class5	2079	we have studied cultured skin fibroblasts and epstein barr virus transformed lymphoblasts of seven family branches of an extended kindred having eight children affected with hvdrr  
class5	2079	we have previously shown that cells from three affected children in this group contain an  ochre  nonsense mutation coding for a premature stop codon in exon 7 within the steroid binding domain of the vdr gene  
class5	2079	in the current studies  we found that cells from affected children failed to bind  3h 1 25 oh 2d3 and had undetectable levels of vdr as determined by immunoblots using an anti vdr monoclonal antibody  
class5	2079	measurement of vdr mrna by hybridization to a human vdr cdna probe showed undetectable or decreased abundance of steady state vdr mrna  
class5	2079	parents  expected to be obligate heterozygotes  showed approximately half the normal levels of  3h 1 25 oh 2d3 binding  vdr protein  and mrna  
class5	2079	the mutation at nucleotide 970  counting from the mrna cap site  results in the conversion of gtac to gtaa  which eliminates an rsa i restriction enzyme site and facilitates identification of the mutation  
class5	2079	we found that polymerase chain reaction  pcr  amplification of exons 7 and 8 from family members and subsequent rsa i digestion allows detection of the specific genotype of the individuals  
class5	2079	when rsa i digests of pcr amplified dna are subjected to polyacrylamide gel electrophoresis  children with hvdrr exhibit a homozygous banding pattern with loss of an rsa i site  
class5	2079	parents exhibit a heterozygotic dna pattern with detection of both normal and mutant alleles  
class5	2079	in summary  our data show that the genetic abnormality is a point mutation within the steroid binding domain of the vdr in all seven related families with hvdrr  
class5	2079	analysis of restriction fragment length polymorphism at the 970 locus of pcr amplified dna fragments can be used to diagnose this mutation in both affected children and parents carrying the disease  
class5	2080	serum uric acid correlates in elderly men and women with special reference to body composition and dietary intake  dutch nutrition surveillance system   
class5	2080	in 460 apparently healthy dutch elderly  aged 65 79 years  serum uric acid correlates were studied by linear regression analyses  for men and women separately  
class5	2080	diuretic therapy  total serum cholesterol  women only  and creatinine clearance  in bivariate analysis only  were significantly associated with serum uric acid level  
class5	2080	positive associations of serum uric acid with body weight  body mass index  body fatness  men  and lean body mass  men  were observed  with and without adjustment for diuretic therapy  creatinine clearance and age  
class5	2080	serum uric acid levels  whether adjusted or not for these variables and for body mass index  were positively associated with alcohol intake  men  and consumption of meat and fish  women   and inversely with consumption of bread  margarine and milk products  women   
class5	2080	these results indicate that limited medication with diuretics  weight control and restriction of alcohol use may help to prevent hyperuricemia in the elderly  
class5	2081	examination by logistic regression modelling of the variables which increase the relative risk of elderly women falling compared to elderly men  
class5	2081	in a community based  prospective study to determine risk factors for falls  465 women and 296 men 70 years and over were followed for 1 year and 507 falls were documented  
class5	2081	a greater proportion of women  32 7   than men  23 0   experienced at least one fall in which there was no or minimal external contribution  
class5	2081	using unconditional logistic regression models we investigated the effect of physical and sociological variables on the sex difference in fall rate  
class5	2081	controlling for the variables age  use of psychotropic drugs  inability to rise from a chair without using arms  going outdoors less than daily and living alone decreased the relative risk of women falling compared to men from 2 02  95  ci  1 40 2 92  to 1 55  95  ci 1 04 2 31   
class5	2081	some of the increased risk of falling associated with being a women was able to be explained and is potentially correctable  
class5	2081	but even after controlling for the physical and social variables which we had assessed  women compared to men still had a significantly increased relative risk of falling  
class5	2082	joint inflammation provoked by a local synovial allergic reaction  
class5	2082	homocytotropic antibody was stimulated in animals by administering protein antigens in a vaccine with b  
class5	2082	pertussis adjuvant  
class5	2082	the titers of the allergic antibody responses were judged by passive cutaneous anaphylaxis reactions  
class5	2082	sera or globulin fractions containing high titers of antibody activity were injected into the knee joints of experimental animals  
class5	2082	after sufficient delay for unfixed proteins to be cleared from the knee joints  animals were challenged intravenously with the corresponding antigen  
class5	2082	the resultant local reaction of swelling and warmth  passive synovial anaphylaxis  was judged visually and by scanning procedures  
class5	2082	histological studies showed evidence of mast cell degranulation concurrent with synovial reaction  
class5	2083	adherent synovial cells from nonrheumatoid arthritis do not release interleukin 1 beta and prostaglandin e2 spontaneously in longterm culture  
class5	2083	adherent synovial cells from both 13 patients without rheumatoid arthritis  ra   gout  osteoarthritis and meniscal lesion  and 8 patients with ra consisted of dendritic cells  macrophage like cells and fibroblast like cells after cloning in a similar fashion as reported in our previous paper  
class5	2083	all the adherent synovial cells from patients without ra did not release interleukin 1  il 1  beta and prostaglandin e2  pge2  spontaneously  while those cells released comparable amounts of il 1 beta  but not pge2 to ra cells after type ii collagen stimulation  
class5	2083	only the synovial cells from ra  irrespective of morphology and cloning  released il 1 beta and pge2 without stimulation  
class5	2083	nonrheumatoid synovial cells may differ functionally from ra cells  
class5	2084	incidence of polymyositis dermatomyositis  a 20 year study of hospital diagnosed cases in allegheny county  pa 1963 1982  
class5	2084	the incidence of hospital diagnosed polymyositis dermatomyositis  pm dm  among residents of pittsburgh and allegheny county  pa was determined from 1963 to 1982  
class5	2084	medical records of all allegheny county hospitals were searched for patients diagnosed pm dm  and each accepted case was reviewed and verified by a physician  according to specified criteria  
class5	2084	direct age adjusted incidence rates were computed for race and sex  as new cases million population year  with the 1970 allegheny county population as the standard  
class5	2084	one hundred seventy seven cases were identified during this 20 year survey for a total annual incidence of 5 5 million population  
class5	2084	incidence more than tripled during 1973 1982 compared to the first decade of study  with the greatest increase occurring in black women  
class5	2084	overall  the female to male incidence ratio was 2 2 1  but during the childbearing years  ages 15 44  this ratio increased to greater than 5 1 in both races  
class5	2084	detection of pm dm is increasing  as shown by temporal trends  
class5	2084	although our series has significantly more adult pm and less dm and overlap cases than other published studies  annual incidence is similar to that reported in other locales  
class5	2085	prevention of a false diagnosis of sexually acquired reactive arthritis by synovial lymphocyte responses  
class5	2085	three cases are reported in which a diagnosis of sexually acquired reactive arthritis might have been made erroneously from the history  but the enteric origin of the reactive arthritis was evident from synovial lymphocyte responses  
class5	2085	the importance of making the correct diagnosis and the avoidance of unwarranted spousal dysharmony is stressed  
class5	2086	restricted dose and duration of corticosteroid treatment in patients with polymyalgia rheumatica and temporal arteritis  
class5	2086	to analyze whether corticosteroids in low doses during limited time periods could be safely used in the treatment of patients with polymyalgia rheumatica  pmr  or temporal arteritis  ta  the records of 91 patients diagnosed between 1980 and 1987 were reviewed  
class5	2086	the mean initial prednisolone dose was in patients with pmr 18 mg day and the mean duration of treatment was 17 months  
class5	2086	in patients with ta the mean initial dose was 31 mg day and the mean duration of treatment 16 months  and in all the corticosteroid treatment was terminated within 24 months  
class5	2086	patients with coexisting ta and pmr demanded longer treatment compared to patients with either ta or pmr and thus 18 91 patients were treated for more than 2 years  
class5	2086	no visual or neurological complications occurred after treatment with corticosteroids had been initiated  
class5	2086	our study indicates that most patients with pmr or ta can be treated safely with an initial prednisolone dose of 10 mg given twice daily  
class5	2086	with few exceptions corticosteroid treatment can be terminated within 24 months  
class5	2087	pyogenic sacroiliitis in a rural population  
class5	2087	we describe 10 cases of pyogenic sacroiliitis occurring in a rural population  
class5	2087	seven were male and 3 were female with a mean age of 22 4 years  
class5	2087	none was a recent intravenous drug abuser  
class5	2087	five patients had a history of recent pelvic trauma  
class5	2087	99mtechnetium scintiscans revealed increased sacroiliac  si  joint uptake in 8 of 8 cases  
class5	2087	blood cultures were positive in 60  of patients  
class5	2087	staphylococcus aureus was isolated in 7 cases from blood and or si aspirates and hemophilus influenzae type b in one case  
class5	2087	nine of 10 patients recovered completely  
class5	2087	one underwent arthrodesis for recurrent si pain without evidence of relapse of infection  
class5	2087	median followup was 18 months  
class5	2088	synthesis and release of phospholipase a2 by unstimulated human articular chondrocytes  
class5	2088	high activity of proinflammatory  type ii phospholipase a2  pla2  was found in synovial fluids  sf  in inflammatory arthritis  
class5	2088	in search for the sources of this pla2  we cultured human articular chondrocytes and cartilage explants from healthy  osteoarthritic and rheumatoid joints  
class5	2088	all cultures  unstimulated by cytokines  released pla2 extracellularly  
class5	2088	cultures obtained from the deep layers of the cartilage released more pla2 than those obtained from the superficial layers  
class5	2088	deep layer explants released 0 38 to 18 16 pmol min mg protein pla2 day  whereas superficial layer explants released 0 39 3 18 pmol min mg day  
class5	2088	chondrocyte cell cultures continuously released pla2  in the first day 909 46347 pmol min  10 6 cells and after 9 26 days of culture 166 2115 pmol min 10 6  cells  
class5	2088	pla2 released from chondrocytes was calcium dependent and had optimum activity at ph 7 5  
class5	2088	cycloheximide markedly inhibited its release  
class5	2088	chondrocyte cultures also released muramidase  lzm  but there was no correlation between pla2 and lzm release  
class5	2088	it may be concluded that cytokine unstimulated human articular chondrocytes synthesize and release pla2 extracellularly which is similar to that found in the sf  
class5	2088	thus  chondrocytes may possibly serve as one of the sources of intraarticular pla2  
class5	2089	sternocostoclavicular hyperostosis  two cases with differing dermatologic syndromes  
class5	2089	sternocostoclavicular hyperostosis is a rare rheumatic condition characterized by ossification and erosion of the clavicle and the first rib  that has been shown to be associated with pustular skin lesions  
class5	2089	we present 2 cases  one of which had features of pustulosis palmaris et plantaris and the other dissecting cellulitis of the scalp  
class5	2089	although the dermatologic manifestations differ  both cases have rheumatologic and roentgenographic features diagnostic of sternocostoclavicular hyperostosis  
class5	2090	yersinia enterocolitica tenosynovitis  the first case  
class5	2090	we describe a case of tenosynovitis of tibialis posterior due to yersinia enterocolitica occurring after injury by a plant thorn in a 55 year old man  
class5	2090	the illness was chronic with 2 recurrences in spite of antibiotic treatment  
class5	2090	full recovery was obtained only after surgical intervention  
class5	2090	our patient s chronic course was fostered by the persistence of thorn fragments in the infected area and the exceptionally pathogenic character of the isolated colony of yersinia  
class5	2091	septic streptococcus milleri spondylodiscitis  
class5	2091	we describe 2 patients presenting lumbar spondylitis due to streptococcus milleri  
class5	2091	in both cases origin was related to preexistent intestinal pathology  
class5	2091	surgical drainage of a collection of pus was necessary in one case  
class5	2091	longterm antibiotic therapy led to full recovery  
class5	2091	despite confused nomenclature streptococcus milleri must be considered a serious pathogen mainly associated with purulent infection with osteoarticular affinity  
class6	2092	evaluation of women with possible appendicitis using technetium 99m leukocyte scan  
class6	2092	the authors evaluated the use of technetium 99m albumin colloid white blood cell  tac wbc  scan in women with possible appendicitis  
class6	2092	one hundred and nine women underwent 110 tac wbc scans  
class6	2092	one woman had a second scan on a separate admission and was considered two individual patients in the analysis  
class6	2092	twenty six women had appendicitis  10 of whom had a perforated appendix at surgery  
class6	2092	the tac wbc scan was indeterminate  abnormal but nondiagnostic for appendicitis  in 52 women  47    nine of whom had appendicitis  
class6	2092	fifty eight scans were read as positive or negative for appendiceal pathology  
class6	2092	there were 16 true positives  5 false positives  36 true negatives  and 1 false negative  
class6	2092	the predictive value of a positive scan was 76   and the predictive value of a negative scan was 97   
class6	2092	the tac wbc scan was positive in 62  of patients with appendicitis and negative in 43  of the patients without appendicitis resulting in an overall accuracy of 47  in the 109 women  
class6	2092	the main value of tac wbc scan in women with possible appendicitis is its high negative predictive value and the main problem with the tac wbc scan is its high indeterminate rate  
class6	2093	intermittent obstruction of an incarcerated hiatal hernia with a total thoracic stomach  
class6	2093	a case of intermittent obstruction of a sliding hiatal hernia is presented  
class6	2093	the obstruction occurred when the patient s stomach was totally above the diaphragm  
class6	2093	the anatomy of sliding hiatal hernias is discussed  as well as the presenting signs and symptoms of obstruction in sliding hiatal hernias  
class6	2094	a retrospective analysis of therapy for acute graft versus host disease  initial treatment  
class6	2094	we have reviewed results of therapy in 740 patients with grades ii iv acute graft versus host disease  gvhd  after allogeneic marrow transplantation  
class6	2094	at the beginning of therapy  597 patients  81   had rash  369  50   had liver dysfunction and 396  54   had gut dysfunction  
class6	2094	initial treatment was with glucocorticoids  n   531   cyclosporine  n   170   antithymocyte globulin  atg   n   156  or monoclonal antibody  n   3  either singly  n   633  or in combination  n   107   
class6	2094	parameters of gvhd severity in each organ were recorded weekly  and evaluation of response was made using values at the initiation of secondary treatment or  for patients without such treatment  using values on day 29 of primary treatment or the last recorded value before death  whichever occurred first  
class6	2094	minimal criteria for improvement or progression were defined for each organ  but no attempt was made to define liver or gut outcome if another complication such as venocclusive disease or infectious enteritis was present  
class6	2094	improvement rates were 43  for skin disease  35  for evaluable liver disease and 50  for evaluable gut disease  
class6	2094	overall complete or partial responses were seen in 44  of patients  
class6	2094	multivariate analyses were carried out to identify patient  disease or treatment factors associated with likelihood of overall improvement and likelihood of response in at least one organ  
class6	2094	a similar analysis was also carried out to identify covariates associated with time to treatment failure  defined as initiation of secondary therapy or death not due to relapse of malignancy   
class6	2094	in all three models  gvhd prophylaxis using cyclosporine combined with methotrexate was associated with favorable gvhd treatment outcome compared to prophylaxis with either agent alone  and treatment with glucocorticoids or cyclosporine was more successful than treatment with atg  
class6	2094	other factors associated with unfavorable outcome in the model of time to treatment failure and also entered in one of the response models were recipient hla disparity with the donor  presence of a liver complication other than gvhd  and early onset of gvhd  
class6	2094	results of this analysis indicate that glucocorticoids represent the best initial therapy available for treatment of acute gvhd  although much room for improvement remains  
class6	2095	the management of pseudomyxoma peritonei  
class6	2095	the management of nine patients with pseudomyxoma peritonei was reviewed  
class6	2095	aggressive surgical resection of tumor is the standard of treatment  with many patients requiring multiple laparotomies  
class6	2095	chemotherapy  including the use of cisplatin is not effective  
class6	2095	long term nutritional support provides a better quality of survival for select patients  
class6	2096	epidural morphine for analgesia after caesarean section  a report of 4880 patients 
class6	2096	this retrospective study was undertaken to assess the efficacy and safety of epidural morphine in providing analgesia following caesarean section under epidural anaesthesia  
class6	2096	the morphine was administered as a single bolus  following delivery  in doses ranging from 2 to 5 mg  
class6	2096	the charts of 4880 caesarean sections  performed on 4500 patients  were reviewed  
class6	2096	the duration of analgesia and the occurrence of any symptoms which might be side effects of the epidural morphine were recorded  
class6	2096	the duration of analgesia was 22 9     10 1 hr and was not correlated with the dose of epidural morphine  
class6	2096	eleven per cent of the patients required no supplemental analgesia during the first 48 hr  
class6	2096	twelve patients  0 25 per cent  had respiratory rates less than 10 breaths per minute  on at least one occasion  
class6	2096	no serious sequelae resulted from these periods of bradypnoea  
class6	2096	pruritus occurred in 58 per cent of patients  nausea and vomiting in 39 9 per cent and dizziness in ten per cent  
class6	2096	herpes simplex labialis was recorded in 3 5 per cent of patients  
class6	2096	epidural morphine is thus confirmed as an effective analgesic technique post caesarean section with 3 mg being the optimal dose  
class6	2096	even in this young healthy patient population  clinically detectable respiratory depression occurs so clinical respiratory monitoring is indicated  
class6	2097	prospective trial comparing a combination ph probe nasogastric tube with aspirated gastric ph in intensive care unit patients  
class6	2097	upper gi bleeding related to stress ulcer syndrome is estimated to affect as much as 15  of patients in an icu  
class6	2097	since the occurrence of bleeding after icu admission may be associated with increased morbidity and mortality  many efforts have been directed at defining optimal therapy for stress ulcer prophylaxis  
class6	2097	titration of intragastric ph with antacids or iv doses of h2 receptor antagonists may prevent stress ulcer bleeding in high risk icu patients  
class6	2097	we evaluated a recently developed ph probe incorporated into an ng tube and compared it with aspiration of gastric contents using ph paper as a means to monitor ph in 22 surgical icu patients  
class6	2097	regression analysis comparing the intragastric probe ph values with the aspirated ph values showed a good correlation between the two methods  r    71   
class6	2097	this new technique for intragastric ph measurement appears technically simple and clinically applicable for use on patients at risk for stress ulcer bleeding  
class6	2097	it may be more accurate than ph paper in patients receiving antacids  
class6	2098	the exeter dysphagia assessment technique  
class6	2098	the exeter dysphagia assessment technique  edat  uses noninvasive equipment to record  simultaneously   feeding respiratory patterns   the time drink entered the mouth  and associated swallow sounds during feeding  
class6	2098	the easily portable equipment enabled patients  swallowing ability to be tested  at the bedside if necessary  using a small amount of fruit flavored drink  
class6	2098	the results appear in chart form  
class6	2098	edat findings from groups of normal subjects aged 2 90 years were compared with those from patients with dysphagia of neurologic origin and normal subjects under experimental feeding conditions  
class6	2098	the results revealed maturation of the feeding respiratory pattern in the teenage years and remarkable consistency thereafter  
class6	2098	differences in the recordings between the normal and abnormal subjects were sufficiently marked to allow the findings to be used in the diagnosis of other patients with dysphagia of doubtful neurologic cause  
class6	2098	interpretation of the charts and recorded timings of the oral and pharyngeal stages of swallowing permitted a more accurate identification of sensory nerve  motor nerve  and functional involvement causing dysphagia of neurologic origin and may be used as a guide to the origin of the sensory deficit  
class6	2099	transient mitral regurgitation due to mitral valve prolapse accompanied by systolic anterior motion of the mitral valve  
class6	2099	a grade 4 6 systolic murmur  systolic anterior motion of the mitral valve  sam   and severe mitral regurgitation  mr  documented by two dimensional doppler echocardiography developed suddenly on the structurally normal heart of a patient with idiopathic portal hypertension  
class6	2099	the patient did not have signs of congestive heart failure and the aforementioned phenomenon disappeared completely when the patient was in hepatic failure  
class6	2099	this could be explained by a change in circulating blood volume either by gastrointestinal hemorrhage or hepatic failure  
class6	2100	resolution of the adult respiratory distress syndrome following colectomy and liver transplantation  
class6	2100	a 32 year old woman with liver failure from end stage cirrhosis and ulcerative colitis developed septicemia and severe ards  
class6	2100	subtotal colectomy and a successful liver transplantation resulted in complete resolution of the ards  
class6	2101	esophageal contribution to chest pain in patients with coronary artery disease  
class6	2101	we conducted a prospective study to determine the role of the esophagus in causing chest pain in patients with established cad on optimum therapy  
class6	2101	thirty two men with documented cad who complained of frequent and usually daily retrosternal chest pain were evaluated  
class6	2101	following a standard esophageal manometry and acid perfusion test  simultaneous two channel ambulatory holter monitor and esophageal ph record tests were performed for 24 hours  
class6	2101	fifty three episodes of chest pain were documented in 20 patients  11 patients were free of pain  
class6	2101	of the 20 patients who complained of chest pains  17  85 percent  demonstrated at least one episode of ppr  defined as a drop in distal esophageal ph to less than 4 within ten minutes before or after the onset chest pain  
class6	2101	episodes of asymptomatic ger were common  
class6	2101	the correlation of ppr with chest pain was 70 percent  37 53 episodes  and of ischemic ecg changes with chest pain 13 percent  7 53   in the remaining  there was no correlation with either  
class6	2101	two patients demonstrated simultaneous ppr and ischemic ecg changes  
class6	2101	seventeen esophageal motility abnormalities were observed in 14 patients  45 percent   
class6	2101	it is our conclusion that esophageal disorders contribute to chest pain in patients with documented cad  
class6	2101	in this group  ger plays a greater role than in those with normal coronary arteries  
class6	2101	in addition  esophageal motility disorders are common in these patients  
class6	2101	esophageal testing can be undertaken safely in these patients  
class6	2102	absorption and motility of the bypassed human ileum  
class6	2102	the authors assessed absorption and motility of the human ileum after a prolonged period of disuse  
class6	2102	in eight patients with ulcerative colitis  a manometric catheter assembly was placed via the ileostomy into the unused portion of distal ileum two months after ileal pouch anal anastomosis and temporary diverting loop ileostomy  
class6	2102	the distal ileum was perfused at 5 ml min with an isosmotic solution of either sodium chloride or ileal chyme diluted with sodium chloride for three hours before and three hours after a meal on two consecutive days  
class6	2102	absorption was measured  single and clustered pressure waves were identified and quantitated with the aid of a computer program  and a motility index was calculated  
class6	2102	mean absorption     s e m  
class6	2102	of both perfusates was poor on day 1   10     2 ml 25 cm x 30 min   and the meal induced no ileal motor response  
class6	2102	by day 2  however  absorption of both perfusates was much improved   1     2 ml 25 cm x 30 min  p less than 0 05   and the number of discrete clustered contractions and the motility index now clearly increased after the meal  2 6     0 6 vs  
class6	2102	7 2     1 0 clustered waves hr  7 5     0 5 vs  
class6	2102	9 7     0 2 motility units 30 min  p less than 0 05   
class6	2102	the conclusion was that absorption and motility of the human ileum were impaired after two months of disuse  but that ileal absorption and motility improved one day after the introduction of isosmotic ileal perfusates  
class6	2103	the freckle sign  an endoscopic feature of the cecum  
class6	2103	mucosal spots  or  freckles   surrounding the appendiceal orifice are an endoscopic feature of the cecum  
class6	2103	these are clusters of 1 to 2 mm round or oval slightly raised spots  each with a pale center and an erythematous border  
class6	2103	they correlate microscopically with subepithelial and submucosal lymphoid follicles  
class6	2103	the freckling pattern  identified in about one third of colonoscopies  was seen best with the videoendoscope and was identified more commonly in patients with systemic illness  
class6	2103	recognition of mucosal freckling around the appendiceal orifice helps identify the cecum and may be useful in the evaluation of cecal and appendiceal pathology  
class6	2104	the starved colon  diminished mucosal nutrition  diminished absorption  and colitis  
class6	2104	nutrition of colonic epithelial cells is mainly from short chain fatty acids  scfas  produced by bacterial fermentation in the colonic lumen  
class6	2104	n butyrate contributes more carbon of oxidation to epithelial cells than glucose or glutamine from the vasculature  
class6	2104	incomplete starvation of colonic epithelial cells through lack of luminal scfas leads  in the short term  to mucosal hypoplasia with either diminished absorption or diarrhea  
class6	2104	a chronic lack of scfas or complete organ starvation in conjunction with other factors leads to nutritional colitis  either  diversion colitis  or  starvation colitis   whether predominantly diarrhea or colitis develops in mucosal malnutrition appears to depend upon the severity and duration of starvation  
class6	2104	ulcerative colitis may be classified as a nutritional colitis in that colonic epithelial cells are unable to utilize scfas reflecting epithelial starvation despite abundant scfas  
class6	2105	crohn s disease and pregnancy  
class6	2105	seventy eight pregnancies in 50 patients were reviewed to evaluate the effects of crohn s disease on the outcome of pregnancy and the influence of the pregnancy on the course of crohn s disease  
class6	2105	overall  21 pregnancies  27 percent  had abnormal outcomes including spontaneous abortions  9   infants small for gestational age  6   premature infants  5   and infants who developed respiratory distress  1   
class6	2105	eight  50 percent  patients with active disease compared with 13  21 percent  patients with inactive disease at conception had abnormal outcomes  p less than 0 05   
class6	2105	during pregnancy 15  55 percent  with active disease and 6  12 percent  with inactive disease had an abnormal outcome  p less than 0 001   
class6	2105	neither medical nor surgical treatment  independent of disease activity  appeared to affect the outcome adversely  
class6	2105	eighteen of 73  25 percent  patients with quiescent or mild disease relapsed  and seven of 16 patients with some disease activity improved  44 percent   
class6	2105	of 34 patients on medication  nine relapsed  27 percent   and of 39 patients not on medication  nine relapsed  24 percent   p   n s    
class6	2105	these results suggest that the outcome of pregnancy is not adversely affected by crohn s disease  
class6	2105	however  patients with active disease at conception and or during the pregnancy have poorer outcomes independent of the use of medication or requirement of surgery  
class6	2105	neither pregnancy nor medications taken affect the course of the disease  
class6	2106	short term chemoprophylaxis with ceftizoxime vs  five day aminoglycoside with metronidazole in  contaminated  lower gastrointestinal surgery  
class6	2106	in a prospective  open  randomized controlled trial  173 patients requiring surgery for potentially  contaminated  lower gastrointestinal surgery were allocated to receive either two doses of ceftizoxime  2 gm  with one dose of metronidazole  1 5 gm  or gentamicin 3 mg kg day for five days with one dose of metronidazole  1 5 gm   
class6	2106	eighty nine patients received ceftizoxime and 84 patients received gentamicin  
class6	2106	the groups were comparable with respect to diagnosis  procedure  type of anastomosis  and wound closure  
class6	2106	the incidence of withdrawal due to failure to respond to the study drug  11 5 percent  was equivalent in the two groups  
class6	2106	there was no difference in the overall incidence of postsurgical infection between the ceftizoxime and metronidazole group  22 2 percent  and the gentamicin and metronidazole group  25 7 percent   
class6	2106	the incidence of wound infection  ceftizoxime and metronidazole  6 9 percent  gentamicin and metronidazole  10 percent  and deep sepsis  ceftizoxime and metronidazole  15 3 percent  gentamicin and metronidazole  15 7 percent  was similar  
class6	2107	gastrointestinal tuberculosis  report of four cases  
class6	2107	gastrointestinal tuberculosis is a rare disease in the united states  
class6	2107	correct identification is often delayed because it is not considered early on in the differential diagnosis  
class6	2107	four patients with gastrointestinal tuberculosis and the symptoms  diagnosis  complications  and treatment of the disease are discussed  
class6	2107	gastrointestinal tuberculosis should be considered in asian immigrant patients who present with symptoms and signs of inflammatory bowel disease  
class6	2108	scintigraphic measurement of oropharyngeal transit in man  
class6	2108	scintigraphic studies of the oropharyngeal transit of a liquid bolus were performed in 15 healthy controls  12 patients with symptoms of oral pharyngeal dysphagia  and 13 patients with neuromuscular disease  who did not have dysphagia  
class6	2108	gamma camera imaging of the head  neck  and upper thorax was undertaken  in the lateral projection  during the swallowing of the radiolabeled bolus of water  
class6	2108	inspection of summed images permitted the selection of regions of interest  roi  to represent the mouth  pharynx  and upper esophagus  
class6	2108	transit times between each roi were calculated and compared  
class6	2108	significant prolongation of bolus transit time between the mouth and esophagus was present in both patients with and without dysphagia  0 59     0 38 sec and 0 33     0 7 sec  mean     sd  respectively  compared with controls  0 26     0 04 sec p less than 0 001  p less than 0 01  respectively  mann whitney u test   
class6	2108	repeat studies in 25 individuals indicated that the transit measurements were more reproducible between swallows in normal subjects than in patients with symptoms  
class6	2108	deglutitive scintigraphy provides a noninvasive technique for the quantitative study of swallowing and its disorders  
class6	2109	effects of milk  prostaglandin  and antacid on experimentally induced duodenitis in the rat  use of myeloperoxidase as an index of inflammation  
class6	2109	ulcerogenesis of the duodenal mucosa frequently involves an inflammatory reaction with infiltration of leukocytes  
class6	2109	measurement of neutrophil myeloperoxidase activity might thus be a sensitive indicator of damage  before visible lesions occur  
class6	2109	to test this possibility  a rat model for duodenal injury was used where fasted animals were treated with indomethacin and histamine dihcl  
class6	2109	twenty four hours after indomethacin treatment  duodenal tissues were collected for histochemical staining and biochemical assay for myeloperoxidase activity  
class6	2109	indomethacin  and histamine challenged rats had significantly elevated myeloperoxidase activity compared to unchallenged controls  p less than 0 05  for both histochemistry and biochemistry  
class6	2109	there was also a significant correlation between these two parameters  r   0 68  p less than 0 001   
class6	2109	the duodenal injury model then was used to test the effectiveness of known gastric protective agents  
class6	2109	results indicated that milk and buttermilk did not aggravate or protect against duodenal injury  while antacid and prostaglandin did significantly protect against inflammation  p less than 0 02   
class6	2109	we concluded that measurement of myeloperoxidase activity is a sensitive and potentially useful estimate of duodenal injury that can be valuable in assessing ulcerogenesis and healing  
class6	2110	gastric dysrhythmias following pylorus preserving pancreaticoduodenectomy  possible mechanism for early delayed gastric emptying  
class6	2110	transient delayed gastric emptying is reported as a frequent complication following pancreas preserving pancreaticoduodenectomy  ppw   
class6	2110	we placed serosal electrodes on the stomach of a patient undergoing ppw  
class6	2110	myoelectric recordings were obtained postoperatively and correlated with simultaneous radionuclide liquid gastric emptying studies  
class6	2110	the patient developed early postoperative gastric atony  associated with frequent gastric dysrhythmias  
class6	2110	these dysrhythmias may have been exacerbated by a perihepatic abscess  
class6	2110	the gastric dysrhythmias correlated with alterations in liquid gastric emptying  
class6	2110	gastric dysrhythmias may be a mechanism for gastric dysfunction in the early postoperative period  
class6	2111	sterol dependence of gastric protective activity of unsaturated phospholipids  
class6	2111	the major aim of this study was to investigate the gastric protective effect of unsaturated phospholipids and to determine the ability of neutral lipids to enhance this activity  
class6	2111	we found that although a liposomal suspension of unsaturated phosphatidylcholine  pc  administered intragastrically failed to protect rats from acid induced gastric ulcer formation  addition of cholesterol to unsaturated pc induced a dose dependent protective response with the maximally effective dose  reducing lesion score greater than 70   
class6	2111	this effect also was seen with the plant sterol  beta sitosterol  reducing lesion score by 81 6     36   but was blocked if cholesterol was esterified to fatty acids of varying chain length  
class6	2111	addition of sterols to liposomes of saturated dipalmitoylphosphatidylcholine  in contrast  attenuated the gastric protective action of the saturated pc  
class6	2111	it appears that the protective mechanism elicited by sterols and unsaturated pc is not mediated by alterations in gastric emptying rate or prostaglandin biosynthesis  although maintenance of surface hydrophobicity may be involved  
class6	2111	these results suggest that the sterol may promote the packing of adjacent unsaturated phospholipid molecules of either the cell membrane or a putative extracellular hydrophobic lining of the gastric epithelium to provide the mucosa with protection against luminal acid  
class6	2112	gastric lesions secondary to long distance running  
class6	2112	gastrointestinal disorders have been reported during long distance running  
class6	2112	the purpose of this study was to evaluate the effects of prolonged exercise on the upper digestive tract  
class6	2112	seven subjects were submitted to a standard endoscopic examination of the upper digestive tract before and after long distance running  range 18 50 km   
class6	2112	mucosal biopsy specimens were taken during all endoscopies  
class6	2112	after running  all runners had histologically pathological features in the stomach  
class6	2112	vascular lesions were present in the chorion in six subjects after running  with the intensity of the lesions ranging from congestion to hemorrhage  
class6	2112	postexercise histological examination also showed a decrease in mucosal secretion  
class6	2112	these lesions secondary to prolonged exercise indicate the presence of hemodynamic perturbations in the upper digestive tract  
class6	2113	outpatient health care utilization of patients with inflammatory bowel disease  
class6	2113	on the basis of the normal life expectancy of inflammatory bowel disease patients  the early onset of their disease  and the variety of symptoms  inflammatory bowel disease patients were anticipated to be frequent users of outpatients services  
class6	2113	this study assesses  1  the characteristics   2  outpatient health care utilization  and  3  the degree of satisfaction with health care of inflammatory bowel disease patients compared to patients with other gastrointestinal disease  
class6	2113	the study method was a secondary analysis of data collected on 395 patients attending the university of calgary gastroenterology outpatient clinic in 1988  
class6	2113	inflammatory bowel disease patients were significantly younger  p less than 0 001  and better educated  p less than 0 05  than other patients  
class6	2113	during the past year inflammatory bowel disease patients consulted significantly more often with their gastroenterologist  p less than 0 001  and spent more time in hospital  p less than 0 05  than other patients  
class6	2113	inflammatory bowel disease patients also consulted more frequently with herbalists and naturopaths  
class6	2113	lastly  inflammatory bowel disease patients were as satisfied with the health care they received as other patients  
class6	2113	these results provide information useful for health care planners as well as for those dealing directly with inflammatory bowel disease patients  
class6	2114	irritable bowel syndrome in women having diagnostic laparoscopy or hysterectomy  relation to gynecologic features and outcome  
class6	2114	we identified irritable bowel syndrome  ibs  in 47 7  of 86 women having diagnostic laparoscopy for chronic pelvic pain  39 5  of 172 women having elective hysterectomy  and 32 0  of 172 controls age matched for the hysterectomy group  p   ns   
class6	2114	constipation and pain subtype ibs were more common in hysterectomy patients than controls  p less than 0 05   
class6	2114	in laparoscopy patients  dyspareunia was more common in those with ibs than in those without it  p less than 0 05   
class6	2114	in the hysterectomy group  more ibs patients had chronic pelvic pain  p less than 0 005   and abnormal menses  p less than 0 01   
class6	2114	chronic pelvic pain was more frequently the only prehysterectomy diagnosis in ibs patients  p less than 0 05   and ibs was present more often when pain was a reason for hysterectomy  p less than 0 01   
class6	2114	one year after laparoscopy  ibs patients gave lower overall status ratings  p less than 0 01  and lower pain improvement ratings  p less than 0 05  than non ibs patients  
class6	2114	in women who had a hysterectomy for pain  there was less pain improvement one year later in those with the pain subtype of ibs than in non ibs patients  p less than 0 05   
class6	2114	ibs is associated with gynecologic symptoms and affects the symptomatic outcome of diagnostic laparoscopy and hysterectomy  
class6	2115	investigation of mode of action of biofeedback in treatment of fecal incontinence  
class6	2115	a study was carried out in 25 incontinent patients to evaluate some of the factors thought to be responsible for the success of retraining for fecal incontinence  
class6	2115	subjects were initially allocated to one of two groups  one group was trained to perceive small rectal volumes  active retraining   the other group carried out the same maneuvers but were not given any information or instruction  
class6	2115	active sensory retraining reduced the sensory threshold from 32     8 to 7     2 ml  p less than 0 001   corrected any sensory delay that was present  p less than 0 004   and reduced the frequency of incontinence from 5     1 to 1     1 episodes per week  p less than 0 01   
class6	2115	sham retraining caused a modest reduction in the sensory threshold  from 29     9 to 20     8  p less than 0 05  but did not significantly reduce the frequency of incontinence  
class6	2115	subsequent strength and coordination training did not significantly improve continence  although at the end of the study  50  of patients had no incontinent episodes at all and 76  of patients had reduced the frequency of incontinence episodes by more than 75   
class6	2115	this improvement in continence was not associated with any change in sphincter pressures or in the continence to rectally infused saline but was associated with significant improvements in rectal sensation  
class6	2115	the functional improvement was sustained over a period of two years in 16 of the 22 patients available for follow up  
class6	2115	in conclusion  the results support the use of retraining in the management of fecal incontinence and suggest that retraining may work by enhancing rectal sensitivity and instilling confidence  
class6	2116	analysis of 24 hour esophageal pressure and ph data in unselected patients with noncardiac chest pain  
class6	2116	fourty four unselected patients with noncardiac chest pain were studied using conventional manometry with additional edrophonium provocation and 24 hour ambulatory esophageal ph and pressure recording with a system developed by our group  
class6	2116	new  fully automated techniques of statistical analysis of the complete set of esophageal pressure and ph signals were used to examine the temporal relation between pain  esophageal motility disturbances  and gastroesophageal reflux  
class6	2116	the analysis used the 97 5th percentile of amplitude and duration of all esophageal contractions in each patient as well as a chi 2 test of the distribution of contraction types to determine whether a pain episode was related to abnormal motility or not  
class6	2116	the edrophonium test results were positive in 2 patients  
class6	2116	only 25 patients  56 8   had at least one pain episode  total  111 episodes  during 24 hour recording  
class6	2116	thirty three percent of the pain episodes were related to reflux and 23 4  to abnormal motility  and 43 2  were not related to an esophageal function disturbance  
class6	2116	in the patient oriented analysis in this study  it was required for a positive correlation that the symptom index  percentage of related pain episodes  was higher than 75   
class6	2116	it was found that the pain was related to reflux in 2 patients  4 6    to reflux and motor abnormalities in 4  9 2    and to motor abnormalities in 2 patients  4 6    
class6	2116	in 36 patients  81 8    no relation with an esophageal abnormality could be established  either because the patients had no pain during the 24 hour study  or because the pain seemed unrelated to reflux or abnormal motility  
class6	2117	phospholipids from rat  human  and canine gastric mucosa  composition and metabolism of molecular classes of phosphatidylcholine  
class6	2117	to validate a recent proposal that a phospholipid lining with a high content of dipalmitoylphosphatidylcholine may protect gastric mucosa against luminal acid  it was decided to study composition and metabolism of phospholipids in the gastric mucosa  
class6	2117	phospholipids were analyzed in rat  human  and dog gastric mucosal surface tissue and in a chloroform methanol lavage of rat and canine stomach  
class6	2117	phosphatidylcholine and phosphatidylethanolamine were the main components  
class6	2117	saturated fatty acids were almost exclusively esterified at the sn 1 position of the glycerol moiety of phosphatidylcholine  and unsaturated fatty acids mainly at the sn 2 position  
class6	2117	the disaturated class of phosphatidylcholine comprised 2  6  of total phosphatidylcholine  
class6	2117	precursors of phosphatidylcholine  i e    32p orthophosphate and  methyl 14c choline  were preferentially incorporated into the disaturated molecular class 0 5 6 hours after iv administration  
class6	2117	it can be speculated that disaturated phosphatidylcholine  although quantitatively a minor component  is specifically triggered in mucosal renewal processes  
class6	2118	multipolar electrocoagulation versus injection therapy in the treatment of bleeding peptic ulcers  a prospective  randomized trial  
class6	2118	this study prospectively compares multipolar electrocoagulation and injection therapy in high risk patients with bleeding ulcers  
class6	2118	patients were considered for entry if they had a bloody nasogastric aspirate  melena  or hematochezia and unstable vital signs  transfusion of greater than or equal to 2 u of blood in 12 hours  or a decrease in hematocrit of greater than or equal to 6  in 12 hours  
class6	2118	sixty patients with endoscopic evidence of an ulcer with active bleeding  n   26  or a nonbleeding visible vessel  n   34  were randomly assigned to receive multipolar electrocoagulation or injection with absolute ethanol  
class6	2118	hemostasis was achieved in 14 of 14 actively bleeding patients with multipolar electrocoagulation vs  
class6	2118	10 of 12  83   treated with injection  
class6	2118	no significant differences were observed between electrocoagulation and injection therapy in any parameter assessed during the hospitalization  incidence of further bleeding  6  vs  
class6	2118	10    units of blood transfused after treatment  1 8     0 6 vs  
class6	2118	1 3     0 4   incidence of surgery for bleeding  6  vs  
class6	2118	7    length of hospital stay in days  5 8     0 9 vs  
class6	2118	7 2     2 5   cost of hospitalization   7160      1630 vs  
class6	2118	 8520      2960   or mortality rate  3  vs  
class6	2118	3    
class6	2118	treatment induced bleeding in nonbleeding visible vessels in 35  of subjects in each group  but this was controlled with continued treatment in all patients  
class6	2118	one delayed perforation occurred 9 days after multipolar electrocoagulation  
class6	2118	multipolar electrocoagulation and injection therapy are of comparable efficacy in the treatment of patients with clinical evidence of a major upper gastrointestinal bleed and endoscopic evidence of an ulcer with active bleeding or a nonbleeding visible vessel  
class6	2119	evolution of fundic argyrophil cell hyperplasia in nonantral atrophic gastritis  
class6	2119	fundic argyrophil cells were studied for a mean period of 68 7 months  range  11 170  in 18 patients with fundic atrophic gastritis and achlorhydria  
class6	2119	initially  12 patients had hyperplasia of the argyrophil cells  the severity of which was assessed using a semiquantitative classification based on the number of argyrophil clusters per square millimeter  
class6	2119	at the end of the study  the degree of hyperplasia was unchanged in 9 patients  had decreased in 2  and had increased in 1  no significant increase in the number of argyrophil clusters  precarcinoid changes  or carcinoid tumors were observed and the high level of gastrinemia  mean  4 8  range  1 9 8 1  times the upper limit for normal  did not change significantly  
class6	2119	of the 6 patients with no hyperplasia at the outset of the study  4 continued without hyperplasia and 2 presented a low grade hyperplasia at the 20th and 130th month  
class6	2119	gastrinemia increased significantly in the last patient and stayed normal in the other 5  
class6	2119	this study argues in favor of the stable appearance of fundic argyrophil cells in patients with atrophic gastritis and stable gastrinemia  
class6	2120	a small animal model of human helicobacter pylori active chronic gastritis  
class6	2120	isolation of a spiral shaped bacterium closely related to helicobacter pylori from the cat stomach made it possible to investigate new small animal models of gastric infection  
class6	2120	pure cultures of this bacterium  provisionally named  helicobacter felis   were fed to germ free mice  
class6	2120	the organism colonized the stomach in large numbers in mucus and deep in the gastric pits and showed the same gastric trophism found with h  
class6	2120	pylori  
class6	2120	significant histopathology was seen in all h  
class6	2120	felis infected mice  
class6	2120	at 2 weeks postinfection  an acute inflammatory response was seen composed primarily of eosinophils and neutrophils  
class6	2120	at 3 weeks  the polymorphonuclear response was more pronounced with large numbers of neutrophils in some areas forming small microabscesses  
class6	2120	lymphocytes also increased in number  
class6	2120	by 8 weeks  several relatively large lymphoid nodules were present in the submucosa  
class6	2120	multiple small microabscesses were still present in the pyloric mucosa  
class6	2120	this is the first animal model of bacterial gastritis to be described that shows progression from acute inflammation to persistent acute on chronic inflammation  active chronic  as is seen in human infection with h  
class6	2120	pylori  
class6	2121	a comparison in vitro of human and rabbit distal colonic muscle responses to inflammatory mediators  
class6	2121	the present study compared in vitro the motor responses of human and rabbit distal colonic longitudinal and circular muscle to acetylcholine  histamine  leukotrienes b4 and d4  and prostaglandins e2 and f2 alpha  
class6	2121	the active and passive mechanical properties of these muscles were also evaluated  
class6	2121	all muscle types were contracted by acetylcholine and histamine  
class6	2121	longitudinal muscle from both species was contracted by prostaglandin e2 and prostaglandin f2 alpha  although rabbit muscle was more sensitive  
class6	2121	prostaglandin e2 relaxed the majority of both human and rabbit circular muscle preparations that were studied  
class6	2121	prostaglandin f2 alpha first relaxed and then contracted circular muscle from both species  
class6	2121	leukotriene b4 had no effect on any tissue studied  
class6	2121	leukotriene d4 caused transient relaxations in a proportion of all muscle types  but the relaxations were not concentration related  
class6	2121	contractile responses did not differ under isotonic recording conditions  but relaxations were much more clearly defined  
class6	2121	based on experiments using atropine  phentolamine and propranolol  and pyrilamine or tetrodotoxin  it was concluded that the responses of both human and rabbit distal colonic muscles to these inflammatory mediators have a similar pharmacological basis  
class6	2121	all muscle types exhibited low passive tension and developed active tension in the range 0 8 1 2 lo  
class6	2121	these data strongly support the belief that after the onset of an induced colitis  the rabbit colon has value as a predictive model for the study of inflammatory mediator induced colonic motility changes in humans  
class6	2122	long term 6 mercaptopurine treatment in adolescents with crohn s disease 
class6	2122	although 6 mercaptopurine is often used to treat adolescents with intractable crohn s disease  its long term efficacy has not yet been studied in this population  
class6	2122	this study shows data derived from 36 adolescents  mean age     sd  16 5     3 3 years  27 males  9 females  treated at least 6 months with 6 mercaptopurine  1 5 mg kg 1 day 1  maximum of 75 mg day   
class6	2122	sites of crohn s disease at the start of 6 mercaptopurine therapy included 17 ileocolic  9 pancolic  7 small bowel  and 3 partial colon  
class6	2122	all had received corticosteroids  sulfasalazine  antibiotics  and nutritional support for 5 0     3 0 years before administering 6 mercaptopurine  but intractable symptoms persisted  
class6	2122	disease activity lessened during the first year of 6 mercaptopurine  reflected by a higher lloyd still disease activity score  pre  64     9 vs  
class6	2122	6 mercaptopurine  72     11  p less than 0 0001   
class6	2122	general activity  physical examination  nutrition  and laboratory subscores all improved  p less than 0 004   
class6	2122	lessened disease activity occurred despite concomitant decrease in duration of prednisone use  pre  9 5     4 2 vs  
class6	2122	6 mercaptopurine  6 6     4 9 months year  p less than 0 001  and cumulative annual prednisone exposure  pre  3672     2106 vs  
class6	2122	6 mercaptopurine  1964     1460 mg  p less than 0 0007   
class6	2122	the frequency of perianal fistulae and abscesses also decreased  p less than 0 01  during treatment  
class6	2122	annual rates of hospitalization decreased in 44  of subjects during 6 mercaptopurine treatment  while increasing in only 22   
class6	2122	follow up beyond 1 year of 6 mercaptopurine treatment showed continued remission in 23 of 30 subjects  
class6	2122	no serious complications were seen  
class6	2122	6 mercaptopurine is an effective long term therapy for adolescents with intractable crohn s disease  
class6	2122	while inducing remission  it also has a significant steroid sparing effect which may be of particular benefit to this population  
class6	2123	anorectal function in incontinent patients with cerebrospinal disease  
class6	2123	anorectal manometry and the electrical activity of the external anal sphincter were measured in 20 patients with well defined  incomplete spinal lesions who were referred because of fecal incontinence and in 30 normal subjects  
class6	2123	six patients had a high spinal lesion  11 had a low spinal lesion  and 3 had mixed high and low spinal lesions  
class6	2123	patients with high spinal lesions had normal basal pressures but abnormally low squeeze pressures and impaired rectal sensation  
class6	2123	unlike normal subjects  there was no relationship between the depth of sphincter relaxation and the distention volumes  
class6	2123	the external sphincter responses to rectal distention and increases in intraabdominal pressure were enhanced  and leakage of perfusion fluid was uncommon  
class6	2123	patients with low spinal lesions had abnormally low basal and squeeze pressures  blunted rectal sensation  and showed impaired external anal sphincter responses to rectal distention or increases in intraabdominal pressures  
class6	2123	most of these patients leaked the infused fluid during these maneuvers  
class6	2123	sphincter function in patients with mixed lesions was more severely impaired than in patients with low and high spinal lesions  
class6	2123	patients with mixed lesions showed abnormally low basal and squeeze pressures  impaired rectal sensation  and no external anal sphincter responses to either rectal distention or increases in intraabdominal pressure  
class6	2123	leakage occurred during these maneuvers in all patients with mixed lesions  
class6	2124	alpha 1 antitrypsin excretion in stool in normal subjects and in patients with gastrointestinal disorders  
class6	2124	fecal clearance of plasma alpha 1 antitrypsin is used as a measure of protein leakage into the intestinal tract  
class6	2124	in this study  the alpha 1 antitrypsin concentration in stool and the plasma clearance of alpha 1 antitrypsin in normal subjects and in a consecutive series of patients with chronic diarrhea  malabsorption  or unexplained hypoalbuminemia was determined  
class6	2124	the normal subjects were studied in their usual state and also when they had diarrhea secondary to ingestion of lactulose  sorbitol  sodium sulfate  or phenolphthalein  
class6	2124	the study first concluded that induced diarrhea can cause an increase in alpha 1 antitrypsin clearance  if this is not considered in establishing normal values  there may be an overdiagnosis of excess protein leakage in patients with diarrhea  
class6	2124	second  there is a highly significant statistical correlation  p less than 0 001  between alpha 1 antitrypsin clearance and serum albumin concentration  
class6	2124	on average  the serum albumin falls below 3 0 g dl  30 g l  when the alpha 1 antitrypsin clearance exceeds 180 ml day  a value that is about threefold higher than the upper limit of normal  
class6	2124	third  three of nine patients with microscopic collagenous colitis had elevated clearance of alpha 1 antitrypsin  by contrast  abnormal alpha 1 antitrypsin clearance was not found in 23 patients with idiopathic secretory diarrhea  
class6	2124	fourth  fecal alpha 1 antitrypsin concentration is not a reliable index of abnormal alpha 1 antitrypsin clearance  
class6	2125	randomized  double blind  placebo controlled trial of somatostatin for variceal bleeding  emergency control and prevention of early variceal rebleeding  
class6	2125	a randomized  double blind  placebo controlled trial of somatostatin was conducted among 120 patients admitted for bleeding esophageal varices  59 placebo  61 somatostatin   
class6	2125	an initial 250 micrograms bolus of somatostatin followed by a 5 day continuous infusion of 250 micrograms h and an identical administration of placebo were evaluated for both the control of bleeding and prevention of early rebleeding from varices  
class6	2125	failure to control bleeding occurred in 22  36   somatostatin patients vs  
class6	2125	35  59   placebo patients  with time to failure occurring earlier with placebo  p   0 036   
class6	2125	blood and plasma transfused per hour during drug infusion of trial drug was reduced in the somatostatin group  median 0 033 vs  
class6	2125	0 105 unit h  p   0 025   
class6	2125	use of balloon tamponade was halved in somatostatin treated patients  
class6	2125	the average effect of somatostatin was a 41  reduction in the hazard of failure  95  confidence interval   1  to 65   p   0 0545  after adjustment for the severity of liver disease  which was the only other variable having a significant influence on time to failure  
class6	2125	there was no difference in 30 day mortality per admission  7 placebo  9 somatostatin  or complications  
class6	2125	it is concluded that somatostatin is safe and more effective than placebo for the control of variceal bleeding  
class6	2126	hemodynamic events in a prospective randomized trial of propranolol versus placebo in the prevention of a first variceal hemorrhage  
class6	2126	in a double blind randomized trial  the hemodynamic events following the administration of propranolol  n   51  or a placebo  n   51  were prospectively studied in cirrhotic patients with esophageal varices  
class6	2126	the hepatic venous pressure gradient  heart rate  and variceal size were determined at the baseline and 3  12  and 24 months after the beginning of therapy  
class6	2126	baseline values were similar in both groups  
class6	2126	at 3 months  the hepatic venous pressure gradient decreased significantly in propranolol treated patients  from 18 1     4 2 to 15 7     3 4 mm hg  p less than 0 05  but not in patients receiving the placebo  19 6     6 8 to 17 5     5 3 mm hg  ns   
class6	2126	at subsequent time intervals this gradient decreased significantly from the baseline value in both groups  
class6	2126	heart rate decreased significantly in the propranolol treated group at all times  p less than 0 001   
class6	2126	variceal hemorrhage occurred in 13 patients  11 placebo   2 propranolol treated  p less than 0 01   all of whom had a hepatic venous pressure gradient greater than 12 mm hg  
class6	2126	in 21 patients  14 propranolol   7 placebo treated  the hepatic venous pressure gradient decreased to less than or equal to 12 mm hg  none of them bled from esophageal varices  and their mortality rate also decreased  
class6	2126	because most of the bleeding events occurred during the first year  10 placebo   1 propranolol treated  p less than 0 01   propranolol seems to have its protective effect during the period associated with the largest reduction in the hepatic venous pressure gradient  
class6	2126	because a reduction in the hepatic venous pressure gradient to less than 12 mm hg protects from variceal bleeding and increases the rate of survival  this should be the aim of the pharmacological therapy of portal hypertension  
class6	2127	effect of weight reduction on hepatic abnormalities in overweight patients  
class6	2127	the effects of weight reduction on hepatic test results and physical findings related to the liver were retrospectively evaluated in 39 overweight patients screened to exclude other factors affecting the liver  
class6	2127	an additional 11 overweight patients with primary liver disease were retrospectively evaluated to compare the effect of weight reduction in patients with liver disease with its effect in those without primary liver disease  
class6	2127	this study showed that in overweight adults without primary liver disease  a weight reduction of greater than or equal to 10  corrected abnormal hepatic test results  decreased hepatosplenomegaly  and resolved some stigmata of liver disease  
class6	2127	in similarly studied overweight patients with primary liver disease  some findings improved  but the changes did not correlate with a greater than or equal to 10  weight loss  
class6	2127	increased alanine aminotransferase activity was the most frequent hepatic enzyme abnormality in this population  
class6	2127	for every 1  reduction in body weight  alanine aminotransferase activity improved by 8 1   
class6	2127	after other causes of liver disease are eliminated by clinical and biochemical parameters  weight reduction should be tried for overweight patients with abnormal hepatic test results in the absence of obvious primary liver disease as judged by clinical and biochemical parameters before extensive and expensive studies are undertaken  
class6	2128	immunochemical characterization and quantitative distribution of pancreatic stone protein in sera and pancreatic secretions in pancreatic disorders  
class6	2128	a fluorometric immunoassay has been established to quantitate pancreatic stone protein providing a sensitivity for concentrations from 0 015 to 0 5 micrograms ml  
class6	2128	when concentrations of pancreatic stone protein were determined from pancreatic secretions obtained either from patients suffering from chronic pancreatitis  n   31   including the calcifying forms  n   10    pancreatic cancer  n   22   or nonpancreatic diseases  n   17   no significant differences were found  
class6	2128	in contrast  increased concentrations were found in serum samples from patients with chronic  39 66  and acute pancreatitis  16 20  compared with control patients  
class6	2128	the differences between these diagnostic groups and controls were highly significant  p less than 0 0001  and independent of pancreatic enzyme activity  
class6	2128	immunochemical analyses of serum pancreatic stone protein showed an isoelectric point  ph 9  similar to that reported for the pancreatic thread protein  
class6	2128	with respect to recent communications  these data do not support the etiopathogenic role postulated for pancreatic stone protein in chronic pancreatitis and chronic calcifying pancreatitis by other investigators  
class6	2129	piezoelectric lithotripsy  stone disintegration and follow up results in patients with symptomatic gallbladder stones  
class6	2129	one hundred symptomatic patients with radiolucent gallbladder stones were treated with a new piezoelectric lithotripter and oral chemolitholytic agents  
class6	2129	stone disintegration was achieved in 99 of these patients  99   with a mean      sd  maximum fragment size of 5 1     4 1 mm  
class6	2129	significant differences were found when the mean      sd  fragment sizes of single stones less than or equal to 20 mm  4 2     2 5 mm  were compared with those of single stones greater than 20 mm  5 8     3 4 mm  p less than 0 05  and multiple stones  6 2     3 8 mm  p less than 0 05   respectively  
class6	2129	none of the patients required anesthesia  analgesics  or sedatives before or during the treatment  
class6	2129	the stone free rates for all patients followed up for up to 4 12 months  mean     sd  10 7     2 9 months  were 18   1 month   25   2 months   38   4 months   52   8 months   and 67   12 months   
class6	2129	partly significant differences were obtained in stone free rates for single stones  less than or equal to 20 mm  compared with larger stones  greater than 20 mm  and multiple stones  p less than 0 05   respectively  
class6	2129	serious adverse reactions  i e   cholestasis and pancreatitis  were observed in only 3 patients  3    
class6	2129	these conditions were induced by fragment impaction in the common bile duct  
class6	2129	in 2 of these patients  endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy was required  
class6	2129	it is concluded that piezoelectrically generated shock waves are suitable for the effective and safe disintegration of gallbladder stones in humans  
class6	2129	the anesthesia free and analgesia free shock wave application opens up the possibility to perform biliary lithotripsy as an outpatient procedure  
class6	2129	the stone free rate achieved in combination with oral bile acids is most promising for single stones  less than or equal to 20 mm   
class6	2130	the effects of synthetic human secretin on calcium carbonate solubility in human bile 
class6	2130	this study sought to determine the effects of synthetic human secretin on ionized calcium and carbonate concentrations in human hepatic bile  
class6	2130	five patients with a nasobiliary drain in the right hepatic duct were studied  
class6	2130	three basal samples of bile were collected  each over a 15 minute period  
class6	2130	synthetic human secretin was then infused iv at 0 05 micrograms kg 1 h 1 for 45 minutes followed by 0 5 micrograms kg 1 h 1 for 45 minutes  
class6	2130	bile was sampled over 15 minute periods  
class6	2130	to document return to baseline conditions  two further samples of bile were obtained over 15 minute periods 2 hours after the infusion was terminated  
class6	2130	bile acid concentration was determined by an enzymatic method  ph and pco2 were measured with an automated analyzer  
class6	2130	total calcium was determined by inductively coupled plasma emission spectrometry and ionized calcium by an ion specific electrode  
class6	2130	bicarbonate and carbonate concentrations were calculated using henry s law and the henderson hasselbalch equation  
class6	2130	the fraction of bile sampled by the catheter was determined by indocyanin green recovery at the end of the experiment  
class6	2130	secretin caused an increase in bile flow and bicarbonate output  
class6	2130	bicarbonate concentrations increased from 26     3 mmol l to 41     3 mmol l  p less than 0 05   and chloride concentrations decreased  
class6	2130	mean bile acid concentrations declined significantly from 14 6     2 mmol l to 4 7     1 mmol l  p less than 0 05   
class6	2130	ionized calcium concentrations decreased from 0 7     0 005 mmol l to 0 5     0 02 mmol l  p less than 0 05  while ph increased significantly from 7 44     0 06 to 7 6     0 04  p less than 0 05   
class6	2130	carbonate concentrations increased significantly from 0 15     0 02 mmol l to 0 26     0 03 mmol l  and the ion product for calcium carbonate increased significantly from 0 099     0 002  mmol l 2 to 0 135     0 015  mmol l 2  p less than 0 05   
class6	2130	synthetic human secretin augments the ion product of calcium and carbonate in human hepatic bile  increasing the tendency for calcium carbonate precipitation  
class6	2131	in vivo assessment of shock wave pressures  implication for biliary lithotripsy  
class6	2131	during extracorporeal shock wave lithotripsy  the pressure profile  which is generated by the lithotriptor  determines the risk of tissue damage  
class6	2131	in the present study  the pressure distribution of a lithotriptor  lithostar  siemens a g   erlangen  federal republic of germany  was investigated in 10 pigs  five of which had gallstones surgically implanted into the gallbladder  
class6	2131	the in vivo values were compared with in vitro data  
class6	2131	measurements were carried out along the shock wave transmission path at the focus within the gallbladder  the adjacent liver  the diaphragmatic surface of the right lung  and the shock wave exit site from the skin  
class6	2131	interposition of ribs did not cause a significant decrease in focal positive pressure  
class6	2131	however  a gallstone positioned in the focus caused a 30  65  reduction in pressure  recorded immediately behind the stone  
class6	2131	pressures obtained in vivo were always 15  25  lower than those measured in vitro  
class6	2131	the spatial distributions of the positive pressure in vivo and in vitro were almost identical  
class6	2131	there was a high correlation between the pressures in vitro and in vivo  r   0 88  p less than or equal to 0 01   
class6	2131	this justifies assessment of shock wave energies generated during biliary lithotripsy by extrapolation of in vitro data  
class6	2131	it is concluded that it is possible to characterize different lithotriptors by in vitro pressure profile measurements  
class6	2132	endoscopic retrograde brush cytology  a new technique  
class6	2132	endoscopic retrograde cholangiopancreatography has been shown to be a very valuable adjunct in the diagnosis of malignancy involving the biliary and or pancreatic ductal system  
class6	2132	however  characteristic endoscopic retrograde cholangiopancreatography radiographic findings associated with malignant strictures are frequently not specific and cytological confirmation becomes essential for the diagnosis  
class6	2132	unfortunately  the current overall diagnostic yield of positive cytology in such circumstances ranges from 18  56  depending on the technique  
class6	2132	a new brush device has been designed which is uniquely adapted to pancreaticobiliary strictures of varying anatomical configurations  
class6	2132	this study shows results using this new cytology brush in a series of 53 patients with pancreaticobiliary malignancy  
class6	2132	a significant improvement in the cytological yield of tumor confirmation was obtained with a diagnostic sensitivity of 70  and specificity of 100  using the new brush technique  
class6	2133	bile duct emptying in response to fat  a validation study  
class6	2133	fatty meal sonography has been suggested to assess patients with biliary pain after cholecystectomy  but the effects of gallbladder removal on biliary dynamics has not been studied prospectively  
class6	2133	before elective cholecystectomy  25 patients had their common hepatic ducts  diameter measured by ultrasonography before and after a fat stimulus  
class6	2133	in 23  tests were repeated 1 month  1 year  and 5 years after surgery  
class6	2133	in preoperative studies  5 patients showed dilatation after fat and 2 of these had stones in the common bile duct  
class6	2133	however  another 4 patients with stones or sludge in the duct did not show dilatation  so that the response to fat was a poor indicator of patients requiring common bile duct exploration  
class6	2133	no patient had major symptoms after surgery  
class6	2133	at 1 month and 12 months  the response to fat was variable with more than half of those tested showing no decrease in duct size  
class6	2133	a more consistent pattern emerged at 5 years  when 14 of 18 patients tested showed a decrease in common hepatic duct after fat  3 were unchanged and 1 increased by 1 mm  
class6	2133	the response to fat was less consistent and more difficult to measure in the common bile duct  even 5 years after operation  
class6	2133	it was concluded that not all patients with indications for exploration of the common bile duct on operative cholangiography show a dilatation response to fat on preoperative testing  
class6	2133	also  fatty meal sonography should be used with caution because the response to fat in asymptomatic patients soon after operation is unpredictable  with occasional patients showing dilation without apparent obstruction  
class6	2133	measurement of common hepatic duct is preferred to common bile duct and increases in diameter of 1 mm are probably not significant  
class6	2134	pemoline associated hepatic injury  
class6	2134	among 100 cases of hepatic injury attributed to the administration of pemoline  43 had sufficient accompanying information to permit analysis  
class6	2134	all but two patients were less than 20 years old  and 80  were less than 12 years old  
class6	2134	males predominated the study  
class6	2134	injury appeared as early as 1 week or as late as greater than 1 year of taking the drug  
class6	2134	the injury was uniformly hepatocellular as judged by the high values for aminotransferases and by death in massive necrosis in one patient  
class6	2134	mechanism was judged to be idiosyncratic  and the idiosyncrasy was probably metabolic rather than immunologic  
class6	2135	endosonography of peri anal and peri colorectal fistula and or abscess in crohn s disease  
class6	2135	transcolorectal endosonography  es  was performed in 36 patients with crohn s disease suspected clinically to have a fistula or abscess  
class6	2135	a hypoechoic or anechoic duct like lesion immediately adjacent to the anorectal lumen compatible with a fistula was found in 32 patients  
class6	2135	a communication between the fistulous tract and adjacent structures such as the skin  anal canal  or vagina was detected in all 32 patients  
class6	2135	an anechoic cavity adjacent to or communicating with the fistula was visualized in 29 of the 36 patients  
class6	2135	a fistula was visualized in the remaining seven patients with no evidence of an abscess  
class6	2135	this anechoic cavity compatible with an abscess was surgically confirmed in 14 of 17 patients  
class6	2135	we judged the extent and configuration of the abnormalities to be more clearly visualized by es when results were compared with fistulography in five patients  
class6	2135	there were no es complications  and we conclude that es is the preferred diagnostic procedure in patients with peri rectal pathology because of the low risk of bacterial dissemination and low incidence of patient discomfort  
class6	2135	utilizing es after non surgical treatment was successful in 19 patients for documentation of the response to therapy  
class6	2136	mechanical lithotripsy of common duct stones  
class6	2136	over the past 8 years we have utilized various types of mechanical lithotriptors to crush common bile duct stones  
class6	2136	the procedure was performed in 93 patients with an overall success rate of 94   
class6	2136	however  because many accessories were in a developmental stage  entrapment of stones was not always possible on the first attempt  and the procedure was repeated in some patients a second or third time  
class6	2136	during the interim  while awaiting another attempt at lithotripsy  cholangitis was prevented by leaving a prosthesis in place  
class6	2136	a variety of lithotriptor models from different manufacturers have proven effective  
class6	2136	we recommend that endoscopists use these devices to rid the bile duct of retained stones  
class6	2137	endoscopic palliative intubation of the esophagus invaded by lung cancer  
class6	2137	thirty two patients with esophageal involvement by lung cancer were managed by endoscopic intubation  
class6	2137	in 22 patients with extrinsic esophageal strictures  the success rate of intubation was 91   and 82  were discharged with their dysphagia relieved and esophageal patency restored  
class6	2137	the mean survival rate was 4 4 months  
class6	2137	in 10 patients with esophago bronchial fistulas  3 had the fistulous tract obliterated and lived a mean of 5 months  
class6	2137	this low success rate of closing fistulas is due to failure to seal off the space between the stent and the fistula because of absence of tumor associated stenosis  
class6	2137	the overall morbidity rate was 28 1   18 8  perforation  6 3  hemorrhage  and 3 1  tracheal obstruction   
class6	2137	the overall mortality rate was 18 8   
class6	2137	although complications were more frequent than in primary esophageal tumors  endoscopic intubation was the only way to palliate this desperate condition and provided 66 6  of patients with relief of symptoms  nutritional improvement  and a mean survival time of 4 5 months  
class6	2138	endoscopic cholangiopancreatography in hepatic clonorchiasis  a follow up study  
class6	2138	cholangiographic changes of the biliary system in 16 patients with proven hepatic clonorchiasis  diagnosed by positive stool or bile ova isolates  were studied  
class6	2138	all patients presented with epigastric pain  
class6	2138	other symptoms included jaundice in 31   5 of 16  and fever in 12 5   2 of 16   
class6	2138	praziquantel given at 25 mg kg for three doses in 1 day were administered  
class6	2138	three consecutive stool tests were performed 3 months after treatment and were negative in 87 5   14 of 16   
class6	2138	ercp studies were repeated at a mean interval of 31 6 months  range  8 to 69 months   
class6	2138	measurements of the bile ducts on retrograde cholangiograms before and after treatment were compared using the paired student s t test  
class6	2138	filling defects and blunting of the terminal bile ducts seen on the initial cholangiogram  interpreted as the presence of adult worms  disappeared after treatment  
class6	2138	however  there was no significant change between pre  and post treatment measurement of bile duct caliber  
class6	2138	bile duct dilation  irregularities  and ductal proliferation persisted despite eradication of the parasite  
class6	2139	the role of ercp in children and adolescents  
class6	2139	the diagnostic and therapeutic role of ercp in 42 patients ranging from 1 to 19 years of age is discussed  
class6	2139	ercp provided useful additional information in 15 patients with biliary tract disease  15 patients with pancreatic disease  and 9 patients with abdominal pain  
class6	2139	the appropriate duct was cannulated in 95  of cases  
class6	2139	mild pancreatitis occurred in two patients after ercp  
class6	2139	endoscopic papillotomy was successful in five patients  
class6	2139	ercp plays an important part in the investigation of unexplained biliary tract and pancreatic disease  
class6	2139	it rarely demonstrates abnormal pathology in patients with otherwise unexplained abdominal pain  
class6	2140	can clinicians accurately assess esophageal dilation without fluoroscopy  
class6	2140	this study questioned whether clinicians could determine the success of esophageal dilation accurately without the aid of fluoroscopy  
class6	2140	twenty patients were enrolled with the diagnosis of distal esophageal stenosis  including benign peptic stricture  17   schatski s ring  2   and squamous cell carcinoma of the esophagus  1   
class6	2140	dilation attempts using only maloney dilators were monitored fluoroscopically by the principle investigator  the physician and patient being unaware of the findings  
class6	2140	physicians then predicted whether or not their dilations were successful  and they examined various features to determine their usefulness in predicting successful dilation  
class6	2140	they were able to predict successful dilation accurately in 97  of the cases studied  however  their predictions of unsuccessful dilation were correct only 60  of the time  
class6	2140	features helpful in predicting passage included easy passage of the dilator  98   and the patient feeling the dilator in the stomach  95    
class6	2140	excessive resistance suggesting unsuccessful passage was an unreliable feature and was often due to the dilator curling in the stomach  
class6	2140	when maloney dilators are used to dilate simple distal strictures  if the physician predicts successful passage  he is reliably accurate without the use of fluoroscopy  however  if unsuccessful passage is suspected  fluoroscopy must be used for confirmation  
class6	2141	endoscopic appearance and significance of functional lymphangiectasia of the duodenal mucosa  
class6	2141	intestinal lymphangiectasia is found in a wide variety of pathologic conditions  
class6	2141	functional lymphangiectasia has not been well characterized  
class6	2141	we report 20 patients followed for 9 to 55 months  mean 30 months  after incidental detection at endoscopy of lymphangiectasia  
class6	2141	our study indicates that functional lymphangiectasia is not pathologic and does not warrant repeat endoscopy in the absence of other clinical indications  
class6	2142	circulating antibodies against human colonic extract enriched with a 40 kda protein in patients with ulcerative colitis  
class6	2142	we have previously described a 40 kda colonic protein s  which is specifically recognised by tissue bound immunoglobulin g obtained from the colon of patients with ulcerative colitis  
class6	2142	we now report the presence of circulating antibodies against this antigen using an enzyme linked immunosorbent assay with a highly enriched preparation of the 40 kda protein from normal colon extracts  
class6	2142	serum was collected from 79 patients with ulcerative colitis  36 with crohn s disease  16 with specific diarrhoeal syndromes  and from 19 normal subjects  
class6	2142	twenty nine of 79 patients with ulcerative colitis  21 of 36 with crohn s disease  and all patients with diarrhoea were symptomatic during the collection of sera  
class6	2142	the difference in optical density values between patients with symptomatic ulcerative colitis and each of the other groups  including patients with ulcerative colitis in remission  was highly significant  p less than 0 01   
class6	2142	seventy nine per cent of patients with symptomatic ulcerative colitis had optical density values above the means for all other groups  
class6	2142	fifty five per cent of sera from patients with symptomatic ulcerative colitis had optical densities beyond two sds of the values for all other groups and only two of 71 sera from non ulcerative colitis patients  one crohn s disease and one normal subject  had values in this range  
class6	2142	these results show the presence of anti colon antibodies against the 40 kda protein s  in the sera of many patients with symptomatic ulcerative colitis  
class6	2143	effect of ulcerative colitis and smoking on rectal blood flow  
class6	2143	rectal blood flow was measured by laser doppler flowmetry over 60 minutes in eight patients with colitis in remission and eight healthy male non smokers  
class6	2143	ten smokers were also examined on two occasions  one of which included smoking a cigarette  
class6	2143	plasma nicotine concentrations were measured in smokers  
class6	2143	all subjects showed a pronounced fall in rectal blood flow in the first 30 minutes and patients with colitis had significantly higher values compared with smokers  p less than 0 002  p less than 0 04  and non smokers  p less than 0 007  p less than 0 002  during the first and second 30 minutes respectively  
class6	2143	values in smokers and non smokers were similar  but smoking a cigarette was associated with a significant fall in blood flow  p less than 0 04  and this change was inversely related to the rise in plasma nicotine concentration  r    0 63  p less than 0 05   
class6	2143	the findings may be relevant to the association between colitis and the smoking history  
class6	2144	daytime reduction of gastro oesophageal reflux after healing of oesophagitis and its value as an indicator of favourable response to maintenance treatment  
class6	2144	in order to investigate the response of gastro oesophageal reflux after medically induced healing of oesophagitis and its relation to the occurrence of relapse during prophylactic treatment  20 patients with erosive ulcerative oesophagitis underwent 24 hour oesophageal ph monitoring before and after healing achieved with 12 to 24 week treatment with ranitidine 150 or 300 mg twice daily  
class6	2144	compared with pretreatment values  after macroscopic healing  a significant reduction in daytime median percentage of reflux time  10 0 v 6 5  p less than 0 05  and median number of reflux episodes lasting more than 5 minutes  5 5 v 1 0  p less than 0 05  were observed  whereas during night time reflux frequency and severity did not change  
class6	2144	during maintenance treatment with ranitidine 150 or 300 mg nocte  five of the six patients  who had shown no improvement in gastro oesophageal reflux after acute healing  relapsed  
class6	2144	these results suggest that  in contrast with previous work  a decrease in gastro oesophageal reflux in patients with reflux oesophagitis can be achieved after macroscopic healing  and that the occurrence of such a reduction after acute healing is predictive of a good response to longterm treatment  
class6	2145	inhibition of cell mediated cytotoxicity by sulphasalazine  effect of in vivo treatment with 5 aminosalicylic acid and sulphasalazine on in vitro natural killer cell activity  
class6	2145	decreased cell mediated cytotoxicity occurs frequently in inflammatory bowel disease  particularly in patients with active disease  
class6	2145	it is not clear  however  whether this decrease is caused by the disease or is a consequence of the medical treatment  
class6	2145	in this study we evaluated the effect of in vivo treatment with 5 aminosalicylic acid and sulphasalazine on the in vitro natural killer cell activity in five patients with inflammatory bowel disease in remission and in four healthy control subjects in a double blind randomised crossover trial preceded and separated by four weeks of treatment with placebo  
class6	2145	the natural killer cell activity was significantly impaired in 67   six of nine subjects  after four weeks  sulphasalazine treatment and tended to be related to subjects with a slow acetylator phenotype  
class6	2145	in contrast  5 aminosalicylic acid treatment caused only a marginal reaction in the natural killer cell activity in 22   two of nine subjects   
class6	2145	the inhibitory effects were found to be reversible since the decreased natural killer cell activity was completely restored after placebo treatment in all subjects  
class6	2145	in conclusion  in vivo treatment with sulphasalazine inhibits the in vitro natural killer cell activity and this seems to be mediated by the sulphapyridine moiety  
class6	2145	this phenomenon may contribute to the low natural killer cell activity found in patients with active inflammatory bowel disease  
class6	2146	soluble interleukin 2 receptor in crohn s disease  relation of serum concentrations to disease activity  
class6	2146	serum concentrations of soluble interleukin 2 receptor  sil 2r  were measured as a marker of immune activation in a group of 30 patients with crohn s disease  
class6	2146	sil 2r concentrations were determined by enzyme linked immunosorbent assay during periods of active and inactive disease and correlated with standard parameters of disease activity  
class6	2146	serum concentrations of sil 2r were significantly raised in patients with active crohn s disease compared with patients with inactive disease  p less than 0 001  and control subjects  
class6	2146	there was a significant correlation between serum sil 2r concentrations and disease activity as assessed by the harvey bradshaw index  r   0 42  p less than 0 01   platelet numbers  r   0 49  p less than 0 01   and orosomucoid  r   0 47  p less than 0 01   alpha 1 antitrypsin  r   0 44  p less than 0 01   and c reactive protein concentrations  r   0 48  p less than 0 001  but not with the erythrocyte sedimentation rate  
class6	2146	measurement of serum sil 2r concentration is a simple and useful laboratory means of assessing disease activity  
class6	2146	raised concentrations in patients with active crohn s disease is further evidence for in vivo immune activation occurring in this disease  
class6	2147	occupational distribution of inflammatory bowel disease among german employees  
class6	2147	previous reports have shown that both crohn s disease and ulcerative colitis affect people in white collar occupations associated with higher income and higher social class more frequently than other groups in the population  
class6	2147	this study sought to carry these analyses one step further and investigate the distribution of inflammatory bowel disease by individual occupations  
class6	2147	the german social security statistics for  rehabilitation  were used to assess the occupational distribution of crohn s disease and ulcerative colitis  
class6	2147	from 1982 to 1988  a total of 12 014 people were granted rehabilitation as a result of inflammatory bowel disease  
class6	2147	low male prevalence of inflammatory bowel disease was found among bricklayers  road construction workers  unskilled workers in brick and stone  unskilled labourers  and security personnel  
class6	2147	low rates were found among women employed in cleaning and maintenance  and in those without occupation  
class6	2147	in contrast  a high male prevalence was found among instrument makers  electricians  bakers  and technical assistants  
class6	2147	among female employees  inflammatory bowel disease was significantly associated with sales representatives  office workers  health occupations  and hairdressers  
class6	2147	these associations were found in the complete data for 1982 8 as well as in the separate data for the two half periods 1982 5 and 1986 8  
class6	2147	highly significant correlations between the occupational distribution of crohn s disease and ulcerative colitis were found among both male and female employees  
class6	2147	it seems that occupations involving work in the open air and physical exercise are protective  while being exposed to air conditioned artificial working conditions or extended and irregular shift working confer a risk of contracting inflammatory bowel disease  
class6	2148	low diacylglycerol values in colonic adenomas and colorectal cancer  
class6	2148	the biochemical events that make colonic epithelial cells proceed along the adenoma carcinoma sequence are not well understood  
class6	2148	the phosphoinositol signal transduction pathway is involved in the regulation of cell growth and differentiation  
class6	2148	to determine its role in colonic neoplasias we performed mass measurements of its second messenger sn 1 2 diacylglycerol in biopsy specimens from normal mucosa and neoplasias of the colon  
class6	2148	normal colonic mucosa was also investigated in patients without colonic abnormalities  n   10   
class6	2148	compared with pooled diacylglycerol values from five colonic sites  100    values in patients with a normal colon were highest in the ascending colon  120  5    p less than 0 05  and lowest in the rectum  81  5    p less than 0 01   
class6	2148	absolute diacylglycerol values in patients with normal colons  2 62  0 16  nmol mg protein  were not significantly different from those found in the normal mucosa of patients with colorectal neoplasias  2 45  0 17  nmol mg protein   
class6	2148	both colonic adenomas  n   15  and colorectal carcinomas  n   14  showed significantly decreased diacylglycerol values compared with the adjacent normal mucosa of each patient  72  4    p less than 0 001  and 71  4    p less than 0 001 respectively   
class6	2148	the appreciable decrease in mass diacylglycerol values clearly distinguishes adenomas and carcinomas of the colon from the surrounding normal mucosa  
class6	2148	this finding suggests that profound metabolic changes of the phosphoinositol signal transduction pathway occur early in the adenoma carcinoma sequence and may be important in colonic carcinogenesis  
class6	2149	use of the pudendo anal reflex in the treatment of neurogenic faecal incontinence  
class6	2149	an electrical stimulator has been devised to treat neurogenic faecal incontinence caused by pudendal nerve neuropathy and works on the basis of repeated stimulation of the pudendo anal reflex arc  
class6	2149	although conduction in the pudendo anal reflex arc may be prolonged  and is so in neurogenic faecal incontinence  it must be shown to be present before the method can be used  
class6	2149	this stimulation results in an immediate rise in the pressure in the anal canal and a significant increase in the electromyographic activity of the external anal sphincter  
class6	2149	maintenance of the stimulus over a two month period raised the mean resting pressure significantly in the anal canal and increased the reflex and voluntary responses of the external anal sphincter to coughing and squeezing actions respectively  
class6	2149	the length of the sphincter was not affected  
class6	2149	there was widening of the mean motor unit potential duration  though this was not significant  
class6	2149	the resting electromyogram was enhanced after the course of treatment  indicating greater spontaneous activity in the external sphincter  
class6	2149	the changes led to seven of the eight patients studied becoming continent at the end of the treatment  
class6	2150	relation between rectal sensation and anal function in normal subjects and patients with faecal incontinence  
class6	2150	the relation between sensory perception of rapid balloon distension of the rectum and the motor responses of the rectum and external and internal anal sphincters in 27 normal subjects and 16 patients with faecal incontinence who had impaired rectal sensation but normal sphincter pressures was studied  
class6	2150	in both patients and normal subjects  the onset and duration of rectal sensation correlated closely with the external anal sphincter electrical activity  r   0 8  p less than 0 0001  and with rectal contraction  r   0 51  p less than 0 001   but not with internal sphincter relaxation  
class6	2150	all normal subjects perceived a rectal sensation within one second of rapid inflation of a rectal balloon with volumes of 20 ml or less air  
class6	2150	six patients did not perceive any rectal sensation until 60 ml had been introduced  while in the remaining nine patients the sensation was delayed by at least two seconds  
class6	2150	internal sphincter relaxation occurred before the sensation was perceived in three of 27 normal subjects and 11 of 16 patients  p less than 0 001   and could be associated with anal leakage  which stopped as soon as sensation was perceived  
class6	2150	the lowest rectal volumes required to induce anal relaxation  to cause sustained relaxation  or to elicit sensations of a desire to defecate or pain were similar in patients and normal subjects  
class6	2150	in conclusion  these results show the close association between rectal sensation and external anal sphincter contraction  and show that faecal incontinence may occur as a result of delayed or absent external anal sphincter contraction when the internal anal sphincter is relaxed  
class6	2151	inter  and intraindividual variation in pressure volume relations of the rectum in normal subjects and patients with the irritable bowel syndrome  
class6	2151	the relation between intrarectal volume and pressure during increasing rectal distension by a latex balloon were studied on repeated occasions in 10 healthy adult volunteers to define variations within and between individuals  
class6	2151	a wide intersubject variation in the maximum tolerable volume  58 908 ml  and pressure  12 2 108 8 cm h2o  at this end point was seen  and these two values were correlated  r   0 78   
class6	2151	intrasubject variation in maximum tolerable volume also occurred which was related to study order and progressively reduced with repeated study  
class6	2151	in 26 unselected patients with pain predominant irritable bowel syndrome similar intersubject variation was noted and virtually all patients data fell within the calculated 95  confidence limits of the normal individuals  
class6	2151	differentiation between patients and normal subjects was not possible from knowledge of rectal responses  
class6	2151	these noticeable inter  and intrasubject variations in rectal responses to distension need to be considered whenever similar techniques are proposed for use in the study of rectal disease or of rectal response to treatment  
class6	2152	referral of patients with primary biliary cirrhosis for liver transplantation  
class6	2152	all patients with primary biliary cirrhosis referred to this unit for consideration for transplantation between april 1981 and january 1989 were analysed retrospectively to assess whether disease stage at referral affects the outcome after grafting and whether greater awareness of the benefits of the procedure means that patients are now being referred at an earlier stage  
class6	2152	seventy of the 107 patients have been grafted  with an overall one year actuarial survival of 62   
class6	2152	a better prognosis at the time of referral  as assessed by both serum bilirubin concentration and a mathematically derived prognostic index  was associated with a greater probability of survival after grafting  
class6	2152	patients in the tertile with the best prognosis  median serum bilirubin concentration at referral 84 mumol l and estimated survival in the absence of transplantation of more than nine months  had a 78  one year actuarial survival after transplantation  whereas those in the tertile with the worst prognosis  median serum bilirubin concentration 467 mumol l and estimated survival of less than four months  had a one year actuarial survival of only 50   
class6	2152	no trend towards earlier referral of patients  however  was shown using either of these two markers  
class6	2152	this retrospective analysis suggests that many patients are being referred too late for an optimal outcome  
class6	2152	we recommend that patients with primary biliary cirrhosis who are potential candidates for liver grafting should be referred to a transplant centre before the serum bilirubin concentration approaches 150 mumol l  
class6	2153	pancreatic duct abnormalities in gall stone disease  an endoscopic retrograde cholangiopancreatographic study  
class6	2153	this study was carried out to assess pancreatic duct abnormalities in gall stone disease  
class6	2153	endoscopic retrograde cholangiopancreatograms of 50 patients with gall stone disease were analysed and the results compared with those obtained in 33 patients investigated for cholestatic jaundice who were found to have a normal biliary tree  control group   
class6	2153	abnormal pancreatograms were obtained in 24  48   patients with gall stone disease and in only two  6   in the control group  the differences were statistically significant  chi 2   14 3  p less than 0 001   
class6	2153	the patients in the control group showed mild abnormalities as did those in the gall stone group  
class6	2153	the frequency of various abnormalities were  mild 16  32    moderate five  10    and severe three  6    
class6	2153	pancreatic duct abnormalities were more severe and occurred more frequently in patients with gall stones who had stones in the biliary tree than in patients with a normal biliary tree  postcholecystectomy patients  55  v 25   but the difference between the two groups just failed to be significant  chi 2   3 34   
class6	2153	in conclusion  nearly half of all patients with gall stone disease have pancreatic duct abnormalities and in 16  these were severe enough to be labelled as chronic pancreatitis  
class6	2154	pancreatic function in crohn s disease  
class6	2154	we investigated exocrine pancreatic function in a population of patients with crohn s disease in order to correlate the pancreatic function with clinical and laboratory variables  
class6	2154	a total of 143 patients affected by crohn s disease and 115 control subjects were studied  
class6	2154	all had a lundh meal test  
class6	2154	as a group patients with crohn s disease had significantly decreased activity of both amylase  p less than 0 02  and lipase  p less than 0 001  in duodenal aspirates  
class6	2154	in patients with crohn s disease enzyme activities were not correlated to duration of disease or to extent or localisation of previous bowel resection  
class6	2154	the lowest enzyme values were found in patients with the most extensive bowel involvement  and they were significantly lower  p less than 0 05  than in patients with disease confined to the terminal ileum  
class6	2154	the differences between enzyme values in other subgroups of patients were not significant  
class6	2154	for the patient group as a whole no correlation was found between disease activity and enzyme values  but for the most uniform group of patients  those with terminal ileitis  pancreatic function was significantly lower  p less than 0 05  in patients with moderate and severe disease compared with patients with mild disease  
class6	2154	thus at least two factors seem to be responsible for impaired pancreatic function in crohn s disease  firstly disease activity and secondly localisation or extent of disease  
class6	2155	loss of duodenal folds allows diagnosis of unsuspected coeliac disease  
class6	2155	we report three patients with coeliac disease who presented without the classic features of malabsorption and who underwent biopsy and were diagnosed only because of the endoscopic finding of the disappearance of kerckring s folds in the descending duodenum  
class6	2155	this sign constitutes a new and valid aid for the identification of patients with otherwise unsuspected coeliac disease  
class6	2156	adult hepatic fibropolycystic disease presenting as obstructive jaundice  
class6	2156	obstructive jaundice caused by compression of the common hepatic duct by a simple hepatic cyst in a 31 year old europid man is reported  
class6	2156	the jaundice and duct compression resolved after percutaneous aspiration of the cyst under ultrasound direction and the patient has been well for 12 months  
class6	2157	evaluation of the magnitude of gastro oesophageal reflux in barrett s oesophagus  
class6	2157	a manometric study to determine the role of gastro oesophageal reflux in barrett s oesophagus was performed on 20 patients with barrett s oesophagus and 53 patients with reflux oesophagitis without barrett s oesophagus  25 with mild oesophagitis and 28 with severe oesophagitis   
class6	2157	for the same reason  the 20 patients with barrett s oesophagus also underwent 24 hour continuous oesophageal ph monitoring  and the results obtained were compared with those of 20 oesophagitis patients without barrett s oesophagus  10 with mild oesophagitis and 10 with severe oesophagitis   
class6	2157	the manometric results show that the motor changes found in the barrett s group are specific but similar to the motor dysfunction associated with reflux oesophagitis  
class6	2157	motor anomalies are probably related more to the inflammatory process in the oesophageal wall than to the metaplastic changes themselves  
class6	2157	the ph monitoring results show that while reflux in the barrett s oesophagus patients was greater overall than in the oesophagitis group without barrett s oesophagus  the changes are similar when the results are compared with the severe oesophagitis group  
class6	2157	in conclusion there are other factors besides gastro oesophageal reflux involved in the pathogenesis of barrett s oesophagus  
class6	2158	comparison of omeprazole and cimetidine in reflux oesophagitis  symptomatic  endoscopic  and histological evaluations  
class6	2158	symptomatic patients with endoscopically verified reflux oesophagitis were randomised to a double blind trial in which they received either omeprazole  20 mg once daily  or cimetidine  400 mg four times daily  for four  and if necessary  eight weeks  
class6	2158	in an  intention to treat  analysis  oesophagitis was found to have healed after four weeks in 77 of 137  56   in the omeprazole group and in 34 of 133  26   in the cimetidine group  p less than 0 001   
class6	2158	by eight weeks these values were 71  and 35  respectively  p less than 0 001  
class6	2158	histological assessments were available for 73  of the patients  
class6	2158	at entry  63   66 of 104  in the omeprazole group and 60   56 of 94  in the cimetidine group  ns  had abnormal histology  
class6	2158	after the study  the proportions of patients who initially had had abnormal histology but who then progressed to normal were 67   44 of 66  omeprazole  and 48   27 of 56  cimetidine  respectively  p less than 0 001   
class6	2158	all patients had reflux symptoms at entry  
class6	2158	after four weeks  46  in the omeprazole group and 22   p less than 0 001  in the cimetidine group were asymptomatic  
class6	2158	diary cards completed for the first two weeks showed that patients treated with omeprazole experienced fewer reflux symptoms by day and night and used fewer antacids  
class6	2158	omeprazole  20 mg once a day for four to eight weeks  healed a greater proportion of patients with reflux oesophagitis than cimetidine  1 6 g per day  assessed endoscopically and histologically  and relieved more patients  symptoms  
class6	2159	reduction of gastric ulcer recurrence after suppression of helicobacter pylori by cefixime  
class6	2159	the effect on the recurrence of gastric ulcers after suppression of helicobacter pylori by combined treatment with cimetidine and the antimicrobial drug cefixime was investigated  
class6	2159	twenty one of 43 patients with endoscopically proved gastric ulcer and h pylori infection were randomly assigned to receive cimetidine 800 mg daily for 12 weeks  the remaining 22 patients received cimetidine 800 mg daily for 12 weeks plus cefixime 100 mg daily for the last two weeks  
class6	2159	after treatment  88  of 17 patients on cimetidine only remained h pylori positive  whereas combined administration of cimetidine and cefixime had suppressed h pylori in 78  of 18 patients  p less than 0 05   
class6	2159	seventeen patients in the former group whose ulcers healed but who remained h pylori positive and 18 patients in the latter group whose ulcers healed and who were no longer infected with h pylori continued to be followed after treatment  
class6	2159	these patients underwent endoscopy to detect ulcer recurrence if symptomatic  or at 12 and 24 weeks if asymptomatic  
class6	2159	at 12 weeks  recurrence was observed in seven of 15  47   patients in whom h pylori persisted  but in only one of 14  7   patients in whom h pylori had been suppressed  p less than 0 05   
class6	2159	at 24 weeks  however  recurrence rates were similar between the two groups  
class6	2159	these findings indicate that h pylori infection may be closely related to early ulcer recurrence  
class6	2160	high grade dysplasia of the gastric mucosa  a marker for gastric carcinoma  
class6	2160	the natural history of gastric epithelial dysplasia and its relation to gastric cancer are ill defined  
class6	2160	a consecutive series of 40 patients with an initial diagnosis of gastric epithelial dysplasia based on examination of endoscopic biopsies has been reviewed to determine the clinical outcome and to evaluate a two tier histological grading system as a predictor of the risk of cancer  
class6	2160	on review  only 20 of the 40 patients were considered to have true dysplasia  seven patients had low grade dysplasia and 13 had high grade dysplasia  
class6	2160	of the 13 patients with high grade dysplasia  11  85   were found to have gastric cancer within 15 months  
class6	2160	of the 10 patients with high grade dysplasia who underwent gastrectomy  six were found to have early gastric cancer  three had cancer invading into the muscularis propria  and none had lymph node metastases  
class6	2160	high grade dysplasia is thus a marker of gastric cancer  
class6	2160	moreover  the cancers associated with high grade dysplasia are usually pathologically favourable and curable  
class6	2160	the finding  by an experienced pathologist  of high grade dysplasia in two separate sets of endoscopic biopsies is therefore an indication for radical surgical treatment  provided that the patient s age and general condition permit such an approach  
class6	2161	towards a true prevalence of peptic ulcer  the sorreisa gastrointestinal disorder study  
class6	2161	this study  designed to overcome methodological problems inherent in earlier prevalence studies of peptic ulcer  was carried out in a municipality in northern norway  
class6	2161	it included the total population of 2027  aged 20 69 years  and comprised a questionnaire and search for previously diagnosed peptic ulcers in the local medical records for all subjects  and additional endoscopy of all subjects with dyspepsia and their matched healthy controls  n   619   
class6	2161	the overall prevalence was 10 5  in men and 9 5  in women  a sex ratio close to one and a higher duodenal gastric ratio than previously reported from this region  
class6	2161	a substantial 1  prevalence of asymptomatic ulcers was also observed  
class6	2162	duodenal ulcer and refined carbohydrate intake  a case control study assessing dietary fibre and refined sugar intake 
class6	2162	an association between duodenal ulceration and a low fibre intake and a high refined carbohydrate diet has been reported  
class6	2162	we therefore compared the current diet  smoking habits  social class  and possible other risk factors of 78 patients with duodenal ulcer and a community control group matched for age and sex  
class6	2162	logistic regression for matched sets was used to calculate the relative risks for successive quintiles of dietary fibre and sugar intake before and after adjustment for total calorie intake and for the possible confounding effect of other known risk factors  
class6	2162	relative risks did not differ materially or consistently for total dietary fibre or for the cereal moiety whether adjusted or not for calorie intake  
class6	2162	by contrast  relative risks tended to be reduced with high vegetable fibre intake and with low refined sugar intake  
class6	2162	after controlling for smoking and social class  both of which were associated with ulcer disease  and for relative weight  quetelet s index   the relation between ulcer disease and low refined sugar intake persisted  while that with high vegetable fibre intake was reduced  
class6	2162	the results of this study indicate that a lack of cereal or total fibre intake plays no part in duodenal ulcer development but that a low refined sugar intake may be a protective factor  
class6	2163	duodenal ulcer is associated with low dietary linoleic acid intake  
class6	2163	it has been suggested that the falling incidence and virulence of duodenal ulcer is related to increased dietary polyunsaturated essential fatty acid intake  
class6	2163	the adipose fatty acid profile  which closely reflects dietary intake  was measured in 35 men with chronic duodenal ulcer and 35 matched control men  
class6	2163	the mean percentage of linoleic acid in adipose tissue was significantly lower in the ulcer group  10 0  0 7  v 12 3  0 7    p less than 0 01  and this difference was found in both smokers and non smokers  
class6	2163	this finding suggests that the diets of duodenal ulcer patients are deficient in linoleic acid and this could be of aetiological importance  
class6	2164	adjuvant antibiotic therapy in duodenal ulcers treated with colloidal bismuth subcitrate  
class6	2164	persistence of helicobacter pylori after duodenal ulcer healing is associated with high rates of ulcer relapse  
class6	2164	we compared colloidal bismuth subcitrate alone with cbs combined with one of four antibiotic regimens in the treatment of duodenal ulcers  
class6	2164	endoscopy and antral biopsies were performed before treatment and four weeks afterwards  
class6	2164	biopsy specimens were examined for histological evidence of gastritis and by gram stain and culture for h pylori infection  
class6	2164	altogether 141 patients were allocated to one of five treatment groups  
class6	2164	giving cbs and metronidazole  400 mg tid for 7 days  with and without amoxycillin  500 mg tid  achieved higher clearance rates of h pylori than treatment with cbs alone  p less than 0 01   
class6	2164	these two combinations also achieved higher rates of antral gastritis healing than cbs alone  p less than 0 01 and p less than 0 05 respectively   
class6	2164	susceptibility to metronidazole was tested in 29 isolates before and in seven isolates after treatment with metronidazole by disc diffusion test and minimum inhibitory concentration assay  
class6	2164	twenty seven  93   of the isolates were sensitive before treatment while six of seven  86   were resistant afterwards  
class6	2164	four of the six resistant strains had acquired resistance during treatment and one of these had acquired metronidazole resistance despite concomitant treatment with amoxycillin  to which it remained sensitive  
class6	2164	cbs with adjuvant metronidazole at a dose of 400 mg tid for seven days significantly improves the eradication of h pylori compared with cbs alone  
class6	2164	acquired metronidazole resistance  however  seems to be an important cause of failure to eradicate h pylori  
class6	2165	biliary cholesterol transport and precipitation  introduction and overview of conference  
class6	2165	cholesterol is secreted into bile as cholesterol phospholipid vesicles  
class6	2165	the cholesterol and phospholipid are subsequently exposed to the bile salts contained in the bile  which leads to the process of micellation  
class6	2165	two situations may arise depending on whether there is enough bile salt in proportion to cholesterol to complete this  maturation  process  
class6	2165	if the cholesterol saturation is low  at equilibrium the bile salts will have completely micellized the vesicles  
class6	2165	on the other hand  if bile is saturated with cholesterol  the micellation process is incomplete and vesicles and micelles will be present at equilibrium  
class6	2165	the residual vesicle in this latter situation may have a higher cholesterol phospholipid ratio because of the greater propensity of phospholipid to be micellized  
class6	2165	this situation may result in cholesterol nucleation  
class6	2165	the mechanism of nucleation from vesicles and the possible role of nucleating and antinucleating proteins in this process have been discussed  
class6	2166	bile sampling  processing and analysis in clinical studies  
class6	2166	obtaining a proper bile sample for investigative purposes is of utmost importance to obtain valid results  
class6	2166	bile can be collected by direct aspiration of the gallbladder  by duodenal intubation or by t tube drainage  
class6	2166	the optimal method of collection depends on the investigative question  as well as on the resources available to the investigator  
class6	2166	the procedures for obtaining  processing and analyzing human bile  gallbladder and hepatic  are summarized  pointing out the disadvantages and pitfalls that may occur  
class6	2167	gallbladder mucin as a pronucleating agent for cholesterol monohydrate crystals in bile  
class6	2167	mucin is a densely glycosylated macromolecule secreted by the gallbladder epithelium as the principal constituent of gallbladder mucus  
class6	2167	hypersecretion of gallbladder mucus occurs in response to a lithogenic diet in experimental animals  and mucus accumulates as a viscous gel within the gallbladder lumen before gallstone formation  
class6	2167	in both animals and man  the initial stage of cholesterol gallstone formation  the nucleation of cholesterol monohydrate crystals  occurs within the mucus gel  
class6	2167	inhibition of mucus secretion with aspirin prevents gallstone formation in the cholesterol fed prairie dog  indicating the importance of mucus in gallstone formation  
class6	2167	mucin contains domains that bind cholesterol and lecithin transported as vesicles in supersaturated bile  
class6	2167	furthermore  mucin accelerates the nucleation of cholesterol crystals in both supersaturated model and native biles  
class6	2167	binding of cholesterol enriched vesicles to hydrophobic domains on the mucin protein core appears to be critical for the acceleration of cholesterol crystal nucleation by mucin  
class6	2167	further study of the structure and function of gallbladder mucin should help to elucidate the pathogenesis of cholesterol cholelithiasis  
class6	2168	nonmucous glycoproteins as pronucleating agents  
class6	2168	cholesterol crystallization promoting factors probably play an important role in the pathogenesis of gallstone disease  
class6	2168	we have isolated one of the factors involved by using lectin affinity chromatography  
class6	2168	a potent promoting activity binds to concanavalin a sepharose  
class6	2168	the activity is heat labile and sensitive to digestion by glycosidase but remarkably insensitive to proteases  
class6	2168	the concanavalin a binding pronucleator affects cholesterol solubilization in model bile in two ways  
class6	2168	it induces a shift of cholesterol and phospholipid from the micellar to the vesicular phase but also interacts directly with cholesterol phospholipid vesicles  
class6	2168	the concanavalin a binding protein fraction contains at least two different promoting factors with gel permeation molecular weights of about 150 kd and 5 kd  respectively  
class6	2168	the higher molecular weight activity could be assigned to a protein with an apparent molecular weight of 130 kd  
class6	2168	concanavalin a binding promoting activity was present in bile from both patients with and without stones  indicating that it is a normal constituent of bile  
class6	2168	however  the activity was strongly increased in bile from patients with multiple cholesterol gallstones  suggesting that it could play a key role in gallstone formation in these patients  
class6	2169	pathogenesis of biliary sludge  
class6	2169	the increasing application of ultrasonography in biliary tract disease had led to more frequent recognition of an old disorder   biliary sludge   sludge is detected on ultrasound as low amplitude echoes without acoustic shadowing  
class6	2169	it layers in the most dependent part of the gallbladder and shifts with positioning  
class6	2169	particulate matter in bile  such as cholesterol monohydrate crystals  has been shown to be echogenic  
class6	2169	agglomeration of these crystals in biles with high mucus content accounts for the layering and the characteristic appearance of the movement of sludge with alteration in patient position  
class6	2169	within the gallbladder  the stability of the vesicular form of cholesterol and protein lipid interactions are important determinants of cholesterol precipitation  
class6	2169	in mixed and pigment gallstones  the equilibrium between ionized and unionized calcium and the hydrolysis of conjugated bilirubin are also important factors  
class6	2169	although the risk factors contributing to the formation of gallbladder sludge have not been critically examined  it is now known that in some instances sludge can produce biliary pain and can be associated with acalculous cholecystitis  recurrent pancreatitis and  ultimately  the formation of gallstones  
class6	2169	a better appreciation of the pathogenesis of sludge formation can help in the understanding of the genesis of gallstones and also perhaps in understanding other documented but poorly understood biliary and pancreatic disorders  
class6	2170	biliary calcium and gallstone formation  
class6	2170	the purpose of this paper is to present a brief overview of the current status of the field of biliary calcium and the role of calcium in the formation and maturation of gallstones  
class6	2170	the study of free ca     ions in bile by electrochemical potentiometric measurements using ca     selective ion exchange electrodes is a relatively new field  but much progress has been made in the past few years  
class6	2170	using this powerful analytical tool  new concepts and findings have arisen in almost every aspect of biliary calcium  
class6	2170	although the current symposium is targeted primarily toward cholesterol gallstones  there are several areas in which understanding of biliary calcium may significantly contribute to a better understanding of the pathogenesis of cholesterol  as well as  pigment   calcium salt   gallstones  
class6	2170	five broad areas are considered in relation to biliary calcium   a  physiology  calcium entry into bile    b  biophysics  the regulation of biliary free  ca      as related to gibbs donnan equilibria   c  physical chemistry  the physicochemical state of calcium in bile   d  thermodynamics  calcium solubility in bile   and  e  kinetics  pronucleating and antinucleating factors and metastable states   
class6	2170	with more specific reference to cholesterol stones  consideration is also made of  a  the calcium salt  seed  hypothesis in cholesterol stone pathogenesis   b  the interactions of ca     with phospholipid cholesterol vesicles  with consideration of possible structural requirements and  c  thermodynamic and kinetic factors as related to peripheral or  eggshell  calcification of existing cholesterol stones  
class6	2171	unconjugated bilirubin and cholesterol gallstone formation  
class6	2171	cholesterol gallstones usually have small amounts of pigment at their centers and often have diffuse pigmentation or pigmented layers alternating with cholesterol layers and or pigmented rims associated with calcium carbonate  eggshell calcification   
class6	2171	the pigments are primarily monomeric calcium salts of unconjugated bilirubin anions and or an insoluble  black  network polymer of tetrapyrroles  
class6	2171	bilirubin presumably can precipitate only if bile is supersaturated with calcium bilirubinates  
class6	2171	among various in vitro model systems  the aqueous solubilities and pk a values for unconjugated bilirubin differ greatly  
class6	2171	it is therefore not known whether normal bile is saturated with unconjugated bilirubin  
class6	2171	however  all systems indicate that unconjugated bilirubin is solubilized by binding to bile salt monomers and oligomers  as well as micelles  marked metastable supersaturation of unconjugated bilirubin can occur in the presence of bile salt micelles  and both pk a values of unconjugated bilirubin are greater than 6 0  probably because of internal hydrogen bonding of the  cooh groups  
class6	2171	lecithin decreases equilibrium solubilization of unconjugated bilirubin crystals but enhances metastable supersaturation of unconjugated bilirubin  
class6	2171	calcium ions form insoluble salts with unconjugated bilirubin monoanions and dianions but soluble complexes with bilirubin conjugates  
class6	2171	the solubility products of the calcium bilirubinate salts suggest that normal hepatic bile is not saturated with cab or ca hb 2 but that gallbladder bile may be supersaturated with ca hb 2  
class6	2172	current concepts of cholesterol transport and crystal formation in human bile  
class6	2172	the presence of vesicles in human bile probably accounts almost entirely for the frequently observed  but hitherto unexplained  phenomenon of metastable cholesterol supersaturation  
class6	2172	this  in turn  largely explains the prolonged stability of cholesterol solubilized in supersaturated human bile  
class6	2172	under certain overall compositional conditions for a supersaturated native bile  the vesicular phase in its contribution to total cholesterol transport also becomes supersaturated in cholesterol  
class6	2172	because of this  the vesicles also become unstable  leading to formation of cholesterol crystals  
class6	2172	a simple but common example of one factor affecting composition in this way is concentration of total solutes  especially the biliary lipids  
class6	2172	conversely  dilution of bile  e g   hepatic bile  markedly reduces the cholesterol saturation level in biliary vesicles  
class6	2172	the result is that such vesicles become much more stable  
class6	2172	under these conditions  cholesterol crystal formation becomes unlikely and rarely  if ever  occurs  
class6	2173	fluorescence assays to monitor membrane fusion  potential application in biliary lipid secretion and vesicle interactions  
class6	2173	membrane fusion constitutes an essential  intermediate step in numerous cell biological processes  occurring for example during endocytosis  membrane recycling and exocytosis  
class6	2173	also less desirable events such as the infection of cells by animal viruses are mediated by membrane fusion during which the viral envelope merges with a cellular membrane  causing the expulsion of the viral nucleocapsid into the cytoplasm of the cell as an initial step in virus replication  
class6	2173	much of our current knowledge concerning the mechanism of membrane fusion has been derived from studies using simple artificial membranes  such as liposomes or phospholipid vesicles  as model systems  
class6	2173	a most essential feature of these studies has been the development of membrane fusion assays that register in a sensitive and continuous fashion the mixing of membranes or the aqueous volumes initially enclosed by these membranes  
class6	2173	not only do these assays allow one to readily detect and quantify fusion  but they also provide the possibility to relate the kinetics of fusion to the rate by which certain molecular changes in membranes take place  
class6	2173	obviously  this insight is of relevance for understanding the mechanism of membrane fusion  
class6	2173	the principles and applications of some representative assays that rely on the use of fluorescence spectroscopy will be discussed  
class6	2173	assays that monitor membrane mixing are commonly based on the detection of changes in resonance energy transfer efficiency or the relief of fluorescence self quenching of appropriate fluorescent lipid analogs  
class6	2173	contents mixing assays rely on either the formation of a  aqueous soluble  fluorescent complex or quenching of a fluorophore  encapsulated in one vesicle population  by a suitable quencher  entrapped in a second population  
class6	2174	hbv dna detection by gene amplification in acute hepatitis b  
class6	2174	serum samples from 62 women  inadvertently infected with hepatitis b virus in an in vitro fertilization program  were tested for the presence of hepatitis b virus dna using the polymerase chain reaction  
class6	2174	under conditions of a strict spatial separation of dna extraction  amplification and product analysis  we succeeded in detection of as few as 360 hepatitis b virus particles per milliliter  
class6	2174	hepatitis b virus dna was detected with a high frequency during hbsag and hbeag antigenemia  98 5   but also in the convalescent phase after appearance of antibody to hbsag  18 2    
class6	2174	however  all patients with hepatitis b virus dna in convalescent sera were hepatitis b virus dna negative 3 to 6 mo later  
class6	2174	all patients with hbeag positive samples showed hepatitis b virus dna positivity by polymerase chain reaction  
class6	2174	for acute hepatitis  gene amplification restores the relationship between hbeag and hepatitis b virus dna observed in serum from chronic hepatitis b patients and calls attention to the prolonged presence of hepatitis b virus dna in serum after generally accepted criteria for resolution of the infection have been reached  
class6	2175	changes of serum hepatitis b virus dna and aminotransferase levels during the course of chronic hepatitis b virus infection in children  
class6	2175	during a follow up period of 3 2     1 6  1 to 8 6  yr  1 087 serum specimens from 230 hbsag carrier children were tested for hepatitis b virus markers  
class6	2175	dividing the serum specimens into four groups according to the status of hbeag and hepatitis b virus dna  the frequency of abnormally elevated alt levels in serum was in the following order  hbeag    hepatitis b virus dna    serum  60    hbeag    hepatitis b virus dna    serum  53    hbeag    hepatitis b virus dna    serum  41    hbeag    hepatitis b virus dna    serum  11    
class6	2175	analysis of the data before hbeag clearance showed that both a high serum alt level and a low serum hepatitis b virus dna level correlated with an imminent clearance of hbeag  
class6	2175	approximately two thirds of children with serum alt levels higher than 100 iu l cleared hbeag within the following year  
class6	2175	clearance of hbeag occurred within the following year in 65   13 of 20  of cases with serum hepatitis b virus dna level less than or equal to 1 000 pg ml  in contrast to 19   30 of 157  of those with serum hepatitis b virus dna level greater than 1 000 pg ml  
class6	2175	among 53 children who lost hbeag and hepatitis b virus dna during follow up  only nine cases did not have an identified period of abnormal serum alt levels  
class6	2175	for the remaining 44 children  abnormal serum alt levels fell to normal with clearance of both hbeag and hepatitis b virus dna in 33 children but remained elevated in the remaining 11 cases after seroconversion  
class6	2176	prospective study of early detection of hepatocellular carcinoma in patients with cirrhosis  
class6	2176	we prospectively monitored 140 cirrhotic patients for the development of hepatocellular carcinoma for 6 yr  using periodical screening by high resolution convex array ultrasonography and alpha fetoprotein  
class6	2176	twenty eight patients were positive for hbs antigen  26 patients had received blood transfusions and were negative for hbs antigen and 26 patients had a history of heavy drinking  
class6	2176	we detected hepatocellular carcinoma in 40 patients during this period  
class6	2176	the overall cumulative incidence of hepatocellular carcinoma in the 6 yr was 39   the cumulative incidence was 59  in patients with hbsag  53  in patients who had had blood transfusions and were negative for hbsag and 22  in patients who had a history of heavy drinking and who were without hbsag  
class6	2176	detection of the carcinoma in 85  of these 40 patients was based on results of ultrasonography  
class6	2176	twenty six of the patients  65   had a small hepatocellular carcinoma of 2 cm or less  
class6	2176	alpha fetoprotein levels were lower than 100 ng ml in 56  of these 40 patients  
class6	2176	patients with cirrhosis are at high risk of developing hepatocellular carcinoma  especially patients with hbsag or with a history of blood transfusion who are negative for hbsag  
class6	2176	periodic monitoring by use of ultrasonography in particular is recommended for early detection of hepatocellular carcinoma  
class6	2177	the auditory p300 event related potential  an objective marker of the encephalopathy of chronic liver disease  
class6	2177	recently many variants of electroencephalogram evoked responses have been studied as potential diagnostic aids in the detection and evaluation of hepatic encephalopathy  
class6	2177	this study assesses the value of the auditory p300 event related potential  a slow component of the auditory evoked response  as a tool in this field  
class6	2177	twenty one nonencephalopathic and 12 encephalopathic  grade 1 2  cirrhotic patients and 26 controls were assessed clinically and psychometrically  
class6	2177	electroencephalogram spectral analysis and visual evoked response recordings were also conducted  
class6	2177	an auditory p300 wave was elicited using the standard two tone discrimination paradigm  
class6	2177	the latency and amplitude of this wave were measured  
class6	2177	the latency of the p300 was found to be significantly increased in the encephalopathic patients compared with both nonencephalopathic cirrhotic and control groups  p less than 0 05   
class6	2177	amplitude of the wave was decreased in both nonencephalopathic and encephalopathic patients  but this was not statistically significant  
class6	2177	this study suggests that the latency of the p300 is a good marker of grades 1 and 2 clinical hepatic encephalopathy  
class6	2177	the delays in the p300 latency may indicate that encephalopathic patients have a deterioration of their stimulus evaluation abilities  
class6	2178	monomicrobial nonneutrocytic bacterascites  a variant of spontaneous bacterial peritonitis  
class6	2178	spontaneous bacterial peritonitis is diagnosed when  a  the ascitic fluid culture is positive   b  the ascitic fluid neutrophil count is greater than or equal to 250 cells mm3 and  c  there is no evident intraabdominal surgically treatable source for infection  
class6	2178	few details are available regarding the variant of ascitic fluid infection in which the culture grows bacteria  pure growth of a single type of organism   but the neutrophil count is less than 250 cells mm3  
class6	2178	in this prospective study of 138 episodes of culture positive spontaneously infected ascites detected in 105 patients  44  31 9   were episodes of  monomicrobial nonneutrocytic bacterascites  compared with 94  68 1   episodes of spontaneous bacterial peritonitis  
class6	2178	seventeen patients had both types of infection  
class6	2178	the infection related mortality and hospitalization mortality were similar between the two groups  
class6	2178	patients with bacterascites appeared to have less severe liver disease  
class6	2178	in 62  of bacterascites episodes in which a second paracentesis was performed before any treatment the fluid spontaneously became sterile without development of ascitic fluid neutrocytosis  
class6	2178	thirty eight percent of patients with bacterascites  who underwent a second paracentesis before treatment was started  progressed to spontaneous bacterial peritonitis  sometimes within a few hours  
class6	2178	the concentration of the chemoattractant c5a was not decreased in the ascitic fluid of the bacterascites patients  this excludes ascitic fluid c5a deficiency as the explanation of the lack of neutrocytosis  
class6	2178	monomicrobial nonneutrocytic bacterascites is a common variant of ascitic fluid infection that may resolve without treatment or may progress to spontaneous bacterial peritonitis  
class6	2179	norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis  results of a double blind  placebo controlled trial  
class6	2179	eighty cirrhotic patients who had recovered from an episode of spontaneous bacterial peritonitis were included in a multicenter  double blind trial aimed at comparing long term norfloxacin administration  400 mg day  40 patients  vs  
class6	2179	placebo  40 patients  in the prevention of spontaneous bacterial peritonitis recurrence  
class6	2179	at entry  both groups were similar with respect to clinical and laboratory data  ascitic fluid protein and polymorphonuclear concentrations  number of previous episodes of spontaneous bacterial peritonitis and causative organisms of the index spontaneous bacterial peritonitis  
class6	2179	norfloxacin administration produced a selective intestinal decontamination  elimination of aerobic gram negative bacilli from the fecal flora without significant changes in other microorganisms  throughout the study in six patients in whom the effect of norfloxacin on the fecal flora was periodically assessed  
class6	2179	fourteen patients from the placebo group  35   and five from the norfloxacin group  12   developed spontaneous bacterial peritonitis recurrence during follow up  chi 2   5 97  p   0 014   mean follow up period   6 4     0 6 mo  range   1 to 19 mo   
class6	2179	ten of the 14 spontaneous bacterial peritonitis recurrences in the placebo group and only one of the five spontaneous bacterial peritonitis recurrences in the norfloxacin group were caused by aerobic gram negative bacilli  chi 2   8 87  p   0 0029   
class6	2179	the overall probability of spontaneous bacterial peritonitis recurrence at 1 yr of follow up was 20  in the norfloxacin group and 68  in the placebo group  p   0 0063  and the probability of spontaneous bacterial peritonitis recurrence caused by aerobic gram negative bacilli at 1 yr of follow up was 3  and 60   respectively  p   0 0013   
class6	2180	relative frequencies of portosystemic pathways and renal shunt formation through the  posterior  gastric vein  portographic study in 460 patients  
class6	2180	percutaneous transhepatic portography was carried out in 460 patients with portal hypertension to study various collateral routes  
class6	2180	besides the left gastric vein  which was the most frequent collateral route and feeder of esophageal varices  a distinct vein located between the left gastric vein and the short gastric vein constituted a major collateral route in 191 patients  42    
class6	2180	in terms of frequency  this vein was more significant than the short gastric  34   and the paraumbilical vein  24   as a collateral route  
class6	2180	we propose that this previously anonymous vein be called the  posterior gastric  vein because it runs posterior to the stomach  
class6	2180	this vein also formed a renal shunt  a common cause of encephalopathy  in 43  23   of the 191 patients  the relative frequency of renal shunt formation by this vein was significantly greater than that by the left gastric vein  12   and the short gastric vein  18    
class6	2181	albumin absorption and protein secretion by the gallbladder in man and in the pig  
class6	2181	to study albumin absorption by the gallbladder in man  an in vitro model was first established in the pig and compared with in vivo function in the same species  
class6	2181	water and electrolyte transport and 125i albumin absorption and protein secretion in vivo and in vitro were compared  
class6	2181	then similar in vitro studies were performed on human gallbladders obtained at surgery  
class6	2181	the in vivo study in the pig was performed without disturbing the gallbladder except to tie a cannula in the cystic duct end  
class6	2181	the in vitro model was identical in the pig and human gallbladders  
class6	2181	gallbladders were excised using a technique causing minimal injury and anoxia  
class6	2181	they were oxygenated on both mucosal and serosal surfaces in a temperature controlled environment  
class6	2181	luminal and external bath test solutions consisted of modified ringers bicarbonate with added glucose  luminal solutions also contained 125i albumin from different species  depending on the study  
class6	2181	active absorption of sodium and water occurred in both types of studies in the pig but in vivo absorption rates were considerably greater than in vitro rates  
class6	2181	albumin absorption in vivo was substantial  although present in vitro  the absorption of albumin was diminished relatively more than electrolyte transport rates  
class6	2181	protein secretion rates into the gallbladder were similar in vitro and in vivo  
class6	2181	the results of studies in the human gallbladders in vitro were similar to the pig  except albumin absorption was greater  
class6	2181	some human gallbladders were obtained from control patients and some from patients with cholesterol gallstones  
class6	2181	there were no significant differences between the two groups for any of the variables studied  however  the numbers were small and some control gallbladders were not normal gallbladders  
class6	2182	diagnostic value of brush cytology in the diagnosis of bile duct carcinoma  a study in 65 patients with bile duct strictures  
class6	2182	malignant strictures of the extrahepatic bile ducts are difficult to distinguish from benign strictures  particularly in patients with primary sclerosing cholangitis  
class6	2182	because attempts at diagnosing small cancers with fine needle aspiration biopsy are not possible in the absence of an associated mass lesion and because the sensitivity of exfoliative biliary cytology is controversial  brush cytology has been used as a potential means of establishing a specific diagnosis of bile duct carcinoma  
class6	2182	herein we report our experience with this technique when performed on 65 patients over a 5 yr period  
class6	2182	each had at least one brushing  
class6	2182	thirty seven were found to have bile duct carcinoma and 28 were found to have benign strictures  
class6	2182	of these 37  the first brushing was positive for malignancy in 15  40    whereas four  11   had cells suspected but not diagnostic of malignancy  
class6	2182	thirteen patients with bile duct carcinoma whose initial brushings were negative for malignancy had second brushings  
class6	2182	of these  five  38   had malignant cells  whereas three  24   yielded suspicious cells  
class6	2182	three of the eight whose first two brushings were negative for malignancy were found to have malignant cells on the third brushing  
class6	2182	in contrast  of the 28 patients with benign strictures  malignant cells were never found  
class6	2182	however  in two patients  suspicious cells were reported with the first but not the second brushing  
class6	2182	a single negative or suspicious cytological finding decreased the probability of bile duct carcinoma to 43   
class6	2182	two and three sequential negative tests reduced the probability to 32  and 0   respectively  
class6	2183	immunohistochemical detection of abnormal cell proliferation in colonic mucosa of subjects with polyps  
class6	2183	previous studies have shown the presence of increased proliferation in the large bowel epithelium of those at high risk of developing colon cancer  
class6	2183	an in vitro technique for labelling large bowel mucosa with the thymidine analogue bromodeoxyuridine  brdu  was therefore developed and its ability to distinguish differences in mucosal proliferation between subjects with colorectal adenomas and normal controls was assessed  
class6	2183	sigmoid biopsy specimens from 15 subjects with polyps and 15 age and sex matched controls were labelled and the incorporated brdu visualised with an immunohistochemical technique  
class6	2183	mean labelling index  li  was significantly higher in those with polyps than in controls  
class6	2183	differences in the pattern of labelling in colonic crypts were compared by the generation of cumulative labelling distributions  
class6	2183	analysis showed a significant expansion of the proliferative compartment in the colon crypts of those with polyps  
class6	2183	it is concluded that in vitro labelling with brdu provides a useful method for the assessment of mucosal proliferation in subjects at high risk of developing colon cancer  
class6	2184	serum pepsinogen i and gastrin concentrations in children positive for helicobacter pylori  
class6	2184	serum pepsinogen i  serum gastrin concentration  and inflammatory scores were measured in a population of 71 children undergoing upper gastrointestinal endoscopy for investigation of upper abdominal pain  
class6	2184	forty four were initially colonised with helicobacter pylori  
class6	2184	the indices were measured before treatment  in 71 children   one month  in 41 children   and six months  in 21 children  after stopping treatment  
class6	2184	before treatment there was a significant correlation between serum pepsinogen concentration  total inflammatory score  and h pylori state  but no correlation between serum gastrin concentrations and h pylori state  
class6	2184	similarly  the total inflammatory score and serum pepsinogen concentrations were significantly correlated  
class6	2184	there was no such correlation in children negative for h pylori  
class6	2184	after treatment the inflammatory score improved in those patients in whom h pylori had been eradicated  
class6	2184	there was also a significant fall in serum pepsinogen i and serum gastrin concentration in those patients in whom h pylori had been eradicated  
class6	2184	these results were similar to those found six months after treatment had been stopped  
class6	2184	these findings suggest that the serum pepsinogen i concentration could be considered a useful marker for gastritis and can be used as an index of severity of gastritis in h pylori positive subjects  
class6	2184	the measurement of serum gastrin concentrations does not give useful information  
class6	2185	photochemotherapy improves chronic cutaneous graft versus host disease  
class6	2185	we have used oral psoralen photochemotherapy  puva  to treat four patients with chronic graft versus host disease of the skin  oral mucosa  and liver  who had responded only partially to long term immunosuppressive therapy  prednisolone  cyclosporine  azathioprine   
class6	2185	puva therapy was delivered to the entire skin but not to the oral mucosa  and immunosuppressive therapy was continued in all patients  
class6	2185	two patients  skin lesions improved considerably  the oral lesions healed and did not recur in one  
class6	2185	immunosuppressive therapy could be reduced in these two patients  
class6	2185	one patient with sicca signs did not improve  
class6	2185	one patient had to interrupt puva therapy because of side effects attributed to 8 methoxypsoralen  nausea and vomiting   
class6	2185	no flare of acute cutaneous graft versus host disease was noted during puva therapy  
class6	2185	chronic graft versus host disease of the liver did not improve in any patient  
class6	2186	imidazole salicylate versus piroxicam in the treatment of arthrosis in elderly patients  a double blind clinical and endoscopic trial  
class6	2186	the clinical efficacy and gastroduodenal tolerability of imidazole salicylate  imidazole 2 hydroxybenzoate  itf 182   a new synthetic drug with an anti inflammatory action  was evaluated endoscopically in comparison with those of piroxicam in elderly patients suffering from osteoarthrosis  
class6	2186	of the 41 patients entering the trial  only 38 completed the protocol  6 men and 32 women  mean age  71  range  65 80 years   
class6	2186	after upper gastrointestinal endoscopy for the purpose of excluding gastric and duodenal mucosal lesions  the patients were allocated at random  according to a double blind  double dummy protocol  to treatment either with imidazole salicylate 750 mg three times daily or with piroxicam 20 mg once daily for a period of 4 weeks  
class6	2186	imidazole salicylate proved active in controlling a number of the pain symptoms caused by arthrosis  although its efficacy was inferior to that of piroxicam  
class6	2186	grade 2 gastric mucosal lesions were detected in 1 of 20 patients  5   treated with imidazole salicylate  lesions corresponding to grades 2  3  and 4 were found in 6 of 18  33   of those treated with piroxicam  p    034   
class6	2186	painful dyspepsia was reported by 15  of the patients in the imidazole salicylate group and by 28  of those in the piroxicam group  
class6	2186	on the basis of these results and under the experimental conditions adopted in this trial  the authors concluded that imidazole salicylate is characterized by good gastric tolerability and can thus be used in the treatment of rheumatic diseases in the elderly  
class6	2187	alternation of gastric mucosal glycoprotein  lectin binding pattern  in gastric mucosa in stress  a light and electron microscopic study  
class6	2187	gastric mucosal cells of the rat glandular stomach were studied by light and electron microscopic procedures by use of lectins in the development of acute gastric mucosal lesions  
class6	2187	effects of the h2 receptor antagonist sofalcone  2 carboxymethoxy 4 4  bis 3 methyl 2  and truncal vagotomy with pyloroplasty on lectin binding sites and distribution were also investigated  
class6	2187	biotinylated lectins in combination with abc  avidin biotinyl peroxidase complex  method were used for light and horseradish peroxidase  hrp  labeled lectins for electron microscopic studies  
class6	2187	gastric mucosal cells showed the specific binding pattern for each lectin by light microscopy  
class6	2187	especially  binding sites and distribution of peanut agglutinin  pna  were characteristic after induction of stress  truncal vagotomy  and administration of each drug  
class6	2187	staining and distribution increased in the gastric mucosa upward and downward after that  
class6	2187	in electron microscopic studies  pna strongly stained the membranes of the intracellular secretory canaliculi of a parietal cell  
class6	2187	these results suggested that alternation of binding sites and distribution was regulated by change of gastric mucosal blood flow and of acidity in the parietal cells  
class6	2187	therefore  increase of glycoconjugate distribution is supposed to be a possibility of cytoprotective effect for a change of environment in the parietal cells  
class6	2188	generation of ammonia and mucosal lesion formation following hydrolysis of urea by urease in the rat stomach  
class6	2188	we examined the morphological changes in gastric mucosa and the generation of ammonia after exposure of the rat stomach to urea in the presence of urease  in attempts to investigate a pathophysiological role of urea  urease  and ammonia system in gastric ulcer diseases  
class6	2188	exposure of the stomach for 20 min to 2 ml urea  0 025 0 2   together with urease  100 iu  induced histological damages in a concentration related manner  
class6	2188	either urea or urease alone did not induce any histological change in the mucosa  
class6	2188	instillation of urea into the stomach generated ammonia in the presence of urease  the amount of ammonia was increased depending on the concentration of urea  and was closely associated with the severity of histological damage  
class6	2188	the exposure of the stomach to ammonia  nh4oh  0 01 0 1   also produced histological damages in the gastric mucosa in a concentration related manner  
class6	2188	the characteristics of injury induced by 0 5 1 0  ammonia were stasis of microcirculation  disruption of the surface epithelial cells  and necrosis of the mucosa  
class6	2188	these results demonstrated that ammonia generated from the hydrolysis of urea by urease in the stomach causes damages in the gastric mucosa  
class6	2189	possible role of leukotrienes in gastritis associated with campylobacter pylori  
class6	2189	this study was done to evaluate the role of leukotrienes  lts  in gastritis associated with campylobacter pylori  
class6	2189	biopsy specimens of gastric mucosa were obtained endoscopically from 18 patients with nonulcer dyspepsia for bacteriological and histological examination and extraction of lts  
class6	2189	there was correlation between the ltb4 level in the mucosa and the degree of gastritis evaluated histologically  
class6	2189	the level was higher when infiltration of neutrophils in the gastric mucosa was more extensive  
class6	2189	the ltb4 level in mucosa infected with c  
class6	2189	pylori was higher than that in noninfected mucosa  
class6	2189	these findings suggest that endogenous lts may be related to the pathogenesis of gastritis associated with c  
class6	2189	pylori  
class6	2190	 healed  experimental gastric ulcers remain histologically and ultrastructurally abnormal  
class6	2190	the present study was designed to assess histologic and ultrastructural features of gastric mucosa in the areas of grossly healed ulcers  acetic acid induced gastric ulcers  in rats  
class6	2190	the specific question we studied was whether the structure and cellular composition of the gastric mucosa in an area of grossly healed ulcer were fully restored  
class6	2190	eighty sprague dawley rats underwent laparotomy  100  acetic acid was applied to the lower gastric corpus serosa for 30 s and the abdomen was closed  
class6	2190	the stomachs were reopened after 2 weeks or after 2  3  or 4 months  
class6	2190	standardized gastric wall specimens from the area of grossly healed ulcers were obtained  processed  and evaluated by light microscopy and by transmission electron microscopy  
class6	2190	the gastric mucosa of grossly healed ulcers demonstrated re epithelialization at each study time but the mucosa beneath the surface epithelium displayed prominent histologic and ultrastructural abnormalities  
class6	2190	two different patterns of scar could be distinguished   a  the mucosa in the area of healed ulcer was thinner  25 45  reduction vs  
class6	2190	normal   with increased connective tissue and poor differentiation and or degenerative changes in the glandular cells  or  b  the mucosa displayed ballooning dilatation of gastric glands  reduction in the microvascular network  and poor differentiation of glandular cells  
class6	2190	we conclude that  i  the subepithelial mucosa of grossly healed gastric ulcer displays disorganized restoration of glandular and vascular structures and remains histologically and ultrastructurally abnormal   ii  these abnormalities may interfere with oxygenation  nutrient supply  and with mucosal resistance and defense  and therefore could be the basis for ulcer recurrence  
class6	2191	vascular and microvascular changes  key factors in the development of acetic acid induced gastric ulcers in rats  
class6	2191	the present study examined the time sequence and histologic and ultrastructural features of the formation and evolution of experimental  acetic acid induced gastric ulcerations in rats  
class6	2191	one hundred percent acetic acid was applied to the gastric serosa of 140 fasted male sprague dawley rats through a polyethylene tube for 30 s  
class6	2191	gastric mucosal changes were evaluated at 1  5  15  and 30 min  1 and 3 h  and 1  2  3  5  8  and 11 days after acetic acid application by visual inspection  by quantitative and qualitative light microscopy  and by transmission electron microscopy  
class6	2191	following exposure to acetic acid  the earliest morphologic changes occurred at 1 min and consisted of dilatation of large submucosal veins and arteries and mucosal collecting venules  
class6	2191	five to 15 minutes after injury  thrombi developed in submucosal veins and collecting venules  leading to microvascular stasis and mucosal necrosis  
class6	2191	by 3 h  necrotic masses started to detach  
class6	2191	by 24 48 h  necrotic changes penetrated the submucosa  
class6	2191	by 72 h  most ulcers underwent transition into a  chronic  stage characterized histologically by the presence of granulation tissue at the bottom  and the appearance of a transitional healing zone at the margins  
class6	2191	by 5 days  an increased amount of granulation tissue was observed and the gastric glands in transitional zones at the ulcer margin displayed cystic dilatation  
class6	2191	based on this study  we conclude that a key feature of acetic acid induced ulcer formation is the early vascular and microvascular injury  which precedes glandular cell necrosis  
class6	2192	further study of mucosal repair by sofalcone in experimental gastritis  
class6	2192	the effect of sofalcone on the glandular structure and cell proliferation in the gastric mucosa of rats with gastritis induced by the administration of sodium taurocholate  tca  for 6 months was examined by histoquantitative analysis and  3h thymidine autoradiography  
class6	2192	morphometric observation revealed that  with tca treatment  mucosal thickness  parietal cell mass  and the ratios of the length of the glandular portion total length of the gastric gland were decreased in both the fundic and pyloric glands  
class6	2192	inflammatory cell infiltration and collagenous fiber proliferation were present in the gastric mucosa following tca and indicated the presence of atrophic gastritis  
class6	2192	these atrophic changes and inflammatory cell infiltration were reversed by a 3 week administration of sofalcone  
class6	2192	cellular proliferative activity assessed by the labeling indices of the gastric mucosa increased in tca induced gastritis in rats  
class6	2192	the administration of sofalcone to rats with tca induced gastritis significantly increased labeling indices  particularly in the pyloric glands  
class6	2192	from these results  it appears that sofalcone stimulates the compensatory increase in proliferative activity of generative cells  which then may become available to heal the gastritis  
class6	2193	effect of epidermal growth factor in combination with sucralfate or omeprazole on the healing of chronic gastric ulcers in the rat  
class6	2193	epidermal growth factor  egf  has been shown to enhance healing of experimental gastric ulcers when given subcutaneously or orally in the drinking water  
class6	2193	this effect of egf occurs without reducing gastric acid secretion  
class6	2193	on the other hand  egf reportedly is excreted rapidly from gastric lumen when administered by intragastric bolus  
class6	2193	this suggests that further stimulation of ulcer healing may be expected if egf is given with an acid suppressive agent or with an agent allowing egf to remain in rat gastric lumen at high concentrations  
class6	2193	in the present study  egf administered by gastric intubation at a dose of 10 micrograms kg  which is three times smaller than reported in previous studies  was evaluated for its effect on acetic acid induced rat gastric ulcers in combination with sucralfate or omeprazole  
class6	2193	sucralfate is well known selectively to bind proteins covering the ulcer base  and omeprazole is a potent acid suppressive agent  
class6	2193	prior to the study of combined egf and sucralfate  oral sucralfate was confirmed to allow endogenous gastric egf and mouse egf given exogenously to remain at high concentrations in gastric contents and tissues  
class6	2193	egf and sucralfate  2 g kg day  given alone failed to stimulate ulcer healing in submandibularectomized rats  smr rat  whose endogenous gastric egf was depleted  
class6	2193	however  the combination of both drugs administered at the same doses significantly accelerated ulcer healing in the smr rat  
class6	2193	omeprazole  200 mg kg day  significantly enhanced ulcer healing regardless of removal of the submandibular glands  
class6	2193	the combination of egf and omeprazole further stimulated ulcer healing in the smr rat  
class6	2194	fibronectin related substance located in the chief cells of human and rat gastric mucosa  
class6	2194	a novel substance located in the chief cells of human and rat gastric mucosa  which was detected immunologically by either polyclonal or monoclonal antihuman fibronectin  fn  antibodies  is reported  
class6	2194	all three polyclonal antihuman fn antibodies used in this study reacted immunohistologically exclusively with the chief cells  
class6	2194	monoclonal antibody against c terminal peptide or cell binding peptide reacted clearly with the human chief cells  but monoclonal antibodies against fn n terminal and midmolecule failed to react with the cells  
class6	2194	western blot analysis of the rat gastric mucosal extract with polyclonal antihuman fn antibody showed that this substance has a molecular weight of about 70 000 da  
class6	2194	therefore  this substance appears to be a fragment containing the c terminal peptide of whole molecule fn and thus in the present study is named fn related substance  fnrs   
class6	2194	in a further study with ethanol induced ulcer model of the rat  the physiological significance of fnrs was examined  
class6	2194	the fnrs decreased remarkably  in a dose dependent manner  in the fundic mucosa of the rats that ingested ethanol  
class6	2194	the fnrs appeared to be associated with development of mucosal damage and repair  subsequently playing  in part  an important role in the gastric mucosal protection mechanism  
class6	2195	evidence for gastric mucosal cell invasion by c  pylori  an ultrastructural study  
class6	2195	it is now generally accepted that campylobacter pylori is closely associated with peptic ulcer disease and chronic type b gastritis  
class6	2195	whether c  
class6	2195	pylori is the direct etiologic cause of either or both of these illnesses remains unclear  
class6	2195	possible pathophysiologic effects of c  
class6	2195	pylori are still a matter of debate and conjecture  
class6	2195	utilizing a small group of patients with gastric ulcers and chronic gastritis  we examined the ultrastructural relationship between c  
class6	2195	pylori and gastric cells  
class6	2195	forty eight percent of our gastric ulcer patients and 57  of our chronic gastritis patients had c  
class6	2195	pylori in their lower corpus mucosa  
class6	2195	examination with the transmission electron microscope indicated a very close proximation by c  
class6	2195	pylori to the surface epithelial cells strongly suggesting adherence  
class6	2195	we also describe for the first time the invasion of gastric cells by c  
class6	2195	pylori  
class6	2195	although an uncommon occurrence  we had repeated observations of c  
class6	2195	pylori invading surface epithelial cells  parietal cells  and chief cells  
class6	2195	most of the intracellular c  
class6	2195	pylori were intact but other forms appearing to be degenerating organisms were also seen  
class6	2195	we suggest that cell invasion may be one mechanism by which c  
class6	2195	pylori causes pathologic changes in the gastric mucosa  
class6	2195	these observations may also explain why c  
class6	2195	pylori chronically infects gastric cells and frequently recurs after treatment  
class6	2196	pelvic pain  lessons from anatomy and physiology  
class6	2196	pelvic pain is often a difficult differential diagnosis in the emergency department  
class6	2196	for physiologic reasons  pain in the pelvis is difficult to localize to a specific organ  and pelvic peritonitis is hard to recognize  
class6	2196	on the other hand  differences in types of pain can be very useful in arriving at a correct diagnosis  
class6	2196	the clinician must learn to recognize superficial and deep somatic pain  and differentiate between various types of visceral pain which originate from inflammation  ischemia  or colic  
class6	2196	a review of the anatomy and physiology of pelvic pain helps identify some of the problems as well as potential aids in approaching the patient with pelvic pain  
class6	2197	biliary lithotripsy  in vitro analysis of gallstone fragmentation for equivalent stone volumes  
class6	2197	the relationship between gallstone fragmentation during extracorporeal shock wave lithotripsy  eswl  and gallstone volume is poorly understood  
class6	2197	clinical results of eswl show that the highest stone free rate at 6 months occurs with radiolucent single gallstones 20 mm or less in diameter  
class6	2197	in an in vitro study  individual gallstones from cholecystectomy specimens were divided by size and composition into nine single  and nine multiple stone groups  the stones were then paired on the basis of similar volume  
class6	2197	eswl was performed in a phantom and the size of the largest fragment was measured at 500  1 000  and 1 500 shock waves  
class6	2197	at 1 500 shock waves  sandlike particles were present in six of nine single stones versus two of nine multiple stone groups  the mean size of the largest fragment at 1 500 shock waves was 2 1 mm  single  and 4 4 mm  multiple  in diameter  
class6	2197	when corrected for volume  the authors  data suggest that single stones are more easily broken into fragments smaller than 5 mm in diameter than multiple gallstones  
class6	2197	the implication  especially when spark gap technology is used  is that more shock wave energy  ie  an increased number of shock waves at a higher kilovoltage  will be necessary to achieve the same results when treating patients with multiple stones versus a single gallstone with a similar stone volume  
class6	2198	segmented turboflash  method for breath hold mr imaging of the liver with flexible contrast  
class6	2198	a method called segmented turboflash imaging allows high resolution  multisection  short inversion time  ti  inversion recovery  stir   t1  or t2 weighted magnetic resonance  mr  studies of the liver to be completed within a breath hold interval  
class6	2198	the method was applied in a phantom and in 19 patients with hepatic lesions  
class6	2198	sequence comparisons were performed among segmented turboflash  single shot turboflash  t1 weighted gradient echo with ultrashort echo time  and t2 weighted spin echo  se  techniques  
class6	2198	signal from fat and liver could be nulled with the segmented turboflash method  with tis of 10 and 300 msec  respectively  signal from these tissues could not be eliminated with the single shot approach  
class6	2198	signal difference to noise ratios and contrast for the best segmented sequences were comparable with those of the best t2 weighted se and t1 weighted gradient echo techniques  
class6	2198	it is concluded that it is feasible to obtain breath hold images with arbitrary tissue contrast by means of segmented turboflash imaging  
class6	2198	the method may prove helpful for the detection and characterization of hepatic lesions and will likely have applications to other anatomic regions such as the chest and pelvis  
class6	2199	intra abdominal palpation of a nasogastric tube in the stomach does not assure appropriate placement  
class6	2199	improperly placed nasogastric  ng  tubes have been associated with considerable morbidity  
class6	2199	the only reliable indicator of correct ng tube placement appears to be the aspiration of gastric contents  
class6	2199	we have reported a case of major morbidity from an improperly placed ng tube that perforated the cervical esophagus  dissected the mediastinum  and terminated in the omental bursa  
class6	2199	no gastric aspirate was obtained by suctioning of the tube  but correct placement was presumed based upon the surgeon s direct intraoperative palpation of the tip of the tube  
class6	2199	failure to aspirate gastric contents should alert the practitioner to the possibility of improper ng tube placement  
class6	2200	broad spectrum penicillin as an adequate therapy for acute cholangitis  
class6	2200	in a previous study of patients with acute cholecystitis  we demonstrated equal efficacy with a broad spectrum penicillin  piperacillin  and a penicillin plus amino glycoside combination  
class6	2200	whether a single agent broad spectrum penicillin is adequate treatment for more severe infections  such as acute cholangitis  however  is still unclear  
class6	2200	we  therefore  conducted a three center  prospective  randomized trial to determine whether or not a broad spectrum penicillin alone is adequate therapy for patients with acute cholangitis  
class6	2200	during a 36 month period  96 patients with sepsis and biliary obstruction were randomly assigned to receive either piperacillin  n   49  or ampicillin plus tobramycin  n   47   
class6	2200	the two groups receiving antibiotics were similar with respect to all clinical and laboratory parameters  
class6	2200	the incidence of blood cultures with positive results  20 versus 21 per cent  and underlying malignant lesions  51 versus 62 per cent  was also similar between the two groups  
class6	2200	the percentage of patients with a clinical cure or significant improvement was the same in the two groups  69 versus 70 per cent   
class6	2200	however  there was a significant difference in the cure rate between patients with benign and malignant biliary obstructions  83 versus 59 per cent  p less than 0 01   
class6	2200	no significant differences were noted between the two antibiotic groups with respect to drug toxicity  but patients with malignant conditions were more prone to antibiotic related toxicities  2 versus 19 per cent  p less than 0 05   
class6	2200	these data suggest that outcome of treatment in patients with acute cholangitis is similar with either a broad spectrum penicillin or a penicillin plus aminoglycoside combination and is dependent upon the nature of the biliary obstruction  
class6	2201	synchronous carcinoma of the colon and rectum  
class6	2201	reports on the incidence of synchronous carcinoma of the colon and rectum have varied from 2 to 11 per cent  
class6	2201	the variability is a result of a lack of uniformity in criteria of diagnosis  differences in the population studied and differences in time period used  
class6	2201	in this study  we evaluated the incidence and distribution of synchronous lesions during a recent time period before the use of colonoscopy became widespread  
class6	2201	we reviewed the records of all patients with newly diagnosed adenocarcinoma of the colon and rectum who were operated upon at our institution between 1976 and 1981  
class6	2201	in a total group of 1 000 patients of which 52 per cent were men  there were 54 patients or 5 4 per cent who had synchronous carcinomas  
class6	2201	the group of patients with synchronous carcinomas were older than the group with nonsynchronous carcinomas  72 4 versus 68 8 years   
class6	2201	there was also a higher incidence of associated benign polyps in the group with synchronous carcinomas  70 versus 30 per cent for a nonsynchronous carcinomas   
class6	2201	the anatomic distribution of carcinomas of the colon and rectum in the group with synchronous lesions  111 in total  revealed a higher percentage of carcinomas located on the right side  29 7 versus 22 5 per cent   although the difference did not reach statistical significance  
class6	2201	synchronous carcinomas were located in nonadjacent segments of the colon in 37 per cent  
class6	2201	there was no difference in stage between the groups with and without synchronous carcinomas  
class6	2201	the preoperative identification of synchronous lesions by either colonoscopy or barium enema is important for the proper treatment of patients with carcinoma of the colon and rectum  
class6	2201	failure to locate these tumors may lead to the demise of the patient  
class6	2202	congenital dilatation of the bile duct in 100 instances and its relationship with anomalous junction  published erratum appears in surg gynecol obstet 1991 mar 172 3  246  
class6	2202	congenital dilatation of the bile duct  cdbd  or choledochal cyst has been demonstrated to be associated with an anomalous junction of the pancreaticobiliary ductal system  
class6	2202	multifarious clinical signs and symptoms of cdbd have been shown to be closely related with the presence of this anomalous junction  
class6	2202	in the present study  100 instances of cdbd treated surgically at our institutions during a 30 year period were classified into two types according to the morphologic features of dilatation of the bile duct  there were 77 instances of the cystic type and 23 of the cylindric type  
class6	2202	morphologic features of the lesion  clinical signs and symptoms and laboratory findings in these 100 instances were clinically analyzed  
class6	2202	in almost all of the patients who were less than one year of age  the disease was of the cystic type and patients presented with either a palpable mass or jaundice as the main symptom  
class6	2202	in patients more than one year of age  the disease was of either the cystic or cylindric type  
class6	2202	a history of episodes of characteristic abdominal pain accompanied by elevated levels of serum amylase was present in 70 of the patients with the cystic type of disease and in all of the patients with the cylindric type  
class6	2202	histologic sections from the patients showed glandular formation with chronic inflammation  possibly a result of refluxed activated pancreatic juice  in contrast  histologic sections from the remaining patients of all ages showed only thickening of the fibrous layer  
class6	2202	thus  such variable morphologic features and clinical signs and symptoms in cdbd are highly dependent on two factors  the age at onset and the reflux of pancreatic juice into the bile duct through the common channel  
class6	2203	a multifactorial analysis of mortality and morbidity in perforated peptic ulcer disease  
class6	2203	perforated peptic ulcer disease remains a source of considerable morbidity and mortality  and the suggested methods of surgical therapy are diverse  
class6	2203	we reviewed the course of 113 patients who were treated surgically and identified 14 factors that influenced the morbidity or mortality rates  or both  
class6	2203	multiple regression analysis showed that the number of coexisting medical conditions  a lower mean blood pressure level and the duration of acute perforation were independent risk factors for death  while age  use of a bronchodilator  a lower mean blood pressure level and the number of coexisting medical conditions correlated positively with all complications  
class6	2203	a duodenal site was independently favorable with respect to all complications  
class6	2203	the type of operation performed either simple closure  vagotomy and drainage or resection  did not influence morbidity or mortality  
class6	2203	the most severely ill patients also did not benefit from any particular type of operation in the short term  
class6	2203	long term results were improved with definitive operation  as measured by the visick classification and the need for reoperations  
class6	2203	definitive operations are recommended for virtually all patients with perforated peptic ulcer  
class6	2204	surgical management of islet cell dysmaturation syndrome in young children  
class6	2204	islet cell dysmaturation syndrome  icds  encompasses the causes of infantile hyperinsulinemic hypoglycemia histologically described as islet cell hyperplasia  pancreatic adenomatosis and nesidioblastosis  
class6	2204	eleven infants underwent 14 pancreatic resections for icds from 1965 to 1990 at the university of california at los angeles medical center for severe hypoglycemia unresponsive to medical therapy  
class6	2204	seizures were the presenting symptoms of hypoglycemia in eight infants  
class6	2204	six patients had nesidioblastosis  four had islet cell hyperplasia and one patient had an adenoma with histologically normal pancreatic islet cells  
class6	2204	four neonates underwent 80 per cent pancreatic resection  three with nesidioblastosis required reoperation  90 to 95 per cent resection   
class6	2204	four older infants underwent 80 per cent pancreatic resection but required diazoxide for less than six months postoperatively  
class6	2204	three infants underwent 90 to 95 per cent pancreatic resection  
class6	2204	none have required reoperation or postoperative medications  
class6	2204	all infants are normoglycemic without pancreatic exocrine insufficiency and none had postoperative complications  
class6	2204	five infants had preoperative neurologic impairment  with three having severe retardation  all showed some improvement postoperatively  but only one infant now has normal findings on neurologic examination  
class6	2204	early diagnosis and aggressive surgical resection should minimize neurologic complications of the icds  
class6	2205	ascending cholangitis  surgery versus endoscopic or percutaneous drainage  
class6	2205	a retrospective review of 61 patients with calculous cholangitis was carried out  
class6	2205	there were 31 men and 30 women and their mean age was 75 8 years  
class6	2205	all patients had abdominal pain  87  had chills and fever  65  had clinical jaundice  23  were in shock  and 54  had positive blood cultures  
class6	2205	because intravenous hydration and antibiotics did not help  33 patients underwent surgery  25 patients underwent endoscopic papillotomy  ep   and three patients underwent percutaneous transhepatic drainage of the common bile duct  ptd   
class6	2205	morbidity in the surgery group included two wound infections  one respiratory failure  and one renal failure  
class6	2205	morbidity in the ep ptd group was one case of arterial bleeding requiring surgery and one of pancreatitis treated conservatively  
class6	2205	two patients  6   died in the surgery group  one of sepsis and the other of cardiorespiratory arrest  
class6	2205	in the ep ptd group nine patients  32   died of sepsis and multisystem organ failure  
class6	2205	these patients were considered too ill to undergo surgery and thus repeat ep ptd was carried out  
class6	2205	cholangitis persisted  and retained common bile duct stones with sepsis was the cause of death  
class6	2205	thus when initial ep or ptd is unsuccessful  surgical exploration of the common bile duct should be carried out to control sepsis  
class6	2206	are cystgastrostomy and cystjejunostomy equivalent operations for pancreatic pseudocysts  
class6	2206	to compare the effectiveness of cystgastrostomy and cystjejunostomy for treatment of pancreatic pseudocysts  39 patients with cystgastrostomy were compared to 59 patients with cystjejunostomy  
class6	2206	the groups were comparable in age  sex  cause of pancreatitis  pseudocyst location  symptoms  and preoperative serum amylase level  
class6	2206	cysts treated with cystgastrostomy were larger  mean diameter  11 1     0 9 cm  than cysts treated by cystjejunostomy  mean diameter  6 7     0 7 cm   p less than 0 05   
class6	2206	mean duration of surgery was 148     11 minutes for cystgastrostomy versus 265     15 minutes for cystjejunostomy  p less than 0 05   
class6	2206	mean blood loss was 397     82 ml for cystgastrostomy versus 703     80 ml for cystjejunostomy  p less than 0 05  mean intraoperative fluid requirements were 2640     313 ml for cystgastrostomy and 4403     362 ml for cystjejunostomy  p less than 0 05   
class6	2206	cyst recurrence was 10  for cystgastrostomy versus 7  for cystgastrostomy  
class6	2206	postoperative gastrointestinal bleeding occurred in 8  of patients with cystgastrostomy and in 2  of patients with cystjejunostomy  
class6	2206	infection problems with cystjejunostomy included two wound infections and one case of septicemia  infection problems with cystjejunostomy included five intraabdominal abscesses  two wound infections  and one case of pneumonia  
class6	2206	two patients died with cystgastrostomy  both from gastrointestinal bleeding   two patients died with cystjejunostomy  one from intraabdominal sepsis and one from pulmonary embolus   
class6	2206	cystgastrostomy was used for significantly larger pseudocysts and was associated with significantly less blood loss and operating time than cystjejunostomy  p less than 0 05   
class6	2206	morbidity and mortality from cystgastrostomy and cystjejunostomy were comparable  although gastrointestinal bleeding was more common with cystgastrostomy and intraabdominal abscess was more common with cystjejunostomy  
class6	2206	since cystgastrostomy can usually be performed more quickly and with less blood loss  it should be considered whenever anatomically feasible  
class6	2207	early results of combined electrohydraulic shock wave lithotripsy and oral litholytic therapy of gallbladder stones at the university of iowa  
class6	2207	one hundred thirty three patients were entered into a randomized  double blind  placebo controlled trial of extracorporeal shock wave lithotripsy for symptomatic gallstones versus extracorporeal shock wave lithotripsy plus adjuvant litholytic therapy with ursodeoxycholic acid  udca   
class6	2207	six months after lithotripsy  patients receiving placebo were crossed over to udca therapy without unblinding the study  
class6	2207	one hundred sixteen patients have completed 6 months of follow up  
class6	2207	five patients were dropped from the study  
class6	2207	nine percent have required cholecystectomy  11 patients with biliary colic and 1 with acute cholecystitis   
class6	2207	ninety one patients had a solitary stone  64 patients had stones less than or equal to 20 mm and 27 patients had stones greater than 20 mm in diameter   and 25 patients had two to three stones  
class6	2207	fifty percent were retreated  
class6	2207	cumulative stone free rates at 6  12  and 18 months were 26   39   and 41   respectively  
class6	2207	at 6 months there was a significant advantage for patients treated with udca versus placebo  36  vs 17  were stone free  that had disappeared by 12 months  placebo treated patients had received 6 months of udca   
class6	2207	patients with solitary stones equal to or less than 20 mm in diameter treated with udca had stone free rates at 6  12  and 18 months of 58   58   and 62   respectively  versus 27   56   and 50   
class6	2207	the difference was significant only at the 6  month follow up  
class6	2207	stone free rates for patients with large solitary stones and multiple stones were very low  
class6	2207	extracorporeal shock wave lithotripsy is both safe and effective therapy for treatment of symptomatic gallstones in patients with a solitary stone equal to or less than 20 mm in diameter  
class6	2207	udca markedly improves the efficiency of the procedure and results in a stone free gallbladder sooner  
class6	2208	the diagnosis and definition of hepatic malignancies by use of arterial enhanced computerized tomographic scanning  
class6	2208	axial computerized tomography is a useful tool in the evaluation of either primary or metastatic hepatic neoplasms  
class6	2208	an adjunct to this technique is visceral arterial enhanced computerized tomography  aect   
class6	2208	to determine the effectiveness of this modality  bolus intravenous enhanced computerized tomography scans and aect were compared and correlated to operative findings  
class6	2208	fifty four consecutive patients were evaluated by aect and bolus intravenous enhanced computerized tomography over a 30 month period  may 1986 to august 1989  for suspected primary or metastatic hepatic malignancies  
class6	2208	forty four patients  81   had hepatic lesions  
class6	2208	fifty two percent  23 of 44 patients  of the metastatic tumors were from colonic or rectal primary lesions  and 20  were hepatocellular primary lesions  
class6	2208	the remainder of the lesions were metastases from a variety of primary lesions  
class6	2208	when studies were compared  34  of the patients  15 of 44 patients  differed in either the location or total number of lesions noted  
class6	2208	the lesions of three of the 15 patients  20   were determined unresectable on the basis of aect  
class6	2208	of the remaining patients  planned resections were revised in seven patients to either lesser or greater procedures  
class6	2208	the number of lesions found at laparotomy equaled the number found by aect in all but two cases  
class6	2208	aect caused no complications  
class6	2208	aect improved our ability to identify and localize primary and metastatic lesions of the liver  
class6	2208	this technique offers the advantage of preoperative definition of the hepatic arterial and portal venous anatomy  
class6	2209	anomalies of intestinal rotation in childhood  analysis of 447 cases  
class6	2209	this report concerns 447 infants and children with anomalies of rotation and fixation  
class6	2209	patients were placed in four groups based on initial symptoms  
class6	2209	group a involved 18 patients with acute midgut volvulus  
class6	2209	at laparotomy  midgut volvulus was noted and reduction of midgut volvulus and a ladd procedure were performed in 10 cases and resection was required in 8  
class6	2209	there were five deaths  28    
class6	2209	group b included 54 children with chronic symptoms of intermittent volvulus or duodenal obstruction  
class6	2209	group c involved 44 cases of malrotation observed during exploration for other disorders  
class6	2209	patients in groups b and c underwent a ladd procedure and appendectomy  
class6	2209	there were five unrelated deaths  
class6	2209	group d included 331 neonates with malrotation caused by either diaphragmatic hernia  n   111  or abdominal wall defects  n   220   
class6	2209	a ladd procedure was performed on 48 patients with abdominal wall defects and 29 surviving children with diaphragmatic hernia  
class6	2209	only 2 of 172  1 2   patients with abdominal wall defects and 1 of 34  2 9   patients with diaphragmatic hernia not treated for malrotation had midgut volvulus  
class6	2209	midgut volvulus is more common in infants and is associated with a high mortality rate  28    
class6	2209	patients with malrotation and chronic obstructive symptoms or those observed during other elective procedures should undergo a ladd procedure because of the risk of midgut volvulus  
class6	2209	the risk of midgut volvulus is low in patients with abdominal wall defects and  probably as a result of adhesions from previous neonatal operations  
class6	2210	long term follow up of the ileoanal anastomosis in children and young adults  
class6	2210	the purpose of this study was to carry out a long term study of the ileoanal anastomosis  iaa  in children and young adults  comparing the straight iaa to the j pouch  
class6	2210	one hundred twenty one young people who had undergone iaa were studied  with 114 available for long term follow up  
class6	2210	one hundred one were 18 years and under  
class6	2210	forty nine patients had a straight iaa and 72 had a j pouch reservoir  
class6	2210	there were no deaths  
class6	2210	after surgery  three children had intraabdominal sepsis and one had pelvic sepsis  but it did not lead to excision of the iaa  
class6	2210	the mean stool frequency in all 114 patients was 5 0     2 5 per day and 1 2     1 1 at night  
class6	2210	the mean number of stools for the straight iaa was 6 per day and 2 1 at night  
class6	2210	the mean number of stools for the straight iaa with balloon dilations was 5 8 per day and 1 2 at night  and for the j pouch it was 4 per day and 1 at night  
class6	2210	patients with both the j pouch and straight iaa had good to excellent sensation  with patients with the j pouch always able to distinguish flatus from stool in 87  of patients and almost always in 13   
class6	2210	daytime continence was very good in both groups  
class6	2210	moderate nighttime loss of stool occurred in 10 patients  6 with a straight iaa and 4 with a j pouch  
class6	2210	ninety five percent of the 114 patients were satisfied or very satisfied  with most children with a j pouch very satisfied  
class6	2210	the j pouch remains the procedure of choice in young people  
class6	2211	circadian esophageal motor function in patients with gastroesophageal reflux disease  
class6	2211	effective esophageal peristalsis is a major determinant of esophageal clearance function and may contribute to the development of complications in gastroesophageal reflux disease  
class6	2211	using 24 hour ambulatory esophageal manometry  we compared the circadian esophageal motor activity of normal volunteers to that of patients with increased esophageal exposure to gastric juice and various grades of mucosal injury  no mucosal injury  esophagitis  stricture  or barrett s esophagus   
class6	2211	the prevalence of a mechanically defective lower esophageal sphincter  esophageal acid exposure time  and the frequency of nonperistaltic esophageal contractions during the supine  upright  and meal periods increased with increasing severity of mucosal injury  
class6	2211	the median amplitude of esophageal contractions was compromised only in patients with a mechanically defective sphincter  
class6	2211	this was particularly so in patients with stricture or barrett s esophagus and was associated with an increased frequency of ineffective contractions  less than 30 mm hg   
class6	2211	these data show that esophageal motor function deteriorates with increasing severity of mucosal injury  
class6	2211	this appears to be caused by persistent reflux of gastric juice across a mechanically defective lower esophageal sphincter  
class6	2211	the need for surgical correction of a mechanically defective sphincter before the loss of esophageal body function is implicated  
class6	2212	abnormal membrane physical properties of red cells in mcleod syndrome  
class6	2212	mcleod red cells  rbcs  lack kx antigens and have weak expression of the kell antigens  
class6	2212	individuals who carry the mcleod phenotype have acanthocytic rbcs and a compensated hemolytic state  
class6	2212	to elucidate the role of the protein on which the kx antigens reside in maintaining membrane deformability  the rheologic properties of mcleod rbcs were determined by ektacytometry  
class6	2212	rbcs were obtained from normal individuals and from four patients with mcleod syndrome  
class6	2212	osmotic gradient deformability profiles of mcleod rbcs showed decreased whole cell deformability  
class6	2212	resealed ghosts from mcleod rbcs also showed decreased deformability  partly because of the decreased cell surface area and partly because of an intrinsic membrane stiffness in this syndrome  
class6	2212	for the measurement of membrane mechanical stability  resealed ghosts were subjected to constant high shear stress in the ektacytomer  and deformability was recorded continuously as the deformable ghosts fragmented into rigid spherical vesicles  
class6	2212	membranes from mcleod rbcs showed a noticeable increase in mechanical stability  
class6	2212	acquired causes of acanthocytosis  such as liver disease  did not cause the rheologic abnormalities observed in mcleod cells  
class6	2212	other abnormalities noted in mcleod rbcs were decreased rbc potassium content and an increased number of dense rbcs  as determined by centrifugation on a discontinuous density gradient  
class6	2212	the data indicate that mcleod rbcs are rigid and have decreased surface area and that their membranes are intrinsically rigid with increased mechanical stability  
class6	2212	these abnormalities may account for the reduced rbc survival observed in mcleod syndrome  
class6	2212	the protein that carries the kx surface antigen seems to be required for the maintenance of the normal physical function of rbc skeletal proteins  
class6	2213	from leningrad to the day care center  the ubiquitous giardia lamblia  
class6	2213	giardiasis is recognized as a worldwide public health problem  
class6	2213	seroprevalence data from both the developing and developed world show high rates of carriage in populations at risk for fecal oral transmission  such as children in day care centers  
class6	2213	outbreak investigation has expanded our understanding of reservoirs for giardia lamblia and of the routes of transmission  
class6	2213	various host factors have been associated with infection  
class6	2213	the pathogenesis of giardial infections is being elucidated  in particular the role of lectin activation in producing disease  
class6	2213	three standard chemotherapeutic agents are available in the united states  
class6	2213	the institution of community wide prevention measures is equally important  
class6	2213	current areas of investigation including antigenic composition and enzymatic variants should result in effective forms of immunotherapy  while more effective forms of chemoprophylaxis could assist in eradicating the pathogen from institutional settings  
class6	2214	pleuropulmonary manifestations of hepatic amebiasis 
class6	2214	pleuropulmonary manifestations of hepatic amebiasis occurred in 30 patients  18  60   presented with at least 1 pulmonary complaint and 10  33   had multiple pulmonary symptoms  
class6	2214	in 14 patients  47    abnormalities were found on examination of the chest  
class6	2214	in 16 chest roentgenograms  53    there was at least 1 abnormality  right sided pleural effusion  9 patients  and elevated right hemidiaphragm  8 patients  were the most common  
class6	2214	all patients were treated with metronidazole  flagyl  and had resolution of the amebic liver abscess and pulmonary disease  
class6	2214	pleuropulmonary disease is a common complication of amebic liver abscess  
class6	2214	the clinical presentation and chest roentgenograms are virtually diagnostic and obviate the need for invasive procedures to confirm the diagnosis  
class6	2214	pleuropulmonary disease resolves with amebicidal treatment of the hepatic abscess  
class6	2215	does paramedic base hospital contact result in beneficial deviations from standard prehospital protocols  
class6	2215	we reviewed written and audio records of paramedic base hospital radio contact to determine whether care differed from that suggested in standard prehospital care protocols  
class6	2215	records of all 659 contacts for seizure  syncope  abdominal pain  or altered mental state during 1987  28 4  of all contacts  were scored for the use of standard therapies  such as intravenous access  oxygen  naloxone hydrochloride  and unanticipated therapies  intubation  nitroglycerin   
class6	2215	cases that involved unanticipated treatments were reviewed to determine whether they could have been prospectively identified by simple clinical findings  
class6	2215	standard therapies were used in the majority of patients  
class6	2215	unanticipated therapies were administered to 13 patients  all of whom had abnormal vital signs  diaphoresis  respiratory distress  or a second prominent symptom  
class6	2215	data suggest that protocols could replace radio contact for most patients and that the few who might benefit from radio contact can be easily identified  
class6	2215	a 90  reduction in radio contacts in los angeles county could save  3 million each year  
class6	2216	sudden death due to delayed rupture of hepatic subcapsular hematoma following blunt abdominal trauma  
class6	2216	blunt abdominal trauma can cause sudden  unexpected death due to injuries to internal organs  
class6	2216	rupture of a hepatic subcapsular hematoma is a relatively rare cause of sudden death following minor blunt abdominal trauma  
class6	2216	death may be delayed several days to weeks  
class6	2216	the autopsy is an invaluable diagnostic tool that can be utilized to uncover sudden deaths due to abdominal trauma  
class6	2216	the case of an alcoholic who died of a ruptured hepatic subcapsular hematoma is presented  
class6	2216	the death investigation revealed that the victim had sustained blunt abdominal trauma during a fall a few days prior to death  
class6	2217	prospective randomized comparison of brown mchardy and microvasive balloon dilators in treatment of achalasia  
class6	2217	we report the results of a randomized prospective study comparing a standard bougie rubber balloon dilator  brown mchardy  bmh   and a newer polyethylene dilator passed over a guide wire  microvasive rigiflex  mvr    
class6	2217	twenty achalasia patients  15m  5f  mean age 45 4 yr  considered candidates for either dilator were randomized  
class6	2217	symptom assessment  body weight  and upright radionuclide solid esophageal emptying study were measured before and 6 months after pneumatic dilatation  
class6	2217	all dilatations were performed by one of three experienced gastroenterologists under fluoroscopic guidance  
class6	2217	overall success occurred with 10 10 bmh and 7 10 mvr  
class6	2217	one patient not improved with mvr had myotomy  the other two were successfully treated by bmh  
class6	2217	no complications occurred with either dilator  
class6	2218	features distinguishing secondary achalasia from primary achalasia  
class6	2218	eighteen patients with cancer induced or secondary achalasia  sa  were compared to 421 patients with idiopathic or primary achalasia  pa   
class6	2218	the aim of the study was to detect any differences in clinical presentation between the two groups  
class6	2218	mean age of patients with sa was 57 1  range 15 78  and 47 1  range 1 90  in patients with pa  p   0 02   
class6	2218	three patients with sa were 15  24  and 36 yr old  respectively  
class6	2218	symptom frequency was comparable in sa versus pa  
class6	2218	mean duration of symptoms in sa was 4 5 months  with 15 of the 18 patients experiencing symptoms for six months or less  
class6	2218	weight loss occurred in 88 2  of patients with sa and 57 3  of patients with pa  p less than 0 05   
class6	2218	cancer was at the gastroesophageal junction in 16 patients  duodenum in one  and breast in one  
class6	2218	endoscopy showed tumor in 12  67    
class6	2218	the esophagram was suspicious for tumor in only 25   
class6	2218	we conclude that patients with sa are older  more likely to lose weight  and have a short duration of symptoms  
class6	2218	however  sa may occur in younger patients  and endoscopy with biopsy is necessary in any newly diagnosed case of achalasia  
class6	2219	healing or amelioration of esophagitis does not result in increased lower esophageal sphincter or esophageal contractile pressure  published erratum appears in am j gastroenterol 1991 feb 86 2  253  
class6	2219	there is conflicting evidence regarding whether lower esophageal sphincter and esophageal contractile pressures are affected by changes in the severity of gastroesophageal reflux disease  
class6	2219	we compared the manometric and endoscopic findings from 30 patients before and after treatment for esophagitis  
class6	2219	before treatment  the grade of esophagitis  i iii  was significantly correlated  r    0 37  p less than 0 05  with lower esophageal sphincter pressure  but not with esophageal contractile pressure  
class6	2219	after treatment  the grade of esophagitis did not change or became worse in 15 patients  and became better in 15 patients  
class6	2219	of these  seven healed  
class6	2219	the group that showed no endoscopic improvement demonstrated no change in lower esophageal sphincter or esophageal contractile pressures  
class6	2219	the group that did show endoscopic improvement also demonstrated no increase in lower esophageal sphincter or esophageal contractile pressures  and this was particularly evident in those whose esophagitis healed  
class6	2219	these data suggest that healing of esophagitis does not result in improvement of esophageal motor function  
class6	2220	sucralfate used as adjunctive therapy in patients with severe erosive peptic esophagitis resulting from gastroesophageal reflux  
class6	2220	a total of 36 patients with grade 2 or greater erosive esophagitis and an abnormal 24 h ph monitor study  were treated in a randomized  double blind fashion to assess the efficacy of sucralfate suspension as adjunctive therapy to cimetidine for severe esophagitis secondary to gastroesophageal reflux  
class6	2220	treatment consisted of cimetidine  300 mg qid and either sucralfate suspension  1 g 10 ml  or an identical placebo suspension  10 ml after meals and 20 ml hs  
class6	2220	patients were treated for 12 wk unless endoscopic healing occurred earlier  
class6	2220	initial evaluation and monthly follow up consisted of symptom monitoring  endoscopic evaluation and pre  and post therapy esophageal manometry  bernstein test  and 24 h ph monitoring  
class6	2220	the combination of cimetidine and sucralfate suspension was superior to cimetidine alone in improving daytime heartburn symptoms  p less than 0 05  but not nighttime heartburn  dysphagia  or regurgitation  
class6	2220	sucralfate plus cimetidine improved the overall endoscopic outcome of esophagitis more than cimetidine alone  p less than 0 05   
class6	2220	more patients exhibited endoscopic healing in the adjunctive sucralfate group than in the cimetidine only group  
class6	2220	endoscopic healing  however  was not statistically different between groups  
class6	2220	we conclude that sucralfate used as adjunctive therapy to cimetidine resulted in improvement of some of the symptoms of reflux  and probably increases the likelihood of complete healing of esophagitis  compared with cimetidine alone  
class6	2221	comparison of coffee intake and coffee induced symptoms in patients with duodenal ulcer  nonulcer dyspepsia  and normal controls  
class6	2221	coffee and decaffeinated coffee stimulate acid secretion  
class6	2221	in addition  many patients experience dyspepsia after coffee ingestion  
class6	2221	therefore  coffee is often prohibited by physicians in patients with peptic diseases  
class6	2221	however  the association between peptic disease and symptoms remains unclear  
class6	2221	this study compares coffee intake and the induction of symptoms by coffee in patients with duodenal ulcer disease  nonulcer dyspepsia  and normal controls  
class6	2221	we have studied the coffee drinking habits of 58 duodenal ulcer patients  55 nonulcer dyspepsia patients  and 55 normal controls  
class6	2221	the use of coffee on a daily basis was not significantly different between duodenal ulcer patients  64   and controls  56    or between nonulcer dyspepsia patients  55   and controls  
class6	2221	there was also no difference between the three groups in the use of decaffeinated coffee  the number of cups per day  the method of preparation  the length of time of coffee use  or any change in coffee intake in the previous year  
class6	2221	the intake of tea  caffeinated carbonated beverages  and aspirin or nonsteroidal anti inflammatory drugs was also similar in the three groups  
class6	2221	the duodenal ulcer patients were more likely to be cigarette smokers  45   than either the controls  16   or the nonulcer dyspepsia patients  24    
class6	2221	daily alcohol intake was not significantly different in the three groups  
class6	2221	the prevalence of coffee induction of dyspeptic symptoms was similar in duodenal ulcer patients  29   and controls  22    but was much more common in nonulcer dyspepsia patients  53   than in controls  22    p   0 0036  
class6	2221	in conclusion  there was no difference in coffee intake between patients with duodenal ulcer  nonulcer dyspepsia  or normal controls  
class6	2221	however  patients with nonulcer dyspepsia  but not duodenal ulcer  were more likely to experience dyspeptic symptoms after coffee ingestion  
class6	2222	duodenal ulcer hemorrhage with and without dyspepsia  
class6	2222	to clarify the clinical significance of dyspepsia in patients with bleeding duodenal ulcer  we studied 298 patients prospectively  
class6	2222	ages of patients ranged from 16 to 81 yr  mean 45 9   
class6	2222	there were 244  82   dyspeptic and 54  18   nondyspeptic patients  
class6	2222	in the dyspeptic group  significantly more patients were taking nonsteroidal anti inflammatory drugs  
class6	2222	in the nondyspeptic group  there was a higher percentage of patients with duodenal bulb deformity  p less than 0 005   which deformity was related to previous peptic ulcer disease  
class6	2222	the age  sex  past history of dyspepsia or bleeding  consumption of alcohol and cigarettes  and the hospital course of the two groups of patients did not differ significantly  
class6	2222	our results show that the clinical course of duodenal ulcer hemorrhage is not significantly different in patients with or without dyspepsia  and indicate that bleeding and dyspepsia probably are two independent presentations in the natural course of the disease  
class6	2222	the significance of the correlation between dyspepsia and duodenal bulb deformity is discussed  
class6	2223	the value of push type jejunal endoscopy in familial adenomatosis coli gardner s syndrome  
class6	2223	push type jejunal endoscopy using a long forward viewing duodenofiberscope was performed in 10 patients with familial adenomatosis coli gardner s syndrome  
class6	2223	jejunal polypoid lesions were detected in nine of the 10 patients  90    
class6	2223	the lesions appeared sessile  whitish  and measured 3 mm or less in diameter  
class6	2223	histologic findings of the biopsy specimens from these polypoid lesions revealed tubular adenoma in all nine patients  
class6	2223	in addition  this method led to the detection of duodenal adenomas in one patient  in whom duodenofiberscopy with the side viewing instrument revealed no polypoid lesions in the bulb and second portion of the duodenum  
class6	2223	in view of these results  we recommend that push type jejunal endoscopy  as well as side viewing duodenofiberscopy  should be added to the usual preoperative examinations done in patients with this disease  
class6	2224	liver pathology in morbidly obese patients with and without diabetes  
class6	2224	the contribution of obesity and or diabetes to liver pathology in the morbidly obese patient is controversial  
class6	2224	we studied the liver biopsies of 100 consecutive patients undergoing gastric bypass surgery for morbid obesity  
class6	2224	multiple morphologic parameters were analyzed and graded independently  without knowledge of the clinical history  liver function tests  and oral glucose tolerance results of the patients  
class6	2224	six percent of the entire group demonstrated no fat  42  mild fat  20  moderate fat  and 24  severe fatty metamorphosis of the liver  
class6	2224	twenty three percent of the patients had central vein fibrosis  23  sinusoidal fibrosis  19  bridging fibrosis  and 4  cirrhosis  
class6	2224	thirty six percent of the patients had some degree of steatohepatitis  66  possessed so called glycogen nuclei of hepatocytes  6  had pas positive thickening of blood vessels in the portal tracts  and 1  had lipogranulomas  
class6	2224	the degree of fatty metamorphosis and fibrosis was analyzed in three separate groups  categorized by the glycemic status of the patient  46 patients with normal glucose tolerance  ngt   23 patients with impaired glucose tolerance  igt   and 31 patients with non insulin dependent diabetes mellitus  niddm   
class6	2224	increasing severity of fatty metamorphosis from the normoglycemic obese to the diabetic obese patients was found  which was statistically significant by chi 2 analysis  
class6	2224	four of the six patients showing no fatty metamorphosis were normoglycemic  
class6	2224	glycogen nuclei and pas positive blood vessels were significantly more prevalent in the diabetic obese than in the normal obese  
class6	2224	in conclusion  the distribution of significant liver histopathology in the morbidly obese patient correlates in severity with the degree of impaired glycemic status  
class6	2225	factors influencing the development of metabolic bone disease in primary biliary cirrhosis  
class6	2225	the prevalence  type  and factors that may influence the development of bone disease in primary biliary cirrhosis  have been investigated in 20 consecutive patients  who  in addition to liver function tests and mineral and vitamin d metabolism studies  were submitted to a transiliac bone biopsy after tetracycline double labeling for quantitative histomorphometric examination  
class6	2225	intestinal calcium absorption was also assessed in 16 patients  
class6	2225	seven patients  35   had reduced bone volume and were considered osteoporotic  
class6	2225	three also had bone mineralization impairment  but did not have criteria for osteomalacia  
class6	2225	bone formation was depressed in 15 patients  and bone resorption was low or normal in 19 cases  
class6	2225	eroded surfaces were reduced in all osteoporotic patients  
class6	2225	duration of primary biliary cirrhosis was significantly longer in patients with osteoporosis  6 3     0 6 yr  than in those without osteoporosis  2 6     0 6  p   0 004   
class6	2225	moreover  osteoporosis was more prevalent in postmenopausal women  and in those who had intestinal calcium malabsorption  which was present in 80  of osteoporotic patients but in only 18  of nonosteoporotic patients  p   0 03   
class6	2225	osteoporosis and mineralization bone impairment were unrelated to the severity of cholestasis  
class6	2225	25 hydroxyvitamin d was significantly lower in those patients with intestinal calcium malabsorption  
class6	2225	the results of this study indicate that osteodystrophy in primary biliary cirrhosis is characterized mainly by  low turnover  osteoporosis  which is related to the duration of the liver disease  postmenopausal condition  and calcium malabsorption  
class6	2226	percutaneous transhepatic cholecystostomy for acute complicated cholecystitis in elderly patients  
class6	2226	we report our experience with percutaneous transhepatic cholecystostomy in 10 elderly patients with acute cholecystitis  complicated by empyema formation  
class6	2226	most of these patients has severe underlying disease  rendering them at high risk for surgical intervention  
class6	2226	in all patients  the percutaneous procedure was followed by a rapid regression of clinical symptoms and of radiologic abnormalities  
class6	2226	six were considered inoperable  
class6	2226	three of these remain free of biliary symptoms  respectively 22  10  and 7 months after percutaneous cholecystostomy  
class6	2226	three others died of nonbiliary disease 1 4 months after cholecystostomy  
class6	2226	three patients underwent successful elective cholecystostomy 1 5 wk after percutaneous cholecystostomy  
class6	2226	in one patient  cholecystectomy had to be performed because of recurrence of hydrops  1 wk after catheter removal  
class6	2226	in our opinion  percutaneous transhepatic cholecystostomy is a safe and effective procedure in the treatment of elderly patients with acute complicated cholecystitis  
class6	2226	it can be followed by elective cholecystectomy in good surgical candidates  or by an expectant conservative management in high surgical risk patients  
class6	2227	comparative studies of du pan 2  carcinoembryonic antigen  and ca19 9 in the serum and bile of patients with pancreatic and biliary tract diseases  evaluation of the influence of obstructive jaundice  
class6	2227	the levels of du pan 2 antigen  carcinoembryonic antigen  and ca19 9 in serum and bile of patients with pancreatic and biliary tract diseases were measured  
class6	2227	the sensitivities  true positive  of du pan 2 in serum to pancreatic carcinoma  64   and to biliary tract carcinoma  62   were similar to those of ca19 9 in serum  69  and 72   respectively   
class6	2227	nine of 18  50   patients with ca19 9 negative pancreatic carcinoma tested positive for du pan 2  
class6	2227	the sensitivities of cea to pancreatic carcinoma  56   and to biliary tract carcinoma  52   were lowest  
class6	2227	the measurement of these antigens in bile seemed to be of little diagnostic value in differentiating between malignant and benign diseases  
class6	2227	false positives of these three assays occurred frequently in patients with benign pancreatic or biliary tract disease coupled with obstructive jaundice  
class6	2227	after percutaneous transhepatic biliary drainage  serum du pan 2 and ca19 9 levels returned to normal ranges in patients with benign diseases  but not in patients with carcinoma of the pancreas or of the biliary tract  
class6	2227	serum ca19 9 and du pan 2 antigens are useful tumor markers for pancreatic and biliary tract carcinomas  
class6	2227	longitudinal assays of these antigens may be useful for the differential diagnosis of patients with obstructive jaundice  
class6	2228	serum amylase in patients with renal insufficiency and renal failure  
class6	2228	results vary with regard to the upper limits of serum amylase seen in patients with renal failure  and very little has been reported with patients with renal insufficiency not yet requiring dialysis  
class6	2228	to determine the level of serum amylase elevation in renal insufficiency and renal failure  we determined serum amylase values in 128 subjects with creatinine clearances less than 90 ml min  
class6	2228	serum amylase remained in the normal range when creatinine clearance was greater than 50 ml min  and did not become elevated until creatinine clearance was less than 50 ml min  
class6	2228	the highest serum amylase recorded in the absence of acute pancreatitis was 503 iu l  normal  less than 128 iu l   
class6	2228	serum lipase and trypsin values paralleled those for serum amylase  values remained normal when creatinine clearance was greater than 50 ml min  and were normal or elevated when creatinine clearance was less than 50 ml min  
class6	2228	these results indicate that elevations of serum amylase  i e   amylase greater than 128 but less than 500 iu l  in asymptomatic patients with impaired renal function are not evident until creatinine clearances fall below 50 ml min  and probably do not represent acute pancreatitis  
class6	2229	comparison of a new immunoassay for determining serum pancreatic isoamylase with two standard techniques  
class6	2229	a method has recently been developed for measuring serum pancreatic  p  isoamylase  using two monoclonal antibodies specific for salivary isoamylase  
class6	2229	we performed this test on 67 healthy controls and 133 patients  15 with acute pancreatitis  53 with chronic pancreatitis  20 during painful relapse and 33 in clinical remission   18 with pancreatic cancer  41 with nonpancreatic disease with abdominal pain  five with macroamylasemia  and one with total pancreatectomy  
class6	2229	results were compared with those of a wheat germ inhibition method and with electrophoresis on cellulose acetate  
class6	2229	a close correlation was found between the results of immunoinhibition assay and those of the other two tests  
class6	2229	all patients with acute pancreatitis had abnormally high values in all three tests  
class6	2229	in the group with chronic pancreatitis studied during painful relapse  16 had an increase in p isoamylase  as determined with the immunoinhibition assay  13 with the wheat germ inhibition test  and 15 with electrophoresis  
class6	2229	in the group with chronic pancreatitis in clinical remission  we found low values in one patient  by immunoinhibition assay  but found low values in 17 and 19 patients by wheat germ inhibition and electrophoresis  respectively  
class6	2229	low p isoamylase values corresponded to a severe exocrine pancreatic insufficiency  
class6	2229	in the group with pancreatic cancer  the three tests showed similar results  and the majority of the patients had normal values  
class6	2229	in the patients with nonpancreatic diseases  abnormally high levels were found in five  by immunoassay  in four by electrophoresis  and in three by the wheat germ inhibition method  
class6	2229	in the five cases with macroamylasemia  both inhibition assays erroneously demonstrated an abnormal p isoamylase elevation  
class6	2229	the results show that the three tests are equally useful for the diagnosis of acute pancreatitis  or chronic pancreatitis during an acute relapse  
class6	2229	in these diseases  the immunoinhibition test would be the preferred assay because it is simple and rapidly performed  
class6	2230	in vivo evaluation of monopolar versus bipolar electrosurgical polypectomy snares  
class6	2230	the energy required and tissue damage in bipolar and monopolar polypectomy snares were compared in a canine model  
class6	2230	the bipolar snare required an average of 34 joules of energy  whereas the monopolar snare required 228 joules to cut the same diameter of gastric mucosa tended into a polypoid structure  p   0 0005   
class6	2230	the reduced energy delivered to the tissue from the bipolar procedure resulted in only 32  average depth of damage to the underlying gastric wall  whereas the monopolar procedure caused an average 69   p   0 001   
class6	2230	surgically created polyps required 247 joules and 69 joules for corresponding monopolar and bipolar polypectomy  p   0 001   
class6	2230	the decreased energy required and the correspondingly reduced damage caused to the underlying bowel wall by the bipolar snare should reduce the incidence of perforation and post polypectomy syndrome  
class6	2230	the bipolar snare completes a local circuit about the snare  eliminating the return electrode and  consequently  the possibility of any return electrode burns  
class6	2230	the bipolar snare thus provides an added safety margin during polypectomy  
class6	2231	hyperplastic gastric polyps associated with persistent helicobacter pylori infection and active gastritis  
class6	2231	we report two cases of patients with 3 yr histories of upper gastrointestinal symptoms  hyperplastic gastric polyps  and active chronic gastritis  
class6	2231	biopsies retrospectively stained with giemsa revealed the persistent presence of helicobacter pylori  hp  in gastric biopsies of both patients throughout the 3 yr  
class6	2231	after treatment with amoxicillin and bismuth subsalicylate  both became asymptomatic  one demonstrating disappearance and recurrence of the gastric polyps in conjunction with the hp  
class6	2231	these cases demonstrate 3 yr of hyperplastic gastric polyps associated with hp and active gastritis  
class6	2232	protein losing enteropathy in systemic lupus erythematosus associated with intestinal lymphangiectasia  
class6	2232	this case report concerns a young woman with systemic lupus erythematosus who presented with a protein losing enteropathy  
class6	2232	intestinal biopsy revealed lymphangiectasia  
class6	2232	mesenteric lymph nodes showed paracortical lymphoid depletion and multiple small sinusoids  
class6	2232	elevated cholesterol levels and normal lymphocyte counts characterized the peripheral blood samples  
class6	2232	lymph nodes  though enlarged  showed no evidence of obstructive pathology  
class6	2232	no secondary cause of lymphangiectasia could be identified  
class6	2232	the patient exhibited antinuclear antibodies and antibodies to dsdna at the onset  and then  5 yr later  the classic features of systemic lupus erythematosus  sle   
class6	2232	the lymphocytopenia and hypolipidemia that characterizes lymphangiectasia is not a feature of the sle cases reported to date  
class6	2232	furthermore  the mechanism for the dilated lymphatics and villous edema is more likely immunological than mechanical disruption of lymphatics  
class6	2233	gallbladder carcinoma producing human chorionic gonadotropin  
class6	2233	a primary carcinoma of the gallbladder producing human chorionic gonadotropin  hcg  was encountered in an 83 yr old japanese woman  with elevation of hcg beta hcg in urine and serum  
class6	2233	remarkable elevation of serum estradiol was an associated finding  with increased hcg  
class6	2233	at autopsy  we found that the primary carcinoma of the gallbladder extensively involved the liver  
class6	2233	histologically  the tumor revealed adenosquamous cell carcinoma in the primary site  and moderately to poorly differentiated adenocarcinoma in metastatic foci  
class6	2233	immunohistochemical staining for beta hcg showed a positive reaction in adenocarcinoma components  
class6	2233	this is an extremely rare case of an hcg producing gallbladder carcinoma  which leads us to speculate that hcg positive tumor cells may occur due to dedifferentiation  
class6	2234	isolated ventral pancreatitis in a patient with pancreas divisum  
class6	2234	a previously healthy 22 yr old woman was found to have chronic pancreatitis restricted to the ventral pancreas in association with pancreas divisum  
class6	2234	when conservative treatment failed  sphincteroplasty of both papillae was performed with good results  
class6	2234	this well documented case represents a clear exception to the commonly held concept that obstruction of the dorsal duct is the essential pathogenic factor in the development of pancreatitis associated with pancreas divisum  
class6	2234	the importance of visualizing both the dorsal and ventral pancreatic ducts to direct therapy for patients with idiopathic pancreatitis is discussed  
class6	2234	theories of the pathogenesis of concomitant pancreatitis and pancreas divisum are reviewed  
class6	2235	exacerbation of chronic active hepatitis type b after short term corticosteroid therapy resulting in fatal liver failure  
class6	2235	the case of a 36 yr old male with chronic active type b hepatitis in whom 4 wk prednisone therapy resulted in prolonged and fatal exacerbation of liver disease is described  
class6	2235	thus  short term corticosteroid therapy may in some patients have disastrous effects on the course of chronic active hepatitis b  
class6	2236	toxoplasmic chorioretinitis and hepatic granulomas  
class6	2236	a 71 yr old male presented with a 2 month history of fever  malaise  and weight loss  
class6	2236	physical exam revealed chorioretinitis  
class6	2236	laboratory studies were notable for elevated levels of alkaline phosphatase  gamma glutamyl transpeptidase  aspartate transaminase  and alanine transaminase  
class6	2236	immunoglobulin g antibody to toxoplasma gondii was positive to a dilution of 1 4096  whereas serologic studies for hepatitis a virus  hepatitis b virus  cytomegalovirus  epstein barr virus  human immunodeficiency virus  brucella  and tularemia were negative  
class6	2236	a percutaneous biopsy of the liver revealed hepatic granulomas  
class6	2236	culture of the biopsy specimen was negative for growth of mycobacteria or fungi  
class6	2236	spontaneous improvement in clinical and laboratory parameters occurred over a 4 month period  
class6	2237	disseminated  nonmeningeal gastrointestinal cryptococcal infection in an hiv negative patient  
class6	2237	gastrointestinal cryptococcosis is extremely rare  especially in patients with no involvement of the central nervous system  
class6	2237	we describe a 63 yr old man undergoing prednisone therapy for chronic hepatitis and cirrhosis who presented with peritonitis  colitis  and skin lesions  
class6	2237	pathological studies revealed necrosis and numerous cryptococcal organisms in the colon  omentum  and skin  and cultures yielded cryptococcus neoformans  
class6	2237	the patient died of multisystem organ failure following emergency exploratory surgery performed when he had onset of symptoms of a bowel perforation after an endoscopic biopsy  
class6	2237	clinicians should be aware that gastrointestinal cryptococcosis can occur in the absence of infection of the central nervous system or lungs  and that it may affect relatively healthy patients who are immunocompromised because of splenectomy  chronic liver disease  or steroid therapy  
class6	2238	peritoneal dialysis in the geriatric patient  
class6	2238	elderly patients on chronic peritoneal dialysis  cpd  from two large chronic peritoneal dialysis programs were compared with younger patients in regard to peritonitis rates  catheter problems  hospital days  transfers to other forms of therapy  and mortality  
class6	2238	peritonitis rates and organisms were similar in younger and older patients  
class6	2238	catheter replacements were less common in the elderly  
class6	2238	differences in hospital days were attributable to hospitalization for vascular disease  
class6	2238	the elderly were more likely to have the first episode of peritonitis  to die and to change dialysis modalities at all times after the first year of continuous ambulatory peritoneal dialysis  capd  treatment  although other than increased mortality  differences between the two groups were small  
class6	2238	cpd appears to be an acceptable form of renal replacement therapy in the elderly  
class6	2239	treatment of wegener s granulomatosis with intermittent high dose intravenous cyclophosphamide 
class6	2239	purpose  concerns regarding the long term toxicity of daily cyclophosphamide  cp  therapy for the systemic vasculitides have led us to evaluate alternative approaches to treatment in an attempt to achieve comparable efficacy with less toxicity  
class6	2239	this study sought to determine the efficacy  toxicity  and immunologic effects of glucocorticoids  gc  and intermittent high dose intravenous cp   pulse  cp  in the treatment of 14 patients with wegener s granulomatosis  wg   
class6	2239	patients and methods  the diagnosis of active wg was supported by a typical clinical presentation and histopathologic findings of vasculitis  granulomatous inflammation  and tissue necrosis  
class6	2239	gc treatment was initially provided on a daily basis and later tapered to an alternate day schedule if vasculitis remained inactive  
class6	2239	pulse cp treatment was initially administered once a month for 6 months  
class6	2239	if after 6 months remission had been attained and gc therapy had been discontinued  then pulse cp treatment was given at less frequent intervals thereafter  
class6	2239	treatment and evaluation were provided for participants as inpatients in a clinical research center  national institutes of health   
class6	2239	results  thirteen of 14 patients  93   initially experienced unequivocal improvement with pulse cp therapy  and seven of 14  50   achieved remission within 4 months  
class6	2239	however  treatment was associated with significant toxicity in two patients and later relapses in nine patients  so that a total of 79  either failed to achieve sustained remission or were unable to continue therapy  
class6	2239	three of 14  21   patients have achieved sustained remissions with the pulse cp protocol and one additional patient  who had a limited exacerbation of wg  continues to receive that therapy after 14 to 22 months  mean 17 months   
class6	2239	conclusions  the use of pulse cp and gc therapy in 14 patients with wg was associated with a high initial response rate  
class6	2239	however  failure to respond initially to treatment  to sustain improvement  or to tolerate continued treatment was noted in 79  of patients within a period of 1 to 22 months  
class6	2239	these observations indicate that this particular pulse cp protocol does not achieve a high degree of lasting efficacy  
class6	2240	association of helicobacter pylori infection with dyspeptic symptoms in patients undergoing gastroduodenoscopy  
class6	2240	purpose  to determine the prevalence of helicobacter pylori in patients with non ulcer dyspepsia and ulcer disease as well as in a control population undergoing endoscopic retrograde cholangiopancreatography  ercp  for suspected pancreatic or biliary disease  
class6	2240	patients and methods  forty six eligible patients undergoing upper endoscopy at massachusetts general hospital were studied over a period of 18 months  as well as 24 patients undergoing ercp for presumed pancreatic or biliary disease  
class6	2240	two biopsy specimens from the fundus and two from the antrum were taken for microbiologic and histopathologic analysis  
class6	2240	sera were examined by enzyme linked immunoabsorbent assay  
class6	2240	all specimens were processed in a blind fashion  
class6	2240	chi square test with yates  correction was used for statistical analysis  
class6	2240	results  h  
class6	2240	pylori was found in 31 of 46  67   study patients and in six of 24  25   control patients  by microbiologic or histologic techniques   p less than 0 01   
class6	2240	h  
class6	2240	pylori was found in all patients with peptic ulcer disease and in 60  of patients without ulcers  
class6	2240	no association between h  
class6	2240	pylori and any specific gastrointestinal symptom was observed  
class6	2240	h  
class6	2240	pylori was identified in the fundus as often as in the antrum  although in the antrum the organism was more often associated with histologic gastritis  
class6	2240	compared with histology  serologic assays for igg and iga antibodies to h  
class6	2240	pylori had sensitivities of 100  and 94   and specificities of 86  and 76   respectively  
class6	2240	reexamination of selected specimens without knowledge of their identity revealed that the specificity of serology exceeded 94  while the sensitivity of histologic and microbiologic studies may have been closer to 80   
class6	2240	conclusions  h  
class6	2240	pylori was more common in dyspeptic patients than in our control subjects undergoing ercp  
class6	2240	multiple biopsy sites from fundus and antrum are required to exclude infection  
class6	2240	serologies of igg and iga were sensitive and specific for h  
class6	2240	pylori  suggesting a possible role for non endoscopic diagnosis of this infection  
class6	2240	the frequent association of h  
class6	2240	pylori with active inflammation rather than with quiescent gastritis is consistent with a pathologic role of this organism  
class6	2241	cardiorespiratory effects of endoscopic esophageal variceal sclerotherapy  
class6	2241	endoscopic variceal sclerotherapy  evs  is an effective means of controlling variceal hemorrhage  which develops as a consequence of portal hypertension  
class6	2241	while esophageal perforation  ulceration  strictures  and mediastinitis are potential complications associated with this procedure  it is not clear whether isolated pleuropulmonary events such as pleuritis  pneumonitis  and adult respiratory distress syndrome are causally related to the evs  
class6	2241	endoscopy and sedation with the attendant risk of aspiration  particularly in the background of hepatic encephalopathy  may account for some of these events  
class6	2241	recent controlled studies of respiratory function demonstrate that evs as such results in minor changes in gas exchange  lung volumes  and pulmonary and systemic hemodynamics  
class6	2241	most pulmonary complications have been reported with the use of sodium morrhuate sclerosant  
class6	2241	comparative studies among different sclerosants are necessary to evaluate relative safety  
class6	2241	finally  there have been rare reports of myocardial ischemia and pericarditis reported in association with evs  but these are of a transient nature  
class6	2241	chest symptoms  roentgenographic pleuropulmonary changes  pulmonary hemodynamics  and cardiac perturbations are transient and should not preclude offering evs to patients with variceal hemorrhage  
class6	2242	pregnancy induced hypertension and acute fatty liver of pregnancy  atypical presentations  
class6	2242	severe pregnancy induced hypertension and markedly elevated levels of serum alkaline phosphatase developed in a 29 year old woman in whom one pregnancy resulted in intrauterine death  
class6	2242	acute fatty liver of pregnancy developed with good fetal outcome in the next pregnancy  
class6	2242	this case suggests that pregnancy induced hypertension and acute fatty liver of pregnancy are part of a clinical spectrum  
class6	2242	moreover  classic abnormalities of liver function tests need not be present in acute fatty liver of pregnancy  
class6	2243	antenatal spontaneous perforation of the extrahepatic biliary tree  
class6	2243	spontaneous perforation of the biliary system is an unusual neonatal phenomenon that is rarely recognized at birth  
class6	2243	to date  it has not been reported antenatally  
class6	2243	a 16 year old pregnant adolescent had an ultrasonogram at 25 weeks of pregnancy that revealed ascites in the fetus  
class6	2243	after the infant was delivered at 32 weeks  a hepato iminodiacetic acid scan showed a spontaneous rupture of the common bile duct  
class6	2243	the infant was treated with external drainage of the biliary tree and recovered well  
class6	2243	this case demonstrates that spontaneous perforations of the bile ducts can occur much earlier than the usually described 2 to 12 weeks after birth  can be diagnosed antenatally  and should be added to the list of causes of fetal ascites  
class6	2244	intrapartum uterine rupture and inflammatory bowel disease  
class6	2244	the incidence of uterine rupture in pregnant women ranges from 0  to 1 1  in large series  
class6	2244	this case report describes a woman with a history of obstetric complications  uterine rupture  and active inflammatory bowel disease that was treated with high dose prednisone  
class6	2245	crohn s disease and retinal vascular disease  
class6	2245	patients with crohn s disease may manifest extraintestinal findings including ocular involvement  
class6	2245	we treated two patients with crohn s disease who manifested retinal vascular disease that may have been related to the immune nature of the underlying disease or possibly to changes in the vasculature or coagulation system  
class6	2245	one patient had a central retinal vein occlusion and the other had retinal vasculitis involving retinal arteries and veins with an apparent branch retinal artery occlusion  
class6	2245	both patients were in excellent health except for crohn s disease  which was confirmed by a biopsy specimen  
class6	2245	in one patient  the diagnosis of retinal vasculitis preceded the clinical diagnosis of crohn s disease  whereas for the second patient the symptomatology of the intestinal disease preceded the ocular manifestations  
class6	2245	we suggest that inflammatory bowel disease should be considered in the differential diagnosis of retinal vascular occlusive disease  especially in a young patient  
class6	2246	update on the epidemiology of anorexia nervosa in a defined region of switzerland  
class6	2246	in this follow up investigation  the authors studied all swiss women in the canton of zurich who developed anorexia nervosa between ages 12 and 25 years and who were hospitalized for the first time with this diagnosis between 1983 and 1985  
class6	2246	data were compared with those from an earlier study  which focused on the periods 1956 1958  1963 1965  and 1973 1975  
class6	2246	the incidence of anorexia nervosa did not increase significantly during 1983 1985 compared to 1973 1975  in contrast to the constant increase found between 1956 and 1975  
class6	2246	however  the more frequent use of vomiting and abuse of laxatives in 1983 1985 may indicate an increase in cases with mixed features of anorexia nervosa and bulimia  
class6	2247	endemic cryptosporidium and giardia lamblia infections in a thai orphanage  
class6	2247	we conducted a point prevalence survey for enteric protozoa in 205 institutionalized orphans 1 61 months of age in bangkok  thailand  
class6	2247	cryptosporidium was identified in 17 children  8    giardia lamblia in 42  20    and 3 children  1   had both parasites  
class6	2247	at the time of diagnosis  diarrheal symptoms were present in a minority of subjects  36  of children with cryptosporidium alone  10  with g  
class6	2247	lamblia alone  and in 20  of those with neither parasite  
class6	2247	although chronic nutritional status  height age  was similar in all groups  acute nutritional status  weight height  was lower only in children with cryptosporidium  z score    1 39     0 13  compared with children with g  
class6	2247	lamblia  mean z score     sem    0 56     0 26  or neither parasite  z score    0 78     0 13  p   0 05   
class6	2247	detectable levels of cryptosporidium specific igg antibodies by elisa were identified in 15 of 16 thai children with cryptosporidium and in 17 of 19 thai children without cryptosporidium  mean od     sem   1 27     0 18 vs  
class6	2247	1 06     0 13  respectively   but in only 1 of 18 sera from toddlers in day care centers in denver  co  od   0 128     0 03   
class6	2247	although neither infection with cryptosporidium nor g  
class6	2247	lamblia was consistently associated with acute diarrheal symptoms  cryptosporidium was more often associated with depressed acute nutritional status than g  
class6	2247	lamblia  
class6	2247	the high prevalence of specific antibodies to cryptosporidium in thai orphans suggests an association between high rates of exposure with asymptomatic excretion of the parasites  
class6	2248	brain and liver dolichol in chronic alcoholism  a necropsy study  
class6	2248	cerebral gray and white matter and liver dolichol levels were measured in postmortem samples from chronic alcoholics and nonalcoholic controls following recent suggestions that dolichol levels may be used as a marker for alcoholism  
class6	2248	no significant differences in brain dolichol were found between the control and alcoholic groups  
class6	2248	a significant reduction in the liver dolichol was observed in the alcoholic group  
class6	2248	this was most marked in those alcoholics with liver disease  
class6	2249	esophageal motor disorder in alcoholics  result of alcoholism or withdrawal  
class6	2249	both acute and chronic ethanol consumption may cause esophageal dysmotility  
class6	2249	in order to systematically evaluate the effect of ethanol on esophageal motility  we studied esophageal motility in 13 healthy subjects before and following acute intravenous administration of 0 8 g kg ethanol and in chronic alcoholics within 6 hr of their last drink  n   6  and following 24 to 48 hr of abstinence when signs of withdrawal were present  n   13   
class6	2249	withdrawing alcoholics were also restudied after intravenous administration of 0 8 g kg ethanol  
class6	2249	ethanol transiently decreased lower esophageal sphincter pressure  lesp  and inhibited les relaxation in all control subjects  this inhibitory effect of ethanol on lesp in alcoholics was significantly less  indicating the development of tolerance  
class6	2249	ethanol moderately decreased esophageal contraction amplitude  eca  in 10 of 13 controls and prolonged duration of contractions in all but had no effect on velocity of esophageal contractions  
class6	2249	in contrast  eca was significantly elevated in both groups of alcoholics  but this was significantly more marked in withdrawing alcoholics  
class6	2249	ethanol infusion returned eca toward normal values in withdrawing alcoholics  
class6	2249	abnormal motility was noted in three intoxicated alcoholics and 10  77   withdrawing alcoholics  
class6	2249	this included nutcracker esophagus in five and hypertensive les in two  
class6	2249	these data indicated that  1  esophageal motor dysfunction is common in alcoholics   2  acute ethanol administration decreases lesp and esophageal contraction amplitude  whereas chronic ethanol consumption and withdrawal from ethanol increases eca  
class6	2249	this suggests development of a compensatory mechanism in chronic alcoholics leading to high pressure esophageal contractions during withdrawal  
class6	2250	a hepatocellular carcinoma of massive arterioportal shunts without tumor stain treated with cddp two route chemotherapy  a case report  
class6	2250	massive arterioportal shunts without tumor vessels or tumor stain are sometimes encountered in advanced cases of liver cirrhosis  
class6	2250	massive arterioportal shunts without tumor stain that responded well to intensive chemotherapy with cis diamminedichloroplatinum ii are reported  
class6	2251	methylene iodide poisoning  
class6	2251	a 20 month old girl ingested a maximum of 25 ml of pure methylene iodide  
class6	2251	within two hours  the patient exhibited lethargy and incoordination and vomited  
class6	2251	an abdominal radiograph demonstrated the radiopaque material in the gut  
class6	2251	in vivo conversion to carbon monoxide was documented with a peak carboxyhemoglobin level of 14 2  reached at 11 hours after ingestion  
class6	2251	two days after ingestion  evidence of hepatotoxicity was apparent  and fulminant hepatic failure quickly ensued  
class6	2251	despite aggressive supportive care and transfer to a liver transplant center  the patient died nine days after ingestion  
class6	2251	methylene iodide ingestion has not been previously reported in human beings  
class6	2251	this case verifies that this substance is a potent hepatotoxin  is metabolized to carbon monoxide in vivo  is radiopaque  and may cause bone marrow suppression  
class6	2252	castor bean intoxication  
class6	2252	we report the cases of a child who ingested two or more castor beans and two adults who each ingested four beans  
class6	2252	all three patients developed severe gastroenteritis and recovered without sequelae after receiving iv fluids  
class6	2252	the literature contains reports of 424 cases of castor bean intoxication  
class6	2252	symptoms of intoxication include acute gastroenteritis  fluid and electrolyte depletion  gastrointestinal bleeding  hemolysis  and hypoglycemia  
class6	2252	delayed cytotoxicity has not been reported  
class6	2252	of the 424 patients  14 died  mortality rates  8 1  of untreated and 0 4  of treated   
class6	2252	deaths were due to hypovolemic shock  
class6	2252	recommended treatment for asymptomatic patients who have chewed one or more raw beans is emergency department evaluation  gastric decontamination  administration of activated charcoal  observation until four to six hours after ingestion  and discharge instructions to return if symptoms develop  
class6	2252	after decontamination and activated charcoal  symptomatic patients require hospitalization for treatment with iv fluids  supportive care  and monitoring for hypoglycemia  hemolysis  and complications of hypovolemia  
class6	2252	monitoring for delayed cytotoxicity is unnecessary  
class6	2252	castor beans and their dust are highly allergenic and may cause anaphylaxis  
class6	2253	management of the acute abdomen complicating oral anticoagulation therapy  
class6	2253	acute abdominal pain in the patient receiving oral anticoagulants poses a difficult diagnostic and therapeutic challenge  
class6	2253	we describe two cases of peritonitis requiring laparotomy in anticoagulated patients  and review 49 similar case reports from the world literature  
class6	2253	these patients were usually explored for signs of bowel obstruction  
class6	2253	at operation  the intestine often appeared infarcted  but pathologic examination commonly revealed intramural hematomata  
class6	2253	in contrast  we present microscopic evidence of hemorrhagic cecal infarction complicating oral anticoagulation therapy in one patient  
class6	2253	intramural intestinal hemorrhage is the most common cause of acute abdominal pain in the anticoagulated patient who undergoes laparotomy  
class6	2253	in addition to intramural hemorrhage  14 per cent of patients had coexistent volvulus  appendicitis  intestinal wall disruption or intestinal infarction  
class6	2253	we conclude that anticoagulated patients with suspected intramural intestinal hemorrhage may have severe intraabdominal pathology requiring operation  
class6	2253	therefore  operation is mandatory for patients who fail to improve after a short course of expectant management  
class6	2254	nonoperative management of small bowel obstruction with endoscopic long intestinal tube placement  
class6	2254	intestinal obstruction remains a major cause of morbidity and mortality in surgical patients  
class6	2254	we reviewed the records of 77 patients with mechanical small bowel obstruction who were treated with endoscopically and fluoroscopically placed leonard long intestinal tube decompression  
class6	2254	most patients  59   had failed a trial of nasogastric tube or miller abbott tube decompression  
class6	2254	overall  29 per cent of patients were able to resolve their obstruction with leonard tube decompression alone  
class6	2254	subdivision of patients on the basis of the etiology of their obstruction demonstrated a much higher rate of success for tube decompression in adhesive obstruction  37   versus malignant obstruction  12   or inflammatory obstruction  no successes   
class6	2254	patients with radiographic and clinical evidence of complete intestinal obstruction were significantly less likely to respond to long intestinal tube treatment  13    
class6	2254	the long intestinal tube was easily passed in all patients  
class6	2254	there were no complications of the intubation procedure in our series  and the incidence of tube related complications was four per cent  
class6	2254	we conclude that an initial period of long intestinal tube decompression allows a significant percentage of patients with mechanical small bowel obstruction to be treated nonoperatively  particularly if a partial obstruction from postoperative adhesions is present  
class6	2254	patients who have failed a trial of nasogastric tube decompression and are poor operative risks should also be considered for long intestinal tube placement  
class6	2255	the influence of sclerotherapy on gastric mucosal blood flow distribution  
class6	2255	hemodynamic events and structural vascular changes of the gastric mucosa in cirrhotics have caught the attention of investigators in the recent past  but as yet it is not known whether therapeutic interruption of variceal blood flow at gastroesophageal level alters such portal hypertensive mucosal features  
class6	2255	the newly developed endoscopic laser doppler technique was used to assess whether variceal eradication by means of endoscopic sclerotherapy influences the gastric mucosal congestion in portal hypertension patients  
class6	2255	gastric mucosal blood flow was determined at ten defined sites of the stomach  before the first session of sclerotherapy and after complete variceal eradication had been achieved in 15 patients  
class6	2255	a statistically significant decrease  p less than 0 01 to 0 05  in microcirculation was found at the gastric antrum and corpus  an increase at the pylorus  p less than 0 05   but no change in the fundic area  
class6	2255	an important question following these findings is  what are the consequences of such aggravation of gastric congestion on the integrity of the gastric mucosa   
class6	2256	a five year u s  army experience with 36 250 abdominal hernia repairs  
class6	2256	thirty six thousand two hundred fifty abdominal hernia repairs were performed in u s  
class6	2256	army medical treatment facilities during a five year period  
class6	2256	this study presents data about the type of hernia  incidence of complications by obstruction or strangulation  age  sex  and mortality  
class6	2256	hernias occurring with intestinal obstruction or gangrene  strangulation  are referred to as complicated hernias  
class6	2256	inguinal hernias in children less than two years of age  femoral hernias  and unusual  such as internal or obturator  hernias were found to have an increased incidence of complications  
class6	2256	surgical repair of ventral  umbilical  and femoral hernias was done with a low surgical risk and the presence of complications did not significantly increase this risk  
class6	2256	an increased risk of mortality is associated with the repair of complicated unusual hernias and complicated inguinal hernias in patients more than 60 years of age  
class6	2257	comparison of ulcer surgery at a veterans administration and university hospital  
class6	2257	we compared the patient populations and outcome of surgery for peptic ulcer disease in 81 patients at a veterans administration hospital  ovah  and 97 patients at an affiliated university hospital  unh   
class6	2257	the surgeons and choice of operation were comparable at both facilities  
class6	2257	patients were similar with respect to severity of ulcer disease  percentage of elderly patients and distribution of comorbid conditions  
class6	2257	there were significantly more female patients  45  vs 2   p less than 0 05   patients less than 40 years old  22  vs 6   p less than 0 05   and patients with gastric ulcers  27  vs 12   p less than 0 05  at unh  
class6	2257	alcoholism was more prevalent at ovah  57  vs 22   p less than 0 05   
class6	2257	postoperative morbidity and mortality rates were 27 per cent and 14 per cent at ovah and 25 per cent and 16 per cent at unh  
class6	2257	these data suggest that quality of care for surgical therapy of ulcer disease at a va hospital is comparable to its tertiary care affiliate with a similar patient population  
class6	2258	toxic shock syndrome after inguinal hernia repair  report of a case with patient survival  
class6	2258	a 40 year old man developed fulminant multisystem failure several days after elective repair of an inguinal hernia  
class6	2258	toxic shock syndrome  tss  was diagnosed  
class6	2258	there was  however  no evidence of wound infection at the time of multisystem failure  
class6	2258	only later in his hospital course did the wound drain  
class6	2258	staphylococcus aureus was cultured from the wound and was the presumed etiologic agent in the patient s life threatening illness  
class6	2258	the patient recovered fully with supportive care  antibiotics  and surgical debridement of the inguinal hernia site  
class6	2258	this case is discussed in the context of existing literature on the toxic shock syndrome  
class6	2258	the site of infection is typically nonsuppurative  but the systemic manifestations are typically life threatening  
class6	2258	the responsible organism is commonly believed to be a strain of s  
class6	2258	aureus that expresses a toxin  tss toxin 1  that effects multisystem failure  but which also diminishes the local inflammatory response and explains the benign appearance of the wound  
class6	2258	although this is a rare clinical entity  elective surgical procedures complicated by fatal tss have been reported  
class6	2258	surgeons should understand this disease and the management necessary to avert mortality  
class6	2259	ct diagnosis of acquired small bowel volvulus  
class6	2259	small bowel volvulus is an uncommon but important cause of small bowel obstruction and often results in ischemia or infarction  
class6	2259	clinical examination and plain film radiography may be nondiagnostic  leading to delay in surgical intervention with subsequent increase in morbidity and mortality  
class6	2259	we present two patients in whom the diagnosis of strangulating small bowel volvulus was made by computed tomography  ct   allowing rapid surgical correction of this potentially life threatening condition  
class6	2260	acute gastroenteritis in infants under 6 months old  
class6	2260	sixty two babies under the age of 6 months who were admitted with gastroenteritis completed a study of gradual refeeding compared with abrupt refeeding after a period of rehydration  
class6	2260	there was no difference in the incidence of recurrence of diarrhoea due to lactose intolerance  effect on weight  or duration of hospital stay  
class6	2260	twenty six babies  42   had recurrence of diarrhoea after refeeding  all of whom settled with the introduction of a lactose free soya based formula  
class6	2260	well nourished babies under 6 months of age with mild to moderately severe gastroenteritis can be fed immediately with full strength milk feeds after rehydration  
class6	2260	the introduction of a lactose free soya based preparation may provide an alternative to repeated attempts at regrading with cows  milk feeds in those patients with lactose intolerance  
class6	2261	management of gastroenteritis  
class6	2261	childhood gastroenteritis remains a common reason for admission to british paediatric units  although the severity of the disease appears to be diminishing in recent years  
class6	2261	we studied 215 infants and children with gastroenteritis admitted consecutively to four paediatric units in south wales in order to determine the severity of the disease  the organisms isolated  the frequency of complications  and the adequacy of management before admission  
class6	2261	stool pathogens were isolated in 125  58   patients  viruses in 65  bacteria in 30  and protozoa in 19  with multiple infection found in 11   
class6	2261	there was a low incidence of morbidity and complications  but prolonged diarrhoea  postenteritis syndrome  was present in 24  11   cases and 77  36   had received inappropriate treatment before admission  
class6	2261	contemporary gastroenteritis is thus a relatively mild disease in the acute phase  but management before admission to hospital is often inadequate  and prolonged diarrhoea may be a feature in a considerable number of cases  
class6	2262	perforated duodenal ulcer  an unusual complication of gastroenteritis  
class6	2262	a 7 year old boy was admitted to hospital with gastroenteritis  which was complicated by an acute perforated duodenal ulcer  
class6	2262	after oversewing of the perforation he made an uncomplicated recovery  
class6	2262	peptic ulceration is under diagnosed in childhood and this leads to delay in diagnosis and appropriate management  
class6	2262	ulceration is associated with severe illness and viral infections  but perforation is rare  
class6	2263	congenital diaphragmatic hernia  impact of prostanoids in the perioperative period  
class6	2263	a prospective study of 10 neonates with congenital diaphragmatic hernia and five controls to determine the importance of prostanoid concentrations perioperatively and the relation with persistent pulmonary hypertension  pph  is reported  
class6	2263	in neonates with congenital diaphragmatic hernia postoperative concentrations of the vasoconstrictor thromboxane b2 rose significantly and were higher during episodes of pph  this rise may provoke pph and subsequent right to left shunting  
class6	2264	cystic tumors of the pancreas  new clinical  radiologic  and pathologic observations in 67 patients  
class6	2264	within a 12 year period we treated 67 patients  49 women  18 men  mean age  61 years  with cystic neoplasms of the pancreas  including 18 serous cystic adenomas  15 benign mucinous cystic neoplasms  27 mucinous cystadenocarcinomas  3 papillary cystic tumors  2 cystic islet cell tumors  and 2 cases of mucinous ductal ectasia  
class6	2264	mean tumor size was 6 cm  2 to 16 cm   
class6	2264	in 39  the patients had no symptoms  and in 37  the lesions had been misdiagnosed as a pseudocyst  
class6	2264	computed tomography was useful for detection  for distinguishing the microcystic subgroup of serous cystadenoma  and for showing rim calcification  all 7 cases were malignant  but was not reliable for distinguishing neoplasm from pseudocyst  serous from mucinous tumors  or benign from malignant  
class6	2264	arteriography showed hypervascularity in 4 of 10 serous adenomas  3 of 11 mucinous carcinomas  and 1 of 1 papillary cystic tumors  
class6	2264	endoscopic pancreatography showed no communication with the cyst cavity in 37 of 37 cases of cystic neoplasms but opacified the ectatic ducts in 2 of 2 cases of mucinous ductal ectasia  
class6	2264	stenosis or obstruction of the pancreatic duct indicated cancer  
class6	2264	the tumor was resected by distal pancreatectomy in 25 patients  by proximal resection in 29  and by total pancreatectomy in one  with no operative deaths  
class6	2264	forty four per cent of the tumors were malignant  
class6	2264	in 10 cases the tumor was unresectable because of local extension or distant metastases  and those patients died at a mean of 4 months  
class6	2264	seventy five per cent of those resected for cure are alive without evident recurrence  
class6	2264	because the epithelial lining of the tumor was partially  5  to 98   absent in 40  to 72  of cases of the major tumor types  and the mucinous component comprised only about 65  of mucinous cystadenoma lining  misdiagnoses on frozen and even permanent sections were made  
class6	2264	mitoses and histologic solid growth correlated with malignancy  
class6	2264	neuroendocrine elements were seen in 87  of benign and 47  of malignant mucinous tumors  
class6	2264	it is recommended that the terms macrocystic and microcystic be abandoned in favor of the histologic designations serous and mucinous  
class6	2264	incomplete examination of the cyst wall can be misleading  however  
class6	2264	it is suggested that mucinous ductal ectasia be recognized separately from cystic tumors and that all of these lesions be resected  with the possible exception of asymptomatic confirmed serous cystadenomas  
class6	2265	ileal pouch anal anastomosis  reoperation for pouch related complications  
class6	2265	the aim was to assess the value of reoperative surgery for pouch related complications after ileal pouch anal anastomosis  ipaa  for chronic ulcerative colitis and familial adenomatous polyposis  
class6	2265	between january 1981 and august 1989  114 of 982 ipaa patients  12   seen at the mayo clinic had complications directly related to ipaa that required reoperation  
class6	2265	among the 114 patients  the complications prevented initial ileostomy closure in 33 patients  25    occurred after ileostomy closure in 68 patients  60    and delayed ileostomy closure in the remaining patients  
class6	2265	the salvage procedures performed included anal dilatation under anesthesia for anastomotic strictures  placement of setons and or fistulotomy for perianal fistulae  unroofing of anastomotic sinuses  simple drainage and antibiotics for perianal abscesses  abdominal exploration with drainage of intra abdominal abscesses with or without establishment of ileostomy  and complete or partial reconstruction of the reservoir for patients with inadequate emptying  
class6	2265	none of the reoperated patients died  
class6	2265	reoperation led to restoration of pouch function in two thirds of patients and  of these  70  had an excellent clinical outcome  
class6	2265	however approximately 20  of the 114 pouches required excision  
class6	2265	excision was common  especially among patients who had pelvic sepsis  
class6	2265	salvage procedures for pouch specific complications can be done safely and will restore pouch function in two thirds of patients  
class6	2265	complications after reoperation  however  may ultimately lead to loss of the reservoir in one in five patients  
class6	2266	the role of prostanoids in the production of acute acalculous cholecystitis by platelet activating factor  
class6	2266	gallbladder tissue from patients with acute acalculous cholecystitis contains increased amounts of prostanoids when compared to normal gallbladder tissue  
class6	2266	platelet activating factor  paf  is a potent stimulus of eicosanoid formation  
class6	2266	it has been implicated as a mediator of acute inflammatory processes and systemic responses to shock  
class6	2266	in this study the role of paf in acute acalculous cholecystitis was evaluated  
class6	2266	anesthetized cats underwent gallbladder perfusion with a physiologic buffer solution containing  14c polyethylene glycol as a nonabsorbable tracer to quantitate mucosal water absorption  
class6	2266	platelet activating factor was infused into the hepatic artery for 2 hours  
class6	2266	control experiments were performed when vehicle alone was infused  
class6	2266	experiments also were performed when indomethacin was administered intravenously and when indomethacin and paf were administered  
class6	2266	gallbladder mucosal absorption secretion and perfusate and tissue prostaglandin e  pge  and 6 keto prostaglandin f1 alpha  6 keto pgf1 alpha  levels were evaluated  
class6	2266	gallbladder inflammation was evaluated by beta glucuronidase and myeloperoxidase tissue concentrations and by a histologic scoring system  
class6	2266	platelet activating factor eliminated gallbladder absorption and produced net fluid secretion associated with dose related increases in perfusate pge concentrations and gallbladder tissue pge and 6 keto pgf1 alpha levels when compared to control values  
class6	2266	platelet activating factor produced significant inflammation in the gallbladder with increases in the histologic score of inflammation and tissue lysosomal enzyme activities  
class6	2266	indomethacin significantly decreased the fluid secretion  prostanoid levels  and inflammation produced by paf  
class6	2266	the results suggest that paf may induce acute gallbladder inflammation associated with systemic stress through a prostanoid mediated mechanism  
class6	2267	surgical aspects of sclerosing cholangitis  results in 178 patients  
class6	2267	of 178 patients with sclerosing cholangitis treated since 1950  88 patients had associated inflammatory bowel disease  72 had no such history  and 18 had iatrogenic injury or stone disease  
class6	2267	a total of 233 biliary operations were performed  with a 75  rate of temporary improvement after initial operation  
class6	2267	subsequent operations resulted in a lower success rate and a higher mortality rate  
class6	2267	radiologic findings included predominant extrahepatic  intrahepatic  and diffuse disease in 29   28   and 43  of patients  respectively  no survival differences were noted  
class6	2267	seventy five of one hundred three deaths  73   were related to liver failure  bleeding  or sepsis  
class6	2267	of 14 patients undergoing portosystemic shunt  13 died of surgical complications or related disease  
class6	2267	orthotopic liver transplantation was performed in 16 patients and resulted in eight deaths  mainly in patients who had previously undergone extensive surgical treatment  
class6	2267	no survival differences were seen between the patients with inflammatory bowel disease  those without the condition  or those who had colectomy  
class6	2267	surgical treatment in patients with sclerosing cholangitis should be minimized  
class6	2267	orthotopic liver transplantation should be offered as the treatment of choice for patients with portal hypertension  refractory cholangitis  advanced cirrhosis  or progressive liver failure  
class6	2268	relief of tracheal compression by aortopexy  
class6	2268	we have performed aortopexy in 12 children with tracheal compression  
class6	2268	six infants had compression secondary to a vascular anomaly  group 1   and the other 6 had previous repair of esophageal atresia  group 2   
class6	2268	eleven of the 12 children are alive after a mean follow up of 36 months  
class6	2268	in group 1  1 patient died and 3 patients  50   experienced recurrent respiratory distress  
class6	2268	five infants sustained a major postoperative complication  and the average postoperative hospital stay was 25 days  
class6	2268	in group 2  however  aortopexy was uniformly successful  
class6	2268	there were no deaths  no postoperative complications  and no cases of postoperative respiratory distress  and the mean postoperative hospital stay was only 10 days  
class6	2268	for children with reflex apnea after repair of esophageal atresia  aortopexy is lifesaving and can be performed with minimal morbidity and mortality  
class6	2268	great caution is indicated in children with tracheal compression from other causes  
class6	2269	pharyngoesophageal perforation after blunt neck trauma  
class6	2269	pharyngoesophageal perforation secondary to blunt neck trauma is an uncommon injury that can cause serious morbidity and mortality if not recognized and treated  
class6	2269	pharyngeal perforation secondary to blunt trauma sustained while boxing is reported  
class6	2269	review of the world literature found 10 cases of pharyngoesophageal perforation secondary to blunt neck trauma  
class6	2269	analysis of these cases indicates that perforations less than 2 cm and limited to the pharynx may be treated medically with close observation  
class6	2269	large perforations and those perforations that extend to the esophageal inlet or involve the esophagus exclusively are best treated surgically  
class6	2270	risk of gastric cancer after gastric surgery for benign disorders  
class6	2270	the objective of this review was to evaluate published evidence for the association between gastric resection for benign disorders and subsequent cancer of the gastric remnant  
class6	2270	we searched the literature through medline  1970 to 1988  and through the references of relevant articles  
class6	2270	fifty eight studies consisting of case series  uncontrolled surveys  and case control or cohort analyses were identified and critically assessed using defined methodological criteria  
class6	2270	there were no consistent differences between the expected and observed number of cancers occurring within 15 years after gastric resection  
class6	2270	however  all case control studies and seven of the eight cohort analyses  in which the prevalence of cancer was stratified by time since gastric resection  indicated a twofold to fourfold increase in the risk of gastric cancer in patients who survived 15 or more years after gastric surgery  
class6	2270	we conclude that most studies of the association of gastric surgery with subsequent gastric cancer have relatively weak designs  
class6	2270	still  the repetitive demonstration of this association by different investigators using different research designs supports the hypothesis that gastric resection increases the risk of cancer in the gastric remnant  
class6	2271	the prevalence of helicobacter pylori in nonulcer dyspepsia  importance of stratification according to age 
class6	2271	helicobacter pylori  formerly campylobacter pylori  is causally related to active antral gastritis and is highly associated with duodenal and gastric ulcers  
class6	2271	however  the relationship of h pylori to nonulcer dyspepsia is less clear  
class6	2271	we determined the presence of h pylori in unselected patients who were undergoing upper gastrointestinal tract endoscopy  and we found a prevalence of 37  in 110 patients with nonulcer dyspepsia that was similar to previous data  
class6	2271	patients with nonulcer dyspepsia who had h pylori were found to be significantly older than patients with nonulcer dyspepsia who did not have h pylori  
class6	2271	in addition  when stratified according to age  we detected an increased prevalence of h pylori in patients with nonulcer dyspepsia with increasing age  similar to that reported for asymptomatic control populations  
class6	2271	this finding casts doubt as to the causal role of h pylori for most patients with nonulcer dyspepsia and stresses the importance of considering epidemiologic factors  such as age  when evaluating the role of h pylori in specific disease states  
class6	2272	study of preneoplastic changes of liver cells by immunohistochemical and molecular hybridization techniques  
class6	2272	the status of hepatitis b virus dna was investigated by in situ hybridization in multifocal areas of a noncancerous hepatitis b virus associated cirrhosis  
class6	2272	this liver exhibited a marked degree of dysplasia and adenomatous hyperplasia  
class6	2272	the results of these studies were correlated with the histopathology and immunohistochemical stains for hepatitis b core and surface antigens  
class6	2272	there was clear evidence of a marked reduction to absence of hepatitis b viral dna by in situ hybridization and absence of hbc and hbsag in the foci of liver cell dysplasia and adenomatous hyperplasia  
class6	2272	these results support the hypothesis that liver cell dysplasia and adenomatous hyperplasia are preneoplastic in nature  
class6	2273	acalculus lymphoeosinophilic cholecystitis associated with interleukin 2 and lymphokine activated killer cell therapy  
class6	2273	a case of unusual cholecystitis that developed on completion of interleukin 2 and lymphokine activated killer cell therapy is described  
class6	2273	a 62 year old man was treated with interleukin 2 and lymphokine activated killer cells for disseminated renal cell carcinoma  
class6	2273	during the course of the immunotherapy  his serum alkaline phosphatase level increased  as did the peripheral eosinophil count  0 31   
class6	2273	subsequently  clinical and radiologic evidence of acute cholecystitis was noted  
class6	2273	the removed gallbladder showed acalculus cholecystitis with extensive diffuse infiltrates of numerous eosinophils and t lymphocytes  but sparse polymorphonuclear leukocytes  
class6	2273	the authors name this unusual cholecystitis acalculus lymphoeosinophilic cholecystitis and believe it to be associated with interleukin 2 and lymphokine activated killer cell therapy  
class6	2273	the pathogenic relationship is discussed  
class6	2274	comprehensive management of acute necrotizing pancreatitis and pancreatic abscess  
class6	2274	achieving reduced mortality rates in patients with necrotizing pancreatitis and pancreatic abscess is possible by employing a comprehensive management plan  
class6	2274	components of the plan include  1  rapid evaluation and assessment of the degree of physiologic and anatomic derangement  the latter by the prompt use of vascular enhanced computed tomographic scan   2  adequate fluid resuscitation determined by early institution of advanced hemodynamic monitoring   3  attempts to identify and document septic foci via computed tomography guided percutaneous aspiration  and  4  aggressive surgical debridement  
class6	2274	close adherence to these policies allowed us to keep mortality in this seriously ill group of patients to 14   
class6	2274	most deaths occurred in patients who were referred to this service late in the course of their disease  
class6	2274	the acute physiology and chronic health enquiry  apache  ii severity of illness index applied at the time of admission proved an accurate predictor of mortality  
class6	2274	a score of 25 or greater was highly predictive of death  and a lesser score  of survival  
class6	2275	blunt intestinal injury  keys to diagnosis and management  
class6	2275	fifty six patients with blunt intestinal injury seen during 39 months were reviewed for keys to diagnosis and treatment  
class6	2275	motor vehicle accidents were involved in 80  of the cases and seat lap belts were in use 69  of the time  
class6	2275	blunt intestinal injury was the only abdominal injury in 70  of the cases  
class6	2275	there were 42 perforations and 20 devascularizations  multiple injuries were common  27    
class6	2275	abdominal tenderness was present on admission in 43 of 44 patients in whom a reliable examination was possible  
class6	2275	peritoneal lavage was positive in 13  93   of 14 patients  
class6	2275	computed tomography was falsely negative in three of four instances in which it was used  
class6	2275	perforations were most common in the upper and lower ends of the small bowel and in the sigmoid colon  devascularizations were most common in the distal ileum and sigmoid colon  
class6	2275	resection anastomosis was performed in 38  of small bowel perforations and in all small bowel devascularizations  
class6	2275	resection diversion was required in most colonic perforations  five of six patients  and devascularizations  four of six patients   
class6	2275	there were five deaths  9    none due to intestinal injury  
class6	2275	there were seven complications related to intestinal injury  
class6	2275	diagnostic delay occurred in two patients  both had resultant morbidity  
class6	2275	blunt intestinal injury is associated with physical findings in conscious patients  
class6	2275	peritoneal lavage should be used when tenderness cannot be evaluated  
class6	2275	timely operative intervention minimizes morbidity and hospital stay  
class6	2276	the recalcitrant perineal wound after rectal extirpation  applications of muscle flap closure  
class6	2276	perineal wounds developing after abdominoperineal resection result in chronic purulent drainage and intermittent episodes of sepsis and are generally unresponsive to conservative medical and surgical treatment  
class6	2276	thirteen consecutive patients  aged 27 to 74 years  mean  48 years  who underwent debridement and immediate muscle flap closure of these wounds were analyzed to identify risk factors for delayed healing and to evaluate the effectiveness of muscle flap coverage  
class6	2276	three risk factors were identified  preoperative or postoperative radiation therapy  resection for recurrent carcinoma  and inflammatory bowel disease  
class6	2276	a total of 19 muscle flaps  11 gracilis  five gluteal thigh  two gluteus maximus  and one rectus abdominis  were used to close these wounds  
class6	2276	during an average 3 5 year follow up  four  31   minor complications and one  8   recurrence were noted to occur  
class6	2276	muscle flaps provide safe  effective  single stage procedures for the closure of chronic perineal wounds  
class6	2277	fibrin glue inhibits intra abdominal adhesion formation  
class6	2277	to determine the effect of fibrin glue on intra abdominal adhesion formation  45 rats were randomized to three groups  
class6	2277	each animal received two adhesion models  
class6	2277	group 1 received no further treatment  
class6	2277	groups 2 and 3 had the adhesion models covered with fibrinogen from fresh frozen plasma  1 77 g l  and cryoprecipitate  23 6 g l   respectively  
class6	2277	in group 1  13 of 15 rats had high grade adhesions in both models  
class6	2277	in group 2  high grade adhesions were noted in nine of 15 rats in model 1 and in 12 of 15 rats in model 2  
class6	2277	in group 3  however  high grade adhesions were seen in only three of 15 rats in model 1  with 11 rats having no adhesions  and in only two of 15 rats in model 2  
class6	2277	histologic analysis suggested accelerated healing in group 3  
class6	2277	we conclude that  1  fibrin glue inhibits intra abdominal adhesion formation in rats   2  the inhibitory action is dependent on the fibrinogen concentration of the fibrin glue  and  3  adhesions are reduced by fibrin glue regardless of whether the peritoneal defect is closed  
class6	2278	reoperative surgery for the morbidly obese  a university experience  
class6	2278	patients who undergo surgery for morbid obesity are often subjected to reoperation for a wide array of indications  
class6	2278	to evaluate outcome following revisional procedures  we reviewed the records of 32 such patients treated at ucla between april 1986 and may 1989  
class6	2278	twenty five women  78   and 7 men  22   with a mean age of 44 years underwent 76 reoperations  2 4 per patient  for complications of prior obesity surgery  
class6	2278	indications for initial surgical revision consisted primarily of metabolic derangements  12 patients  and weight related problems  11 patients   
class6	2278	in contrast  indications for the patients  final surgical procedure were commonly for bowel obstruction  41    intra abdominal sepsis  12    and gastrointestinal bleeding  6    
class6	2278	following initial revision  23 patients  71 8   required further surgery for major complications and four patients died  12 5    
class6	2278	while initial revisions are frequently indicated for metabolic problems  final reoperations are more frequently undertaken for urgent  life threatening complications  
class6	2278	revisional procedures for morbid obesity should be carefully considered  and the potential for major complications and or death should be weighted heavily against proposed benefits  
class6	2279	endocrine consequences of alcohol abuse  
class6	2279	the recognized endocrine consequences of alcohol abuse are reviewed on an organ by organ basis  
class6	2279	the organ systems for which the most information is available  liver  heart  brain  are presented first followed by those where the information base is less  
class6	2280	t cell subsets  tc  th  ts  tsi  and il2 receptor bearing cells in peripheral blood of patients in the acute phase of alcoholic hepatitis  
class6	2280	the present study was designed to evaluate the proportion of t cell subsets and il2 receptor positive cells in the peripheral blood of patients with acute alcoholic hepatitis  aah  using monoclonal antibodies to t cell antigens and tac in a double immunofluorescent technique  
class6	2280	the results indicate that the percentage of the total t cells and the intensity of all the t cell antigens are significantly reduced and the percentage of t helper cells and the ratio between th ts cells are significantly increased in aah when compared to healthy controls  
class6	2280	but  significant differences in values observed in this study were not found for the absolute number of these cells  
class6	2280	these altered values returned to normal levels during convalescence  
class6	2281	pharmacokinetics of propofol infusions in patients with cirrhosis  
class6	2281	we have compared the pharmacokinetics of propofol as an infusion in 10 control and 10 patients with cirrhosis  
class6	2281	anaesthesia was induced within 3 4 min during administration of an infusion of propofol 21 mg kg 1 h 1  
class6	2281	after 5 min  the infusion was decreased in a stepwise manner to 12 mg kg 1 h 1 and subsequently 6 mg kg 1 h 1  
class6	2281	the mean recovery time after discontinuation of the infusion was significantly longer in the cirrhotic group  however  when patients opened their eyes  blood concentrations of propofol were similar in both groups  1 micrograms ml 1   
class6	2281	pharmacokinetic analysis was performed from the beginning of infusion to 8 h after termination  
class6	2281	total body clearance was not reduced significantly in cirrhotic  1 56  sd 0 48  litre min 1  compared with control  1 75  0 32  litre min 1  patients  
class6	2281	the volume of distribution at steady state was significantly greater in patients with cirrhosis than in control patients  202  82  litre vs 121  49  litre   
class6	2281	however  this difference did not change terminal elimination half life  
class6	2281	the pharmacokinetics of propofol given by infusion to maintain general anaesthesia were not affected markedly by moderate cirrhosis  
class6	2282	pivoting larynx  an unusual clinical observation at laryngoscopy  
class6	2282	rigid oesophagoscopy was planned in the investigation of a young patient with dysphagia  
class6	2282	during laryngoscopy for tracheal intubation an unusual pivoting manoeuvre was required to see the vocal cords  
class6	2282	although the initial diagnostic investigations were unhelpful  follow up directed at explaining the clinical observations led to an eventual diagnosis of anterior tubercles of c6  which explained the observation and accounted for the dysphagia  
class6	2283	postoperative analgesic requirements in patients exposed to positive intraoperative suggestions  
class6	2283	objective  to establish whether positive suggestions given to a patient under general anaesthesia reduce postoperative pain and analgesic requirements  
class6	2283	design  prospective double blind randomised study  
class6	2283	setting  operating theatre and gynaecology ward of a teaching hospital  
class6	2283	patients  63 woman undergoing elective abdominal hysterectomy were randomised to be played either a tape of positive suggestions or a blank tape during the operation through a personal stereo system  
class6	2283	interventions  three women were withdrawn from the study  
class6	2283	anaesthesia was standardised for all of the women  
class6	2283	postoperative analgesia was provided through a patient controlled analgesia system for the first 24 hours  
class6	2283	pain scores were recorded every six hours  
class6	2283	main outcome measures  morphine consumption over the first 24 hours after the operation  pain scores  
class6	2283	results  mean morphine requirements were 51 0 mg  95  confidence interval 42 1 to 60 0 mg in the women played positive suggestions  and 65 7 mg  55 6 to 75 7 mg  in those played a blank tape  
class6	2283	the point estimate  95  confidence interval  for the difference of means was 14 6 mg  22 4    1 9  2 9   to 27 3 mg  41 6    p   0 028   
class6	2283	pain scores were similar in the two groups  
class6	2283	conclusion  positive intraoperative suggestions seem to have a significant effect in reducing patients  morphine requirements in the early postoperative period  
class6	2284	bile acids and the increased risk of colorectal tumours after truncal vagotomy  
class6	2284	an association between colorectal cancer and previous peptic ulcer surgery is reported  
class6	2284	in a prospective screening study  100 asymptomatic patients  80 men and 20 women  who had undergone truncal vagotomy at least 10 years previously were investigated by barium enema  colonoscopy and gallbladder ultrasonography  
class6	2284	control data were obtained from forensic autopsy subjects  
class6	2284	the incidence of neoplasms greater than or equal to 1 0 cm in the vagotomized group was 14 per cent  11 adenomas  3 carcinomas  and 3 per cent in controls  p   0 01   
class6	2284	duodenal bile obtained at endoscopy from 21 vagotomized patients with normal gallbladders and from 21 control patients undergoing endoscopy was analysed by high performance liquid chromatography  
class6	2284	the mean percentage of cholic  ca   chenodeoxycholic  cdca   deoxycholic  dca  and lithocholic  lca  acids in the bile of vagotomized patients was 32 3  45 6  20 7 and 1 4 per cent respectively compared with 45 3  36 2  17 9 and 0 7 per cent respectively in controls  
class6	2284	the increased proportions of cdca and lca and decreased proportions of ca in the duodenal bile of vagotomized patients were significant  p less than 0 001  p   0 02  p   0 007   
class6	2284	abnormalities in bile acid metabolism may help to explain the increased risk of colorectal neoplasia 10 years after truncal vagotomy  
class6	2285	urinary tissue factor activity in colorectal disease  
class6	2285	procoagulant activity  pca  in normal urine has been recognized for over 50 years  
class6	2285	although tissue factor  tf  is produced by certain tumours  and is increased in both tumour associated macrophages and blood monocytes  the possibility that it might also be increased in urine has not been studied in patients with cancer  
class6	2285	we have measured urinary pca in hospital controls without inflammatory or neoplastic disease  n   79   in patients with rheumatoid arthritis  n   8   inflammatory bowel disease  n   19   colorectal cancer  n   70  and in patients undergoing colonoscopy  n   50   
class6	2285	urinary pca was higher  p less than 0 001  in patients with colorectal cancer and inflammatory bowel disease than controls or patients with rheumatoid arthritis  
class6	2285	fourteen  88 per cent  out of 16 colonoscopy patients subsequently found to have carcinoma or inflammatory bowel disease had levels above the control upper quartile  compared with 8  24 per cent  out of 34 with normal colonoscopy  p less than 0 001   
class6	2285	tf inhibitors confirmed the nature of the pca and western blotting studies indicated a urinary tf molecular weight of approximately 38 000  
class6	2285	these studies provide further evidence of abnormal haemostasis in malignancy and suggest that determination of urinary tf may provide a useful screening test in patients undergoing colonoscopy  
class6	2286	malignant left sided large bowel obstruction managed by subtotal total colectomy  
class6	2286	of 60 patients presenting with acute obstructing carcinoma of the left colon  49 underwent immediate resection either by radical subtotal total colectomy  31 patients  group i  or by radical segmental resection  18 patients  group ii  of whom three had immediate anastomosis after on table bowel irrigation and 15 had a planned staged procedure  
class6	2286	the operative mortality rate was 3 per cent in group i and 11 per cent in group ii  not a statistically significant difference   
class6	2286	however  substantial differences were found for major morbidity  6 versus 44 per cent in groups i and ii respectively  p less than 0 01  and mean length of hospital stay  17 days in group i versus 35 days in group ii  p less than 0 05   
class6	2286	all three patients who had on table lavage developed anastomotic leaks which necessitated a second operation to form a stoma  
class6	2286	six patients  19 per cent  in group i required antidiarrhoeal medication in the immediate postoperative period  
class6	2286	however  subsequent improvement in stool frequency was noted in all patients  
class6	2286	it is concluded that subtotal total colectomy is an acceptable means of managing patients with obstructing carcinoma of the left colon in that it is associated with a low morbidity and mortality rate and good functional results  
class6	2287	blood transfusion and recurrence of colorectal cancer  the role of platelet derived growth factors  
class6	2287	efforts to explain the possible effects of blood transfusion on the recurrence of colorectal cancer have been based entirely on the immunosuppressive effects of blood transfusion  
class6	2287	however  the relationship between solid tumour development and the immune system is inconclusive  
class6	2287	we have investigated an alternative mechanism involving the potential role of growth factors in this phenomenon  
class6	2287	using a human fibroblast   125i deoxyuridine uptake mitogenesis assay  the relative amounts of growth factor in the plasma of stored blood were measured  
class6	2287	there was a progressive increase in mitogenesis from day 0  n   6  to day 28  n   6  p less than 0 001  mann whitney u test   
class6	2287	the effect of growth factors on the development of liver and intraperitoneal metastases was studied in hooded lister rats  
class6	2287	following an intraportal injection of 10 5  mc28 tumour cells  the experimental group  n   25  received 2 ml of syngeneic serum intravenously for 4 days  
class6	2287	likewise  colonic anastomoses were performed on omentectomized rats and the peritoneal cavity seeded with 10 3  cells  
class6	2287	the experimental groups  n   20  received either 2 ml serum intravenously repeatedly or 3 ml serum intraperitoneally  n   19   
class6	2287	there was no significant increase in liver metastases or peritoneal disease following intravenous infusion of serum but serum delivered intraperitoneally resulted in a significant increase in tumour from 22 per cent in the controls to 89 per cent in the study group  p less than 0 01   
class6	2287	growth factors released from platelets following blood loss into the peritoneal cavity may be important in enhancing local recurrence of colorectal cancer  
class6	2288	experimental study of starch induced intraperitoneal adhesions 
class6	2288	the effects of starch on the development of postoperative adhesions were examined in 144 sprague dawley rats  
class6	2288	groups of rats were injected intraperitoneally with suspensions of washings from starched gloves  starch free gloves and starch poor washed gloves  and after operative manipulation of the bowel  
class6	2288	the incidence of adhesions was greatest  78 per cent  after laparotomy and injections of starch rich washings and least when starch poor  33 per cent  or starch free glove suspensions  37 per cent  were used  confirming an advantage for washing gloves or switching to starch free products  
class6	2289	on table pancreatography  importance in planning operative strategy  
class6	2289	we describe our experience with 124 on table pancreatograms performed during 117 operative procedures on 112 patients in a wide variety of clinical settings  
class6	2289	endoscopic retrograde cholangiopancreatography  ercp  was performed on 84 occasions with a 73 per cent success rate for visualization of the main pancreatic duct  
class6	2289	on table pancreatography  otp  was performed by one of five different techniques  retrograde  prograde or ambigrade ductography  cystography and ascending loopography after pancreaticojejunostomy  
class6	2289	otp provided important information about the main pancreatic duct when endoscopic visualization was unsuccessful  n   23   incomplete  n   17  or not performed  n   33   there was a failure rate of 4 per cent  
class6	2289	in 35 patients either the additional information or discrepancies between ercp and otp findings resulted in a change of operative plan  19 extra procedures  16 altered procedures   
class6	2289	complete ductography was especially helpful in the 63 patients with chronic pancreatitis  
class6	2289	otp is technically simple  free from complications and invaluable for planning operative strategy  
class6	2290	laser recanalization versus endoscopic intubation in the palliation of malignant dysphagia  
class6	2290	forty patients with widely disseminated or locally advanced malignant obstruction of the middle or lower third of the oesophagus underwent endoscopic treatment by either ndyag laser recanalization or intubation  
class6	2290	groups were matched on the basis of tumour location and swallowing was graded clinically before and after treatment  
class6	2290	technical success was achieved in 17 of 20 laser treated and 18 of 20 intubated patients  
class6	2290	pretreatment swallowing ability  histology  tumour location and overall length were unrelated to functional outcome in both groups  
class6	2290	however  circumferential tumour length identified endoscopically strongly influenced the quality of swallowing after laser recanalization  
class6	2290	patients with excellent swallowing quality  n   7  had significantly shorter circumferential tumour lengths  3 1 1 0  cm  than those with poorer quality swallowing  n   10   6 3 1 6 cm   p less than 0 001   
class6	2290	both methods of treatment had low complication rates and there was one death in the series in the laser treated group  
class6	2290	laser recanalization provides a better functional result than intubation for short  less than 4 cm  circumferential tumour  
class6	2290	intubation at a single session seems more appropriate than repeated laser therapy when tumour length exceeds 4 cm  
class6	2291	aetiology of pancreatic cancer 
class6	2291	curative surgery is possible in only a small minority of patients with pancreatic cancer and  to date  responses to chemotherapy and radiotherapy have been disappointing  
class6	2291	to make any impact on the incidence of the disease a clearer understanding of its aetiology is required  
class6	2291	this review explores present knowledge of the aetiology and epidemiology of pancreatic cancer  
class6	2292	abdominal wall pain  an alternative diagnosis  
class6	2292	the cause of abdominal pain need not necessarily reside in the viscera  the abdominal wall is another source of symptoms  
class6	2292	some causes of abdominal wall pain are obvious  e g  
class6	2292	hernias  but not so others such as nerve entrapment syndromes  
class6	2292	this review is concerned with causes of abdominal wall pain which  although common  may be easily overlooked  
class6	2293	toxicity of high dose cytosine arabinoside in the treatment of advanced childhood tumors resistant to conventional therapy  a pediatric oncology group study  
class6	2293	experience with high dose cytosine arabinoside  hdac  in pediatric solid tumors is limited  
class6	2293	sixteen children with solid tumors resistant to conventional therapies were registered in a pilot pediatric oncology group  pog  study that required the administration of hdac at 3 g m2 every 12 hours for four doses  
class6	2293	there were four cases of rhabdomyosarcoma  two cases of fibrosarcoma  four cases of neuroblastoma  and one case each of germ cell tumor  wilm s tumor  retinoblastoma  hepatocellular carcinoma  ewing s sarcoma  and burkitt s lymphoma  
class6	2293	all eligible patients had advanced diseases and had previously received extensive chemotherapy  
class6	2293	thirteen patients received one course of hdac and three patients received two courses of hdac  
class6	2293	due to prior treatments  patients had less than normal marrow reserves  
class6	2293	short term toxicity included nausea  vomiting  suppression of hemopoiesis  drug fever  and increased blood urea nitrogen  bun   creatinine  and liver enzymes  
class6	2293	all evaluable patients recovered from their toxicities  
class6	2293	there were no drug related deaths  
class6	2293	none of the patients had neurologic problems  including the only patient with prior irradiation to the skull  
class6	2293	with the above schedule  hdac appears to have manageable toxicity  
class6	2294	effectiveness of periodic checkup by ultrasonography for the early diagnosis of hepatocellular carcinoma  
class6	2294	periodic checkup by ultrasonography was conducted on patients with chronic liver diseases for early detection of hepatocellular carcinoma  
class6	2294	in 19 months  a total of 2004 examinations were performed on a total of 660 cases  179 cases with liver cirrhosis in the compensatory stage  younger than 70 years  481 cases with chronic hepatitis  aged 40 to 70 years for men and 50 to 70 years for women   
class6	2294	of the 660 cases  22 hcc cases  3 3   were detected and finally diagnosed by angiography and or histologic examination  
class6	2294	four of those cases  18   had a single nodule smaller than 1 cm in diameter  and 11 cases  50   had a single nodule smaller than 2 cm  
class6	2294	surgical resection was performed on 12 cases  55    
class6	2294	in comparison with the control group  83 hcc cases not receiving any periodic checkup   the frequency of small liver cancer and the surgical resection rate in the study group were significantly higher  
class6	2294	this examination system by periodic ultrasonography checkup of patients with chronic hepatic diseases was effective for early detection and permitted aggressive therapy of hepatocellular carcinoma  
class6	2295	parathyroid hormone like peptide in normal and neoplastic mesothelial cells  
class6	2295	mesothelioma has not been commonly reported as a cause of hypercalcemia of malignancy  
class6	2295	we have studied a patient with malignant mesothelioma and hypercalcemia in association with elevated plasma concentrations of parathyroid hormone like peptide  plp   
class6	2295	immunohistochemical analysis of the tumor and seven of eight other mesotheliomas that were not associated with hypercalcemia revealed the presence of plp cytoplasmic immunopositivity  
class6	2295	plp immunopositivity was also detected in normal and reactive mesothelial cells  
class6	2295	the results of these studies suggest that plp immunoreactivity is common in normal and neoplastic mesothelial cells and raises the possibility that plp production may play a role in the pathogenesis of hypercalcemia associated with mesothelioma  
class6	2296	glomerular iga deposits in patients with celiac disease  
class6	2296	glomerular immunopathology was studied in 25 patients with newly diagnosed celiac disease  
class6	2296	none had clinical signs of renal disease  
class6	2296	glomeruli were obtained by fine needle aspiration biopsy  
class6	2296	the specimens were processed and studied by indirect immunofluorescence for immunoglobulins and complement  
class6	2296	mesangial iga was found in 8 of the patients  
class6	2296	it occurred occasionally together with slight igg or igm  but c3 was not seen in these patients  
class6	2296	iga class circulating immune complexes  cic   antireticulin antibodies  ara   antigliadin antibodies  aga   and rheumatoid factor  rf  occurred significantly more often in the patients with mesangial iga than in the 17 patients having no mesangial iga  
class6	2296	the patients with mesangial iga also had significantly higher mean levels of serum iga  iga ara and iga aga than those without  
class6	2296	the results suggest that glomerular mesangial deposits of iga occur frequently in untreated celiac disease and that they are in some way associated with circulating iga class antibodies and immune complexes  
class6	2296	in this situation iga seems to be deposited without being able to induce clinically overt glomerulonephritis  a circumstance that may be related to the lack of complement in the deposits  
class6	2297	acute deterioration of renal function associated with enteric hyperoxaluria  
class6	2297	enteric hyperoxaluria due to malabsorption syndromes has been well documented to cause renal calculi and chronic tubulointerstitial renal damage  
class6	2297	rarely  in the setting of intestinal bypass operations for morbid obesity  enteric hyperoxaluria has produced acute renal failure  
class6	2297	we report two patients who suffered acute deterioration of renal function associated with increased intestinal absorption and renal excretion of oxalate associated with steatorrhea  
class6	2297	one patient had a large portion of his small bowel resected many years prior to the onset of the renal failure and the second patient had chronic pancreatitis causing steatorrhea  
class6	2297	both patients had renal biopsy documentation of the acute nature of the tubular damage produced by oxalate deposition  
class6	2297	the mechanisms of their deterioration of renal function may relate to sudden increases in steatorrhea in association with episodes of volume depletion  
class6	2297	enteric hyperoxaluria may be an easily overlooked and potentially preventable etiology of acute renal dysfunction  
class6	2298	computed tomography in patients with esophageal perforation  
class6	2298	contrast esophagram is the diagnostic procedure of choice in patients with clinically suspected perforation of the esophagus  
class6	2298	in patients in whom the usual clinical signs or symptoms are unrecognized and in whom the diagnosis is obscure  the diagnosis of a perforated esophagus may be suggested by the finding of mediastinal fluid and air on ct  
class6	2298	three patients are reviewed  
class6	2298	the perforations included one spontaneous  one from erosion of an esophageal carcinoma  and one iatrogenic  
class6	2298	in two of the three patients  the diagnosis of perforated esophagus had not been made initially and in one patient the initial esophagram was interpreted as normal  
class6	2298	computed tomography of the chest in each patient led to the suspected diagnosis of perforated esophagus  
class6	2298	prompt appropriate surgical intervention followed  
class6	2298	the findings of mediastinal fluid and more importantly mediastinal air on ct of the chest are strongly suggestive of esophageal perforation  
class6	2299	systemic hemodynamic and cardiac function changes in patients undergoing orthotopic liver transplantation  
class6	2299	the objective of this study was to determine the changes in systemic hemodynamics  systemic vascular resistance  svr   cardiac output  co   systemic blood pressure  sbp   and cardiac function  pulmonary artery pressure  pap  and pulmonary wedge pressure  pwp   during the 96 hours following orthotopic liver transplantation  olt  and correlate these with changes in hepatic and renal function and patient outcome  
class6	2299	the study took place in a 12 bed medical respiratory intensive care unit in a large teaching hospital  
class6	2299	twenty one patients had olt performed over a 21 5 month period  january 1988 to october 15  1989  for end stage liver disease  esld  from a variety of causes  
class6	2299	a flow directed right heart catheter and an indwelling arterial cannula were inserted for hemodynamic monitoring over a 96 hour postoperative period  
class6	2299	liver and renal function studies  total serum calcium  serum albumin  and fluid balance were determined daily  
class6	2299	the svr increased significantly to 12 8     0 6 u at 48 hours compared with immediate  less than 8 hours  postoperative levels  p less than 0 05  and remained elevated for 96 hours  
class6	2299	the co fell progressively and was significantly lower than baseline values from 64 to 96 hours  
class6	2299	there was significant inverse correlation between the increase in svr and the fall in co  r    85  p less than 0 01   
class6	2299	the sbp was stable except for a small  but significant fall at 16 and 24 hours postoperatively  
class6	2299	the pwp increased significantly from a baseline value of 12 5     0 9 mm hg to 15     0 9 mm hg at 32 hours and remained elevated through 96 hours  p less than 0 05   
class6	2299	the serum bilirubin level fell progressively postoperatively and the prothrombin time and partial thromboplastin time  ptt  shortened significantly  
class6	2299	bile flow increased progressively from 107     120 ml 24 hours at the end of the first 24 hours to 188     125 ml 24 hours by 96 hours postoperatively  
class6	2299	five patients died from nine to 43 days postoperatively  
class6	2299	these patients  hemodynamic parameters were not significantly different from the patients who survived  
class6	2299	successful olt is associated with a rapid increase in svr and a fall in co without changes in sbp  
class6	2299	these findings tend to parallel the improvement found in results of liver function tests  
class6	2299	however  there is no correlation between the improvement in the hemodynamic state and long term survival  
class6	2300	colonoscopic screening of asymptomatic patients with a family history of colon cancer  
class6	2300	the records of 201 asymptomatic patients who underwent colonoscopy based solely on a family history of colon cancer were reviewed  
class6	2300	eighty five patients  42 percent  had a total of 166 lesions  
class6	2300	fifty four  27 percent  patients of the screened population had neoplastic lesions  while 31  15 percent  patients had nonneoplastic polyps  
class6	2300	four carcinomas were found  
class6	2300	twenty five of the patients with polyps  29 percent  had no polyps distal to the splenic flexure  these proximal polyps  and two carcinomas  would have been missed on screening with fiberoptic sigmoidoscopy  
class6	2300	nineteen of these 25 patients had polyps smaller than 0 5 cm  which likely would have been missed with contrast enemas  
class6	2300	almost one half  47 percent  of all polyps discovered at screening colonoscopy were proximal to the descending colon  
class6	2300	only one patient younger than 40 years old had adenomas  
class6	2300	the yield of polyps and cancer in patients with familial risk indicates screening colonoscopy should be considered after age 40  
class6	2301	perirectal abscess in crohn s disease  drainage and outcome  
class6	2301	the role of surgical intervention in the treatment of patients with anorectal crohn s disease is controversial  
class6	2301	to clarify the success of aggressive drainage and the subsequent clinical course of patients with crohn s disease and perirectal abscesses  the authors reviewed the records of 38 patients who presented with this condition during an eight year period  
class6	2301	twenty two male and 16 female patients  median age  32 years  range  17 to 61 years  with clinically or pathologically confirmed crohn s disease of the bowel underwent operation for perirectal abscesses  
class6	2301	thirty two percent of patients had no previous history of anorectal crohn s disease  
class6	2301	thirty simple abscesses and 8 complex horseshoe abscesses were treated  
class6	2301	at operation  53 percent of patients underwent incision and drainage whereas 26 percent received loop indwelling drains and 21 percent had mushroom catheters placed  
class6	2301	after resolution of the index abscess  recurrent abscesses occurred in 45 percent of the patients who underwent catheter drainage and 56 percent of the patients who underwent incision and drainage  
class6	2301	more importantly  44 percent of the incision and drainage group and only 31 percent of the catheter drainage group required subsequent proctectomy to control perineal sepsis  
class6	2301	the healing time of the perineal wound was longer than six months in 83 percent of patients requiring rectal excision  
class6	2301	we concluded that long term catheter drainage may offer substantial benefit in the overall outcome of the treatment of patients with crohn s disease and perirectal abscess  
class6	2302	the surgical management of children with ulcerative colitis  the old vs  the new  
class6	2302	the authors  experience with children who have chronic ulcerative colitis was reviewed to compare their current surgical approach  ileoanal anastomosis  with earlier methods of management  
class6	2302	between 1960 and 1984  137 children with chronic ulcerative colitis underwent surgery  mean duration of follow up  7 1 years   
class6	2302	in 91 patients  the procedures were a total proctocolectomy with ileostomy or kock pouch  66  or a lesser colectomy with either an ileostomy  16  or an ileorectal anastomosis  9   group i   
class6	2302	forty six patients underwent an ileoanal anastomosis procedure  group ii   
class6	2302	children in group i were more likely to have significant preoperative loss of weight  a debilitated condition  and malnutrition  
class6	2302	urgent or emergency surgical intervention was required in 25 percent of patients in group i but in only 4 percent of patients in group ii  
class6	2302	trends included 1  a younger age at operation in group ii  2  a higher mortality in group i  7 7 percent  than group ii  0 percent   and 3  a higher perioperative mortality with emergency operations  23 percent  than elective procedures  1 6 percent   
class6	2302	in group i  98 percent of patients had an abdominal ostomy  but no patients in group ii had an abdominal ostomy  
class6	2302	the children with an ileoanal anastomosis had an average of 4 8 stools during waking hours and 1 3 stools each night  
class6	2302	on the basis of this experience  the authors recommend use of the ileoanal anastomosis procedure in the surgical treatment of chronic ulcerative colitis in children  
class6	2303	accumulation and pepsin solubility of collagens in the bowel of patients with crohn s disease  
class6	2303	the collagen content of resected strictured intestine  with and without fistulas  from patients with crohn s disease has been compared with that in macroscopically normal intestine removed from the same patients and from others without inflammatory bowel disease  
class6	2303	collagen content per unit wet or dry weight of tissue was significantly increased in all grossly diseased tissue whether fistulated or not  
class6	2303	although there was a significant increase in collagen types i  iii  and v in diseased tissue  the relative proportions of major collagen types extracted by limited pepsin digestion were similar for both crohn s and non crohn s intestine  type i  65 to 70 percent  type iii  25 to 30 percent  type iv  2 to 3 percent  and type v  2 5 to 3 percent   
class6	2303	cnbr digestion of pepsin insoluble material showed a similar relative abundance of types i and iii  indicating no major change in collagen type distribution between older  insoluble  and more newly synthesized collagen  
class6	2303	there was no evidence of the presence of type i trimer collagen  
class6	2303	type vi collagen  although not quantitated  was observed in 70 percent of intestinal specimens  
class6	2303	the proportion of total collagen solubilized by pepsin treatment was significantly greater in both grossly diseased and macroscopically normal crohn s bowel compared with non inflammatory bowel disease bowel  
class6	2303	these findings suggest that there are disturbances of collagen metabolism in crohn s intestine  which account for the stricturing process and which may predate gross pathologic changes  
class6	2304	endometrioma  an intra abdominal troublemaker  
class6	2304	a ten year review of intestinal and abdominal wall endometriomas is reported  
class6	2304	seven cases of intestinal and two cases of abdominal wall endometriomas are presented  
class6	2304	symptoms were varied but a majority had some gynecologic complaint  
class6	2304	in this select group of patients  preoperative investigations did not assist in establishing the diagnosis  
class6	2304	all patients underwent surgery and coexisting inflammatory bowel disease was present in two patients  
class6	2304	this review suggests that endometrioma of the intestine requires a high index of suspicion for diagnosis and that danazol does not appear to be effective treatment for these patients  
class6	2305	enteroglucagon and peptide y y response after construction of a pelvic reservoir in humans  
class6	2305	the results of an investigation of plasma levels of gastrointestinal hormones in patients after the construction of a pelvic reservoir are reported  
class6	2305	enteroglucagon  eg  and peptide tyrosine tyrosine  pyy   two hormones believed to play a relevant role in the adaptive response to bowel resection  were investigated using a specific radioimmunoassay in basal conditions and after a standard meal  
class6	2305	pouch patients showed a statistically significant increase in basal levels of both enteroglucagon and pyy compared with control subjects  p less than 0 02 and p less than 0 001  respectively   
class6	2305	the response of enteroglucagon to food ingestion  evaluated by means of the total integrated response  was similar in patients and controls  
class6	2305	conversely  the response of pyy was significantly increased in pouch patients compared with control cases  p less than 0 02   
class6	2305	results of this investigation suggest that gut hormones may be involved in mediating the adaptive response of the intestine to pouch construction  
class6	2305	changes of gut peptides may explain  at least in part  the functional results observed after pouch construction  
class6	2306	malignant potential of juvenile polyposis coli  report of a case and review of the literature  
class6	2306	juvenile polyps of the colon and rectum traditionally have been viewed as being benign inflammatory or harmartomatous lesions without potential for malignant change  
class6	2306	the authors report a case of adenocarcinoma developing in a patient with sporadic juvenile polyposis  
class6	2306	juvenile polyposis was diagnosed in the patient at age 4 years  
class6	2306	he underwent subtotal colectomy at age 6 years  
class6	2306	at age 12  he underwent a proctectomy and a swenson pull through because of adenomatous changes in the rectal stump  
class6	2306	at age 19 surveillance endoscopy revealed invasive cancer in a juvenile polyp  
class6	2307	yersinia enterocolitica abscess of the transverse colon  report of a case  
class6	2307	yersinia enterocolitica abscess of the bowel is a rare entity  
class6	2307	only five cases have previously been reported  none in the surgical literature  
class6	2307	a unique presentation for yersinia infection  abscess of the transverse colon  is described  and the literature of y  
class6	2307	enterocolitica intestinal perforation and abscess is reviewed  
class6	2308	ileocolic nipple valve anastomosis for preventing recurrence of surgically treated crohn s disease  long term follow up of six patients  
class6	2308	to prevent coloileal reflux after ileocecal resection  an ileocolic nipple valve anastomosis was constructed in six patients with crohn s disease  
class6	2308	the patients were observed for more than 7 years and were compared with 21 crohn patients in whom conventional end to end ileocolic anastomosis was performed during the same period  
class6	2308	the outcome was more favorable in the group with nipple valve anastomosis  i e   longer interval between surgery and symptomatic relapse  and tendency to less frequent recurrence and re resection  
class6	2308	an association was found between radiologically preserved nipple valve and remission  and two patients with intact valve at long term follow up remained symptom free  
class6	2308	the observations implied that protection of the terminal ileum from coloileal reflux after ileocecal resection for crohn s disease may favorably influence the prognosis  
class6	2309	plasma neurotransmitters and cortisol in duodenal ulcer patients  role of stress  
class6	2309	levels of noradrenaline  adrenaline  dopamine  free serotonin  platelet serotonin  and cortisol were measured in the plasma of duodenal ulcer patients and controls  
class6	2309	all subjects received antacids  and these substances were also measured  
class6	2309	during relapse  all patients showed raised noradrenaline  adrenaline  dopamine  free serotonin  and cortisol values  
class6	2309	in contrast  platelet serotonin showed very low values  which correlated negatively with all the former  except free serotonin  
class6	2309	no correlations were found in parameters of the controls  
class6	2309	after healing  significant reductions of noradrenaline  adrenaline  dopamine  free serotonin  and cortisol and significant increases of platelet serotonin values were observed  
class6	2309	however  only dopamine  free serotonin  and cortisol reached normal values  
class6	2309	noradrenaline and adrenaline remained higher and platelet serotonin lower  both significantly more so than normals  
class6	2309	these still altered parameters showed similar correlations to those found during relapses  
class6	2309	the present results demonstrate that some baseline autonomic system imbalance exists in patients  amplified and accentuated during relapse  
class6	2309	we discuss the possibility that stress plays some role in triggering duodenal ulcer relapse  
class6	2310	putative mechanisms of cytoprotective effect of certain antacids and sucralfate  
class6	2310	an investigation of cytoprotective activity of certain antacids and inert particles was carried out by treating ethanol induced gastric mucosal damage in rats in order to clarify possible mechanisms by which aluminum containing antacids act  
class6	2310	al oh 3 inhibited gastric mucosal damage in a dose related and time dependent manner  
class6	2310	neither aluminum ions themselves nor the particle size of the al oh 3 complex were responsible for the observed cytoprotection  since neither alcl3  chemically inert al2o3 c  nor sea sand showed protective effects  
class6	2310	hyperosmolality in the gastric lumen was not a deciding factor in inducing cytoprotection  
class6	2310	silicic acid and titanium dioxide  with superficial charge similar to al oh 3 proved to be effective in inhibiting gastric hemorrhagic lesions and releasing pge2  suggesting that the surface charge of al oh 3 may be important in its cytoprotective properties  
class6	2310	the same may also be valid for sucralfate  
class6	2310	since antacid induced cytoprotection was only partly reduced by pretreatment with indomethacin  it is likely that additional mechanisms and mediators other than prostaglandins  such as nonprotein sulfhydryls  also are involved in gastric cytoprotection arising from aluminum containing antacids  
class6	2311	gastric contents retained in rat stomach following mild irritant exposure contribute to adaptive cytoprotection  
class6	2311	fluid retained in the gastric lumen immediately preceding the administration of a damaging product will dilute that product and decrease its injurious capacity  
class6	2311	in an attempt to explain the phenomenon of adaptive cytoprotection  we studied the effect of mild irritant exposure on the volume of fluid retained in the gastric lumen  
class6	2311	rats treated with 0 2 n 0 4 n hcl had a larger volume of gastric fluid retained as compared to animals treated with 0 4 n nacl  
class6	2311	additionally  a mixture of gastric juice derived from rats exposed to 0 4 n hcl with 2 ml ethanol was significantly less damaging to the gastric mucosa than a similar mixture containing an equal volume of gastric juice derived from 0 4 n nacl exposed rats  
class6	2311	we conclude from our observations that in mild irritant exposed stomachs  the gastric juice is a main contributor to the protection against ethanol injury  
class6	2312	modulatory action of adenosine on gastric function and ethanol induced mucosal damage in rats  
class6	2312	this study examines the gastric effects of adenosine and its antagonist  theophylline  on secretory function  mucosal blood flow  and on ethanol induced glandular mucosal damage in rats that were fasted for 24 hr before experimentation  
class6	2312	the animals were anesthetized with sodium pentobarbitone  50 mg kg intraperitoneal  and their tracheae cannulated  
class6	2312	an ex vivo stomach chamber then was prepared  
class6	2312	the luminal bathing solution was collected every 15 min and the concentrations of h  and na  were determined by a ph autotitrator and an ionmeter  respectively  
class6	2312	the glandular mucosal blood flow was measured by a laser doppler flowmeter and the severity of lesions was determined by measuring the hemorrhagic areas  
class6	2312	adenosine administration  2 5 or 7 5 mg kg  subcutaneous  markedly lowered the h  and na  output but increased the secretory volume and mucosal blood flow in a dose dependent manner  
class6	2312	the same doses of the nucleoside also prevented ethanol induced mucosal damage  
class6	2312	these effects were prevented by pretreatment with theophylline  30 or 60 mg kg  subcutaneous   
class6	2312	ethanol given alone significantly depressed the h  and na  secretion  
class6	2312	both effects were not modified by adenosine treatment  
class6	2312	however  the depressive action of ethanol on mucosal blood flow was prevented by adenosine  
class6	2312	these findings indicate that adenosine modulates the physiological function of the stomach  
class6	2312	it also directly activates the defensive mechanism of the stomach  which is partially mediated by the improvement of the gastric mucosal blood flow and an increase in the nonacid component of gastric secretion  
class6	2313	dynamic ct scanning of pancreatic duct after secretin provocation in pancreas divisum  
class6	2313	variations in pancreatic duct diameter at ct scanning and serum pancreatic amylase response following secretin administration were studied in 29 patients with pancreas divisum and unexplained upper abdominal pain  
class6	2313	eleven healthy individuals were used as controls  
class6	2313	at endoscopic retrograde pancreatography  erp  six patients had signs of marked and six moderate pancreatitis  whereas there were no pancreatitis changes in 17 of the patients  
class6	2313	at ct scanning patients with marked pancreatitis  erp  had significantly increased pancreatic duct diameter as compared to patients without signs of pancreatitis  
class6	2313	the duct was visualized in 52  of all patients before and 71  after secretin stimulation the corresponding figures for healthy controls  being 18  both before and after secretin  
class6	2313	in patients without signs of pancreatitis  it was demonstrated in 5 17  29   before and 11 17  65   after secretin  whereas it was seen in 10 12  83   pancreatitis patients both before and after the hormonal provocation  
class6	2313	in five of the nonpancreatitis patients in whom the duct was measurable before and at all study intervals  10  20  and 50 min  after secretin  there was a significant duct dilation response both at 10 min and when comparing the maximal duct diameter after secretin to the initial values  
class6	2313	in contrast secretin did not affect the duct caliber in pancreatitis patients  
class6	2313	serum pancreatic amylase increased significantly after secretin administration to healthy controls and nonpancreatitis patients but was uninfluenced in the marked and moderate pancreatitis groups  respectively  
class6	2313	however  when all pancreatitis patients were grouped together  the amylase levels were significantly elevated by secretin  
class6	2313	in conclusion  secretin provocation caused duct dilation at ct scanning in pancreas divisum patients without signs of pancreatitis at erp  
class6	2314	improved scintigraphic assessment of severe cholestasis with the hepatic extraction fraction  
class6	2314	in previous studies  we found that biliary scintigraphy with technetium 99m labeled iminodiacetic acid   99mtc ida  provided excellent discrimination between intrahepatic and extrahepatic cholestasis  except in patients with profound cholestasis who had poor visualization of the biliary tree  
class6	2314	in this study  we have used deconvolution analysis to determine the hepatic extraction fraction  hef  of a hypothetical single circulatory pass of  99mtc ida  
class6	2314	our hypothesis was that extraction of radionuclide from the blood would be normal in patients with extrahepatic obstruction alone  but would be impaired in patients with intrahepatic disease  ihd   
class6	2314	the purpose of this study was to compare the hef in patients with profound cholestasis  bilirubin greater than or equal to 3 0 mg dl  due to either ihd or common bile duct obstruction  cbdo   
class6	2314	normal subjects  n   13  had an hef of 100   
class6	2314	patients with cbdo  n   13  had slightly reduced hef values  92 8     3 2   despite profound hyperbilirubinemia  6 1     1 0 mg dl   
class6	2314	patients with ihd  n   23  had a markedly reduced hef  43 1     4 1   which was significantly lower than patients with cbdo and normal subjects  p less than 0 001   
class6	2314	we conclude that the determination of the hef during biliary scintigraphy is helpful in distinguishing between intrahepatic and extrahepatic disease in patients with hyperbilirubinemia  bilirubin greater than or equal to 3 0 mg dl   
class6	2315	effect of race upon organ donation and recipient survival in liver transplantation  
class6	2315	the effect of the race of the donor on organ donation and on the outcome of clinical liver transplantation has not been addressed previously  
class6	2315	the aims of this study were to determine   1  the number of organs donated by each of the major racial groups of the united states   2  the outcome of transplantation of these organs across racial groups  and  3  the pattern of liver disease that required transplantation in each of these racial groups  
class6	2315	a significantly higher proportion of organs were donated by white non hispanic americans than either black or hispanic americans  
class6	2315	there was no significant difference in survival when an organ was transplanted between black and white americans and vice versa  
class6	2315	postnecrotic cirrhosis from a variety of causes was the most common indicator affecting black and white recipients  while primary biliary cirrhosis and primary sclerosing cholangitis were uncommon in the black population  
class6	2315	while the number of organs donated by blacks was low  it was  however  proportional to the number of black recipients in this study  
class6	2315	reasons for the low rate of donation by the black and white hispanic population are discussed  
class6	2315	it is concluded that race is not a criteria to be used in selection of donors for liver transplantation  
class6	2315	educational programs addressing issues of organ donation and transplantation directed towards the black and hispanic populations are recommended  
class6	2316	cirrhosis of the liver  a risk factor for development of cholelithiasis in males  
class6	2316	an ultrasonographic study about the prevalence of cholelithiasis was performed in 410 cirrhotic patients and in 414 controls matched for age and sex  
class6	2316	gallstone disease was found more often in cirrhotic patients  31 9   than in controls  20 7    p less than 0 001   
class6	2316	the female to male ratio of gallstones prevalence in cirrhotic patients approached to 1 1  
class6	2316	gallstone disease in cirrhotic patients vs controls was significantly higher  30 2  vs 16 5    p less than 0 001  in males only  
class6	2316	no difference was found  for gallstone disease prevalence in cirrhosis of different etiology  
class6	2316	the prevalence of cholelithiasis increased from child s a to child s c with a significant trend  p less than 0 001   this difference was significant in males  12 3  vs 40 5    p less than 0 001  but not in females  
class6	2316	this study shows that cirrhosis represents a risk factor for the development of cholelithiasis in males  
class6	2316	we suggest that high levels of estrogens could play a role in these patients  by an impairment of gallbladder emptying similar to that observed in pregnant women  
class6	2317	corticosteroid treatment reduces mast cell numbers in inflammatory bowel disease  
class6	2317	mast cell degranulation in the gut causes mucus secretion  mucosal edema  and increased gut permeability and may be responsible for some of the symptoms and signs of inflammatory bowel disease  
class6	2317	we have used a novel monoclonal antibody  aai  against tryptase expressed exclusively in the granules of mast cells to enumerate mast cells in rectal biopsies in order to study the effect of inflammatory bowel disease and drug treatment upon rectal mast cell numbers  
class6	2317	rectal mast cell numbers are significantly reduced in inflammatory bowel disease patients taking corticosteroids  mean 4 95 cells mm2  when compared with control patients  10 1  p less than 0 001  and inflammatory bowel disease patients not taking corticosteroids  9 7  p less than 0 001 wilcoxon rank sum test   
class6	2317	the reduction in mast cell counts was independent of the degree of inflammation or architectural distortion  
class6	2317	there was a negative correlation between the dose of corticosteroids and mast cell count  r   0 53  p less than 0 05 spearman rank correlation   and the mast cell count was reduced within a few days of treatment and remained low throughout steroid therapy  
class6	2317	mucosal mast cell depletion may be an important mechanism of action of corticosteroids in inflammatory bowel disease  
class6	2318	small bowel phytobezoar mimicking presentation of crohn s disease  
class6	2318	a case of small bowel phytobezoar formed from unusual ingested vegetation is described  
class6	2318	the patient presented with recurrent subacute obstruction and a right iliac fossa mass mimicking the presentation of crohn s disease  
class6	2318	none of the usual gastrointestinal disorders that predispose to bezoar formation were present  
class6	2318	the phytobezoar passed spontaneously following small bowel enema and colonoscopy  
class6	2318	it is possible that relaxation of the gut secondary to the antispasmodics administered at investigation or the physical disturbance during these procedures enabled migration through the ileocecal valve  
class6	2318	antispasmodics may be of use in the conservative management of bezoars obstructing otherwise normal bowel  
class6	2319	pancreatitis  
class6	2319	pancreatitis is a common but rather poorly understood entity most often associated with alcohol abuse or biliary tract disease  
class6	2319	despite the availability of a variety of diagnostic tests and imaging techniques  the diagnosis of pancreatitis continues to be primarily a clinical one  
class6	2319	of major concern to the emergency physician is distinguishing pancreatitis from other  potentially lethal  causes of abdominal pain  and identifying those patients with severe pancreatitis who are at risk for a complicated course secondary to the remote systemic effects of the disease  
class6	2320	alcoholic liver disease  
class6	2320	alcoholic liver disease presents a wide spectrum of clinical manifestations ranging from mild asymptomatic fatty liver to alcoholic hepatitis and severe life threatening liver failure with ascites  hemorrhaging esophageal varices  and encephalopathy  
class6	2320	although still poorly understood  the mechanism of this injury is probably the result of numerous direct toxic and metabolic effects of alcohol on the hepatocyte  
class6	2320	therapy consists primarily of abstinence and supportive care  
class6	2320	however  several newer treatments are actively being studied  
class6	2320	these include prednisolone  anabolic steroids  glucagon and insulin  propylthiouracil  and cyanidanol  
class6	2320	colchicine is promising as an agent to inhibit fibrosis  
class6	2320	complications of cirrhosis  including ascites and variceal hemorrhage  are the result of end stage disease  
class6	2320	a return to old techniques of ascitic fluid management suggests that therapeutic large volume paracentesis with albumin infusion is a safe and effective form of therapy  
class6	2320	variceal hemorrhage is best treated with sclerotherapy  vasoconstrictors  and balloon tamponade  
class6	2320	little has been done to alter the ultimately dismal prognosis and long term survival of alcoholic liver disease  
class6	2321	natural history of congestive gastropathy in cirrhosis  the liver study group of v  cervello hospital  
class6	2321	in a prospective study of the natural history of congestive gastropathy  212 consecutive cirrhotic patients  75 treated with sclerotherapy  were included  
class6	2321	mean follow up was 46 months  
class6	2321	mild gastropathy  mosaiclike pattern  was found in 110 patients and severe gastropathy  granular mucosa with cherry spots  was found in 20  
class6	2321	prevalence of helicobacter pylori  formerly campylobacter pylori  was 50  in patients without  43  in those with mild  and 28  in those with severe gastropathy  
class6	2321	congestive gastropathy was significantly more frequent in patients treated with sclerotherapy  83  vs  
class6	2321	50   p less than 10  5    
class6	2321	sixty month actuarial proportions of patients free of anemia  in the absence of hematemesis or melena   were 17  with severe  62  with mild  and 93  without gastropathy  p less than 10  8   
class6	2321	corresponding figures for overt bleeding were 25   73   and 87   p less than 10  7   whereas those for survival were 46   72   and 85   p   0 0005   respectively  
class6	2321	a multivariate regression analysis supported the following conclusions   a  sclerotherapy and the presence of large esophageal varices significantly increase the risk of congestive gastropathy  which  b  is a significant risk indicator of both chronic and overt bleeding but does not independently affect survival  
class6	2322	24 hour intragastric acidity and plasma gastrin after omeprazole treatment and after proximal gastric vagotomy in duodenal ulcer patients 
class6	2322	the relationship between suppressed gastric acidity and the increase in plasma gastrin levels after pharmacological and surgical treatment of peptic ulcer disease were compared in this study  
class6	2322	eight patients with chronic duodenal ulcer and referred for proximal gastric vagotomy were studied  
class6	2322	24 hour intragastric acidity and plasma gastrin levels were investigated in the same patients on three consecutive occasions  preentry without any treatment  after 4 weeks of administration of 20 mg of omeprazole daily  and 4 6 months after proximal gastric vagotomy  
class6	2322	intragastric acidity was slightly more reduced by omeprazole  94   than after proximal gastric vagotomy  78    with no difference found during the day or night with either  
class6	2322	plasma gastrin levels increased slightly more after proximal gastric vagotomy  284   median  2120 pmol h l  range  733 2831 pmol h l   than after omeprazole administration  186   median  1586 pmol h l  range  495 2573 pmol h l    
class6	2322	there is strong evidence that the increased plasma gastrin concentration following omeprazole treatment is caused by the reduced intragastric acidity  
class6	2322	the slight increase in plasma gastrin concentration following proximal gastric vagotomy despite a lesser reduction in intragastric acidity may be the result of additional effects on gastrin release by the vagotomy  
class6	2322	both treatments resulted in a modest increase in plasma levels of gastrin that were far below the gastrin levels observed in achlorhydric patients  e g   patients with pernicious anemia  
class6	2323	role of epidermal growth factor  prostaglandin  and sulfhydryls in stress induced gastric lesions  
class6	2323	epidermal growth factor promotes the growth of and protects gastric mucosa against various ulcerogens  including stress  but little is known about its role in the pathogenesis of stress ulcerations  
class6	2323	in this study  wistar rats with intact and resected salivary glands were exposed to water immersion and restraint stress  
class6	2323	during 2 14 hours of water immersion restraint stress  the formation of gastric ulcerations increased progressively and the duration of stress was accompanied by a decrease in dna synthesis in the gastric mucosa  
class6	2323	following sialoadenectomy  a significant increase in the number of stress ulcerations and further reduction in dna synthesis were observed  
class6	2323	exogenous epidermal growth factor and dimethyl prostaglandin e2 significantly reduced the ulcerations in the stressed rats with intact salivary glands  but this reduction was significantly less pronounced after sialoadenectomy  
class6	2323	water immersion restraint stress also resulted in about 50  reduction in mucosal prostaglandin e2 generation  and the pretreatment with indomethacin  which suppressed prostaglandin e2 by about 90   almost doubled the number of stress ulcerations and abolished the gastro protective effect of exogenous epidermal growth factor  but not dimethyl prostaglandin e2  against the stress lesions  
class6	2323	an inhibition of ornithine decarboxylase activity by difluoromethyl ornithine also augmented stress induced ulcerogenesis and abolished the protective action of epidermal growth factor while the administration of spermine almost completely prevented stress ulcerations in rats both without and with pretreatment with difluoromethylornithine  
class6	2323	water immersion restraint stress also significantly reduced mucosal content of glutathione  
class6	2323	cysteamine increased tissue glutathione and reduced stress ulcerations but n ethylmaleimide  an sulfhydryl blocker  decreased mucosal content of glutathione without affecting the stress ulcerations  
class6	2323	this study indicates that the stress ulcers are accompanied by the reduction in mucosal synthesis of dna  prostaglandin  and glutathione and that the presence of salivary glands attenuates the stress ulcerogenesis probably by releasing epidermal growth factor which acts  in part  by enhancing ornithine decarboxylase activity  mucosal growth  and prostaglandin and glutathione formation  
class6	2324	acute and chronic stress in duodenal ulcer disease  
class6	2324	acute and chronic life event stressors were objectively assessed in a sample of duodenal ulcer patients and community controls  
class6	2324	stress was assessed on two dimensions   personal threat  and  goal frustration   chronic stressors  those of 6 months  duration or more  involving high goal frustration were significantly and independently associated with the onset and relapse of duodenal ulcers  as were acute events of high immediate but transient personal threat  
class6	2325	role of visceral afferent mechanisms in functional bowel disorders  
class6	2325	this report analyzes the clinical and physiological evidence supporting a role for altered visceral afferent mechanisms in the pathogenesis of two functional bowel syndromes  noncardiac chest pain and the irritable bowel syndrome  
class6	2325	considerable recent evidence indicates that increased contractility is present only in a minority of patients and that hypercontractile episodes are not temporally related to abdominal pain  
class6	2325	in contrast  altered sensation and motor reflexes in response to physiological stimuli  such as mechanical distention or acid  is common when appropriately investigated  
class6	2325	the vagal and spinal afferent innervation mediates visceral sensation and is involved in multiple reflex loops regulating gastrointestinal effector function  such as motility and secretion  
class6	2325	sensory input can be modulated peripherally at the afferent nerve terminal  at the level of prevertebral ganglia  the spinal cord  and the brainstem  
class6	2325	an up regulation of afferent mechanisms would result both in altered conscious perception of physiological stimuli and in altered motor reflexes  
class6	2325	current evidence is consistent with an alteration in the peripheral functioning of visceral afferents and or in the central processing of afferent information in the etiology of altered somatovisceral sensation and motor function observed in patients with functional bowel disease  
class6	2326	glucose disposal  beta cell secretion  and hepatic insulin extraction in cirrhosis  a minimal model assessment  
class6	2326	factors controlling glucose metabolism after iv load were studied in nine patients with compensated cirrhosis and in six age matched controls  
class6	2326	the time courses of glucose  insulin  and c peptide were analyzed by means of the minimal model technique  
class6	2326	in cirrhosis  insulin sensitivity was reduced by approximately 70  and glucose dependent glucose uptake  glucose effectiveness  by 45   
class6	2326	decreased glucose effectiveness explained 65  of the variance of glucose disappearance and correlated with the ratio of urinary creatinine to height  an independent measure of muscle mass  r   0 839   
class6	2326	beta cell responsiveness to glucose  measured on c peptide kinetics  was variable and increased on average by 170  and 107   first phase and second phase  respectively   
class6	2326	the total amount of insulin secreted by beta cells in the course of the study was nearly doubled  whereas the basal insulin secretion rate was in the normal range  
class6	2326	the time courses of hepatic extraction of insulin did not differ between groups  and basal extraction was on average 58  in controls and 56  in patients with cirrhosis  
class6	2326	it was reduced to 30  in a single patient who had severe hepatocellular failure and large spontaneous portosystemic shunting  
class6	2326	we conclude that the alterations in glucose metabolism of cirrhosis include a decreased insulin sensitivity  a reduced glucose effectiveness  and an increased pancreatic responsiveness to glucose  leading to hyperinsulinemia  
class6	2326	the hepatic extraction of insulin is reduced only in the very advanced stages of the disease  possibly because of a large reserve capacity of the hepatic parenchyma  
class6	2327	host response to mycobacterial infection in the alcoholic rat  
class6	2327	animals  chronically treated with alcohol  were inoculated with mycobacteria  bacillus calmette guerin  10 2 x 10 6  organisms  into the spleen to produce a granulomatous hepatitis  
class6	2327	before infection  chronic alcohol ingestion was associated with a depressed skin test response to phytohemagglutinin  71 7  of baseline  p   0 009   
class6	2327	mycobacterial  bacillus calmette guerin  infection stimulated phytohemagglutinin skin test response to 417  of baseline in controls and 299  in alcoholics  p less than 0 001   
class6	2327	the hepatic granuloma response was altered with smaller but more numerous granulomas  mean     sem  81 2     1 5 microns2 of area with a frequency of 1 8 granulomas per field in alcoholics vs  
class6	2327	129 8     5 71 microns2 and 1 2 granulomas per field in controls  p less than 0 001   
class6	2327	these changes were associated with a 10 fold increase in colony forming units per gram of liver  54 5     18 2 in alcoholics vs  
class6	2327	5 6     1 83 in controls  p   0 0006   
class6	2327	this model offers precise parameters for host response to infection and indicates that alcohol significantly impairs the clearing capacity for mycobacteria from the liver  
class6	2328	pathogenesis of ceftriaxone associated biliary sludge  in vitro studies of calcium ceftriaxone binding and solubility  
class6	2328	ceftriaxone  a semisynthetic third generation cephalosporin  has recently been associated with biliary sludge formation  
class6	2328	analysis of the biliary concretions induced by this agent shows a calcium salt of ceftriaxone  
class6	2328	the present in vitro studies were undertaken to provide insight into the pathogenesis of ceftriaxone associated biliary sludge formation by evaluating possible interactions that may exist between calcium  bile salts  and ceftriaxone  
class6	2328	ceftriaxone possessed high calcium binding affinity  
class6	2328	the formation constant for the calcium ceftriaxone salt at 37 degrees c was about 157 3 l mol  stoichiometry of the salt was 1 1  i e   calcium ceftriaxone  
class6	2328	the calcium binding property of ceftriaxone was observed to be additive to that of taurocholate in mixed taurocholate ceftriaxone solutions  
class6	2328	although the solubility product constant for calcium ceftriaxone was only 1 62 x 10  6  mol l2  marked metastability was observed  neither visible nor microscopic precipitates developed until the  ca2   x  ceftriaxone  ion product exceeded the solubility product constant by a factor of 10 4  
class6	2328	metastability of the calcium ceftriaxone salt was also observed in human gallbladder bile in vitro  
class6	2328	estimates of human biliary calcium ceftriaxone solubility in vivo were than calculated from previously reported values for biliary  ca2     ceftriaxone   and from the solubility product constant as defined in this study  
class6	2328	calculated saturation indices for calcium ceftriaxone in human bile generally increased  corresponding to a decrease in solubility  with increasing ceftriaxone dose  
class6	2328	at doses less than or equal to 1 g  saturation index was well within the metastable range of this calcium salt  
class6	2328	however  at doses greater than or equal to 2 g  the saturation index surpassed the metastable limit  
class6	2328	under these conditions  precipitation of ceftriaxone could occur  
class6	2328	it was concluded that the development of ceftriaxone induced biliary sludge is a solubility problem that occurs in patients receiving high dose treatment  greater than or equal to 2 g   
class6	2328	this study proposes that the risk of developing ceftriaxone associated biliary  pseudolithiasis  increases with increasing ceftriaxone dose and in patients with impaired gallbladder emptying  
class6	2329	gallbladder motility in cholesterol gallstone disease  effect of ursodeoxycholic acid administration and gallstone dissolution 
class6	2329	gallbladder motility was evaluated by ultrasonography in 75 cholesterol gallstone patients and in 77 matched control subjects  
class6	2329	all 75 gallstone patients were candidates for oral bile acid therapy  radiolucent gallstones  less than 2 cm in diameter  in well opacified gallbladder   and 38 of them were also studied during ursodeoxycholic acid administration  
class6	2329	an additional 20 gallstone patients were studied 1 year after confirmed gallstone dissolution with oral bile acids  
class6	2329	gallstone patients showed significantly greater fasting and residual volumes  a decreased percent of gallbladder emptying  but a similar absolute emptying and emptying rate compared with the control subjects  
class6	2329	greater fasting volumes and reduced percents of gallbladder emptying were also found in gallstone free patients who achieved complete dissolution with oral bile acids  
class6	2329	after ursodeoxycholic acid administration  fasting gallbladder volumes were greater  and percents of gallbladder emptying were further decreased than in untreated gallstone patients  
class6	2329	in conclusion  greater fasting volumes  and not reduced gallbladder contractility  account for the defective gallbladder function in radiolucent  cholesterol rich  gallstone patients  
class6	2329	this condition is likely to precede  and possibly to promote  gallstone formation because it persists after gallstone dissolution  
class6	2329	ursodeoxycholic acid administration worsens the defect observed in gallstone patients  
class6	2329	this finding also suggests  although indirectly  that the expected normalization of cholesterol saturation during oral bile acid administration is not paralleled by an improvement in gallbladder function  
class6	2330	primary biliary cirrhosis  quantitation of autoantibodies to purified mitochondrial enzymes and correlation with disease progression  
class6	2330	primary biliary cirrhosis is characterized by the presence of antimitochondrial antibodies  
class6	2330	recently  six of the autoantigens have been identified as components of the 2 oxo acid dehydrogenase multienzyme complexes located within mammalian mitochondria  
class6	2330	immunoblotting studies have shown that two of these components  namely e2 and protein x of pyruvate dehydrogenase complex  are the major antigenic polypeptides recognized by autoantibodies  
class6	2330	this study shows the development of an enzyme linked immunosorbent assay to detect and quantitate antibodies to these two purified antigens  
class6	2330	coded serum samples from 166 patients with primary biliary cirrhosis  140 patients with other liver and or autoimmune disease  and 52 normal women were analyzed for reactivity using this immunoassay  
class6	2330	these results indicate that this rapid  simple method has a 93  sensitivity and 96  specificity in the diagnosis of primary biliary cirrhosis  
class6	2330	the titer of immunoglobulin g autoantibodies correlated not only with antimitochondrial antibody titer measured by indirect immunofluorescence  p less than 0 0001  but also with histological stage of disease  p less than 0 04  and prognostic biochemical variables such as higher serum bilirubin and lower serum albumin levels  p   0 038 and 0 028  respectively   
class6	2330	there was no significant correlation between titer of autoantibodies and serum globulin or immunoglobulin g levels  indicating that the positive correlation with disease progression was not secondary to hypergammaglobulinemia  
class6	2331	long term outcome after surgery for biliary atresia  study of 40 patients surviving for more than 10 years  
class6	2331	to define long term prognosis of children who underwent surgery for biliary atresia  a retrospective study was undertaken in 122 children who underwent one of the kasai procedures between 1968 and 1977  
class6	2331	forty of the 122 children  32 7   were alive after 10 years  
class6	2331	firm hepatomegaly was present in 31 and splenomegaly in 29 children  
class6	2331	serum bilirubin or all liver function tests were normal in 21 and 11 children  respectively  survival rate decreased with the age at operation  but no significant difference was observed in the rate of children surviving with normal serum bilirubin whether they underwent surgery before age 2 months or between 2 and 3 months  
class6	2331	twenty four had esophageal varices and 15 experienced gastrointestinal bleeding  
class6	2331	normal liver function tests and absence of portal hypertension were observed in 11 of 122 children  
class6	2331	these results indicate that kasai s procedures were helpful in a significant proportion of children with biliary atresia who underwent surgery during this period  
class6	2331	however  80  of children who initially underwent surgery with kasai s procedures should eventually undergo liver transplantation  
class6	2332	microprocessor assisted solvent transfer system for gallstone dissolution  in vitro and in vivo validation  
class6	2332	to improve the efficacy  safety  and convenience of contact dissolution of gallbladder stones  a microprocessor assisted solvent transfer system was developed  
class6	2332	the system s two pumps simultaneously infuse and aspirate solvent into and from the gallbladder at a high flow rate through a multilumen catheter  
class6	2332	the microprocessor controls the pumps using a closed feedback loop control algorithm to regulate intragallbladder pressure to prevent solvent escape into the duodenum  
class6	2332	turbulent solvent flow at the catheter end in the gallbladder is designed to induce rapid stone dissolution and to suspend insoluble residue  thus promoting its aspiration  
class6	2332	the system s response and gallbladder emptying capacity was 160 fold faster than the natural gallbladder emptying rate  
class6	2332	the rate at which gallstones were dissolved by methyl tert butyl ether using the system was compared with that achieved with a syringe pump  
class6	2332	for 6 of 11 pairs of stones that totally dissolved  the mean dissolution time with the system was 10     6 minutes compared with 112     81 minutes for the syringe pump  
class6	2332	in the 5 of 11 stone pairs which dissolved incompletely  insoluble residue was completely eliminated by the system in 21     9 minutes but not by the syringe pump even at 360 minutes  
class6	2332	when the system was used in gallstone patients  solvent recovery was 99      1   and the concentration of a nonabsorbable marker did not change  confirming the lack of appreciable absorption of methyl tert butyl ether  
class6	2332	these studies suggest that the microprocessor assisted solvent transfer system is a device capable of safe  complete  and fully automatic contact dissolution of cholesterol gallbladder stones using methyl tert butyl ether or similar solvents  
class6	2333	esophageal obstruction after ingestion of a fiber containing diet pill  
class6	2333	foreign bodies of the esophagus in adults may be the result of a food bolus that becomes lodged proximal to a structural abnormality of the distal esophagus  
class6	2333	a case of peptic stricture of the esophagus in a patient who presented with acute dysphagia after ingesting an over the counter diet pill composed of guar gum is discussed  
class6	2333	it is recommended that anorectics composed of dietary fiber should not be used in patients with a history of esophageal stricture  
class6	2334	idiopathic biliary ductopenia in adults  a report of five cases  
class6	2334	the clinical and pathological findings of five adult cases of idiopathic nonsyndromatic paucity of interlobular bile ducts are reported  
class6	2334	patients were 18 32 years old at the onset of the disease  four presented with pruritus and or jaundice and one with bleeding of the esophageal varices  
class6	2334	two patients were siblings  
class6	2334	serum alkaline phosphatase counts ranged from 1 to 16 times the upper normal value  and total bilirubin counts ranged from 0 6 to 8 8 mg dl  10 to 150 mumol l   
class6	2334	initial liver biopsy showed portal and periportal fibrosis with cholangiolar proliferation and reduction in the number of interlobular bile ducts  
class6	2334	antimitochondrial antibodies were absent  and bile ducts were normal after opacification  
class6	2334	the patients were observed for 3 11 years  
class6	2334	repeated liver biopsies in the five patients showed progression of the lesions  with development of biliary type cirrhosis in four  
class6	2334	two of the four patients with cirrhosis died of hepatic failure 3 and 11 years after onset of the disease  
class6	2334	in the two other cases  liver transplantation was performed successfully  
class6	2334	these cases suggest that chronic cholestasis with marked ductopenia resembling the nonsyndromatic paucity described in infancy and childhood may reveal itself at an adult age  
class6	2334	this disorder  possibly familial  may rapidly progress to severe and even fatal liver disease and could be a new indication for liver transplantation  
class6	2335	omeprazole in the management of intractable esophageal ulceration following injection sclerotherapy  
class6	2335	transient esophageal ulceration is a common finding after sclerotherapy of varices  
class6	2335	a small proportion of these ulcers become chronic and resistant to conventional therapy  
class6	2335	such chronic ulcers have been associated with pain  stricture formation  and recurrent hemorrhage  
class6	2335	the use of omeprazole  a proton pump inhibitor  was examined in the current study in the treatment of 10 patients  6 women  4 men  age range  27 86 years  with cirrhosis  pbc  4  sclerosing cholangitis  2  chronic active liver disease  2  alcohol  1  and cryptogenic  1  who developed an esophageal ulcer after a mean of 13  range  8 21  sessions of sclerotherapy  
class6	2335	the ulcers had been present for 3 54 months despite prolonged treatment with high dose h2 receptor antagonists and sucralfate  
class6	2335	in each case one or more complications had occurred  severe pain in 3  stricture formation in 4  and recurrent hemorrhage in 7 cases  
class6	2335	after an 8 week course of omeprazole  40 mg daily  endoscopy confirmed complete healing of the ulceration in all 10 cases with symptom resolution  
class6	2335	in 2 cases the ulcer recurred  with associated bleeding within 6 weeks of discontinuing the treatment in 1 patient  
class6	2335	both cases responded to repeat therapy  
class6	2335	these results confirm the efficacy of omeprazole for postsclerotherapy ulceration and imply that acid pepsin has a role in perpetuating such ulcers  
class6	2336	heterotopic liver transplantation for fulminant wilson s disease  
class6	2336	wilson s disease may present with severe acute hepatocellular failure  
class6	2336	the only effective treatment for fulminant wilson s disease is liver transplantation  which may lead to reversal of the underlying disease  
class6	2336	some patients with cirrhosis who are too ill to undergo orthotopic liver transplantation have been treated with heterotopic liver transplantation  
class6	2336	however  use of heterotopic liver transplantation for fulminant hepatocellular failure has not been successful  
class6	2336	this case study involves a patient in whom a heterotopic liver transplant was successfully used for treatment of wilson s disease presenting with fulminant hepatocellular failure  
class6	2337	caseating hepatic granulomas in hodgkin s lymphoma  
class6	2337	a 68 year old man presented with recurrent hodgkin s lymphoma after a 9 year disease free interval induced by chemotherapy  
class6	2337	in addition to histological evidence of recurrent hodgkin s disease  the liver biopsy specimen showed extensive caseating granulomas  
class6	2337	cultures of bone marrow and liver tissue tested negative for mycobacterium tuberculosis  
class6	2337	no antituberculous treatment was administered  and the patient had an excellent clinical response to additional chemotherapy for lymphoma  
class6	2337	hodgkin s lymphoma should be added to the list of disease entities associated with caseating granulomas in the liver  
class6	2338	colonic lipomas  outcome of endoscopic removal  
class6	2338	colonic lipomas are benign adipose tumors which are usually submucosal  
class6	2338	with the increase in the number of endoscopic procedures being performed  these tumors are often detected incidentally at colonoscopy  
class6	2338	although the risks of removing these tumors have been recognized  numerous reports have documented safe removal by snare electrocautery  
class6	2338	we have reviewed the clinical outcome and the endoscopic and histopathologic features of seven lipomas that were endoscopically removed over a 5 year period  
class6	2338	four patients recovered uneventfully  while three patients  42 8   developed colonic perforation after the polypectomy  
class6	2338	in the latter group  the lipomas were significantly larger than they were in the patients who did not develop colonic perforation  1 9     0 4 and 4 2     0 7 cm  respectively  p   0 048   
class6	2338	furthermore  the polypectomy specimens from those patients who developed perforation all contained significant muscularis propria  
class6	2338	lipomatous polyps that are identified at endoscopy to be greater than or equal to 2 cm in diameter and to have a limited pedicle are at the greatest risk for endoscopic perforation  
class6	2339	a laser induced scar at the cardia increases the yield pressure of the lower esophageal sphincter 
class6	2339	low yield pressure of the lower esophageal sphincter is associated with esophageal reflux  and fundoplication must increase yield pressure if it is to prevent reflux  
class6	2339	we attempted to increase yield pressure endoscopically in the dog by using the nd yag laser to produce a fibrous scar at the cardia in the approximate line of the gastric sling fibers  
class6	2339	ten beagle dogs were studied  
class6	2339	in a pilot study with two dogs  15 watts for 4 2 sec were found to produce a scar deep into the muscle coat of the stomach  
class6	2339	three configurations of scar were used  
class6	2339	one produced significant rises in yield pressure in all four of the dogs treated  the second produced a significant rise in one of the two dogs treated  and the third caused a significant drop in yield pressure in the one dog treated  
class6	2339	one dog died of gastric perforation 10 days after lasering  but no other animal experienced any ill effects  
class6	2339	these findings may have therapeutic implications for the management of esophageal reflux  
class6	2340	endoscopic retrograde cannulation of the gallbladder  direct dissolution of gallstones  
class6	2340	percutaneous transhepatic catheterization of the gallbladder for dissolution of cholesterol stones by instillation of methyl tert butyl ether  mtbe  is an invasive therapeutic procedure  
class6	2340	the only non invasive alternative available to now  endoscopic retrograde cannulation of the cystic duct  was difficult because of the cystic duct s tortuosity and spiral valves  
class6	2340	we therefore developed a catheter system which  using conventional duodenoscopes during a routine endoscopic retrograde cholangiography  erc  procedure  permits reliable and safe catheterization of the gallbladder without the need for endoscopic sphincterotomy  
class6	2340	in 18 of 22 patients  82   we were able to place a cysto nasal catheter  and in 14 patients mtbe dissolution therapy was then performed  
class6	2340	eight patients  57   were completely free of stones after treatment  the other six  43   had residual debris  
class6	2340	in 4 of 22 patients  18   cannulation attempts failed  in 3 patients due to cystic duct blockage by a calculus  
class6	2340	endoscopic retrograde cannulation of the gallbladder  ercg  represents a promising alternative to the invasive percutaneous transhepatic catheterization procedure  
class6	2341	expandable biliary metal stents for malignancies  endoscopic insertion and diathermic cleaning for tumor ingrowth  
class6	2341	seventeen patients with malignant biliary strictures have been treated by endoscopic insertion of self expandable metallic prostheses  
class6	2341	two patients received two prostheses inserted simultaneously in both the left and right hepatic ducts for klatskin tumor type iii  
class6	2341	immediate results were satisfactory despite an operative mortality of 18   and neither early nor late clogging was observed even in patients who presented previously with sludge above plastic stents that were removed  
class6	2341	however  among five patients followed for more than 4 months  two presented with obstruction due to tumor ingrowth into the stent through the metallic mesh  
class6	2341	accordingly  initial enthusiasm concerning long term patency of these stents has decreased  
class6	2341	however  we describe a technique of  diathermic cleaning  of tumor ingrowth which can easily restore the stent patency  
class6	2341	the advantages of these wire mesh 30 f stents are their easier insertion  better immediate drainage  and absence of dislocation or perforation  
class6	2342	pain on common bile duct injection during ercp  does it indicate sphincter of oddi dysfunction  
class6	2342	the reproduction of a patient s biliary type pain upon initial injection of contrast material into the common bile duct during diagnostic ercp is a dramatic experience for both patient and physician  
class6	2342	the significance of this phenomenon is not clear  but it is touted by some to be a provocative test for sphincter of oddi dysfunction  
class6	2342	sphincter of oddi manometry was performed on 224 consecutive patients referred over a 2 year period for evaluation of post cholecystectomy syndrome and suspected sphincter of oddi dysfunction  
class6	2342	all patients received only intravenous diazepam as premedication for ercp  
class6	2342	delayed drainage time  greater than 45 min   bile duct dilation  greater than or equal to 12 mm   and a basal sphincter of oddi pressure of greater than 40 mm hg  mean     3 sd  were considered elevated  
class6	2342	we observed a reproduction of pain in 15 of 224 patients  6 7   immediately following contrast injection  
class6	2342	there was no correlation between pain on contrast injection and elevated basal sphincter of oddi pressure  delayed common bile duct drainage  bile duct dilation  or abnormal liver enzymes  
class6	2342	therefore  we feel that reproduction of the patient s biliary type pain associated with contrast injection of ercp is not a provocative test for sphincter of oddi dysfunction  
class6	2343	sphincter of oddi manometry  decreased risk of clinical pancreatitis with use of a modified aspirating catheter  
class6	2343	this study was undertaken to determine whether routine use of a modified triple lumen five french sphincter of oddi manometry catheter would reduce the frequency and severity of post manometry pancreatitis and pancreatic enzyme elevation  
class6	2343	seventy six patients were alternately assigned to undergo sphincter of oddi manometry  som  with a standard perfusion  infused group  catheter or the newly developed aspiration  aspirated group  catheter  
class6	2343	after som  there were significantly more patients in the infused group with both amylase and lipase values elevated at least two times the upper limits of normal at 2  p less than 0 001   6  p   0 01   and 18 hours  p   0 03  after the procedure  
class6	2343	as compared with the standard perfusion system  the aspiration catheter was associated with a decreased frequency of clinical pancreatitis  23 5  vs  
class6	2343	3   p   0 01  reduced hospital stay  5     1 83 days  mean     se  versus 1 day  p   0 03  and milder pancreatitis  
class6	2343	the aspiration manometry catheter should be considered for standard use for som  particularly if the pancreatic duct sphincter is being evaluated  
class6	2344	the role of endoscopic injection sclerotherapy in the management of bleeding peristomal varices  
class6	2344	peristomal varices usually occur in patients with enterostomies who develop portal hypertension  and represent a cause of recurrent or intractable gastrointestinal bleeding  
class6	2344	treatment options for such bleeding include surgical ligation of varices  stoma revision with devascularization  injection sclerotherapy  portacaval shunt  or liver transplantation  
class6	2344	we reviewed the records of seven patients with peristomal varices  who were followed for a mean of 17 months after diagnosis  
class6	2344	fourteen episodes of clinically significant peristomal bleeding occurred in six patients  
class6	2344	surgical ligation of varices was ineffective in controlling bleeding in two of three patients  although stoma revision with devascularization was temporarily effective in two other patients  
class6	2344	injection sclerotherapy  used in three patients  effectively controlled acute bleeding without serious complications or need for surgery  
class6	2344	definitive treatment for peristomal bleeding  portacaval shunt or liver transplantation  has prevented any further bleeding in three patients for a mean of 8 months after surgery  
class6	2345	variceal sclerosis in schistosomotic patients  a 5 year follow up study  
class6	2345	to assess the therapeutic possibilities of injection sclerosis in schistosomotic portal hypertension  a 5 year prospective study was conducted in northeast brazil  where this parasitosis is endemic  
class6	2345	fifty patients undergoing endoscopy for upper gastrointestinal hemorrhage from rupture of esophageal varices from july through december 1981 were chosen for the study  
class6	2345	the 32 consenting patients were submitted to injection sclerotherapy paravariceally  using ethanolamine oleate  the 18 refusing to participate were assigned to the control group  
class6	2345	the incidence of rebleeding was 28 1  in the former and 44 5  in the latter  a difference which was not statistically significant  fisher s test  p   0 375   
class6	2345	mortality from rupture of esophageal varices was 3 1  in the sclerotherapy group and 27 7  in the control group  a statistically significant difference  fischer s test  p   0 017   
class6	2345	since sclerotherapy markedly improved the long term survival rate of the patients  this procedure is advocated for the treatment of esophageal varices in cases of portal hypertension due to schistosomiasis  
class6	2346	schatzki s ring  long term results following dilation 
class6	2346	the purpose of this study is to report long term results of 61 patients with schatzki s ring who were dilated for relief of dysphagia  
class6	2346	the severity of schatzki s ring was mild in 28 patients  46    moderate in 26  43    severe in 5  8    and indeterminate in 2  3    
class6	2346	follow up information was available in 56 of 61 patients  mean  75 months   
class6	2346	during follow up  35 patients  63   developed recurrent dysphagia and required repeated dilations  19 patients  34   had one to two dilations  9 patients  16   had three to seven dilations  6 patients  11   had more than seven dilations  1 patient underwent surgery for resection of the schatzki s ring  2    
class6	2346	the mean  range  dilation free interval was 50 1 months  11 8 to 100 months  in mild cases  44 5 months  8 9 to 82 months  in moderate cases  and 28 6 months  9 to 76 months  in severe cases  
class6	2346	there was no significant correlation between the severity of schatzki s ring on initial presentation and the subsequent dilation free interval  
class6	2346	our data indicate that recurrent dysphagia is common among patients with schatzki s ring after a successful dilation  and that the severity of schatzki s ring is not a good prognostic indicator of the need for subsequent dilation  
class6	2347	witzel pneumatic dilation for achalasia  safety and long term efficacy 
class6	2347	forceful dilation of the lower esophageal sphincter is considered primary therapy for achalasia  
class6	2347	the witzel pneumatic balloon dilator  unlike fluoroscopically placed dilators  is placed over a standard gastroscope allowing positioning and dilation under direct vision  
class6	2347	we report our experience with the witzel dilator in 45 patients with achalasia over a 5 year period  
class6	2347	all patients had at least one major symptom score of 8 out of 10 for dysphagia and or regurgitation before dilation  
class6	2347	after witzel dilation  symptomatic response was graded as excellent  score 0 to 2   good  score 3 to 5   fair  score 6 to 8   and poor  no improvement   
class6	2347	symptom response was assessed after 1 week  1 month  6 month  1 year  and present  
class6	2347	the mean period of follow up was 25 months  range  3 to 85 months   
class6	2347	passage of the balloon across the gastroesophageal junction was technically unsuccessful in three patients  
class6	2347	esophageal perforation occurred in two patients  4   and transient chest pain greater than 2 days in three patients  7    
class6	2347	there was no bleeding or death  
class6	2347	symptomatic long term improvement was excellent in 25 patients  63    good in 6 patients  15    fair in 4 patients  10    and poor in 5 patients  12    
class6	2347	a repeat witzel dilation was performed in five patients but resulted in good excellent improvement in only one patient  
class6	2347	we conclude that pneumatic dilation with the witzel balloon is a safe  effective procedure for achalasia  
class6	2348	fatty liver hepatitis  steatohepatitis  and obesity  an autopsy study with analysis of risk factors  
class6	2348	steatohepatitis  fatty liver hepatitis   histologically identical to alcoholic disease  occurs in some obese patients after jejunoileal bypass  
class6	2348	a similar lesion occurs rarely in obese patients without bypass surgery  but the risk factors are poorly understood  
class6	2348	hepatic steatosis  steatohepatitis and fibrosis were sought in 351 apparently nonalcoholic patients at autopsy and various risk factors were evaluated  
class6	2348	incidence of steatosis and steatohepatitis correlated with the degree of obesity  
class6	2348	steatohepatitis was found in 18 5  of markedly obese patients and 2 7  of lean patients  
class6	2348	additional risk factors for steatohepatitis were type ii diabetes  weight loss in the preterminal period shortly before death and intravenous glucose therapy in the last week of life  
class6	2348	severe fibrosis was found in 13 8  of markedly obese patients and in 6 6  of lean patients  this difference was largely explained by the higher prevalence of diabetes in obese groups  
class6	2348	the risk factors defined in this study are known to be associated with abnormalities of free fatty acid metabolism  
class6	2348	obesity  type ii diabetes and intravenous glucose therapy are associated with hyperinsulinemia  which may inhibit fatty acid oxidation  
class6	2348	obesity and weight loss increase the presentation of fatty acids to the liver  
class6	2348	similar metabolic changes may occur in obese patients after jejunoileal bypass surgery  
class6	2348	thus this study supports the hypothesis that fatty acids have a role in the hepatocellular necrosis found in some obese individuals  
class6	2349	immunological studies before and during interferon therapy in chronic hbv infection  identification of factors predicting response  
class6	2349	lymphoblastoid interferon is effective therapy in some but not all patients with chronic hepatitis b virus infection  
class6	2349	to assess whether immunological parameters were predictive of response to interferon therapy  we determined the human leukocyte antigen type  cd4 cd8 ratio  natural killer cell activity  igm anti hbc antibody levels and concanavalin a induced lymphocyte proliferative response in 30 patients before treatment  
class6	2349	in addition  to investigate the mechanisms of action of interferon in promoting hepatitis b virus clearance  we serially measured the cd4 cd8 ratios  natural killer activity and lymphocyte proliferative response at wk 4  8 and 12 of treatment  
class6	2349	a beneficial response to therapy was defined as the sustained clearance of hbeag and serum hepatitis b virus dna within 1 yr of commencing therapy  
class6	2349	elevated igm anti hbc levels were associated with a beneficial response to therapy  but there was no correlation observed between response and pretreatment cd4 cd8 ratio  natural killer activity or lymphocyte proliferative response  
class6	2349	six of seven human leukocyte antigen dr3 positive patients responded  
class6	2349	no measurable changes in the immunological parameters studied were observed in the nonresponder group  whereas a significant rise in cd4 cd8 ratio  associated with a fall in peripheral cd8 number and a decline in measurable nk activity  was seen in the responder group  
class6	2349	these changes were maximal at the time of hepatitis b virus dna clearance  which was associated with a transient increase in hepatic inflammation  
class6	2350	hormonal and enzymatic parameters of hepatic regeneration in patients undergoing major liver resections  
class6	2350	thirteen patients who underwent 40  to 80  removal of their livers had blood samples drawn initially and daily on postoperative days 1 to 7  
class6	2350	the enzyme marker of heightened polyamine metabolism  ornithine decarboxylase  and the indicator of dna synthesis  thymidine kinase  were measured  
class6	2350	in addition  the hormones  insulin  glucagon  estradiol and androgen   which in animals are known to reflect and possibly modulate regeneration  were measured  
class6	2350	changes in all these indices followed the same pattern as in rats  dogs and swine but at a slower rate  
class6	2350	ornithine decarboxylase and estradiol increased within 24 hr  but thymidine kinase and insulin rises did not become statistically significant until 3 to 5 days  
class6	2350	using these plasma or serum indices as surrogate measures of biochemical events in the liver itself  regeneration reached a maximum after 4 or 5 days  
class6	2350	by computed tomography scan analysis  restoration of hepatic cell mass was not complete until 3 wk  
class6	2351	human hepatic regenerative stimulator substance  partial purification and biological characterization of hepatic stimulator substance from human fetal liver cells  
class6	2351	current support or replacement therapies for fulminant acute hepatic failure are frequently very disappointing  
class6	2351	in this study  human hepatic stimulator substance  a liver specific growth factor  was partially purified from human fetal liver cells and characterized by its biological effects  
class6	2351	almost 70 fold protein content was purified with an approximately 80 fold increase in specific growth stimulator activity  
class6	2351	human hepatic stimulator substance proved to be heat stable  protease sensitive  organ specific and species nonspecific  
class6	2351	human hepatic stimulator substance produced a two  to threefold increase of 3h thymidine incorporation into hepatic dna when injected intraperitoneally into growing weanling mice  nonhepatectomized  or regenerating rats  34  hepatectomy   
class6	2351	the effects of hhss in reversing the lethality of d galactosamine  1 6 gm kg body weight  induced hepatic necrosis in rats were further evaluated  
class6	2351	a survival rate of 4   n   24   41   n   12  p less than 0 05   33   n   12  p less than 0 05   31   n   13  p less than 0 05  and 18   n   11  p greater than 0 05  was observed when the rats were injected with 4 ml of saline intraperitoneally  4 ml of human intact fetal hepatocytes  2 4 x 10 8  intraperitoneally  4 ml of human hepatic stimulator substance intraperitoneally  2 ml of twofold concentrated human hepatic stimulator substance intravenously and 1 ml of fourfold human hepatic stimulator substance intramuscularly  respectively  20 hr after poisoning  
class6	2352	hepatic vascular disease and portal hypertension in polycythemia vera and agnogenic myeloid metaplasia  a clinicopathological study of 145 patients examined at autopsy  
class6	2352	the pathogenesis of portal hypertension arising in patients with myeloproliferative disorders has been difficult to understand because liver biopsy findings often show minimal changes  
class6	2352	it has been suggested that increased splenic blood flow  hepatic infiltration with hematopoietic cells or sinusoidal fibrosis may be important  
class6	2352	we have reviewed the autopsy findings and clinical histories of 97 patients with polycythemia vera and 48 patients with agnogenic myeloid metaplasia collected from three institutions and from the polycythemia vera study group  
class6	2352	cirrhosis was present in seven patients  one of whom had bleeding varices  
class6	2352	esophageal varices were present clinically in 10 patients without cirrhosis  seven polycythemia and three agnogenic myeloid metaplasia   
class6	2352	all of these patients had lesions in small or medium sized portal veins and four had stenosis of the extrahepatic portal vein with histology compatible with organized thrombi  
class6	2352	nodular regenerative hyperplasia occurred in 14 6  and correlated closely with the presence of portal vein lesions  
class6	2352	thirty patients had greater than 500 ml of ascites  seven of these patients also had varices and six of them had hepatic vein thrombosis  
class6	2352	ascites also correlated with hepatic vein disease confined to small intrahepatic branches  
class6	2352	no correlation was seen between hepatic hematopoietic infiltration and signs of portal hypertension  
class6	2352	we conclude that esophageal varices are common and are almost always associated with portal vein lesions visible by light microscopy  
class6	2352	these portal vein lesions  and the secondary effects of nodular regenerative hyperplasia and portal hypertension  are most likely a result of portal vein thrombosis in patients with myeloproliferative disorders  
class6	2353	selective intestinal decontamination increases serum and ascitic fluid c3 levels in cirrhosis  
class6	2353	selective intestinal decontamination for 7 days with norfloxacin was performed in 14 cirrhotic patients with ascites and low ascitic fluid total protein  
class6	2353	variations in serum and ascitic fluid of c3 and c4 and ascitic fluid total protein after therapy were compared with those of a control group of 14 untreated patients with similar characteristics  
class6	2353	after oral norfloxacin administration  we saw a significant increase of c3 in serum  p less than 0 05  and ascitic fluid  p   0 01   
class6	2353	a significant increase was also observed in ascitic fluid total protein  p less than 0 05  but not in serum and ascitic fluid c4  
class6	2353	there were no changes in serum c3  ascitic fluid c3  ascitic fluid c4 or in ascitic fluid total protein in group 2  
class6	2353	these data demonstrate that selective intestinal decontamination increases serum and ascitic fluid c3 levels and  therefore  might be useful in preventing spontaneous infections in cirrhotic patients at high risk of infection  
class6	2354	pathological observations of intrahepatic peribiliary glands in 1 000 consecutive autopsy livers  iii  survey of necroinflammation and cystic dilatation  
class6	2354	pathological changes and significance of intrahepatic peribiliary glands  hitherto poorly recognized intrahepatic elements  have been evaluated in our laboratory  
class6	2354	in this report  we surveyed necroinflammatory and cystic changes of the peribiliary glands in 1 000 consecutive autopsy livers because these two changes coexisted frequently in the same liver  
class6	2354	the necroinflammatory change was found in 228 livers  22 8   and the cystic change in 202 livers  20 2    and 103 cases showed both changes in the same liver  
class6	2354	the necroinflammatory change was frequently found in intrahepatic cholangitis and extrahepatic biliary obstruction with bacterial infection  suggesting that biliary bacterial inflammation extends into these peribilary glands  
class6	2354	this change was also frequent in systemic infection or septicemia without biliary bacterial infection  implying that the peribiliary glands were also damaged in such conditions without direct infection  
class6	2354	the cystic change was frequent in livers with portal hypertension or obstruction  adult polycystic disease and necroinflammation of the glands  suggesting that the cystic change of the glands could occur as the result of the disturbance of intrahepatic circulation or as the result of inflammatory destruction of the glandular conduits  
class6	2354	some of peribiliary cysts may be of congenital origin  
class6	2354	dysfunction related to these pathological changes in the glands may diminish seromucous secretion and cause alterations in hepatic bile composition  
class6	2354	the cystic change of the glands may retard bile flow by compressing bile duct lumina  
class6	2355	inflammatory abdominal aortic aneurysms  
class6	2355	in a series of 517 operations for abdominal aortic aneurysm from 1971 to 1988 there were 45 cases  8 7   with an inflammatory aneurysm with a typical thick glistening whitish fibrous layer  
class6	2355	almost two third of the patients had rather severe chronic or acute progressive pain in the abdomen  the back or the flank  
class6	2355	unilateral  7  or bilateral  2  hydronephrosis due to ureteral compression occurred in 9 patients  20    
class6	2355	a diagnosis of inflammatory aneurysm was made preoperatively only in 10 patients  
class6	2355	in 8 of the 9 patients with hydronephrosis ureterolysis was done  unilaterally  6  or bilaterally  2   
class6	2355	after ureterolysis all had complete resolution of the hydronephrosis  
class6	2355	preoperative diagnostic methods are excretory urography  showing medial deviation  ultrasonography and ct scanning of the abdominal aorta  
class6	2355	all patients with an inflammatory aneurysm should undergo aortic replacement to prevent rupture and achieve pain relief  
class6	2355	ureterolysis in cases of hydronephrosis is strongly recommended and may be performed safely and with excellent results  
class6	2356	left retroperitoneal exposure for distal mesenteric artery repair  
class6	2356	distal disease in the mesenteric arteries has usually been repaired transabdominally since it is believed that only the proximal centimeter of each vessel is accessible through the retroperitoneum  
class6	2356	we treated five patients with chronic visceral ischemia and lesions extending beyond the orifice using a retroperitoneal approach  
class6	2356	exposure was obtained with a left flank incision through the tenth interspace  
class6	2356	the left crus of the diaphragm was divided in order to control the supraceliac aorta  
class6	2356	the mesenteric vessels were identified and dissected until their entrance into the peritoneum  
class6	2356	there were no difficulties in exposing the superior mesenteric artery  sma  as it coursed under the pancreas and over the duodenum for an approximate length of 5 to 10 cm  
class6	2356	the uncinate process of the pancreas was not a limiting factor for exposure of the sma in this region and further distal exposure could be obtained by incising the peritoneum  
class6	2356	the trifurcation of the celiac artery and the splenic artery were accessible through this exposure  however  only the first centimeter of the hepatic and gastric branches could be reached  
class6	2356	revascularization was performed with endarterectomy  2 patients  and bypass  3 patients   
class6	2356	bowel viability was assessed at the conclusion of the procedure by incising the peritoneum  
class6	2356	there were no complications from this exposure and no patient required reoperation for ischemic bowel  
class6	2356	we conclude that the left retroperitoneal approach is not only acceptable for orifice lesions but is also applicable for distal disease  
class6	2357	parathyroid hormone and cirrhosis of the liver  
class6	2357	fifty patients with liver cirrhosis  36 alcoholic  1 drug induced  7 posthepatitic  and 6 cryptogenic  and normal renal function were investigated to determine whether pth levels in serum  measured using the common midregion human pth  44 68  ria  are elevated in such patients and whether this is related to impaired liver function rather than to the effect of secondary hyperparathyroidism  
class6	2357	their data were compared with those from 25 control subjects  
class6	2357	the median pth level of 462     18 ng l      sem  was significantly increased  p less than 0 01  in cirrhotics compared with that of 236     13 ng l in the control group  
class6	2357	significant correlations were found between pth levels and parameters of liver function such as prothrombin time  r    0 40  p less than 0 01   albumin as a percentage of total protein  r    0 48  p less than 0 01   bilirubin  r   0 35  p less than 0 05   albumin  r    0 34  p less than 0 05   and cholesterol  r    0 32  p less than 0 05   but not for antipyrine clearance  suggesting increasing pth with decreasing liver function  
class6	2357	the median calcium level  2 26     0 03 mmol l   corrected for changes in albumin  was near the lower limit of the normal range  2 25 2 60   but corrected calcium and pth were positively correlated  r   0 33  p less than 0 05   indicating that the elevation is not reactive to calcium depletion  
class6	2357	a negative correlation existed between pth and 25 hydroxy cholecalciferol  r    0 49  p less than 0 05   the main circulating metabolite of vitamin d  
class6	2357	normal values in an immunoradiometric assay that detects the whole sequence of human pth  1 84  suggest that fragments rather than the intact hormone are responsible for pth elevations in cirrhosis  
class6	2357	the positive correlation between midregion pth and corrected calcium is probably an artifact of the correction formula  
class6	2357	in conclusion  midregion pth fragments are increased in patients with liver cirrhosis  
class6	2357	the reason for this elevation may well be the impaired liver function rather than secondary hyperparathyroidism  
class6	2358	gastrointestinal side effects of octreotide during long term treatment of acromegaly  
class6	2358	gastrointestinal side effects of prolonged therapy  greater than 2 yr  with the long acting somatostatin analog octreotide were studied in 10 acromegalic patients  
class6	2358	after 2 yr of therapy  6 of 10 patients had newly developed gallstones  complicated by cholangitis and jaundice in 1  
class6	2358	serum vitamin b 12 concentrations declined in all 10 patients  from 380     32 to 172     21 pmol l  mean     se   p   0 023  and became abnormally low in 4  
class6	2358	gastric biopsy specimens  obtained during gastroscopy  9 patients   showed moderate to severe active gastritis  with damage to the superficial and deeper layers of the mucosa in 9 of 9 and focal atrophy in 7 of 9 patients  
class6	2358	campylobacter pylori was found in the antral mucosa in 8 of 9 patients  
class6	2358	although information is lacking on similar studies in untreated acromegalic patients  we suggest that patients receiving chronic octreotide therapy be closely monitored for these and possible other side effects related to gastrointestinal actions of octreotide  
class6	2359	crypt cell proliferation and hla dr expression in pelvic ileal pouches  
class6	2359	to investigate the nature of the morphological changes that occur in ileal pouches  26 biopsy specimens from patients with functioning ileo anal pouches  eight with pouchitis  were studied  
class6	2359	normal ileum  n   10  was used as a control  
class6	2359	mucosal morphometry  using linear measurements   crypt cell proliferation  ccp   using the monoclonal antibody ki67   and epithelial hla dr expression  monoclonal antibody cr3 43  were assessed  
class6	2359	ccp  expressed as the percentage of ki67 positive nuclei for each crypt  was significantly higher in pouches with pouchitis  compared with those without  and in pouches without pouchitis compared with normal ileum  
class6	2359	ccp values in some pouches without pouchitis approached values found in those with pouchitis  
class6	2359	ccp was related inversely to villous height and an index of villous atrophy  vh tmt   and directly to crypt depth  
class6	2359	in the presence of pouchitis there was intense epithelial hla dr expression that extended into the crypts  
class6	2359	in some pouches with high ccp values  but without clinically important inflammation  surface epithelial hla dr expression was weak and patchy  
class6	2359	it is concluded that villous atrophy and crypt hyperplasia in ileal pouches are associated with high ccp values  
class6	2359	these may be increased even in the absence of active inflammation  and this increase may occur as a response to the new luminal environment  
class6	2360	abnormal cardiac sensitivity in patients with chest pain and normal coronary arteries  
class6	2360	the causes of chest pain in patients found to have angiographically normal coronary arteries during cardiac catheterization remain controversial  
class6	2360	cardiac sensitivity to catheter manipulation  pacing at various stimulus intensities and intracoronary injection of contrast medium was examined in several groups of patients who underwent cardiac catheterization  
class6	2360	right heart  especially right ventricular  catheter manipulation and pacing and intracoronary contrast medium provoked chest pain typical of that previously experienced in 29  81   of 36 patients with chest pain and angiographically normal coronary arteries and 15  46   of 33 symptomatic patients with hypertrophic cardiomyopathy  
class6	2360	in contrast  only 2  6   of 33 symptomatic patients with coronary artery disease experienced their typical chest pain with these sensitivity tests  p less than 0 001   
class6	2360	none of 10 patients with valvular heart disease but without a chest pain syndrome experienced any sensation with these tests  
class6	2360	cutaneous pain threshold testing demonstrated that patients with chest pain and normal coronary arteries had a higher pain threshold to thermal stimulation compared with patients who had coronary artery disease or hypertrophic cardiomyopathy  
class6	2360	no relation existed between cardiac sensitivity and cutaneous sensitivity testing  
class6	2360	thus  patients who have chest pain despite angiographically normal coronary arteries may have abnormal cardiac sensitivity to a variety of stimuli  
class6	2360	this increased sensitivity may be of causal importance to their chest pain syndrome or may contribute to their perception of ischemia induced pain  
class6	2360	the same phenomenon was also commonly seen in symptomatic patients with hypertrophic cardiomyopathy  
class6	2360	whether this phenomenon represents abnormal activation of pain receptors within the heart or abnormal processing of visceral afferent neural impulses in the peripheral or central nervous system is unknown  
class6	2361	crohn s disease  what about the pancreas   editorial  
class6	2361	crohn s disease  cd  is now accepted as a systemic illness  
class6	2361	the importance of extraintestinal manifestations is underlined by the fact that such  complications  can be more prominent and even more difficult to control than the intestinal disease itself  
class6	2361	lately  evidence for a more than accidental association of pancreatitis and exocrine pancreatic insufficiency with cd is growing  
class6	2361	this might have a significant impact on the treatment of abdominal pain and diarrhea in cd  symptoms which have so far been attributed exclusively to the intestinal rather than the extraintestinal manifestations of the disease  
class6	2362	can the blood urea nitrogen creatinine ratio distinguish upper from lower gastrointestinal bleeding  
class6	2362	we wanted to know if the blood urea nitrogen to creatinine  bun cr  ratio could help distinguish upper from lower gastrointestinal bleeding  
class6	2362	we analyzed retrospectively patients admitted to our hospital for gastrointestinal bleeding over the past 5 years  
class6	2362	a total of 126 patients represented 74 upper bleeds and 52 lower bleeds  
class6	2362	the mean bun cr ratio was significantly higher in upper than lower bleeders  34 8 and 17 8 respectively  p less than 0 001   
class6	2362	no lower bleeder had a ratio of greater than or equal to 36  whereas 38  of upper bleeders had a ratio of greater than or equal to 36  
class6	2362	the bun cr ratio may be an easy  cheap method of distinguishing upper from lower gastrointestinal bleeding in some cases  
class6	2362	a bun cr ratio of greater than or equal to 36 suggests upper gastrointestinal bleeding  whereas a ratio of less than 36 is not helpful in locating the source of bleeding  
class6	2363	stasis syndromes following gastric surgery  clinical and motility features of 60 symptomatic patients  
class6	2363	we retrospectively reviewed the records of 60 patients who had been referred for gastrointestinal manometry because of stasis after gastric surgery  
class6	2363	nausea  vomiting  bloating  abdominal pain  and weight loss were the most common symptoms  
class6	2363	two thirds of these patients had a well documented history of peptic ulcer before their initial operations  in others  surgery was performed for other reasons  such as obesity  5   or reflux esophagitis  8    
class6	2363	twelve patients had undergone truncal vagotomy and a  drainage operation  and 48 had received a partial gastrectomy with a gastroenterostomy  billroth i  n   8   billroth ii  n   11   roux en y  n   29   
class6	2363	all patients had recordings of gastrointestinal manometry  16 also had a scintigraphic measurement of gastric emptying  
class6	2363	measurements were compared with data from healthy controls  
class6	2363	gastric manometry  which could be assessed only in the group with an intact antrum  was characterized by antral hypomotility  p less than 0 05   
class6	2363	gastric emptying studies showed rapid early emptying of liquids and delayed emptying of solids  both p less than 0 05   
class6	2363	in the whole group  fasting jejunal motility was characterized by absence of phase ii in 13  presence of bursts of phasic activity in 18  and abnormal propagation of phase iii in 8  
class6	2363	a significantly increased frequency of phase iii of mmc was noted in the patients after billroth ii and roux en y operations  
class6	2363	postprandially  19 patients failed to develop a  fed pattern    
class6	2364	rosacea and ulcerative colitis  a possible association  
class6	2364	although rosacea was formerly believed to be associated with gastrointestinal upsets  no one any longer finds a significant association between rosacea and the intestinal tract  
class6	2364	we describe four patients with a combination of ulcerative colitis and rosacea  
class6	2364	in all four  ulcerative colitis preceded the onset of severe papulopustular rosacea  and we therefore feel that the severity of rosacea could have been due to the associated bowel disorder  
class6	2364	in one  the severity and poor initial response of rosacea to treatment was clearly related to the activity of the ulcerative colitis  and the rosacea improved only after proctocolectomy  
class6	2364	while it is possible that this purported association is fortuitous  we report these cases in the hope that others may have seen this combination of diseases  to our knowledge previously unreported  
class6	2365	limitations in the evaluation of therapy in inflammatory bowel disease  suggestions for future research  
class6	2365	the current treatment of inflammatory bowel disease  ibd   though improved over earlier therapies  remains variable rather than consistent and supportive rather than curative  
class6	2365	the similar management of ulcerative colitis  uc  and crohn s disease  cd   which are thought to be differing though related disorders  suggests that therapy is nonspecific  
class6	2365	the variation in therapeutic practices results from the fact that the etiologies of the diseases are obscure  from limited knowledge of the biological and pharmacological actions of drugs commonly prescribed  sulfasalazine  5 asa compounds  steroids  6 mp and azathioprine   from an inadequate understanding of genetic differences influencing drug metabolism  from insufficient awareness of the factors influencing drug efficiency  concurrent use of antimotility drugs  cigarette smoking  food combinations   from the variability of the patient groups studied  extent and severity of disease   and from incomplete documentation of the clinical status of patients at the time of therapeutic trial  
class6	2365	future advances in treatment will depend on gaining new information about the nature of ibd and of drug pharmacology and bioavailability  derived from collaborative studies by clinicians  clinical investigators  and basic scientists  
class6	2365	important areas for ibd research include the biology of intestinal epithelium  the nature of the ibd inflammatory reaction and of gut mucosal immune regulation  via the application of new biotechnologies  and more representative experimental animal models  
class6	2365	decisive multicenter therapeutic studies require agreement on definitions of ulcerative colitis and crohn s disease  accurate characterization of patient groups  acceptable objective criteria of ibd severity and activity  and reliable indicators of therapeutic response  
class6	2366	frequency of recovery of blastocystis hominis in clinical practice  
class6	2366	we examined the frequency of isolation of blastocystis hominis from stools of patients seen in an indigent care teaching hospital  
class6	2366	over a 2 year period  2 744 stool specimens were examined prospectively  
class6	2366	b  
class6	2366	hominis was found in 262 stools  9 5  of all stool specimens and 53 5  of the positive specimens   
class6	2366	clinical data were obtained from 80 patients with stools positive for b  
class6	2366	hominis  
class6	2366	b  
class6	2366	hominis was the only parasite isolated in 39 of 47  83   of the adults  compared with 17 of 33  52   of the children  p   0 006   
class6	2366	all but 2 of 52 patients without concomitant parasitic infection or bacterial pathogens in stool had gastrointestinal symptoms  41 abdominal pain  26 diarrhea  and 5 vomiting   but no association was seen with fever  peripheral leukocytosis  stool occult blood  fecal leukocytes  or endoscopic or radiologic evidence of colitis  
class6	2366	therefore  b  
class6	2366	hominis was frequently recovered from stools examined in a hospital clinical parasitology laboratory  
class6	2366	the clinical presentations of patients in our series did not suggest that b  
class6	2366	hominis was invasive  
class6	2366	most patients with b  
class6	2366	hominis probably do not require treatment since they will either have spontaneous resolution of symptoms or will be found to have an alternative explanation for their problem  
class6	2367	clinical significance of cholelithiasis in patients with decompensated cirrhosis  
class6	2367	there is general agreement that the prevalence of gallstones in cirrhotics is high  at least twice that in the general population   but the pathogenetic link between cirrhosis and cholelithiasis is still uncertain  
class6	2367	the influence of cholelithiasis on survival in cirrhotics is also unknown  
class6	2367	during an 8 year period  we observed 90 patients affected by decompensated cirrhosis  36 of them  40   turned out by cholecystographic cholangiographic or ultrasonographic examination to have cholelithiasis  
class6	2367	we were not able to demonstrate any correlation between cholelithiasis and sex  age of patients  etiology of cirrhosis  severity of the illness  degree of portal hypertension  previous gastrointestinal bleeding  number of pregnancies  or levels of serum cholesterol  bilirubin  and triglycerides  
class6	2367	during the follow up observation   range  1 91 months   30 patients died  
class6	2367	survival curves analyzed by the log rank test did not show any difference between patients with or without gallstones  
class6	2367	we therefore confirm that cirrhosis is a lithogenic condition  but we were not able to explain the reasons for the close relationship between cholelithiasis and cirrhosis  
class6	2367	gallstones  however  did not affect the survival of these patients  
class6	2368	risk factors for gallstones among chinese in taiwan  a community sonographic survey  
class6	2368	a health survey of adults aged 30 years or more was carried out in southwest taiwan to determine the prevalence of gallstones and to study risk factors associated with gallstones  
class6	2368	blood samples were collected and abdominal sonographic examination and anthropometric measurements were performed on a total of 923 people  
class6	2368	the 40 gallstone cases detected resulted in a prevalence of 4 3   
class6	2368	the risk factors explored included age  sex  hepatitis  obesity  hyperlipidemia  and diabetes mellitus  dm   
class6	2368	age and dm were the only significant factors associated with gallstones in our study  
class6	2368	with a reference group of 30 39 year olds as a comparison  multiple logistic regression analysis showed a trend effect with odds ratios of 1 73  3 74  and 6 32 for age groups of 40 49  50 59  and 60 or above  respectively  
class6	2368	the odds ratio for dm was as high as 2 59  
class6	2368	however  sex  body weight index  chronic hepatitis b  and hyperlipidemia were not significantly associated with gallstones  
class6	2369	gallstone disease in north india  clinical and ultrasound profile in a referral hospital  
class6	2369	we studied the prevalence of gallstones in patients with upper abdominal pain  heaviness  or discomfort by ultrasound examination of the gallbladder  
class6	2369	the actual ultrasound examination was performed by a clinical gastroenterologist blinded to the symptoms  
class6	2369	of 1 680 consecutive dyspeptic patients  500  29 8   had gallstones  
class6	2369	the gallbladder was contracted in 450  91 2    normal size in 36  7 2    and distended in 8  1 6    
class6	2369	biliary colic was more frequently the presenting complaint in patients with a contracted gallbladder than in those with normal size gallbladder  p less than 0 001   
class6	2369	dyspepsia was more frequent in the presence of a normal size gallbladder than a contracted one  p less than 0 001   
class6	2369	we conclude that ultrasonography of the gallbladder by the clinician has a high diagnostic yield  and the symptom complex has an excellent correlation with the sonographic appearance  
class6	2370	tuberculous peritonitis  a study comparing cirrhotic and noncirrhotic patients  
class6	2370	tuberculous peritonitis is a rare disease  which often goes unrecognized because of the subtle clinical clues and its insidous onset  
class6	2370	we retrospectively analyzed the records of 37 cases of tuberculous peritonitis diagnosed over a 15 year period  and compared the clinical and diagnostic features of cirrhotic and noncirrhotic patients  
class6	2370	in cirrhotic patients  tuberculous peritonitis can simulate ascites from liver disease or spontaneous bacterial peritonitis  
class6	2370	the diagnosis is difficult in these patients because the ascitic fluid may not be of the exudative type as a result of the low albumin level in serum  and lymphocytes do not predominate in all cases  
class6	2370	adenosine deaminase  ada  activity in ascitic fluid was elevated  higher than 40 u l  in all 11 patients  four patients with hepatic cirrhosis   
class6	2370	the time required to achieve a correct diagnosis was significantly longer in cirrhotic than in noncirrhotic patients  
class6	2370	the overall mortality was 13   with deaths occurring exclusively among cirrhotic patients  
class6	2370	we emphasize that tuberculous peritonitis in cirrhotic patients can present an atypical picture  
class6	2370	a considerable element of suspicion is necessary  
class6	2371	small bile duct abnormalities in sarcoidosis  
class6	2371	we report four patients with hepatic involvement of sarcoidosis manifested primarily by bile duct depletion  
class6	2371	the patients developed fever  weight loss  anorexia  a markedly elevated alkaline phosphatase  and mildly abnormal serum levels of aspartate aminotransferase  
class6	2371	endoscopic retrograde cholangiopancreatography showed slight intrahepatic irregularities but were not diagnostic of sclerosing cholangitis  
class6	2371	liver biopsy showed predominantly bile duct depletion  ranging from an estimated 10 100  absence of bile ducts in portal areas  which correlated with the degree of fibrosis  
class6	2371	the degree of bile duct depletion is useful as a histological marker in patients with sarcoid liver disease  
class6	2371	steroids improve symptoms  but do not inhibit the development of  ductopenia    
class6	2372	spontaneous reactivation in chronic hepatitis b  patterns and natural history  
class6	2372	we identified spontaneous reactivation of hepatitis b virus  hbv  retrospectively by utilizing serum alanine aminotransferase and hbv dna in 19 men  79  homosexual   with an estimated annual incidence of 7 3   
class6	2372	in 11 patients  spontaneous reactivation occurred as a single episode and in eight patients  reactivation was recurrent  with two to five episodes each  
class6	2372	the mean serum alanine aminotransferase level was elevated over 10 fold at the peak of reactivation  
class6	2372	serum anti hbc igm was detected during 73  of the reactivation episodes  
class6	2372	actuarial analysis revealed that reactivation was long lasting with 45  and nearly 20  of episodes continued after 6 and 24 months  respectively  
class6	2372	the course of 24 chronic hbv carriers with a negative serum hbv dna test and normal alanine aminotransferase levels at initial appearance was unremarkable  
class6	2372	we could not identify clinical features predictive of reactivation or its resolution  
class6	2372	severe reactivation hepatitis occurred in three patients  10    with two deaths  6    
class6	2372	none of the patients lost hbsag  
class6	2372	spontaneous reactivation in chronic hepatitis b can appear variably  persist long term  recur  and be fatal  
class6	2372	therefore  accurate classification of chronic hbv infection requires prolonged observation  and spontaneous reactivation should be considered a variable in therapeutic trials for chronic hepatitis b  
class6	2373	mallory weiss syndrome after cardiopulmonary resuscitation  
class6	2373	we report hematemesis from mallory weiss tears after successful cardiopulmonary resuscitation  cpr   
class6	2373	a computer search of the english language literature disclosed only 3 similar cases  and we review them  
class6	2373	this complication of cpr may occur more frequently than recognized and should be prevented by careful technique  
class6	2374	a nongastrin malignant ampullary tumor causing gastric acid and pepsin hypersecretion  a case report  
class6	2374	we report a case of multiple duodenal ulcers with gastric hypersecretion due to a nongastrin secretagogue produced by a malignant tumor of the pancreas in a 78 year old man  
class6	2374	the case resembled a zollinger ellison syndrome  zes  with high acid output  basal acid output 27  sham meal stimulated 37  maximum acid output 47 meq h   but with fasting gastrin 43 pg ml  nonresponsive to secretin  
class6	2374	as in zes  pepsin output was comparatively low  and secretion was inhibitable by atropine  50  inhibited by 1 microm   
class6	2374	the tumor removed at surgery contained less than 1 ng gastrin per gram  but was many times more potent than pentagastrin in stimulating acid from a lumen perfused rat stomach  
class6	2374	the tumor also contained cholecystokinin  cck 8 and cck 33   motilin  insulin  and somatostatin  which were also present in adjacent normal pancreas  in addition  the tumor contained pancreatic polypeptide and pancreatic cancer associated antigen  
class6	2374	this case represents a rare syndrome due to an as yet undefined peptide secreted by a  frequently malignant  pancreatic endocrine tumor and masquerading as zes  
class6	2374	this is the first report of studies of pepsin secretion and of the effect of atropine  suggesting that the physiologic effects of the secretagogue resemble that of gastrin  
class6	2375	chylous ascites should suggest constrictive pericarditis even in a patient with cirrhosis  
class6	2375	chylous ascites  a milky  high triglyceride fluid is usually found in patients with lymphatic obstruction from malignancy  
class6	2375	we describe a patient with cirrhosis who developed constrictive pericarditis and chylous ascites  
class6	2375	long standing portal hypertension compounded by elevated central venous pressure provided several pathophysiologic contributions to the formation of the chylous ascites  
class6	2375	chylous ascites even in a cirrhotic requires prompt assessment for conditions leading to elevated central venous pressure  
class6	2376	morphological study of cholesterol hepatolithiasis  report of three cases  
class6	2376	three cases of pure cholesterol intrahepatic stones are compared morphologically to those of calcium bilirubinate stones  
class6	2376	cholesterol stones were found in the intrahepatic bile duct of the left lateral lobe in two cases and in both the left lateral and the right posterior lobe in one  
class6	2376	although the chronic inflammatory reaction and fibrous thickening of bile duct wall were similar in both types of hepatolithiasis  the proliferation of intrahepatic periductal glands and the production of mucin were rather mild  compared to that is the liner containing calcium bilirubinate stones  
class6	2376	multiple intramural cholesterol calculi and cholesterin granulomas  cholesterin crystals surrounded by foreign body giant cells  were found within the cystically dilated small bile duct branches and or conduits of periductal glands  
class6	2376	the calculi and granulomas were characteristic for cholesterol hepatolithiasis  
class6	2376	these findings suggest that the formation of the cholesterol stones differs from that of calcium bilirubinate stones  the perturbation of factors influencing cholesterol nucleation in the hepatic bile may be related to the changed microenvironment of the intrahepatic bile ducts  which is followed by the formation of cholesterol stones  
class6	2377	portal venous gas in a patient with crohn s disease  
class6	2377	portal venous gas usually occurs in the setting of an acute abdomen  
class6	2377	several causes for benign portal venous gas  pvg  have been reported  
class6	2377	we describe the finding of pvg by computed tomography in a febrile patient with crohn s disease and discuss the clinical implications of such a finding  
class6	2378	cellular immune response to hepatitis b virus encoded antigens in acute and chronic hepatitis b virus infection  
class6	2378	the proliferative response of pbmc to hepatitis b virus  hbv  envelope  core  and e ag was analyzed prospectively in 21 patients with acute self limited hbv infection and compared with the response of patients with chronic hbv infection and different levels of hbv replication  i e   hepatitis e ag  hbeag   or anti hbe positive  and liver damage  i e   chronic active hepatitis or chronic asymptomatic carriers   
class6	2378	our results indicate that  1  hbv infected subjects who develop a self limited acute hepatitis show a vigorous pbmc response to hepatitis b core ag and hbeag  as expression of t cell activation  2  appearance of a detectable lymphocyte response to hbv nucleocapsid ag is temporally associated with the clearance of hbv envelope ag  3  in patients with chronic hbv infection the level of t cell responsiveness to hepatitis b core ag and to hbeag is significantly lower than that observed during acute infection  4  t cell sensitization to hbv envelope ag in acute and chronic hbv infection is usually undetectable and when measurable is expressed transiently and at low levels  
class6	2378	these results may reflect immune events of pathogenetic relevance with respect to evolution of disease and viral clearance  
class6	2379	evaluation of wc3 rotavirus vaccine and correlates of protection in healthy infants  
class6	2379	the safety  immunogenicity  and efficacy of wc3 rotavirus vaccine was evaluated in a double blind  placebo controlled trial of healthy infants 2 12 months of age  103 received one dose of vaccine and 103 received placebo  
class6	2379	vaccination appeared to be safe and induced an antibody response  wc3 neutralizing antibody  in 97  of vaccinees  
class6	2379	only 9  9   of these  however  produced antibody to human rotavirus serotypes  at least 7 of the 9 were naturally infected before vaccination  
class6	2379	neither the number of symptomatic episodes of rotavirus diarrhea  21 vs 25  nor the number of moderate to severe rotavirus illnesses  9 vs  
class6	2379	15  was significantly different in vaccine or placebo recipients  respectively  during a predominantly serotype 1 rotavirus season  
class6	2379	a slight but significant decrease in mean symptom score was detected in vaccine recipients  
class6	2379	despite an overall lack of efficacy  protection could be correlated to previous rotavirus infection  high levels of wc3 neutralizing antibody  and preexisting  maternal  serotype 1 neutralizing antibody with a titer greater than or equal to 30  
class6	2380	properties of strains of escherichia coli o26 h11 in relation to their enteropathogenic or enterohemorrhagic classification  
class6	2380	thirty seven strains of escherichia coli o26 h11 from infants and calves with diarrhea were examined for properties associated with enteropathogenic  epec  or enterohemorrhagic e  
class6	2380	coli  ehec   
class6	2380	strains were heterogeneous with respect to vero cytotoxin  vt  production and hybridization with the ehec plasmid specific  cvd419  probe  26 strains produced vt1  1 produced vt2  
class6	2380	twenty four of 27 vt  strains and 5 of 10 vt  strains hybridized with the cvd419 probe and produced enterohemolysin  these properties are characteristic of ehec  
class6	2380	the strains did not hybridize with the epec adherence factor probe  a property characteristic of some epec  
class6	2380	nevertheless  36 strains adhered to hep 2 cells in a localized manner and were positive by the fluorescence actin staining  fas  test that is considered to correlate with the ability to cause attaching and effacing lesions in vivo  
class6	2380	epec and ehec cause these lesions  
class6	2380	although the fas test appeared to be the most general pathogenicity test for the o26 h11 strains  it could not be used to assign strains specifically to epec or ehec groups  
class6	2381	fucosylated oligosaccharides of human milk protect suckling mice from heat stabile enterotoxin of escherichia coli  
class6	2381	human milk protects suckling mice from the diarrheagenic effects of heat stabile enterotoxin of escherichia coli  st   
class6	2381	to identify the human milk fraction responsible for this protection  pooled skimmed  deproteinated milk was passed through charcoal  whereupon lactose was separated from the oligosaccharides  
class6	2381	the oligosaccharides contained st protective activity  the lactose did not  
class6	2381	the neutral  but not the acidic  fraction exhibited protective activity against st  22  vs  
class6	2381	57  mortality  respectively  p less than  001   
class6	2381	the fucosylated  but not the nonfucosylated  subfractions of the neutral fraction contained the factor protective against st  35  vs  
class6	2381	50  mortality  respectively  p less than  05   
class6	2381	an oligosaccharide isolation scheme based on different principles produced confirmatory results  
class6	2381	the commercially available neutral fucosylated oligosaccharides of human milk did not significantly protect the mice from the effects of st  
class6	2381	thus  the protective factor against st seems to be a minor neutral fucosyloligosaccharide of human milk  
class6	2382	rotavirus specific antibody response in saliva of infants with rotavirus diarrhea  
class6	2382	the reliability of saliva as an indicator of rotavirus infection was assessed among 15 infants  3 12 months  with rotaviral and 15 with nonrotaviral diarrhea  
class6	2382	paired salivary samples collected during acute and convalescent phases were tested for rotavirus specific iga and igm by an elisa  
class6	2382	the sensitivity of iga or igm alone to predict infection was 53 3  and 46 6   respectively  used in conjunction  the sensitivity rose to 80   
class6	2382	it seems that infants with rotaviral diarrhea mount mucosal antibody responses as reflected in their saliva  possibly salivary antibodies could be used to evaluate vaccine  take  in rotavirus vaccine trials  
class6	2383	adult immunization in a network of family practice residency programs  
class6	2383	a substantial proportion of morbidity and mortality associated with vaccine preventable diseases occurs among adults  
class6	2383	teaching residents about disease prevention is mandated in the curriculum guidelines for family practice programs  
class6	2383	a cooperative study among the kansas city family practice residency programs was begun to look at immunization behaviors in these teaching programs  
class6	2383	a retrospective audit of medical records and a prospective survey of residents and faculty were performed  
class6	2383	from the medical records of 400 patients seen for health maintenance examinations  the frequency of tetanus diphtheria immunizations recorded was 4 75   
class6	2383	the pooled immunization rate recorded for pneumococcal vaccine was 25   and for influenza vaccine  24   
class6	2383	although 93  of respondents knew patients need tetanus diphtheria immunization every 10 years  on a written questionnaire giving clinical examples  they were less likely to elect to immunize older patients eligible for tetanus diphtheria vaccine  
class6	2383	the following immunization criteria were listed by respondents  for pneumococcal vaccine  age over 65 years  86    for influenza vaccine  age over 65 years  85    chronic diseases  69    residence in a chronic care facility  7    and being a health care worker  28    
class6	2383	educational interventions stressing the appropriate criteria and involvement of the patient are planned at the separate programs  
class6	2384	phase i clinical and pharmacologic study of intraperitoneal cisplatin and fluorouracil in patients with advanced intraabdominal cancer  
class6	2384	fluorouracil  5 fu  and cisplatin display marked therapeutic synergy in preclinical models and are effective in the treatment of a number of solid tumors when combined and administered intravenously  iv   
class6	2384	each drug has also been administered intraperitoneally  ip  and displays a favorable pharmacologic profile and acceptable clinical toxicity  
class6	2384	we therefore undertook a phase i study to determine the feasibility and toxicity of combination ip chemotherapy with these agents  
class6	2384	thirty one patients with histologically documented malignancy confined to the peritoneal space were treated with cisplatin 90 mg m2 mixed with 5 fu in 2 l of lactated ringer s solution and given ip for 4 hours every 28 days  
class6	2384	cohorts of at least three patients received starting 5 fu concentrations ranging from 5 mmol l  1 300 mg in 2 l  to 20 mmol l  
class6	2384	the dose limiting toxicity was neutropenia with a median granulocyte nadir of 156 cells per microliter occurring at a 5 fu dose of 20 mmol l  
class6	2384	intrapatient escalation of the 5 fu dose was permitted and 15 cycles of chemotherapy were delivered at 5 fu concentrations greater than 20 mmol l  the highest concentration being 30 7 mmol l  8 g of 5 fu in 2l   
class6	2384	other toxicities included mild to moderate nausea during all cycles of therapy  vomiting in 54  of cycles  and diarrhea in 15  of cycles  
class6	2384	abdominal pain  renal dysfunction  peripheral neuropathy  and oral mucositis occurred infrequently and were not related to the 5 fu dose  
class6	2384	peritoneal fluid and plasma 5 fu concentrations were measured by high performance liquid chromatography  hplc  in selected patients  
class6	2384	mean peak plasma 5 fu concentrations ranged from 6 19 mumol l to greater than 60 mumol l  and peritoneal fluid to plasma 5 fu area under the curve  auc  ratios ranged from 85 to 1 150  
class6	2384	nine of 15 patients with nonbulky disease had resolution of malignant ascites or at least a 50  reduction of peritoneal studding by tumor at repeat laparotomy  
class6	2384	we conclude that combination ip chemotherapy with cisplatin and 5 fu is technically feasible and has acceptable clinical toxicity and a favorable pharmacologic profile  
class6	2384	the recommended starting 5 fu dose for phase ii trials is 3 900 mg mixed with 90 mg m2 of cisplatin in 2 l of isotonic fluid  
class6	2385	transient renal acidification defect during acute infantile diarrhea  the role of urinary sodium  
class6	2385	we studied urinary acidification daily during the hospital course of 16 infants with acute gastroenteritis and metabolic acidosis  
class6	2385	urine ph value on admission was higher than 5 5 in 14  87   patients  
class6	2385	we hypothesized that inappropriate urinary acidification was due to sodium deficiency and inadequate sodium delivery to the distal nephron  
class6	2385	forty one urinary samples were collected during metabolic acidosis  
class6	2385	the mean ph of 24 urine samples with sodium concentration less than 10 mmol l was significantly higher than the ph of 17 samples with sodium concentration greater than 10 mmol l  6 04     0 06 vs 5 19     0 1  p less than 0 001   
class6	2385	the urine ratios of titratable acid to creatinine and of total acidity to creatinine were significantly higher in urine samples containing more sodium  p less than 0 02   whereas the ammonium creatinine ratio was not  
class6	2385	after administration of furosemide or correction of the sodium deficit  appropriate acidification was observed  
class6	2385	we conclude that impaired urinary acidification is frequently found during metabolic acidosis in infants with acute gastroenteritis and results from a sodium deficit rather than from transient distal renal tubular acidosis  
class6	2386	azathioprine in the treatment of children with inflammatory bowel disease  
class6	2386	during a 6 year period  we treated 21 patients with azathioprine  2 mg kg day  as an adjunct to their customary regimen  
class6	2386	nine patients had ulcerative colitis and 12 patients had crohn disease  the patients  ages ranged from 3 to 17 years  
class6	2386	the median duration of disease before the start of azathioprine therapy was 2 years  and median follow up was 2 years  
class6	2386	sixteen patients seemed to respond to azathioprine therapy  six patients in each disease group had complete responses and four patients  one with ulcerative colitis and three with crohn disease  had partial responses  
class6	2386	two patients with ulcerative colitis and three patients with crohn disease did not respond  
class6	2386	the median time until patients responded was less than 3 months for patients with ulcerative colitis and 4 months for those with crohn disease  
class6	2386	reduction of corticosteroid dose was possible for all patients who responded to azathioprine therapy  
class6	2386	only minimal side effects were attributable to the drug  
class6	2386	we conclude that azathioprine is an effective adjunctive agent for the treatment of inflammatory bowel disease in childhood  but because questions remain regarding its long term safety  its use should be reserved for children with refractory disease or severe and unacceptable side effects of corticosteroids  
class6	2387	effects of cisapride in patients with cystic fibrosis and distal intestinal obstruction syndrome  
class6	2387	in a double blind  placebo controlled  crossover trial  we investigated the effects of the prokinetic drug cisapride in patients with cystic fibrosis and chronic recurrent distal intestinal obstruction syndrome  dios   
class6	2387	after a baseline period  17 patients  12 9 to 34 9 years  12 boys  received  in random order  cisapride  7 5 to 10 mg  and placebo three times daily by mouth  each for 6 months  
class6	2387	gastrointestinal symptoms  flatulence  abdominal pain  fullness  abdominal distension  nausea  anorexia  heartburn  diarrhea  vomiting and regurgitation  were scored three times monthly and physical examinations assessed  
class6	2387	at baseline and at each 6 month period  assessment included food intake for 7 days  3 day stool collection  pulmonary function tests  and abdominal radiographs  
class6	2387	during cisapride therapy compared with placebo  there were significant reductions in flatulence  p less than 0 005   fullness  and nausea  p less than 0 05   
class6	2387	patients with the worst symptom scores benefited most from cisapride  
class6	2387	with cisapride  12 patients felt better and three worse  p less than 0 05   physicians judged 11 patients improved and two worse  p less than 0 05   
class6	2387	no side effects were noted  
class6	2387	there were no significant differences between cisapride and placebo periods in nutritional status  x ray scores  pulmonary function  food intake  fat  protein  calories   stool size and consistency  and fecal losses of fat  bile acids  chymotrypsin  and calories  
class6	2387	for acute episodes of dios  intestinal lavage was needed 6 times in 4 patients during treatment with cisapride  and 11 times in 6 patients receiving placebo  
class6	2387	in comparison with unselected patients with cystic fibrosis and pancreatic insufficiency who were receiving enzyme supplements and who had no distal intestinal obstruction  fecal fat losses  percentage of intake  were almost twice as high in the study group with dios  31 2     20 6  vs 16 2     17 6   p less than 0 01   
class6	2387	we conclude that in the dosage used  long term treatment with cisapride appears to improve chronic abdominal symptoms in patients with cystic fibrosis and dios  but fails to abolish the need for intestinal lavage  
class6	2387	cisapride treatment had no effect on digestion and nutritional status of cystic fibrosis patients with pancreatic insufficiency  
class6	2388	prospective study of the frequency and size distribution of polyps missed by colonoscopy  
class6	2388	an important determinant in interpreting the results of colorectal polyp chemoprevention trials is the rate of polyps missed during colonscopic examination  
class6	2388	we prospectively examined 90 patients by tandem colonoscopy performed by two alternating examiners  
class6	2388	in 69  76 7   patients  221 neoplastic lesions were documented histologically  
class6	2388	of a total of 58 lesions detected in 31 patients  no neoplastic lesion greater than or equal to 10 mm in size was missed  16  of diminutive  less than or equal to 5 mm  neoplastic polyps and 12 3  of medium sized  6 9 mm  neoplastic polyps were missed by the first examiner  
class6	2388	we conclude that an experienced colonoscopist will miss about 15  of colorectal neoplastic polyps less than 10 mm in size in the setting of adequate bowel preparation  
class6	2388	large  greater than or equal to 10 mm  polyps were rarely missed  however  with the  miss  rate in our study equal to 0  with a 95  confidence limit of 4 64   
class6	2389	effect of endotoxin and a burn injury on lung and liver lipid peroxidation and catalase activity  
class6	2389	both endotoxin and a burn alone produce oxidant induced tissue lipid peroxidation  
class6	2389	the endotoxin response is due in large part to hydrogen peroxide  
class6	2389	the combination of endotoxin after a burn results in an increased liver  but not lung  oxidant injury  
class6	2389	our purpose was to determine whether the burn oxidant injury inactivated endogenous liver tissue catalase  thereby amplifying a subsequent h2o2 insult  
class6	2389	twenty six adult sheep were studied  
class6	2389	twelve sheep had a 15  tbs burn  
class6	2389	tissue catalase activity  measured in lung and liver 3 days postburn  was significantly decreased from a control of 3 58     1 8 and 193     63  respectively  to 1 72     0 63 and 148     33 k sec 1  0 5 gram tissue  
class6	2389	the addition of endotoxin 3 days postburn resulted in an increase in liver malondialdehyde  mda  a measure of lipid peroxidation  from a control of 110     80 to 450     54 nmol gram tissue  
class6	2389	this value was significantly greater than the 210     80 nmol gram tissue seen after endotoxin alone  
class6	2389	lung tissue mda with burn and endotoxin was 65     8 compared to 42     7 for control and 80     6 nmol gram for endotoxin alone  
class6	2389	we conclude that a decrease in liver catalase activity occurs after a burn  
class6	2389	the decrease corresponds to an accentuated oxidant induced lipid peroxidation after an added endotoxin insult where h2o2 is known to be an etiologic agent  
class6	2389	the catalase activity also decreases in postburn lung  but accentuated lung damage was not seen  indicating a variable tissue response from the burn induced decrease in antioxidant activity  
class6	2390	the abdominal trauma index  a critical reassessment and validation  
class6	2390	the abdominal trauma index  ati  was devised to quantify the risk of complications following abdominal trauma  
class6	2390	with scores greater than 25  the risk of postoperative complications became exponential  
class6	2390	the purpose of the present study was to determine if  1  the organ risk factors previously assigned were more statistically valid  and 2  the addition of physiologic variables would enhance the prediction of postinjury intra abdominal sepsis  
class6	2390	fifteen abdominal organ systems and 17 physiologic variables in 300 consecutive patients were analyzed to determine ability to predict intraabdominal sepsis  
class6	2390	there were no significant differences in predictive ability between the old and new organ risk factors  
class6	2390	the addition of physiologic factors did not enhance the prediction of intra abdominal sepsis  
class6	2390	this clinical study demonstrates that  1  the risk of intra abdominal sepsis increases with increasing ati score  2  the previous  1979 initial  organ risk grading concept is statistically valid  3  six of the 15 organ systems warrant a change in their relative rank order  1989 revision   4  the addition of demographic  physiologic  and immunologic variables did not significantly improve the prediction of intra abdominal sepsis  
class6	2391	gastrointestinal pathology in adult iron overdose  
class6	2391	the gastrointestinal effects of iron overdose have been described in children  
class6	2391	they may occur acutely  ranging in severity from mucosal injury to complete infarction  or several weeks later  as obstruction due to stricture formation  
class6	2391	they typically occur in the stomach or proximal small bowel  
class6	2391	we describe an adult example of both  each occurring in the distal portion of the small intestine  
class6	2391	both patients had ingested enteric coated iron preparations and both experienced significant  protracted abdominal pain  
class6	2391	thus adults as well as children are at risk for severe gastrointestinal complications after iron overdose  
class6	2391	significant protracted abdominal pain should alert the clinician of its possibility  
class6	2391	damage to distal areas of the bowel can occur with complete sparing of proximal portions particularly if the iron is an enteric coated preparation  
class6	2392	renal scintigraphy in the diagnosis and surgical management of a patient with caliceal colic  a case report  
class6	2392	a patient with persistent renal colic and a caliceal stone is presented  
class6	2392	furosemide renography  commonly used to differentiate functional stasis from mechanical obstruction of an entire kidney or duplicated collecting system  can make this determination at the caliceal level  
class6	2392	as in this case such determination can affect clinical management of the patient  
class6	2393	small cell carcinoma of the pancreas and biliary tract  
class6	2393	four cases of anaplastic carcinoma of the pancreas or biliary tract were studied clinicopathologically and immunohistochemically  
class6	2393	all four cases were intermediate cell type and contained a minimum amount of microscopic foci of differentiated glandular adenocarcinoma  
class6	2393	argyrophilic tumor cells were not seen in any of the four tumors  
class6	2393	immunohistochemically  no tumor was positive for hormonal products  but all tumors were positive for epithelial markers  
class6	2393	these findings suggest that the anaplastic carcinoma are not derived from argyrophilic cells  but rather from adenocarcinomas which have the potential for anaplastic metaplasia  
class6	2393	the long term survival of one patient emphasized the importance of chemotherapy in the treatment of small cell carcinoma of the pancreas and biliary tract  
class6	2394	obstructing carcinoma of the cecum  
class6	2394	carcinoma of the cecum  the third most common location for malignancy of the large bowel  was examined with attention centered upon cecal cancers producing obstruction  
class6	2394	reviewing 136 patients revealed 11 obstructing lesions  8 1   presenting as distal small bowel obstructions  
class6	2394	the mean age of the patients was 74 years  
class6	2394	all but one patient had resection for cure which consisted of a right hemicolectomy with ileotransverse colostomy  
class6	2394	there was no operative mortality or significant morbidity  
class6	2394	bowel obstruction due to cecal carcinoma is an infrequent occurrence arising in elderly patients and carries a poor survival rate due to advanced disease at the time of diagnosis and treatment  
class6	2395	complications of stapled anastomoses in anterior resection for rectal carcinoma  colorectal anastomosis versus coloanal anastomosis  
class6	2395	postoperative results of 48 patients who underwent anterior resection using the eea stapler were evaluated  
class6	2395	in all but 2 cases the indication for surgery was colorectal carcinoma  
class6	2395	in 24 patients an anastomosis was created above the 5 cm level  above the anal verge  colorectal anastomosis  and in 24 at the 0 5 cm level  coloanal anastomosis   
class6	2395	there was no perioperative mortality  
class6	2395	the only complication observed in the colorectal anastomosis group was one case of late anastomotic stenosis  
class6	2395	in the coloanal anastomosis group there were 4 cases with early anastomosis leaks  3 cases with late stenosis and 5 cases with various degrees of late fecal incontinence  ultimately resulting in a permanent diverting stoma in 5  10 4   patients  
class6	2395	we conclude that for rectal tumors the eea stapled anterior resection provides excellent functional results in most cases  
class6	2395	stapled coloanal anastomoses more often demonstrate various  early and late  complications  
class6	2395	nevertheless in spite of chronic discomfort  many patients still prefer their complaints to a permanent stoma  
class6	2396	assessment of functional gastrointestinal disease  the bowel disease questionnaire  
class6	2396	a need exists for a self report questionnaire that reliably and accurately measures symptoms and that distinguishes patients with functional gastrointestinal disease from those with other conditions  
class6	2396	we have developed such an instrument  the bowel disease questionnaire  and herein describe details of its discriminatory validity  
class6	2396	data from 399 subjects were analyzed  
class6	2396	patients with gastrointestinal symptoms were ultimately diagnosed as having functional gastrointestinal disease  82 with the irritable bowel syndrome and 33 with functional dyspepsia  or organic gastrointestinal disease  n   101   
class6	2396	there were 145 healthy control subjects and 38 patients with a psychiatric disease  somatoform disorder  which includes those with a diagnosis of hypochrondriasis  psychogenic pain  and somatization or conversion disorder   
class6	2396	all subjects completed the questionnaire before undergoing an independent diagnostic assessment by experienced physicians  
class6	2396	functional gastrointestinal disease could be distinguished from organic disease  somatoform disorder  and health by using models derived from logistic discriminant analysis  
class6	2396	with use of these models  the estimated probability of functional gastrointestinal disease was then calculated  
class6	2396	descriptive symptom scores were of less value than the scores derived from the data sets by logistic discriminant analysis  
class6	2396	age did not significantly affect the responses to the questionnaire items  
class6	2396	we conclude that  in the population studied  the bowel disease questionnaire is a valid measure of symptoms of functional gastrointestinal disease  and this instrument may have clinical and research applications  
class6	2397	impact of active immunisation against enteritis necroticans in papua new guinea  
class6	2397	enteritis necroticans  known locally as pigbel  has been a major cause of illness and death among children in the highlands of papua new guinea  
class6	2397	after a successful trial of active immunisation against the beta toxin of the causative organism  clostridium perfringens type c  immunisation of children was begun in 1980  
class6	2397	the effects of the immunisation programme on pigbel admissions in 3 of the 5 major highland hospitals were assessed  
class6	2397	in each of the centres studied the proportion of admissions due to enteritis necroticans dropped significantly after immunisation was introduced  p less than 0 001  and hospital admissions for pigbel in 1984 86  when immunisation was well established  were less than one fifth of previous figures  
class6	2398	preliminary report  the antegrade continence enema  
class6	2398	the principles of antegrade colonic washout and the mitrofanoff non refluxing catheterisable channel were combined to produce a continent catheterisable colonic stoma  
class6	2398	the intention was that antegrade washouts delivered by this route would produce complete colonic emptying and thereby prevent soiling  
class6	2398	the procedure has been successfully carried out in five patients with intractable faecal incontinence  
class6	2399	increased cholecystectomy rates in saudi arabia 
class6	2399	gallstones have become increasingly prevalent in saudi arabia  where cholecystectomy is now one of the commonest major abdominal operations  
class6	2399	2854 people underwent cholecystectomy in the 14 hospitals of the country s eastern province in the years 1977 to 1986  
class6	2399	during this period the overall frequency of cholecystectomy increased by 978   a finding not explained by the 67  increase in population or the 87  increase in other operations  
class6	2399	simultaneously  the average daily individual consumption of total calories  fat  and sugar increased by 81   197   and 164   respectively  and consumption of high fibre grain fell by 75   
class6	2399	this striking increase in the frequency of cholecystectomy  which presumably reflects the incidence of gallstones  cannot be explained by demographic changes and seems more closely linked to the concomitant changes in dietary habits  
class6	2400	binding to human jejunum of serum iga antibody from children with coeliac disease  
class6	2400	jejunal histology and the presence of serum iga antibodies  jab  binding to human jejunum in vitro were studied in 139 children with severe malabsorptive symptoms  
class6	2400	among 33 children with confirmed coeliac disease  espgan criteria   13  93   of 14 sampled before starting on a gluten free diet had jab  none of 21 sampled had jab while on a gluten free diet of long duration  and 90  of 30 sampled during gluten challenge had jab  
class6	2400	53 children had severe jejunal villous atrophy  probable coeliac disease   71  of those younger than 2 years and 94  of those aged 2 18 years had jab during gluten intake  
class6	2400	jab could not be detected in 53 disease control patients  normal jejunal histology  and in 3 coeliac disease patients with selective iga deficiency  
class6	2400	simultaneous determination of antigliadin  aga  and antiendomysium  ema  levels  and gliadin and tissue absorption studies  showed that jab and aga are different  whereas jab and ema are probably identical  
class6	2400	iga jab could be the target organ related autoantibodies in coeliac disease  
class6	2401	a chronic granulomatous syndrome of unknown origin  
class6	2401	a small clinically distinct group of patients with widespread tissue granulomata are described  
class6	2401	the principal presenting symptoms are malaise  fever  and weight loss  although a wide variety of complaints are documented  
class6	2401	pulmonary involvement is uncommon  
class6	2401	the granulomata are noncaseating with a few multinucleate giant cells and some surrounding chronic inflammatory infiltrate  
class6	2401	there is no evidence of an associated arteritis  
class6	2401	the disease has a relapsing and remitting course and although it may require treatment with immunosuppressive drugs  particularly if the kidneys are involved  the prognosis is relatively good  
class6	2401	we propose that this entity be called granulomatous syndrome of unknown origin  
class6	2401	the characteristics that set this syndrome apart from the other granulomatous vasculitides are discussed  
class6	2401	the current limited understanding of granuloma formation does not allow us to propose a definite etiology for this condition  
class6	2401	it is emphasized that it is not helpful to encompass it within a label of sarcoidosis  
class6	2401	first  it may only serve to confuse the doctor in assessing and treating this very particular group of patients  
class6	2401	secondly  it may hinder future attempts to understand the different pathogenetic mechanisms underlying the various conditions in which granulomata may arise  
class6	2402	pancreaticopleural fistula  report of 7 patients and review of the literature  
class6	2402	pancreaticopleural fistula is an uncommon clinical condition  
class6	2402	its presentation is often confusing because of the paucity of clues suggestive of pancreatic disease and the preponderance of pulmonary symptoms and signs  
class6	2402	most patients are alcoholics but only one half will have a clinical history of previous pancreatitis  
class6	2402	pleural effusions are large  recurrent  and highly exudative in nature  
class6	2402	many patients go through extensive pulmonary evaluation before the pancreas is identified as the site of primary pathology  
class6	2402	an elevated serum amylase may be the first clue to the diagnosis  
class6	2402	however  the key to the diagnosis is a dramatically elevated pleural fluid amylase  
class6	2402	effusions in association with acute pancreatitis  esophageal perforation  and thoracic malignancy are important to consider in the differential diagnosis of an elevated pleural fluid amylase but are usually easy to exclude  
class6	2402	computed tomography is excellent in defining pancreatic abnormalities and should be the first abdominal imaging study in suspected cases  
class6	2402	endoscopic retrograde cholangiopancreatography  ercp  is used as a diagnostic tool only in confusing cases  
class6	2402	although no systematic study evaluates medical versus surgical therapy  we recommend an initial 2 to 4 week trial of medical therapy  including allowance of no oral intake  total parenteral nutrition  chest tube thoracostomy  and possibly a regimen of somatostatin or its analogs  
class6	2402	the major complication in these patients is superinfection  which results in significant morbidity and mortality  
class6	2402	failure of medical therapy should be considered failure of pleural effusion s  to clear  recurrence after reinstatement of oral intake  or superinfection  
class6	2402	for those patients who fail to benefit from medical therapy  surgery is indicated  
class6	2403	coccidioidomycosis during human immunodeficiency virus infection  a review of 77 patients  
class6	2403	through a retrospective review  we identified 77 previously unreported cases of coccidioidomycosis during hiv infection  
class6	2403	patients were classified into 1 of 6 categories based on their primary clinical presentation  20 had focal pulmonary disease  group 1   31 had diffuse pulmonary disease  group 2   4 had cutaneous coccidioidomycosis  group 3   9 had meningitis  group 4   7 had extrathoracic lymph node or liver involvement  group 5   and 6 has positive coccidioidal serology without a clinical focus of infection  group 6   
class6	2403	coccidioidal serologies were positive on initial testing in 83  of the patients in whom such serologic testing was performed  
class6	2403	sera from 39  of patients were positive for tp antibodies while 74  had cf antibodies  
class6	2403	eleven of 12 seronegative patients had pulmonary disease  group 1 or 2   
class6	2403	serologic results of other patients sent to a single reference laboratory were similar  with 26  positive for immunodiffusion tp antibodies and 79  positive for immunodiffusion cf antibodies  
class6	2403	for the 77 patients in this study  the cd4 lymphocyte count was below 0 250 x 10 9  cells l in 46 of the 55 patients who had this test performed  and a low cd4 count was significantly associated with mortality  p less than 0 01   
class6	2403	at the time of follow up  32 of the 77 patients  42   had died  
class6	2403	there were significantly more deaths in those with diffuse pulmonary disease  group 2  than in other groups  p less than 0 001   
class6	2403	amphotericin b  ketoconazole  fluconazole  and itraconazole were all used as antifungal therapies  
class6	2403	outcome could not be related to the therapy used  
class6	2403	of note  3 patients developed coccidioidomycosis while receiving ketoconazole for other conditions  
class6	2404	aspiration in bilateral stroke patients  
class6	2404	seventy patients with bilateral strokes underwent neurologic and videofluoroscopic barium swallowing examinations  34  48 6   aspirated  
class6	2404	patients with aspiration were more likely to have posterior circulation strokes  abnormal cough  abnormal gag  and dysphonia  
class6	2404	however  patients likely to aspirate can be identified best by the presence of an abnormal voluntary cough  an abnormal gag reflex  or both  
class6	2404	the prediction of patients at risk for aspiration was not improved by additional clinical information  ie  presence of dysphonia or bilateral neurologic signs   
class6	2405	cyclic pelvic pain  
class6	2405	cyclic pelvic pain is a common gynecologic problem caused by relatively few diseases  which usually can be diagnosed and remedied quickly  
class6	2405	some complaints reflect normal physiologic aspects of the menstrual cycle  mittelschmerz  menstrual awareness   
class6	2405	premenstrual syndrome can be diagnosed  but an effective and convenient treatment is lacking  
class6	2405	dysmenorrhea is the commonest source of cyclic pain  diagnosed by its characteristic history and rapid relief on administration of antiprostaglandin agents  
class6	2405	endometriosis is diagnosed surgically and best treated either surgically then  or medically by danazol or gnrh agonists  
class6	2405	in contrast  adenomyosis is a problem commonly encountered in later life  and hysterectomy is usually needed for both definitive diagnosis and treatment  
class6	2406	pelvic pain and infections  
class6	2406	infectious etiologies of both acute and chronic pelvic pain are common and may involve multiple organ systems  
class6	2406	in the evaluation of the acute pain  it is important to remember that rapidity of diagnosis is important because of the possibility of significant morbidity and even death if a condition is not attended to rapidly  
class6	2406	in recent years  laparoscopic evaluation of the pelvis has provided a better understanding of the pathophysiology of some of these infections  as well as possible therapeutic maneuvers  
class6	2406	the evaluation of chronic pelvic pain requires a thorough attempt at careful diagnosis with minds open to the possibility that other organ systems besides the genital tract may be involved  
class6	2406	laparoscopy also may be an important diagnostic and therapeutic tool in the evaluation of the sequelae of pelvic inflammation leading to chronic pelvic pain  
class6	2406	all therapeutic modalities that are instituted on the basis of the diagnostic evaluation must take into consideration that a strong emotional component is generally associated with chronic pelvic pain  
class6	2406	such components must be addressed in order to achieve the best possible results for the patient  
class6	2407	an epidemic outbreak of cryptosporidiosis  a prospective community study from guinea bissau  
class6	2407	in the first year of a prospective community study of childhood diarrhea conducted in a semiurban area in the capital of guinea bissau  cryptosporidium sp  
class6	2407	was found in 73  6 0   of 1216 episodes of diarrhea  
class6	2407	the parasite was the second most prevalent intestinal parasite  and the only one significantly associated with diarrhea  or   2 79  p   0 0006   
class6	2407	the seasonal distribution was striking  with a peak prevalence in the beginning of the rainy season  may 17 6   when an epidemic outbreak of diarrhea started  
class6	2407	the prevalence was highest in children younger than 18 months  an age at which prevalences of other intestinal parasites were low  
class6	2407	this reverse age pattern may possibly be explained by the small infective dose needed to create severe infections  by air borne transmission and by the development of protective immunity  
class6	2408	case control study of cryptosporidium parvum infection in peruvian children hospitalized for diarrhea  possible association with malnutrition and nosocomial infection  
class6	2408	a retrospective  hospital based case control study was used to investigate whether there were any clinical characteristics that could distinguish cryptosporidium parvum infected children with diarrhea from other non c  
class6	2408	parvum infected children with diarrhea  
class6	2408	ten percent  24 of 248  of children admitted to a rehydration ward at cayetano heredia university hospital  lima  peru  were infected with c  
class6	2408	parvum  
class6	2408	the 24 patients infected with c  
class6	2408	parvum  cases  were matched to an equal number of noninfected patients  controls   
class6	2408	c  
class6	2408	parvum infected patients were more likely to be malnourished than were children without this infection  p less than 0 05   
class6	2408	also nosocomial infection caused by c  
class6	2408	parvum occurred in three severely malnourished patients  two of whom died  
class6	2408	no other clinical or laboratory characteristics were found that would distinguish children with diarrhea caused by c  
class6	2408	parvum from other children with diarrhea  
class6	2408	in children hospitalized for diarrhea c  
class6	2408	parvum infection occurs most frequently in malnourished children  
class6	2409	clinical features of adenovirus enteritis  a review of 127 cases  
class6	2409	we retrospectively analyzed the clinical features of 127 hospitalized pediatric patients whose fecal samples were positive for adenovirus  ad  by electron microscopy during an 18 month period  
class6	2409	serotyping results obtained by microneutralization tests and restriction endonuclease analysis were available for 105 of 127 cases  
class6	2409	there were 69 males and 58 females and 94  of patients were less than 4 years of age  
class6	2409	the average body temperature was 38 degrees c rectal  range  36 2 40 8 degrees c  with an average duration of fever of 1 6 days  
class6	2409	the average duration of clinical illness was 8 8 days  range  1 to 32 days   
class6	2409	although ad 40 and ad 41 were isolated in the majority of cases  59 of 105  56    ad 31 was associated with 18 of 105 cases  17    
class6	2409	of the 18 cases associated with ad 31  14 were nosocomial and associated with diarrhea  
class6	2409	our survey confirms the importance of fastidious enteric ad in infantile diarrhea  ad 40  ad 41  and suggests that ad 31 produces a clinical syndrome indistinguishable from that caused by ad 40 and ad 41  
class6	2409	the occurrence of ad enteritis in patients admitted for unrelated illnesses well after initial hospitalization suggests that ad is also an important cause of nosocomial enteritis in our hospital  
class6	2410	advanced assessment of the abdomen and gastrointestinal problems  
class6	2410	there are many unique physical assessment findings that are associated with specific gastrointestinal disorders  
class6	2410	the detection of these findings enables the nurse to manage gastrointestinal emergencies on the patient unit in a timely fashion  preventing deterioration and maintaining the safety of the patient  
class6	2410	these skills build well on the traditional  detailed  and comprehensive assessments the nurse makes when using the nursing process  
class6	2410	specific abdominal assessments include detection of signs associated with appendicitis such as rebound tenderness and mcburney s  rosvig s  and aaron s signs  
class6	2410	the nurse must always be alert to the possibility of peritonitis and the urgency of early detection and treatment  
class6	2410	the patient with cirrhosis of the liver presents a distinct clinical picture  
class6	2410	there is a need for subtle evaluation of mental status to detect early signs of hepatic coma  
class6	2410	another extra abdominal assessment of this complication is asterixis  
class6	2410	finally  the assessment of the patient is enhanced when the nurse is able to help identify the location of bleeding  
class6	2410	improving abdominal and gastrointestinal system assessment leads to early detection of nursing problems and appropriate interventions  
class6	2411	nausea  vomiting  and retching  
class6	2411	although nausea  vomiting  and retching have plagued mankind since antiquity  limited attention has been given to the three symptoms as separate entities  
class6	2411	although knowledge of symptom occurrence is essential to practice  nurses must focus on patients  response or distress to the occurrence of symptoms  
class6	2411	the differentiation of symptom occurrence and symptom distress of nausea  vomiting  and retching is critical to the management and self care demands of patients and the enhancement of their quality of life  
class6	2411	basic research on patterns of these individual symptoms and their components promises to provide a more progressive and fruitful approach to the patient response to these symptoms  
class6	2412	diarrhea  
class6	2412	diarrhea is one manifestation of gi disturbance  
class6	2412	symptoms may be acute if caused by such things as infections  drug reactions  alterations in diet  heavy metal poisoning  or fecal impaction  
class6	2412	chronic diarrhea is a symptom of gi diseases such as irritable bowel syndrome  lactase deficiency  cancer of the colon  inflammatory bowel disease  and malabsorption diseases  
class6	2412	chronic diarrhea may also be associated with gi surgery  radiation therapy  laxative abuse  alcohol abuse  and chemotherapeutic agents  
class6	2412	when interventions are required to deal with diarrhea  they may include such things as alteration in tube feeding products and methods of administration  fluid replacement by oral rehydration procedures  a rapid return to feeding  and education aimed at the health information clients need to prevent or control the symptom of diarrhea  
class6	2413	colonoscopy in critically ill patients  what conditions call for it  
class6	2413	indications for colonoscopy in the intensive care unit include acute lower intestinal bleeding  sigmoid volvulus  pseudo obstruction of the colon  and suspicion of pseudomembranous colitis  
class6	2413	although the incidence of cardiorespiratory complications may be higher in these critically ill patients  the procedure can be done safely with proper attention to detail  
class6	2413	because of colonic dilatation  endoscopy can often be done without bowel preparation  
class6	2414	interventional radiologic alternatives to cholecystectomy  
class6	2414	it has been estimated that 20 million people in the united states have gallstone disease  
class6	2414	the choice of the optimal management strategy for a patient with symptomatic gallstones in the 1990s will take into account the clinical status of the patient  the characteristics of the gallstones  and the patient s preference  
class6	2414	only patients whose doctors understand the advantages and disadvantages of the newer methods can make properly informed choices  
class6	2414	when interventional radiologic alternatives to cholecystectomy are being contemplated  one approach is to first consider the patient s clinical presentation  acute or nonacute  and then their risk of death after cholecystectomy  low or high   
class6	2414	figure 5 shows an algorithmic approach to the management of gallbladder stones based on this concept  
class6	2414	this algorithm also can be used as a framework for discussion of treatment options with any individual patient  
class6	2415	interventional radiology of the biliary tract  transcholecystic intervention  
class6	2415	diagnostic and therapeutic biliary intervention by percutaneous access to the gallbladder is an important new area in interventional radiology  
class6	2415	the anatomy of the gallbladder  biliary tree  and surrounding viscera is reviewed in this article as a preliminary to discussion of the diagnostic techniques of aspiration  cholangiography  biopsy  and the therapeutic techniques of gallbladder drainage and cholelithotomy  
class6	2415	recently there has been a bewildering proliferation of procedures aimed at removal  fragmentation  and dissolution of gallbladder stones  
class6	2415	several of these are discussed in this article  
class6	2415	removal of common bile duct stones by percutaneous cholecystostomy also is discussed  
class6	2416	interventional gallbladder procedures  
class6	2416	interventional radiologic procedures in the gallbladder are influencing both the diagnosis and therapy of many gallbladder disorders  
class6	2416	current diagnostic and therapeutic percutaneous techniques offer important alternatives for their management  
class6	2416	this article highlights the spectrum of interventional radiologic techniques available for gallbladder diseases  
class6	2417	intracorporeal biliary lithotripsy  
class6	2417	most bile duct calculi can be removed with standard percutaneous or endoscopic techniques  
class6	2417	very large stones are the most common cause for failure  
class6	2417	intracorporeal lithotripsy  and ehl in particular  can be used safely in either the biliary tree or gallbladder to fragment these large stones and allow percutaneous removal or passage  
class6	2417	intracorporeal ehl requires direct vision to prevent damage to the bile duct mucosa  
class6	2417	intracorporeal laser lithotripsy may offer some safety advantages  but the laser requires much more expensive equipment than intracorporeal ehl  
class6	2417	additional studies are needed to determine the technique that is better in each circumstance  
class6	2418	technical aspects of biliary extracorporeal shock wave lithotripsy  
class6	2418	radiologic imaging procedures play a major role in the evaluation of the potential patient for biliary extracorporeal shock wave lithotripsy  both during the procedure and in follow up evaluation  
class6	2418	the treating physician must have a thorough knowledge of ultrasonography techniques  
class6	2418	lithotripsy requires continual monitoring and frequent reassessment to optimize targeting and fragmentation of the gallstones while maintaining patient comfort  
class6	2419	clinical experience with biliary extracorporeal shock wave lithotripsy  
class6	2419	biliary lithotripsy is a new and important development in the nonsurgical management of gallbladder  cystic duct  and bile duct stones  
class6	2419	most patients do not require general or epidural anesthesia with newer second generation machines  
class6	2419	patient selection and the use of adjuvant therapy to aid fragment clearance are important issues that are discussed  
class6	2419	results from different centers are compared but few long term results are yet available  i e   longer than 18 months  
class6	2420	ablation of the cystic duct and the gallbladder  experimental basis and initial clinical observations  
class6	2420	bipolar radiofrequency electrocoagulation of the cystic duct by catheter can be performed safely and reproducibly using fluoroscopic control and induces endoluminal scar formation  
class6	2420	the scar within the cystic duct forms a reliable barrier between the gallbladder and the biliary system and avoids recanalization of the cystic duct at a later date  
class6	2420	sclerotherapy of the isolated gallbladder with 95  ethanol and 3  sts can be performed without toxic or otherwise adverse effects and is suitable to ablate the porcine gallbladder  
class6	2420	initial clinical trials with this new technique on a small number of patients are promising and have demonstrated that the protocol can be applied safely to humans  
class6	2420	the electrocoagulation technique by catheter appears suitable to ablate the human cystic duct  
class6	2420	follow up evaluation of our first patients is under way and must determine whether our regimen is appropriate to ablate the human gallbladder on a long term basis  
class6	2420	further development of this new approach may eventually enable definitive nonoperative treatment of cholecystolithiasis in selected patients  
class6	2421	combined radiologic and retrograde endoscopic and biliary interventions  
class6	2421	methods of treating complex biliary duct problems by a team composed of an endoscopist and interventional radiologist are described  
class6	2421	these procedures are of two types  those in which all manipulations are performed through the endoscope and those in which an antegrade transhepatic and a retrograde endoscopic approach are combined  
class6	2422	a case of group b streptococcal pyomyositis 
class6	2422	the group b streptococcus is an opportunistic pathogen that causes a variety of serious infections including bacteremias  puerperal sepsis  and neonatal meningitis  
class6	2422	group b streptococcal infections of muscle are rare  
class6	2422	we report here an unusual case of group b streptococcal pyomyositis  
class6	2422	pyomyositis arises predominantly from infections caused by staphylococcus aureus and  occasionally  streptococcus pyogenes  
class6	2422	because of the rarity of pyomyositis in temperate climates  the common lack of localizing signs or symptoms  and the frequently negative blood cultures  considerable delay often precedes the diagnosis of pyomyositis  in fact  the infection has been initially misdiagnosed as muscle hematoma  cellulitis  thrombophlebitis  osteomyelitis  or neoplasm  
class6	2422	diagnosis may be greatly aided by radiologic techniques that can demonstrate the sites of muscle enlargement and the presence of fluid collections  
class6	2422	the response to antibiotics is usually rapid  but resolution of the infection may require aspiration of deeply situated muscle abscesses  
class6	2422	this report describes a diabetic patient with an unusual presentation of pyomyositis that mimicked an acute abdomen  
class6	2423	visceral protothecosis mimicking sclerosing cholangitis in an immunocompetent host  successful antifungal therapy  
class6	2423	a healthy 39 year old man who had clinical findings consistent with sclerosing cholangitis was found to have systemic protothecosis at surgery  
class6	2423	severe granulomatous inflammation and palpable nodules were found in the gallbladder  on the surface of the liver  and in the duodenum  
class6	2423	prototheca wickerhamii was detected in biopsied specimens and stool  the titer of indirect fluorescent antibody to this organism was 1 2 000  
class6	2423	the patient recovered after a short course of treatment with amphotericin b and 3 months of oral therapy with ketoconazole  
class6	2423	he had no other concurrent illness and had no abnormality in his immune system  
class6	2423	this is the second reported human case of systemic protothecosis  
class6	2423	an elevated igg level  an elevated erythrocyte sedimentation rate  eosinophilia  and abnormal levels of enzymes in the liver were found in both cases  
class6	2423	protothecosis should be considered in the differential diagnosis of hepatic and biliary inflammatory diseases of uncertain etiology  
class6	2424	postoperative pancreatic abscess due to plesiomonas shigelloides  
class6	2424	plesiomonas shigelloides is being recognized with increasing frequency as a human pathogen  
class6	2424	the organism is ubiquitous in fresh and brackish water  and clinical illness has been associated with foreign travel and ingestion of inadequately cooked seafood  
class6	2424	we describe a 64 year old filipino woman who presented 2 weeks after elective cholecystectomy and pancreatic biopsy with left upper quadrant pain  abdominal distention  and fever  
class6	2424	computerized tomography of the abdomen revealed an abscess in the tail of the pancreas with fluid accumulation in the lesser omental sac  
class6	2424	percutaneous aspiration yielded purulent material  and p  
class6	2424	shigelloides was recovered in pure culture  
class6	2424	to our knowledge  this is the first reported case of pancreatic abscess due to p  
class6	2424	shigelloides  
class6	2425	emphysematous gastritis  case report and review  
class6	2425	emphysematous gastritis is a condition involving gastric wall inflammation  radiologic or intraoperative evidence of intramural gas  and systemic toxicity  
class6	2425	a recent case of emphysematous gastritis in a 57 year old diabetic man is reported  and 27 cases published since 1889 are reviewed  
class6	2425	predisposing factors include ingestion of corrosive substances  37   and alcohol abuse  22    
class6	2425	diagnosis of emphysematous gastritis is based on the clinical presentation of an acute abdomen with systemic toxicity and on radiographs demonstrating gas bubbles within the stomach wall  
class6	2425	for the case reported herein  computed tomography was useful both in establishing the diagnosis and in following the resolution of emphysematous gastritis  
class6	2425	organisms most commonly involved were escherichia coli  six cases   streptococcus species  six cases   enterobacter species  five cases   and pseudomonas aeruginosa  three cases   
class6	2425	the mortality was 61   17 of 28 patients   and morbidity with gastric contractures occurred in 21  of cases  6 of 28   
class6	2425	optimal therapy has not been defined  however  antimicrobial chemotherapy and surgery  when appropriate  may improve survival rates  
class6	2426	preventing colorectal cancer  
class6	2426	knowledgeable patients should not die of colorectal cancer  
class6	2426	increasing the intake of dietary fiber  decreasing fat consumption  and increasing the use of modern technology to detect adenomatous polyps and early cancer can greatly decrease the mortality associated with colorectal cancer  
class6	2427	normeperidine induced seizures in hereditary coproporphyria  
class6	2427	seizures are common in acute exacerbations of hepatic porphyria  even though the etiology is not identified in most cases  
class6	2427	we have reported a case of normeperidine induced seizures in a patient with hereditary coproporphyria  
class6	2427	although meperidine is commonly used for pain control during acute attacks in these patients  this report suggests that meperidine is not a good analgesic choice in porphyria  
class6	2427	normeperidine induced seizures in patients with porphyria may be treated by withdrawal of meperidine therapy and selective use of anticonvulsants  
class6	2428	traumatic diaphragmatic hernia and intestinal obstruction due to penetrating trunk wounds  
class6	2428	we have reported two cases of intestinal obstruction due to traumatic diaphragmatic hernia  both resulting from apparently trivial knife wounds  
class6	2428	when tdh is due to a penetrating injury  it tends to produce symptoms of intestinal obstruction  
class6	2428	a high index of suspicion  a chest x ray film  and barium studies of the gastrointestinal tract are usually needed to make the diagnosis  though ct scans  ultrasonography  laparoscopy  and radionuclide scanning may also be useful  
class6	2428	surgeons and emergency physicians should be aware of the potential for tdh when there is a history of a penetrating wound of the chest or abdomen  
class6	2429	adenocarcinoma of the appendiceal stump  
class6	2429	we have reported the case of a 58 year old woman with nonspecific abdominal complaints in whom barium enema and subsequent colonoscopy showed a 3 cm lobulated adenocarcinoma within a villous adenoma arising from the appendiceal stump  
class6	2429	because such appendiceal malignancies have no specific clinical signs  symptoms  or radiologic features  preoperative diagnosis is extremely difficult  and colonoscopy may be required to clarify radiologically demonstrated irregularities  
class6	2430	adenocarcinoma of the colon occurring with intussusception in an adolescent  
class6	2430	hydrostatic reduction of intussusception is definitive therapy in most infants with this abnormality  
class6	2430	in the older child  adolescent  and adult  a polyp or tumor is often present  
class6	2430	operative intervention should be considered earlier in the clinical course both to relieve the intussusception and to define the nature of the lead point  
class6	2431	preventing postoperative acute bleeding of the upper part of the gastrointestinal tract  
class6	2431	two hundred and ninety eight critically ill patients at risk for the development of postoperative stress ulcers and bleeding were randomized into three groups  
class6	2431	the first group comprised 85 patients who received meciadanol  a new bioflavonoid  500 milligrams every six hours through a nasograstric tube  the second group comprised 100 patients who received sucralfate  crushed tablets   1 000 milligrams every six hours through a nasogastric tube  and the third group comprised 113 patients who received an antacid  maalox  magnesium aluminum hydroxide gel   through a nasogastric tube at an initial dose of 15 milliliters every hour  
class6	2431	the gastric ph was measured hourly and titrated to a ph greater than or equal to 4 0 in patients in the group receiving the antacid  
class6	2431	the gastric ph was measured every two hours in the other two groups  
class6	2431	bleeding in the upper part of the gastrointestinal tract was determined visually  frank blood in gastric contents  or by guaiac testing  
class6	2431	bleeding occurred in seven patients receiving meciadanol  nine receiving sucralfate and six receiving the antacid  
class6	2431	the difference in rates of bleeding was not statistically significant  
class6	2431	correlation between the severity of illness index and the development of bleeding was poor  at least in the low and intermediate index range  
class6	2431	in contrast  there was a strong correlation between the age of the patient and the development of bleeding  
class6	2431	only one patient younger than 50 years had bleeding develop  
class6	2431	apparently  meciadanol exerts its action by a mechanism other than ph control  
class6	2431	it may  therefore  fill an important gap in the ability to prevent postoperative stress ulcers and bleeding  
class6	2432	intraoperative scintigraphy for active small intestinal bleeding  
class6	2432	localizing active sites of bleeding within the small intestine remains a difficult task  
class6	2432	endoscopic  angiographic or scintigraphic studies may point to the small intestine as the site of blood loss  but at operation  without a palpable lesion  the exact site of bleeding remains elusive  
class6	2432	patients are managed at laparotomy with intraoperative endoscopy  angiography  multiple enterotomies   blind  resections  or placement of an enterostomy  
class6	2432	we describe two patients in whom intraoperative scintigraphy accurately identified active sites of bleeding in the small intestine when other modalities failed  
class6	2432	intraoperative scintigraphy is rapid  easy to perform and is an effective means of identifying active sites of bleeding within the small intestine  
class6	2433	high or low hepaticojejunostomy for bile duct strictures  
class6	2433	the 19 patients who underwent 22 postoperative repairs of bile duct stricture in our institution between 1973 and 1984 were evaluated to assess whether the recognition of the tenuous blood supply of the supraduodenal bile duct in 1979 had improved the results thereafter  
class6	2433	thirteen of these 22 operations followed a previous biliary tract repair  in 10 of the operations a low anastomosis had been performed without taking blood supply into account  
class6	2433	follow up was complete and ranged from 5 to 15 years  
class6	2433	there were no operative deaths and minimal morbidity  
class6	2433	there were three deaths at a later time  
class6	2433	five of the 11 patients treated by surgery to 1979 had a clinically unsatisfactory result  recurrent strictures developed in all five patients  
class6	2433	all but one of the eight patients receiving a high hepaticojejunostomy from 1980 had a clinically satisfactory result with no recurrent strictures  
class6	2433	the one exception was the patient who had a second repair with separate high right and left hepatic duct anastomoses and who has ongoing symptoms from preexisting secondary sclerosing cholangitis  
class6	2433	the results in the five high repairs performed for low strictures were particularly striking  all five were asymptomatic  
class6	2433	this study lends support to the hypothesis of an ischemic basis for biliary strictures and to the recommendation that strictures be repaired with a high hepaticojejunostomy  
class6	2434	biliobiliary fistula  preoperative diagnosis and management implications  
class6	2434	experience with cholecystohepaticodochal and cholecystocholedochal fistulas as a result of an erosion of gallstones from the gallbladder into the adjacent common duct in five patients is presented  
class6	2434	the incidence was 1 4  in a population of 350 patients undergoing cholecystectomy  
class6	2434	the condition was indicated clinically on the basis of a symptom triad of jaundice  fever  and pain with cholelithiasis in a small contracted gallbladder  
class6	2434	in addition  proximal intra  and extrahepatic ductal dilatation  calculus in the common duct  and normal caliber  or unprofiled  distal common duct on ultrasound scan were present in all the patients  
class6	2434	endoscopic retrograde cholangiopancreatography proved to be the most useful means of investigation  and it confirmed the diagnosis in four patients before surgery  
class6	2434	a modified antegrade cholecystectomy was performed with the gallbladder opened inferiorly at the fundus  and the stones were evacuated  
class6	2434	a partial cholecystectomy and choledochoplasty were accomplished with gallbladder flaps whenever feasible  
class6	2434	other useful operative procedures are side to side hepaticodochojejunostomy and hepaticodochoduodenostomy  
class6	2434	in the presence of high benign bile duct stricture  an approach to the left hepatic duct is now preferred for biliary bypass  
class6	2435	the role of gastric resection in the management of multicentric argyrophil gastric carcinoids  
class6	2435	a patient with pernicious anemia  atrophic non antral gastritis  hypergastrinemia  and widespread hyperplasia of enterochromaffin like cells and manifest enterochromaffin like cell carcinoma was followed up during 39 months  including 15 months after gastric resection  
class6	2435	in this case normalization of gastrin levels did not prevent the development of multiple gastric carcinoids in the fundic mucosa  suggesting that factors other than gastrin are of importance in the pathogenesis  
class6	2436	esophageal reflux before and after isolated myotomy for achalasia  
class6	2436	four patients with achalasia underwent 24 hour esophageal ph measurements as ambulatory patients before and after limited myotomy without fundoplication  
class6	2436	resting lower esophageal sphincter pressure was reduced from 24 3     1 3 mm hg to 7 5     4 3 mm hg  
class6	2436	no significant differences  p greater than 0 05  were found before and after operation in the total 24 hour ph data distribution  ph 6 24     0 84 vs 5 75     1 03   the fraction of time below ph 4 0  4 8      5 3  vs 8 0      6 9    or the mean duration of reflux episodes greater than 5 minutes  22 8     18 8 minutes vs 23 0     10 minutes   all     sd  
class6	2436	effective relief of esophageal obstruction in achalasia is feasible by isolated limited myotomy without producing gastroesophageal reflux  
class6	2437	incisional parapubic hernias  
class6	2437	a parapubic hernia  distinct from other lower abdominal wall hernias  is identified as a particular type of incisional hernia  
class6	2437	this hernia results from the disruption of the musculotendinous elements of the abdominal wall as they insert into the pubis  
class6	2437	this disruption is brought about by either the destruction of these musculotendinous tissues at their lower end or the resection of portions of the pubic bone as is sometimes done in suprapubic radical prostatectomies for easier access to the prostate  
class6	2437	seven cases have been identified and reported  
class6	2437	men and women were seen to make up a clinical picture that is suggestive of the diagnosis  namely  multiple previous operations through the lower abdominal wall  procedures of a gynecologic or urologic nature  a herniation that mimics an incisional or inguinal hernia  and a defect that cannot possibly be corrected without the use of a prosthesis  
class6	2437	when the diagnosis is accurately established  the polypropylene mesh is inserted in the preperitoneal space and anchored laterally to the ligaments of cooper and in between to the arcuate pubic ligament and the periosteum of the posterior aspect of the pubis  
class6	2437	excellent results have been obtained  and the success must be ascribed to the recognition of the parapubic hernia as a distinct entity  
class6	2438	portal vein resection with a new antithrombogenic catheter  
class6	2438	curative resection of pancreatic and hepatobiliary tumors is rarely possible because of local invasion  especially into the portal vein  
class6	2438	we developed a new antithrombogenic catheter using a heparinized hydrophilic polymer to allow portal vein bypass during resection of tumors invading the portal vein  
class6	2438	pancreatectomy or hepatectomy accompanied by portal vein resection was performed for pancreatic or hepatobiliary cancer  with an intraoperative shunt from the superior mesenteric vein to the femoral vein or from the superior mesenteric vein to the intrahepatic portal vein through the umbilical vein or the hepatic hilar portal vein  
class6	2438	use of the shunt prevented stasis in the superior mesenteric vein and hepatic ischemia even during prolonged occlusion of the portal vein  and portal vein resection was performed in 81 patients with hepatobiliary and pancreatic disease with greater safety and ease  
class6	2439	gastric outlet obstruction caused by traumatic pseudoaneurysm of superior mesenteric artery  
class6	2439	traumatic pseudoaneurysms of the superior mesenteric artery  sma  are extremely rare  
class6	2439	we describe two cases of posttraumatic proximal sma pseudoaneurysms with symptoms of gastric outlet obstruction  
class6	2439	repair was accomplished by aorta sma bypass with saphenous vein  
class6	2439	injuries to the proximal sma are easily missed at laparotomy  especially if intestinal ischemia or hematomas are absent  
class6	2439	recognition and repair are stressed to avoid the complications associated with pseudoaneurysm formation  
class6	2440	high ethanol consumption as risk factor for intracerebral hemorrhage in young and middle aged people  
class6	2440	we examined the prevalence of high ethanol intake  hypertension  and other risk factors for intracerebral hemorrhage in a case control study of 24 young and middle aged patients with intracerebral hemorrhage  
class6	2440	we recorded ethanol consumption  history of hypertension  liver disease  cigarette smoking  and mild or severe coagulation disorder in each case of intracerebral hemorrhage and in 48 control patients matched by sex and age  
class6	2440	in univariate matched analyses  the frequencies of high ethanol intake  p   0 009   hypertension  p   0 05   and coagulation disorder  p   0 05  were higher in the cases than in the controls  
class6	2440	after controlling for possible confounding factors  we found that high ethanol intake and hypertension were the only independent risk factors for intracerebral hemorrhage  p   0 02 and p   0 05  respectively   
class6	2440	the hemorrhagic lesion found in cases with a high ethanol intake tended to be located in the cerebral lobes  p   0 01   contrasting with the typical basal ganglia location of hypertensive hematomas  p   0 009   
class6	2440	we conclude that chronic  high ethanol intake should be considered as an important risk factor for lobar hematomas in young and middle aged people  
class6	2441	dietary predictors of symptom associated gallstones in middle aged women  
class6	2441	in 1980  88 837 women aged 34 59 y completed a semiquantitative food frequency questionnaire and were followed for 4 y  
class6	2441	four hundred thirty three women reported a cholecystectomy for recent cholecystitis  and 179 reported unremoved  newly symptomatic gallstones diagnosed by ultrasound or x ray  
class6	2441	among the 59 306 women with quetelet s index of relative weight less than 25 kg m2  inverse associations were observed between intakes of vegetable fat and vegetable protein and the risk of reportedly symptomatic gallastones  after adjusting for age  quetelet s index in 1980  weight change between 1976 and 1980  energy intake  and alcohol intake  
class6	2441	the relative risk in the highest quintile of vegetable fat intake  as compared with the lowest quintile  was 0 6  95  confidence interval  ci   0 4 0 9   and the corresponding relative risk for vegetable protein intake was 0 7  95  ci  0 6 0 9   
class6	2441	no significant associations were found with energy adjusted intakes of cholesterol  animal fat  animal protein  carbohydrate  or sucrose  
class6	2442	effects of common illnesses on infants  energy intakes from breast milk and other foods during longitudinal community based studies in huascar  lima   peru  
class6	2442	to assess the effects of common infections on dietary intake  131 peruvian infants were observed longitudinally  
class6	2442	home surveillance for illness symptoms was completed thrice weekly  and food and breast milk consumption was measured during 1615 full day observations  
class6	2442	mean      sd  energy intakes on symptom free days were 557     128 kcal d  92 4     26 5 kcal kg 1 d 1  for infants aged less than 181 d and 638     193 kcal d  77 7     25 7 kcal kg 1 d 1  for infants aged greater than 180 d  
class6	2442	statistical models controlling for infant age  season of the year  and individual showed significant 5 6  decreases in total energy intake during diarrhea or fever  
class6	2442	there were no changes with illness in the frequency of breast feeding  total suckling time  or amount of breast milk energy consumed  
class6	2442	by contrast  energy intake from non breast milk sources decreased by 20 30  during diarrhea and fever  and the small decrements in total energy consumption during illness were explained entirely by reduced consumption of non breast milk foods  
class6	2443	inflammatory myofibroblastic tumor  plasma cell granuloma   clinicopathologic study of 20 cases with immunohistochemical and ultrastructural observations  
class6	2443	twenty cases of inflammatory myofibroblastic tumor  imt  were studied  19 involved the lung and 1 the esophagus only  
class6	2443	the patients  ages ranged from 3 to 72 years  
class6	2443	there were 9 males and 11 females  
class6	2443	involvement of a bronchus was seen in one case and of mediastinal structures in four  
class6	2443	chest pain and dyspnea were common symptoms  eight patients were asymptomatic  
class6	2443	seven patients underwent lobectomy  12 local excision  and 1 biopsy alone  
class6	2443	the lesions were nonencapsulated and ranged from 1 2 to 15 cm  
class6	2443	various proportions of plasma cells  histiocytes  and spindle cells were observed  the latter corresponded ultrastructurally to fibroblasts and myofibroblasts  were immunoreactive for vimentin and actin and focally for desmin  and were negative for epithelial markers  
class6	2443	plasma cells were polyclonal for light chains  
class6	2443	one patient had two recurrences  and in one case a large pleural imt was found eight years after the excision of a similar lesion in the lung  
class6	2443	all patients with follow up  ten  were well as long as ten years after the diagnosis  average  3 7 years   
class6	2444	computerized tomography in acute gastrointestinal disorders  
class6	2444	in recent years  computerized tomography  ct  has become one of the most important imaging modalities in evaluation of patients with acute gastrointestinal disorders  
class6	2444	its role  diagnostic accuracy  indications  and limitations in some of the most commonly encountered acute abdominal conditions are succinctly presented and reviewed  
class6	2444	ct should not be used indiscriminantly  but is best considered a valuable primary or complimentary diagnostic tool in critically ill patients  
class6	2444	its selective use in a variety of emergency abdominal diseases will significantly improve accuracy of clinical diagnoses  leading to a prompt and adequate medical or surgical management  
class6	2445	effect of omeprazole and high doses of ranitidine on gastric acidity and gastroesophageal reflux in patients with moderate severe esophagitis 
class6	2445	thirty to fifty percent of patients with reflux esophagitis fail to heal after treatment with conventional doses of h2 receptor antagonists  whereas omeprazole administration induces more than 90  healing  
class6	2445	to investigate the effect of omeprazole and higher than presently recommended doses of h2 blockers  we evaluated gastric acidity and gastroesophageal reflux in 17 patients with severe moderate esophagitis before and after treatment with 300 mg ranitidine twice daily or 20 mg omeprazole once daily  
class6	2445	three ph metric studies were performed  in a cross over design  before and after 8 days of treatment with omeprazole or ranitidine  
class6	2445	both drugs significantly reduced intragastric acidity  p less than 0 001  during both night and day hours  
class6	2445	median hourly 24 h intragastric ph was 1 8 in the basal study  2 9 after ranitidine  and 3 4 after omeprazole  
class6	2445	intragastric acidity fell from 84 0 mmol l in the basal study to 14 2 mmol l  79  inhibition  with ranitidine and 9 3 mmol l  84  inhibition  with omeprazole  
class6	2445	patients with esophagitis were significantly more exposed to acid than healthy subjects  in both the supine and upright position  p less than 0 01   
class6	2445	the time with esophageal ph less than 4 dropped from 23 9  in the basal study to 8 5  with ranitidine and to 7 2  with omeprazole  p less than 0 001   
class6	2445	both drugs significantly reduced esophageal exposure to acid in both the supine and upright positions  p less than 0 001   whereas neither had any effect on esophageal acid clearance  
class6	2446	esophageal 24 h ph monitoring  is prior manometry necessary for correct positioning of the electrode  
class6	2446	in 24 h esophageal ph monitoring  the electrode is usually positioned 5 cm above the manometrically localized esophagogastric junction  
class6	2446	in order to replace esophageal manometry for this purpose  we tested whether the esophagogastric junction can be identified correctly by fluoroscopy or the determination of the ph step between stomach and esophagus  compared with esophageal manometry  
class6	2446	the distance from the nares to the esophagogastric junction was determined three times with each of the three methods in 46 patients and 14 volunteers  
class6	2446	fluoroscopy assumed the esophagogastric junction 1 23     0 23 cm  mean     se  lower than the peak pressure point determined at manometry  ph step only 0 45     0 16 cm  
class6	2446	with ph step  only one subject had a difference of more than 3 cm to the manometrically defined esophagogastric junction  whether gastroesophageal reflux disease  as proven by ph monitoring  was present or not  
class6	2446	we conclude that the esophagogastric junction can usually be identified with sufficient accuracy by the measurement of the ph step between stomach and esophagus  
class6	2446	fluoroscopy is far less accurate than ph step  and should not be used  
class6	2447	dysphagia following fundoplication   slipped  fundoplication versus achalasia complicated by fundoplication  
class6	2447	failure to obtain preoperative esophageal manometry in patients being considered for antireflux surgery can result in immediate persistent postoperative dysphagia due to a missed diagnosis of achalasia  
class6	2447	we describe the clinical assessment and management of a case of delayed postoperative dysphagia due to a  slipped  fundoplication  which is contrasted with three patients with immediate postoperative dysphagia due to a missed diagnosis of achalasia  
class6	2447	surgical revision was required to correct the  slipped  fundoplication  and pneumatic dilatation was successfully used in two of three cases of achalasia complicated by fundoplication  
class6	2447	careful preoperative esophageal evaluation with manometry is essential to rule out the presence of a primary esophageal motor disorder  
class6	2448	endoscopic management of chronic organoaxial volvulus of the stomach  
class6	2448	endoscopic correction of the chronic organoaxial volvulus of the stomach was attempted in seven cases of primary and three cases of secondary volvulus  
class6	2448	endoscopic correction was successful in six cases of primary volvulus and one case of volvulus secondary to duodenal carcinoma  
class6	2448	this paper describes the details of the technique of endoscopic correction of gastric volvulus  and documentation of correction of the volvulus by barium meal study with a follow up of 5 26 months  
class6	2449	recurrence of duodenal ulcer and elevated serum pepsinogen i levels in smokers and nonsmokers  
class6	2449	we determined serum pepsinogen i  pg i  levels by radioimmunoassay in 472 patients with duodenal ulcer and 141 normal subjects to investigate whether serum pg i levels were related to cigarette smoking  and in 225 patients to determine whether the recurrence of duodenal ulcer was related to serum pg i levels or cigarette smoking  
class6	2449	serum pg i levels were not influenced by cigarette smoking in either patients with duodenal ulcer or normal subjects  
class6	2449	the recurrence rate of duodenal ulcer not under maintenance therapy was significantly higher in hyperpg i patients than in normopg i patients  regardless of their smoking habits  
class6	2449	only in hyperpg i patients was the recurrence rate in smokers higher than in nonsmokers  
class6	2449	patients under maintenance therapy showed similar results  
class6	2449	multilogistic regression indicated that hyperpg i had a greater effect than cigarette smoking on ulcer recurrence  
class6	2449	these findings indicate that serum pg i levels are not influenced by smoking  and the important characteristic in patients with recurrent duodenal ulcers is the increased serum pg i levels  
class6	2450	adenocarcinoma arising in barrett s esophagus after total gastrectomy 
class6	2450	a 64 yr old japanese male who underwent a partial gastrectomy for a duodenal ulcer at the age of 21  a total resection of the remnant stomach for a stomal ulcer at age 25  and in whom barrett s esophagus was diagnosed at age 47  was found to have a tumor at the distal esophagus and was operated on by thoracic esophagectomy  
class6	2450	the tumor was a well to moderately differentiated adenocarcinoma invading down to the muscularis propria  
class6	2450	the entire esophageal mucosa in the resected specimen was lined by columnar epithelium  
class6	2450	this tumor was thought to derive from the barrett s esophageal epithelium  
class6	2451	 spontaneous sump syndrome   successful treatment by duodenoscopic sphincterotomy  
class6	2451	 sump syndrome  is a rare complication of side to side choledochoenterostomy operations which develops in the distal  nonfunctioning limb of the common bile duct where lithogenic bile  gastrointestinal contents  and debris accumulate  
class6	2451	we report here a patient who developed spontaneous sump syndrome as a result of the formation of choledochoduodenal fistula  and who presented with multiple pyogenic liver abscesses  
class6	2451	the patient s symptoms and liver abscesses resolved completely after treatment by endoscopic sphincterotomy and antibiotics  
class6	2451	this case demonstrates that sump syndrome may occur spontaneously  that it can be a cause for pyogenic liver abscess formation  and that it may be treated effectively by endoscopic sphincterotomy  
class6	2452	hepatic portal venous gas  an unusual presentation of crohn s disease  
class6	2452	hepatic portal venous gas is associated with numerous conditions and traditionally has been regarded as an ominous prognostic sign  
class6	2452	there are several reports of hepatic portal venous gas occurring in patients with inflammatory bowel disease after or during the performance of colonic diagnostic studies  
class6	2452	we report an unusual case of crohn s disease whose initial presentation included hepatic portal venous gas  
class6	2452	the literature of hepatic portal venous gas associated with inflammatory bowel disease is reviewed  
class6	2453	oral dissolution therapy for cholelithiasis  mix and match  
class6	2453	the authors conducted a prospective  randomized trial of chenodeoxycholic and ursodeoxycholic acid versus ursodeoxycholic acid alone in patients with cholelithiasis to determine their efficacy for dissolution of gallstones  
class6	2453	one hundred and twenty patients with radiolucent gallstones  less than or equal to 15 mm and who had a functioning gallbladder were enrolled  
class6	2453	the patients were divided into two groups based on the diameter of their largest stones  
class6	2453	seventy patients had stones larger than 5 mm but less than 15 mm  whereas 50 patients had stones that measured 5 mm or less  
class6	2453	the patients were randomly assigned to treatment with chenodeoxycholic acid plus ursodeoxycholic acid  5 mm kg of each  or ursodeoxycholic acid  10 mm kg  alone  
class6	2453	oral cholecystography  plain abdominal x rays  and ultrasonography of the gallbladder were done at 6  12  and 24 months  
class6	2453	dissolution was deemed to be complete if not stones were visualized on two examinations  
class6	2453	partial dissolution was defined as a 50  reduction in stone size and or number  
class6	2453	stones that were not detected by cholecystography but still detected during ultrasonography were considered to be partially dissolved  
class6	2453	plasma triglycerides  serum cholesterol  hdl  and serologic liver function tests were determined at 1  3  6  12  18  and 24 months  
class6	2453	in a select group of patients  bile rich duodenal aspirates were aspirated and analyzed for biliary lipid contents  
class6	2453	in the group with small stones  defined as less than or equal to 5 mm  complete stone dissolution occurred significantly more often utilizing combination therapy at 6 months  52  vs 24    and this trend persisted  although no longer significant  at 12 and 24 months  
class6	2453	combination therapy also achieved an improved rate of dissolution for large stones within 6 months  however  this did not persist at 12 and 24 months  
class6	2453	although not statistically significant  stone calcification occurred less often with combined therapy  
class6	2453	all treatment regimens were well tolerated  with only minor changes in bowel habits and mild elevations in serum transaminase levels  
class6	2453	serum lipid levels did not change with either therapy  
class6	2453	the authors concluded that the combination of chenodeoxycholic acid and ursodeoxycholic acid was the preferred therapy for gallstone dissolution  because it dissolves stones more rapidly  with a lower incidence of stone calcifications  and thus might reduce the long term cost of treatment  
class6	2454	autosomal dominant polycystic kidney disease  more than a renal disease  
class6	2454	autosomal dominant polycystic kidney disease  adpkd  is the most common genetic disease  affecting a half million americans  
class6	2454	the clinical phenotype can result from at least two different gene defects  
class6	2454	one gene that can cause adpkd has been located on the short arm of chromosome 16  
class6	2454	this discovery has made possible new methods for diagnosing the disorder in gene carriers prior to the development of renal cysts  
class6	2454	although renal cysts are clearly an important manifestation of the gene defect  other systemic manifestations are both common and clinically important  
class6	2454	cardiac valvular lesions  intracranial aneurysms  hepatic cysts  and diverticula are included in the array of systemic manifestations  
class6	2454	moreover  renal cysts are only one of a myriad of renal manifestations  
class6	2454	although adpkd was long considered an adult cystic disease  it is also a common cause of childhood cystic disease and must be considered in the differential diagnosis in that setting  
class6	2455	adult and pediatric peritonitis rates in a home dialysis program  comparison of continuous ambulatory and continuous cycling peritoneal dialysis  
class6	2455	we reviewed our 115 month experience with continuous ambulatory peritoneal dialysis  capd  and continuous cycling peritoneal dialysis  ccpd  in adult and pediatric patients to determine whether there is a difference in the incidence of peritonitis between patients performing capd or ccpd  
class6	2455	peritonitis rates were similar in patients performing capd or ccpd in both the adult and pediatric age groups  
class6	2455	the overall capd peritonitis rate was significantly lower in adult patients when compared with pediatric patients  
class6	2455	there was no difference in peritonitis rates for ccpd between adult and pediatric patients  
class6	2455	when the data are divided into 3 year subgroups  the incidence of peritonitis is significantly lower in adult patients undergoing either capd or ccpd when compared with pediatric patients during the years 1986 to 1988  
class6	2455	there is significant improvement over time in the incidence of peritonitis in both adult and pediatric patients performing ccpd  similarly  there is a trend toward improvement in patients performing capd  
class6	2455	staphylococcus species organisms remain the most common bacterial cause of peritonitis  except in pediatric patients under the age of 2 years or with nephrostomies  where gram negative rod infections were more common  
class6	2455	peritonitis resulted in discontinuation of peritoneal dialysis in a greater number of adult patients  
class6	2455	these results suggest that the number of catheter manipulations is not important in determining the incidence of peritonitis  
class6	2455	pediatric patients are more likely than adult patients to develop peritonitis with either capd or ccpd  
class6	2455	adult patients are more likely than pediatric patients to discontinue peritoneal dialysis secondary to peritonitis  
class6	2456	clinical and manometric aspects of diffuse esophageal spasm in a cohort of subjects evaluated for dysphagia and or chest pain  
class6	2456	manometric criteria for diffuse esophageal spasm have recently been restated  
class6	2456	in this study  a cohort of 358 subjects was evaluated in a gastrointestinal motility laboratory for dysphagia and or chest pain  
class6	2456	applying the recently proposed criteria of richter and castell  18 subjects  5   were diagnosed as having des  
class6	2456	dysphagia was the major complaint  89    while 44  of patients complained of chest pain and 33  of both symptoms  
class6	2456	all patients shared more than 30  simultaneous contractions after wet swallows interspersed with normal peristaltic sequences  
class6	2456	associated manometric findings were repetitive  greater than 3 peaks  contractions  67    high amplitude contractions  33    spontaneous activity  22    prolonged duration  11    and lower esophageal sphincter abnormalities  5    
class6	2456	radiology disclosed significant abnormalities in only 27  of des patients  
class6	2457	endometrioma of the liver  
class6	2457	hepatic endometriosis is extremely rare  
class6	2457	we describe a patient sent to us with epigastric pain as the only symptom and who was found to have associated endometrioma of the liver and left ovary  
class6	2457	we suggest a gynecologic evaluation before surgery for hepatic cyst of unknown cause  
class6	2458	hemoperitoneum as a result of coital injury without associated vaginal injury  
class6	2458	hemoperitoneum as a result of coital injury without associated vaginal injury is an extremely rare entity  and evidence by only five cases that have been reported in the medical literature to date  
class6	2458	we report five additional cases encountered in two medical centers  
class6	2458	two of these were ruptured corpus luteum cysts  one was a laceration of the round ligament  another was a laceration of an ovary  and the fifth was rupture of a serous cystadenoma  
class6	2458	this diagnosis should be considered in patients with hemoperitoneum after coitus  
class6	2459	the associated anomalies that determine prognosis in congenital omphaloceles  
class6	2459	cogenital abdominal wall defects such as omphaloceles can be recognized by fetal ultrasonography  
class6	2459	to determine whether associated anatomic features may be useful in determining fetal prognosis  a retrospective study was performed over a 5 year period  
class6	2459	there were 28 cases of omphalocele  16 were larger than 5 cm and classified as giant  and the remainder were considered small  
class6	2459	eleven of the 12 infants with small omphaloceles survived with minimal neonatal complications  
class6	2459	ten of the 16 infants with giant omphaloceles died because of associated congenital anomalies  
class6	2459	these were congenital heart disease  central nervous system malformations  and diaphragmatic hernias  
class6	2459	this review suggests that the prognosis is good when a prenatal diagnosis of giant omphalocele is made and careful fetal ultrasonography  including echocardiography  does not identify heart  central nervous system  or diaphragmatic malformations  even when there is liver herniation into the omphalocele  
class6	2460	a clinicopathologic study of the eyes in familial adenomatous polyposis with extracolonic manifestations  gardner s syndrome   
class6	2460	the eyes of a 51 year old woman with familial adenomatous polyposis and extracolonic manifestations  gardner s syndrome  were obtained postmortem and studied by light microscopy and by transmission and scanning electron microscopy  
class6	2460	we found a generalized abnormality in melanogenesis of the retinal pigment epithelium and at least three types of pigmented lesions  
class6	2460	the histologic findings in one type of lesion were consistent with congenital hypertrophy of the retinal pigment epithelium or benign pigmented nevus of the retinal pigment epithelium  
class6	2460	the other two types of lesion were most consistent with hamartomatous malformations of the retinal pigment epithelium featuring cellular hypertrophy  hyperplasia  and rarely retinal invasion and formation of a minute mushroom shaped tumor  
class6	2460	these histopathologic findings indicate a generalized effect of the familial adenomatous polyposis gene on the retinal pigment epithelium  
class6	2460	this oncogene  which is responsible for tumor formation in the gastrointestinal tract  soft tissues  bone  and other locations in patients with familial adenomatous polyposis  also leads to a generalized defect in melanogenesis and focal lesions of the retinal pigment epithelium  
class6	2461	histologic similarity of murine colonic graft versus host disease  gvhd  to human colonic gvhd and inflammatory bowel disease  
class6	2461	in a study designed to determine which t cell subsets are involved in the development of murine graft versus host disease  gvhd   a prospective histologic analysis of gastrointestinal involvement was performed  
class6	2461	in c57bl 6jxdba 2f1  b6d2f1  recipients of dba 2 donor spleen and bone marrow cells  the colonic histologic findings were found to be similar in many respects to the histologic findings reported in human colonic gvhd and were much more severe and diffuse than were the abnormalities of the small intestine  
class6	2461	host irradiation before transplantation was found to play an additive or synergistic role in the development of gvhd  
class6	2461	furthermore the histologic features noted in dba 2    b6d2f1 murine colonic gvhd suggest that bone marrow and spleen cell transplantation in this strain combination may be a useful model for studying the immunologic mechanisms involved in human inflammatory bowel disease  
class6	2461	thus severe colonic disease noted during the course of dba 2    b6d2f1 murine gvhd was found to have significant histopathologic similarities to both human gvhd enteropathy and other inflammatory diseases of the human colon  
class6	2462	development of multiple necrotizing enteritis induced by a tumor necrosis factor like cytokine from lipopolysaccharide stimulated peritoneal macrophages in rats  
class6	2462	we report the development of an animal model of multiple necrotizing enteritis  mne  in rats  
class6	2462	when rats were injected directly with a culture supernatant of lipopolysaccharide  lps  stimulated rat peritoneal macrophages into the abdominal aorta  the overt pathologic lesions of mne developed within 30 minutes after injection  
class6	2462	the rats showed an elevated level of blood fibrinogen degradation product content even 30 minutes after injection  
class6	2462	furthermore the rats that were pretreated intravenously with heparin sulfate did not develop mne  indicating the acute disturbances of blood microcirculation in the intestine  
class6	2462	multiple necrotizing enteritis was developed also by the injection with recombinant tumor necrosis factor  rtnf  but rarely was observed with even a high dose of recombinant interleukin 1  ril 1  or platelet activating factor  paf   
class6	2462	the supernatant was cytotoxic in vitro to tnf susceptible lm and many other cells but was less cytotoxic to the tnf resistant lr line  
class6	2462	partial purification of the supernatant suggested that the supernatant contained a cytokine that has biochemical features of tnf  
class6	2462	furthermore polyclonal anti tnf antibody could inhibit not only the cytotoxicity in vitro but also mne development in vivo by this factor  
class6	2462	these data strongly indicate that mne possibly could be caused by a tnf like cytokine produced by macrophages that are stimulated by the endotoxin  
class6	2463	association of hepatitis b surface antigen and core antibody with acquisition and manifestations of human immunodeficiency virus type 1  hiv 1  infection  
class6	2463	we examined the associations between seropositivity for hepatitis b virus  hbv  with the presence or development of antibodies to human immunodeficiency virus  hiv 1  and with hiv 1 induced t helper lymphocyte deficiency or acquired immunodeficiency syndrome  aids   
class6	2463	serologic data on hbv and hiv 1  cytometric enumeration of cd4  lymphocytes  clinical events  aids by centers for disease control criteria  and hepatitis b vaccination histories were available on 4 498 homosexual participants in the multicenter aids cohort study  men were classified as to previous infection with hbv and prevalent or incident infection with hiv 1  
class6	2463	although there was an association between seropositivity for hbv infection and hiv 1 infection at enrollment  odds ratios anti hbc 2 6  hbsag 4 2   the relation between hbv seropositivity and subsequent seroconversion to hiv 1 was weaker  odds ratios 1 3 and 1 6   
class6	2463	hiv 1 seroconversion was also associated with a history of certain other sexually transmitted diseases  but predisposing sexual practices did not account for the association between hbv and hiv 1 infection  
class6	2463	seropositivity for hbv infection at entry was not related to initially low or more rapid subsequent decline in t helper lymphocyte counts and was not associated with an increased incidence of aids during 2 5 years of follow up  
class6	2463	history of vaccination against hbv did not appear to decrease susceptibility to hiv 1 infection or to subsequent progression of immunodeficiency  
class6	2463	we conclude that prior hbv infection is unlikely to be specifically associated with acquisition of hiv 1 infection and is unrelated to more rapid progression of hiv 1 induced immunodeficiency  
class6	2464	human t cell lymphotropic virus infection in guaymi indians from panama  
class6	2464	preliminary studies found that 9  of guaymi indians from bocas del toro province have antibody to human t cell lymphotropic virus  htlv i ii   
class6	2464	the present study enrolled 317  21  of the population  guaymi indians from changuinola  the capital of bocas del toro province and 333  70  of the population  from canquintu  an isolated rural village  
class6	2464	demographic information and family relationships were ascertained and subjects were screened for neurologic diseases  
class6	2464	serum specimens were screened by an enzyme linked immunosorbent assay for htlv i ii antibody and positives were confirmed according to u s  
class6	2464	public health service criteria  
class6	2464	twenty five  8   guaymi residing in changuinola and 7  2 1   from canquintu were confirmed seropositive  
class6	2464	in changuinola  antibody was virtually limited to residents greater than or equal to 15 years of age  24  16   of 153  and rates were slightly higher in males than in females  in canquintu  antibody rates did not increase significantly with age and appeared higher in females than in males  
class6	2464	in changuinola  there was no evidence for household clustering of infection  
class6	2464	in contrast  htlv antibody among canquintu residents clustered significantly by household  
class6	2464	htlv associated neurologic disease was not detected in either population  
class6	2464	the atypical seroepidemiology observed in both locations might be explained if the virus endemic to the guaymi differed from htlv i previously described in the caribbean basin and japan  
class6	2465	recurrence rate after discontinuation of long term mebendazole therapy in alveolar echinococcosis  preliminary results   
class6	2465	the recurrence rate was investigated in 19 patients with non resectable alveolar echinococcosis after discontinuation of a long term therapy with mebendazole  average treatment 4 3 years   
class6	2465	a control group consisted of 14 patients who underwent radical surgery and finished a course of prophylactic postoperative mebendazole treatment of 2 years  
class6	2465	in the controls  no recurrence was observed after a post therapy period averaging 3 5 years  
class6	2465	in contrast  recurrence occurred in 7 19 patients  37   with non resectable alveolar echinococcosis an average of 1 6 years after discontinuation of the long term mebendazole therapy  
class6	2465	the absence of clinically detectable recurrence in the remaining 12 patients seems to be due either to spontaneous inactivation of alveolar echinococcosis preceding chemotherapy or too short post therapy surveillance  
class6	2465	the patients with recurrence responded favorably to reintroduction of chemotherapy  
class6	2465	the data indicate that mebendazole therapy is parasitostatic rather than parasiticidal  
class6	2466	high incidence of viral hepatitis among american missionaries in africa  
class6	2466	protestant missionaries  n   360  serving in sub saharan africa between 1967 1984 were studied to determine the risk of hepatitis a virus  hav  and hepatitis b virus  hbv  infection  
class6	2466	personnel were serologically screened for antibody to both the hepatitis a virus  anti hav  and the surface antigen to the hepatitis b virus  anti hbs  prior to departure  periodically during service abroad  and upon completion of their african tour  
class6	2466	rates of seroconversion were used as measures of the incidence of infection  
class6	2466	prior to service  16  of the staff had anti hav and 3  had anti hbs  post service rates were 42  and 26   respectively  
class6	2466	over 90  of the staff with greater than 20 years of service were seropositive for anti hav  
class6	2466	for both viruses  the infection rate was highest during the first 1 2 years of service  when 28  of those susceptible to hav and 11  of those susceptible to hbv became infected  
class6	2466	over the next decade  the median annual attack rate was 5 4  for hav and 4 2  for hbv  
class6	2466	differences in the missionary hbv infection rate among the various african nations served tended to reflect differences in the magnitude of chronic hbv carriage among indigenous population groups  
class6	2466	we conclude that missionaries to sub saharan africa are at enhanced risk of both hav and hbv infection  and that all should receive passive immunization with immune globulin and active immunization with hepatitis b vaccine  
class6	2467	outpatient laparoscopic laser cholecystectomy  
class6	2467	laparoscopic laser cholecystectomy has been performed clinically in the united states since 1988  
class6	2467	after refinement of the technique  the procedure was offered on an outpatient basis  
class6	2467	eighty three patients underwent laparoscopic laser cholecystectomy during the study period  
class6	2467	thirty seven  45   had the procedure as an outpatient  
class6	2467	younger patients were more suited for the outpatient procedure and those without previous surgery were more likely to have the procedure done as an outpatient  
class6	2467	weight  operating time  and gallbladder pathology were similar  although patients with acute inflammation of the gallbladder were more likely to require hospitalization  
class6	2467	the primary reason for patient admission was patient preference  
class6	2468	rectal prolapse in infants and children  
class6	2468	rectal prolapse that is intractable to the usual medical therapy was successfully managed without significant complications in 10 patients by simple subcutaneous encirclement of the anus with a heavy nonabsorbable suture  which was in place until the suture was removed or broke after 4 to 6 months  
class6	2468	four patients required two sutures and one needed a third insertion  
class6	2468	since this procedure is simple  has no serious complications  and controls rectal prolapse  it is recommended as the preferred initial surgical treatment of this condition  
class6	2469	prevention of pancreatic fistula by modified pancreaticojejunal anastomosis  
class6	2469	a major cause of morbidity after pancreatoduodenectomy is leakage from the pancreaticojejunal anastomosis  
class6	2469	to prevent this complication  we have employed mucosal stripping from the proximal jejunum prior to end to end anastomosis in 19 patients with good results  
class6	2470	role of surgery in antibiotic induced pseudomembranous enterocolitis  
class6	2470	with the increased use of prophylactic and broad spectrum antibiotics  pseudomembranous colitis has emerged as a significant clinical problem  
class6	2470	management with specific anti clostridium difficile therapy  vancomycin or metronidazole  has reduced mortality to less than 2   
class6	2470	nevertheless  the disease may progress to a fulminant toxic colitis or colonic perforation  
class6	2470	additionally  another subset of patients will present with a dramatic clinical picture  suggesting acute peritonitis  eventuating in unnecessary laparotomy  
class6	2470	this report reviews both the medical and surgical literature during the past 15 years of patients treated for pseudomembranous colitis  
class6	2470	analysis of this clinical data has provided us with the opportunity to both define the role of surgery in this disorder and illustrate the necessity for a combined medical and surgical cooperative approach in the early management of this iatrogenic disease  
class6	2471	blood contamination of anaesthetic and related staff 
class6	2471	the incidence of skin contamination of anaesthetic and related staff by patient s blood and saliva was studied during 270 anaesthetics in cardiff hospitals over seven continuous days in october 1989  
class6	2471	a survey was also made of current hepatitis b immunisation status and glove wearing habits of 75 anaesthetists  
class6	2471	blood from 35  14   patients caused skin contamination of 65 staff during 46 incidents  
class6	2471	twenty eight  61   of the contamination incidents occurred during vessel cannulation  
class6	2471	five  8   of the 65 staff contaminated by blood already had cuts on their hands  
class6	2471	there were nine incidents  4   of skin contamination by saliva  
class6	2471	fifty three  71   anaesthetists were immunised against hepatitis b  
class6	2471	only seven  9   anaesthetists wear gloves for oral or nasal intubation  six  8   for insertion of peripheral venous cannulae  47  63   for insertion of arterial lines and 67  89   for insertion of central lines  
class6	2471	all anaesthetic and associated staff should wear gloves on a routine basis  
class6	2472	acute abdominal pain in the elderly  
class6	2472	study objectives  to determine the incidences of both specific diagnosis and surgical diseases in patients more than 65 years old who present to the emergency department with nontraumatic abdominal pain of less than one week s duration  and to determine the ed staff s ability to diagnose and triage elderly patients with acute abdominal pain  
class6	2472	design  a 12 month retrospective review of all elderly patients who presented to the ed with acute  nontraumatic abdominal pain  
class6	2472	setting  a regional trauma center serving a predominately rural population in the midwest  
class6	2472	the ed has 55 000 patient visits yearly  
class6	2472	measurements and main results  of the 127 patients enrolled  30  24   had no specific diagnosis made in the ed  
class6	2472	biliary tract disease  12   and small bowel obstruction  12   were the two most common specific diagnoses  
class6	2472	overall  53 patients  42   required surgery  usually during the initial hospitalization  
class6	2472	in four cases  the postoperative diagnosis differed significantly from the ed diagnosis  
class6	2472	of the 74 patients  58   who did not undergo surgery  51 had follow up information available  
class6	2472	in 14 patients  the follow up diagnosis differed from the original diagnosis  but most of these changes did not appreciably alter the treatment and outcome  
class6	2472	conclusions  the incidence of surgical disease is high in elderly patients with acute abdominal pain  and ed staff are able to diagnose and triage these patients accurately  
class6	2473	colobronchial fistula  a rare complication of crohn s colitis  
class6	2473	a 29 yr old white woman presented with chronic pneumonia in the left lower lobe and with left pleural effusion  
class6	2473	she was known to have inflammatory bowel disease  but she was asymptomatic under maintenance treatment with 5 asa  
class6	2473	she received numerous antibiotic regimens according to susceptibility testing of microorganisms cultured from sputum and bronchial lavage and on an empiric basis was also given antituberculosis treatment  but there was no clinical improvement or change in the chest radiographic findings  
class6	2473	sputum was repeatedly examined and yielded  among other organisms  clostridium inocuum  enterobacter  klebsiella pneumoniae  proteus mirabilis  and staphylococcus aureus  
class6	2473	on one microscopic examination of sputum  the presence of feculent material was suspected  
class6	2473	a subsequent gastrografin enema revealed a cologastric and colobronchial fistula between the splenic flexture of the colon and the greater curve of the stomach and the bronchial system  
class6	2473	segmental resection of the colon and resection of the lower lobe of the left lung were performed  
class6	2473	histologic findings of the resected colon were consistent with crohn s disease  
class6	2473	after a long period of postoperative recovery  the patient returned to good general health and well being  
class6	2473	to our knowledge  a colobronchial fistula caused by crohn s colitis has not been previously reported  
class6	2474	gastroesophageal reflux and sclerotherapy strictures  
class6	2474	the development of esophageal stricture is common following endoscopic variceal sclerotherapy  evs   
class6	2474	gastroesophageal reflux may be at least partly responsible  
class6	2474	twelve randomly selected male patients underwent chronic evs for the management of bleeding esophageal varices  
class6	2474	six patients developed strictures during or after evs  six did not  
class6	2474	there were no significant differences between stricture and nonstricture patients during 24 hour esophageal ph monitoring  
class6	2474	three of the six stricture patients and four of the six nonstricture patients had an abnormal amount of reflux  
class6	2474	gastroesophageal reflux occurs frequently in patients undergoing evs  and it is not likely to play a major role in evs stricture formation  
class6	2475	starch peritonitis  a case report and clinicopathologic review  
class6	2475	a case of starch peritonitis is presented with a review of the history of this continuing problem  
class6	2475	the syndrome s presentation  diagnosis  histopathology and treatment are discussed  
class6	2475	the rarity of starch peritonitis today may be due to more attention to glove washing by surgeons  fewer impurities in the glove powder or lack of recognition of the syndrome  
class6	2475	in order to prevent a resurgence of the starch peritonitis syndrome we must continue to emphasize the importance of washing gloves  maintain the quality control and purity of the powder used  and be cognizant of the signs and symptoms so that such cases may be managed nonoperatively  
class6	2476	cecal diverticulitis presented as a cecal tumor  
class6	2476	seven patients diagnosed as having acute appendicitis were operated on and a cecal wall mass due to cecal diverticulitis was found  
class6	2476	in two patients the mass could not be separated from the cecal wall and right colectomy was performed  
class6	2476	in five patients  in whom the mass could be separated from the cecum  conservative operations  three diverticulectomies and two wedge resections  were performed  thus avoiding needless  more extensive surgery  
class6	2477	intra abdominal abscesses in crohn s disease  
class6	2477	we reviewed 22 patients who had intra abdominal abscesses secondary to crohn s disease  
class6	2477	a total of 29 abscesses were discovered  
class6	2477	these included superficial and deep intraperitoneal as well as pelvic and retroperitoneal abscesses  
class6	2477	diagnosis was aided by ultrasound and computer tomographic scanning  
class6	2477	barium studies continue to play an important role in delineating the extent of bowel involvement and fistulization  
class6	2477	treatment varied depending on the location and size of the abscess  
class6	2477	the need for ultimate bowel resection was determined in the majority of cases by the presence of fistulization between the abscess cavity and the bowel  
class6	2477	the terminal ileum or neoterminal ileum were almost always involved  
class6	2478	association of acute colonic pseudo obstruction  ogilvie s syndrome  with herpes zoster  
class6	2478	ogilvie s syndrome  or acute pseudo obstruction of the colon is characterized by massive distension of the colon in the absence of organic distal obstruction  
class6	2478	the syndrome is associated with various unrelated and  most often  extra abdominal causes  
class6	2478	an association between ogilvie s syndrome and herpes zoster has been reported only once  by ceccese et al  
class6	2478	in 1985  
class6	2478	we present a second such case  
class6	2478	this patient did not show evidence of any active illness other than the involvement of the t10 dermatome by herpes zoster  
class6	2478	the patient s symptoms of colonic obstruction subsided with resolution of the zosteriform rash  
class6	2479	jejunal rectal fistula as a complication of postoperative radiotherapy  
class6	2479	we present the case of a patient with an unusual  complex enteric fistula with multiple tracts and associated abscesses  
class6	2479	the fistula was a late complication of radiotherapy  administered three years earlier  after resection for carcinoma of the sigmoid colon  
class6	2479	most of the small bowel was involved in the radiation induced disease  
class6	2479	a wide resection was performed successfully  
class6	2479	this report reviews current literature on intra abdominal postradiotherapy injuries  particularly intestinal fistulae  
class6	2480	the role of endoscopic retrograde pancreatography  erp  in blunt abdominal trauma  
class6	2480	the diagnosis of pancreatic injury is often difficult because it lies retroperitoneally in a protected area  
class6	2480	delayed diagnosis and treatment of blunt pancreatic trauma can result in significant morbidity and mortality  
class6	2480	endoscopic retrograde pancreatography  erp  is infrequently used in the diagnosis of pancreatic injury  
class6	2480	we reviewed our experience with the use of erp in patients with blunt pancreatic injury  
class6	2480	two stable patients with traumatic pancreatitis underwent erp shortly after injury  
class6	2480	ct scans revealed a transverse fracture of the distal pancrease in one and fluid accumulation in the other around the pancreas extending to the right kidney and left hepatic lobe  
class6	2480	the absence of ductal disruption on erp allowed nonoperative management of the pancreatitis  
class6	2480	resolution was documented by the absence of symptoms on regular oral intake  normal serum amylase levels  and normal follow up ct scans  
class6	2480	a third patient with persistent fistulae three months postinjury underwent preoperative erp revealing ductal obstruction  
class6	2480	this facilitated the planning of a distal pancreatectomy and subsequently the fistulae healed  
class6	2480	a fourth patient underwent an exploratory laparotomy on the basis of clinical and ct scan findings that could have been circumvented with preoperative erp  
class6	2480	erp in selected patients allows nonoperative treatment in the absence of ductal injury or earlier operative treatment of ductal injury  
class6	2480	it also aids the treatment of late complications by delineating ductal anatomy  
class6	2481	risk for colon adenomas in patients with rectosigmoid hyperplastic polyps 
class6	2481	objective  to determine whether hyperplastic polyps found in the rectosigmoid area of the colon are associated with proximal adenomas  and to judge whether patients with distal hyperplastic polyps found during sigmoidoscopy might benefit from full colonoscopy  
class6	2481	design  data on patients having colonoscopy collected prospectively according to a set protocol  
class6	2481	the size and location of all polyps were noted  and all polyps were biopsied  
class6	2481	setting  two university hospitals  
class6	2481	patients  one thousand eight hundred and thirty six consecutive patients referred for colonoscopy between 31 december 1987 and 31 august 1989  
class6	2481	results  of the 970 patients who met eligibility requirements  274  28 3   had adenomas and 108  11 1   had hyperplastic polyps  
class6	2481	the proportion of patients with distal hyperplastic polyps and proximal adenomas  31 9   was similar to the proportion of those without distal hyperplastic polyps  23 0    crude odds ratio  1 57  95  ci  0 77 to 3 06   
class6	2481	after adjusting for age and sex  the results were unchanged  adjusted odds ratio  1 53  ci  0 82 to 2 88   
class6	2481	patients with distal adenomas  on the other hand  were three times more likely to have proximal adenomas than those without distal adenomas  adjusted odds ratio  3 42  ci  1 99 to 5 88   
class6	2481	conclusions  distal hyperplastic polyps are not strong predictors of risk for proximal adenomas  
class6	2481	based on the magnitude of the risk difference  we do not believe that finding a hyperplastic polyp during sigmoidoscopy justifies doing a full colonoscopy to search for proximal adenomas  
class6	2481	because rectosigmoid adenomas are associated with proximal adenomas  however  small polyps seen during sigmoidoscopy should be biopsied to determine their type  
class6	2481	colonoscopy should be reserved for patients who are proved to have adenomas  
class6	2482	sexual and physical abuse in women with functional or organic gastrointestinal disorders  
class6	2482	study objectives  to determine the prevalence of a history of sexual and physical abuse in women seen in a referral based gastroenterology practice  to determine whether patients with functional gastrointestinal disorders report greater frequencies of abuse than do patients with organic gastrointestinal diseases  and to determine whether a history of abuse is associated with more symptom reporting and health care utilization  
class6	2482	design  a consecutive sample of women seen in a university based gastroenterology practice over a 2 month period was asked to complete a brief questionnaire  
class6	2482	measurements  the self administered questionnaire requested information about demographics  symptoms  health care utilization  and history of abuse  
class6	2482	physicians indicated the primary diagnosis for each patient and whether she had ever discussed having been sexually or physically abused  
class6	2482	results  of 206 patients  89  44   reported a history of sexual or physical abuse in childhood or later in life  all but 1 of the physically abused patients had been sexually abused  
class6	2482	almost one third of the abused patients had never discussed their experiences with anyone  only 17  had informed their doctors  
class6	2482	patients with functional disorders were more likely than those with organic disease diagnoses to report a history of forced intercourse  odds ratio  2 08  95  ci  1 03 to 4 21  and frequent physical abuse  odds ratio  11 39  ci  2 22 to 58 48   chronic or recurrent abdominal pain  odds ratio  2 06  ci  1 03 to 4 12   and more lifetime surgeries  2 7 compared with 2 0 surgeries  p less than 0 03   
class6	2482	abused patients were more likely than nonabused patients to report pelvic pain  odds ratio  4 05  ci  1 41 to 11 69   multiple somatic symptoms  7 1 compared with 5 8 symptoms  p less than 0 001   and more lifetime surgeries  2 8 compared with 2 0 surgeries  p less than 0 01   
class6	2482	conclusions  we found that a history of sexual and physical abuse is a frequent  yet hidden  experience in women seen in referral based gastroenterology practice and is particularly common in those with functional gastrointestinal disorders  
class6	2482	a history of abuse  regardless of diagnosis  is associated with greater risk for symptom reporting and lifetime surgeries  
class6	2483	ondansetron compared with high dose metoclopramide in prophylaxis of acute and delayed cisplatin induced nausea and vomiting  a multicenter  randomized  double blind  crossover study  
class6	2483	objective  to compare the efficacy and side effects of ondansetron with those of high dose metoclopramide in treating acute and delayed cisplatin induced nausea and vomiting  
class6	2483	design  randomized  double blind  crossover trial  
class6	2483	setting  conducted at two university hospitals  a cancer institute  and six community hospitals  
class6	2483	patients  of 125 patients  95 were evaluable for the acute phase and 79 for the delayed phase  
class6	2483	major reasons for not being evaluable were no second course  14 patients   protocol violation  5 patients   and change in cisplatin dose  3 patients  for the acute phase  and rescue medication on day 1  7 patients   protocol violation  3 patients   and inadequate data  4 patients  for the delayed phase  
class6	2483	interventions  all patients received cisplatin  50 to 100 mg m2 body surface area  median  75 mg m2   none had previously received chemotherapy  
class6	2483	thirty minutes before the cisplatin administration  ondansetron was given intravenously over 15 minutes  at a loading dose of 8 mg followed by a continuous infusion of 1 mg h for 24 hours  
class6	2483	metoclopramide was given at a loading dose of 3 mg kg body weight  followed by a continuous infusion for 8 hours  4 mg kg   
class6	2483	for the delayed phase  days 2 through 6   the first oral dose was given as soon as the infusion was completed  the oral dose consisted of either metoclopramide  20 mg three times daily  or ondansetron  8 mg three times daily for another 5 days  
class6	2483	measurements and main results  in the acute phase  a major or complete response was seen in 72  of the ondansetron treated and 41  of the metoclopramide treated patients  p less than 0 001   
class6	2483	nausea was significantly better controlled among the ondansetron treated patients  p   0 04   
class6	2483	in the delayed phase  no statistically significant difference was seen between ondansetron  and metoclopramide treated patients  
class6	2483	nausea was significantly better controlled with metoclopramide  p   0 016   
class6	2483	conclusions  ondansetron is significantly more effective than metoclopramide in preventing acute nausea and vomiting  
class6	2483	in the delayed phase  the results of both drugs were disappointing  although metoclopramide s effect on delayed nausea was superior  
class6	2483	patients preferred ondansetron  
class6	2484	polyneuropathy  ophthalmoplegia  leukoencephalopathy  and intestinal pseudo obstruction  polip syndrome  
class6	2484	we describe 5 individuals  from three separate families  with a progressive neurological disorder characterized by sensorimotor peripheral polyneuropathy  cranial neuropathies  external ophthalmoplegia  deafness   and the syndrome of chronic intestinal pseudo obstruction  
class6	2484	magnetic resonance imaging showed widespread abnormality of the cerebral and cerebellar white matter in the 2 patients studied  
class6	2484	autopsy examination in 3 revealed widespread endoneurial fibrosis and demyelination in the peripheral nervous system  possibly secondary to axonal atrophy  and poorly defined changes in cerebral white matter  leukoencephalopathy   
class6	2484	the cranial nerves and spinal roots were less severely involved and the neurons in the brainstem and spinal cord were intact  
class6	2484	the fatal gastrointestinal dysmotility was due to a severe visceral neuropathy  
class6	2484	we suggest that these patients manifested a hereditary disorder with distinctive clinical  radiological  and neuropathological features  and propose the acronym polip to emphasize the distinctive tetrad of polyneuropathy  ophthalmoplegia  leukoencephalopathy  and intestinal pseudo obstruction  
class6	2485	preoperative stabilisation in congenital diaphragmatic hernia  
class6	2485	between january 1983 and november 1986  26 newborn infants with congenital diaphragmatic hernia were treated by early operation at a mean of 7 hours of age  
class6	2485	a further 23 infants admitted between december 1986 and december 1989 were stabilised for a mean period of 40 hours before operation  
class6	2485	there was no significant difference in survival between the two groups  
class6	2485	delayed operation is not detrimental to infants with congenital diaphragmatic hernia  
class6	2486	the acutely affected abdomen in paraplegic spinal cord injury patients  
class6	2486	the records of 145 paraplegic or quadriplegic patients were reviewed to identify those factors useful in the correct diagnosis of the acute abdomen in this population  
class6	2486	twenty one patients had 22 episodes of acute or subacute abdominal problems  
class6	2486	presenting complaints  physical findings  and laboratory results were useful in various ways  
class6	2486	however appropriate radiographic studies led to the correct diagnosis in 77  of patients  
class6	2486	although paraplegic and quadriplegic patients are predisposed to a distinct constellation of medical problems  including urinary tract infection and calculi  they also may present with other abdominal conditions that cause significant morbidity and mortality if not promptly recognized  
class6	2487	results of a multicenter trial comparing imipenem cilastatin to tobramycin clindamycin for intra abdominal infections  
class6	2487	we designed a multicenter study to compare tobramycin clindamycin to imipenem cilastatin for intra abdominal infections  
class6	2487	we included the acute physiology and chronic health evaluation  apache ii  index of severity and excluded patients without established infection  
class6	2487	two hundred ninety patients were enrolled  of whom 162 were evaluable  
class6	2487	using logistic regression to analyze both outcome at the abdominal site of infection and outcome as mortality  we found a significant correlation for both with apache ii score  p less than 0 0001 for both   
class6	2487	next we analyzed the residual effect of treatment assignment and found a significant improvement in outcome for imipenem cilastatin treated patients  p   0 043   
class6	2487	the differences in outcome were explained by a higher failure rate for patients with gram negative organisms for tobramycin clindamycin treated patients  p   0 018   
class6	2487	this was reflected in a significantly higher incidence of fasciitis requiring reoperation and prosthetic fascial replacement  
class6	2487	maximum peak tobramycin levels were analyzed for 63 tobramycin clindamycin patients harboring gram negative organisms  
class6	2487	for failures the maximum peak was 6 4     1 9 micrograms ml  and time to maximum peak was 4 6     5 2 days  
class6	2487	for successes the maximum peak was 6 1     1 7 micrograms ml  occurring at 3 8     2 6 days  
class6	2487	this study supports inclusion of severity scoring in statistical analyses of outcome results and supports the notion that imipenem cilastatin therapy improves outcome at the intra abdominal site of infection as compared to a conventionally prescribed amino glycoside based regimen  
class6	2488	parietal cell vagotomy and dilatation for peptic duodenal stricture  
class6	2488	gastric outlet obstruction due to peptic duodenal stricture  pyloric stenosis  was treated with parietal cell vagotomy and dilatation of the stricture in 32 patients  
class6	2488	follow up is in the range of 5 years in 37 4  of the patients  while 6 to 10 years follow up is available in 62 4  of the patients  
class6	2488	at their last follow up  74 9  of the patients were in either visick 1 or 2 clinical status  
class6	2488	recurrence rates have been 3 1  at 1 year  9 3  at 5 years  and 21 8  after 6 to 10 years follow up  
class6	2488	there has been only one instance  3 1   of restenosis  
class6	2488	two patients required reoperation because of recurrence and one of them died  
class6	2489	prognostic determinants in extracorporeal membrane oxygenation for respiratory failure in newborns  
class6	2489	extracorporeal membrane oxygenation  ecmo  is becoming an accepted therapeutic modality for newborn respiratory failure  but there is little information available regarding the prognostic determinants with this technique  
class6	2489	one hundred thirty five newborns treated with ecmo over a 4 year period were critically analyzed with regard to the influence that birth weight  gestational age  age at initiation of ecmo  best blood gases before ecmo  number of hours on ecmo  renal failure  intracerebral hemorrhage  and long distance air transport had on survival  
class6	2489	infants with meconium aspiration and those undergoing long distance transfer showed significant differences in blood gases before ecmo  with survivors having more normal ph and carbon dioxide tension values  
class6	2489	intracerebral hemorrhage and renal failure that developed during ecmo were grave prognostic signs  with few survivors in either group  
class6	2489	these data show that ability to ventilate patients before ecmo  giving normal carbon dioxide tension and ph values  is an important prognostic sign in infants with meconium aspiration and undergoing long distance transfer for ecmo  whereas renal failure and intracerebral hemorrhage are usually lethal complications of ecmo  
class6	2489	each center performing ecmo should continually reevaluate this invasive technique and its results and complications  
class6	2490	acquired benign esophagorespiratory fistula  report of 16 consecutive cases  
class6	2490	sixteen cases of acquired benign esophagorespiratory fistula were treated in a 20 year period  
class6	2490	a delay in diagnosis was usual  and most patients were first seen with a pulmonary infection already developed  
class6	2490	contrast esophageal x ray studies established the diagnosis in all patients  
class6	2490	there were seven esophagotracheal and nine esophagobronchial fistulas  
class6	2490	a fistula between the esophageal diverticulum and a bronchus considered to be of inflammatory origin developed in 7 patients  
class6	2490	a fistula as the consequence of trauma developed in 9 patients  and these fistulas were situated at a higher level of the respiratory tree  
class6	2490	all patients underwent surgical treatment  in 12 it was definitive  and in 4 temporary gastrostomy was performed to improve nutrition before definite repair  
class6	2490	the definitive repair consisted of eventual diverticulectomy  division of the fistula  and suture of both esophageal and respiratory defects  
class6	2490	two patients required esophageal resection and later reconstruction with colon interposition  
class6	2490	one patient died  creating an operative mortality of 8 3  in the definitive repair group  
class6	2490	the remaining 11 patients had a gratifying long term result  
class6	2490	there were two deaths in the gastrostomy group due to an extremely poor condition of patients and debilitating pulmonary infection  
class6	2490	early diagnosis of this rare condition is necessary if severe pulmonary complications are to be avoided  
class6	2490	early direct repair gives excellent results  
class6	2491	collis gastroplasty  origin and evolution  
class6	2491	in 1957 j  
class6	2491	leigh collis published his innovative operation for treating the difficult problem of the irreducible hiatal hernia  esophagitis  and stricture  
class6	2491	the design of the operation was based on the relatively primitive understanding of hiatal hernia and the newly emerging concept of reflux esophagitis  
class6	2491	a variety of antireflux operations by different surgeons emerged over the years to follow  
class6	2491	the original collis gastroplasty has been subsequently modified with the addition of both partial and complete fundoplication procedures  
class6	2491	the place of the modified collis gastroplasty fundoplication operations in today s approach to the problems of hiatal hernia and gastroesophageal reflux disease remains unsettled  
class6	2492	congenital tracheoesophageal fistula associated with carcinoma of the lung in an adult  
class6	2492	a rare case of adult congenital h type tracheoesophageal fistula was diagnosed  
class6	2492	subsequently  at operation  large cell  undifferentiated carcinoma of the right middle lobe with extension to the right lobe and adherence to the diaphragm was documented  
class6	2492	the diagnosis  surgical intervention  and 4 year follow up are presented  
class6	2493	acute autonomic neuropathy  two cases and a clinical review  
class6	2493	acute autonomic neuropathy is an uncommon syndrome  usually affecting healthy young people  
class6	2493	presentation is often dramatic and initial misdiagnosis is common  
class6	2493	we describe two young women with acute autonomic neuropathy who presented with gastrointestinal involvement heralding widespread dysautonomia and review 26 additional cases of acute autonomic neuropathy from the english language literature  
class6	2493	acute autonomic neuropathy can be primarily cholinergic without orthostatic hypotension  26   or pandysautonomic  74   involving sympathetic adrenergic functions  
class6	2493	onset has been temporally related to viral syndromes in 20  of cases  with autonomic deficits usually evolving over 1 to 3 weeks  
class6	2493	gastroparesis  69   and syncope  12   are frequent presenting complaints  
class6	2493	spinal fluid protein levels are often  75   elevated in pandysautonomic subtypes  
class6	2493	prolonged and incomplete recovery is the rule  60    with persistent gastroparesis and orthostatic hypotension  
class6	2493	other specific diseases that occasionally mimic acute autonomic neuropathy include botulism  porphyria  amyloidosis  and paracarcinomatous neuropathies  
class6	2493	acute autonomic neuropathy shares several clinical features with acute idiopathic polyneuropathy  guillain barre syndrome   suggesting an immune mediated pathogenesis  
class6	2494	primary malignant peritoneal mesothelioma  a report of seven cases and a review of the literature  
class6	2494	mesothelioma of the peritoneum is a rare malignant neoplasm easily mistaken by both surgeon and pathologist for one of the more common neoplasms of the abdomen  
class6	2494	review of our records from metropolitan area hospitals for the past 15 years identified seven patients with primary peritoneal mesotheliomas  
class6	2494	their diagnosis  management  and survival is analyzed  
class6	2494	we report a case of an extended survivor  7 years  and one of a long term survivor  15 years   as well as what we believe to be the only case in the literature presenting with a coexistent malignant neoplasm  
class6	2494	prevention of this commonly fatal neoplasm is linked to avoiding occupational exposure to asbestos  long term survival for a few patients may be achieved with correct identification of the neoplasm and aggressive management  
class6	2494	this report includes a review of the literature  
class6	2495	management of perineal wounds following abdominoperineal resection with inferior gluteal flaps  
class6	2495	our experience treating perineal wounds secondary to abdominoperineal resection  either for inflammatory bowel disease or cancer  is presented  
class6	2495	a total of 16 patients were treated either on a delayed basis or at the same time as the abdominoperineal resection  
class6	2495	all wounds were closed using the inferior gluteal myocutaneous flap  
class6	2495	fifteen of 16 patients have achieved healing  eight of whom had no complications  
class6	2495	only minor revisions or local wound care were required in the remaining patients  with only one patient failing to heal  
class6	2495	our results compare favorably with previous reports of treatment of this difficult problem  
class6	2496	extrahepatic biliary obstruction by lymphoma  
class6	2496	extrinsic compression of the common bile duct by enlarged lymph nodes is an unusual cause of obstructive jaundice  
class6	2496	we describe two patients with such a manifestation of lymphoma and the use of endoscopic retrograde cholangiopancreatography in distinguishing this rare complication from other causes of jaundice in lymphoma  
class6	2496	patients may have rapid resolution of both symptoms and biochemical abnormalities by nonoperative biliary bypass combined with chemotherapy and or radiotherapy  
class6	2496	lymphomatous obstruction should be considered a cause of potentially treatable jaundice in patients with known lymphoma  endoscopic retrograde cholangiopancreatography can be valuable as a diagnostic and therapeutic tool  
class6	2497	plasma thrombomodulin in health and diseases  
class6	2497	sodium dodecyl sulfate polyacrylamide gel electrophoresis followed by immunoblot analysis of plasma thrombomodulin concentrate revealed that four degraded forms of thrombomodulin with different molecular weights are present in plasma  
class6	2497	plasma concentrations of thrombomodulin in patients with various diseases were measured by two methods of enzyme linked immunosorbent assay using monoclonal antibodies  
class6	2497	one method measures intact thrombomodulin and degraded forms of thrombomodulin  the other does not detect the two smaller degraded forms of thrombomodulin present in plasma  
class6	2497	the results indicated that thrombomodulin was increased in the circulating blood of patients with disseminated intravascular coagulation syndrome  pulmonary thromboembolism  adult respiratory distress syndrome  chronic renal failure  or acute hepatic failure  
class6	2497	the different values obtained by the two methods indicate that the increase of plasma thrombomodulin found in these patients was mainly due to an increase of the smaller fragments of degraded forms  suggesting that the release of thrombomodulin from endothelial cells was accelerated in various disease states by proteolytic activity generated on the surface of the endothelium and may be removed from the circulation mostly by the kidneys and liver  
class6	2498	ultrasonography in patients with suspected acute appendicitis  a prospective study  
class6	2498	the diagnostic accuracy of high resolution real time ultrasonography was prospectively studied in 240 patients admitted to the hospital with suspected acute appendicitis  
class6	2498	the criteria for ultrasound diagnosis of appendicitis included a sausage shaped  aperistaltic  hypoechoic structure when imaged along its longitudinal axis  with a target like appearance on transverse section  
class6	2498	the ultrasonographic findings were correlated with surgical pathological outcome in 82 cases with proven appendicitis  with laparotomy findings in another 21 patients and with clinical follow up in the remainder  
class6	2498	the overall sensitivity  specificity and accuracy of ultrasonography in the diagnosis of acute appendicitis were 78   92  and 87   respectively  
class6	2498	the positive predictive value was 84  and the negative predictive value was 88   
class6	2498	ultrasonography may significantly improve the diagnostic accuracy in patients with suspected acute appendicitis and should be performed in all patients in whom the clinical diagnosis is equivocal  
class6	2498	the ultrasonographic findings must be interpreted in light of the clinical findings  
class6	2499	a combined electromyographic and cineradiologic investigation in patients with defecation disorders  
class6	2499	records from 20 patients on whom defecography and electromyography were performed simultaneously because of defecation disorders were analyzed  
class6	2499	according to the electromyographic investigation  the patients could be divided into three main groups  1  normal sphincter reaction  2  paradoxical sphincter reaction  and 3  combined reaction  
class6	2499	group a was characterized by a marked reduction of muscular activity during emptying and a pronounced closing reflex after emptying  
class6	2499	this was followed by return of normal tonic activity  
class6	2499	patients in group b had no relaxation of the sphincters during emptying but a pronounced increased activity in the external sphincter and the puborectalis muscle  
class6	2499	they also had severe emptying difficulties at defecography  
class6	2499	no closing reflex was seen  
class6	2499	in group c the electrical activity in the sphincters increased during moderate straining and when emptying was complete a clear closing reflex was seen  
class6	2499	in this study  a dynamic visualization of the defecation together with a registration of electromyographic activity in the striated anal sphincters was performed  
class6	2499	it was shown that patients with paradoxical sphincter reaction were lacking a closing reflex after emptying was complete  
class6	2499	this has not been reported previously and is important evidence for the paradoxical defecation pattern  
class6	2499	it was also shown that the patients with rectoceles had paradoxical sphincter reaction  
class6	2500	perianal abscess and fistula in ano in children  
class6	2500	the authors present a retrospective review of 40 pediatric patients with perianal abscess and or fistula in ano  
class6	2500	the total patient population could be divided clinically into 2 broad groups  
class6	2500	the first group consisted of 22 infants younger than 2 years of age  all of whom were males  and 10 of whom presented with recurrences after previous incision and drainage  
class6	2500	of the 14 infants presenting with an abscess  in 12  85 7 percent   a fistula in ano was discovered at surgery  
class6	2500	in contrast  in the group of 18 children older than 2 years of age  there were 7 females and 11 males  and fistulas were identified in only 7 of 13 patients  54 8 percent  who presented with abscesses  
class6	2500	surgical treatment consisted of examination under anesthesia and a diligent search for a fistulous tract  
class6	2500	abscesses were primarily saucerized and fistulotomy and cryptotomy of the confluent crypt was performed if a fistulous tract was identified  
class6	2500	the only recurrences with this form of treatment occurred in the two immunocompromised patients  
class6	2501	nitrite from inflammatory cells  a cancer risk factor in ulcerative colitis  
class6	2501	elevated levels of luminal nitrite and a lowered luminal ph were found in 77 percent of patients with acute ulcerative colitis  
class6	2501	no luminal nitrite was found in healthy control subjects  
class6	2501	nitrites are a secretory product of activated macrophages and neutrophils of the lamina propria  whereas the lowered luminal ph is due to diminished bicarbonate formation by impaired colonocytes  
class6	2501	a hypothesis is put forward that nitrites  lowered ph  and bacterial amines are conducive to formation of carcinogenic n nitroso compounds  which reflect a cancer risk in patients with ulcerative colitis dependent on the type and extent of inflammatory cell activation as well as metabolic impairment of colonic epithelial cells  
class6	2502	intestinal perforation due to cytomegalovirus infection in patients with aids  
class6	2502	intestinal perforation due to cytomegalovirus  cmv  infection in patients with aids is the most common life threatening condition requiring emergency celiotomy in these patients  
class6	2502	the authors describe a patient with aids with intestinal perforation due to cmv infection  and review 14 additional cases reported in the english language surgical literature  
class6	2502	the diagnostic triad of pneumoperitoneum on x ray  evidence or history of cmv infection  and aids occurred in 70 percent of patients  
class6	2502	the most common site of intestinal perforation was the colon  53 percent   followed in frequency by the distal ileum  40 percent  and appendix  7 percent   perforation usually occurred between the distal ileum and splenic flexure of the colon  
class6	2502	colonoscopy  rather than sigmoidoscopy  is recommended as a screening examination in patients with aids suspected of having colonic ulceration due to cmv infection  
class6	2502	multiple biopsies of ulcerated tissue should be obtained  
class6	2502	gross and microscopic analyses of involved intestinal tissue reveal the characteristic findings of ulceration and cmv infection  
class6	2502	despite aggressive therapy  the operative mortality rate in patients with aids with intestinal perforation due to cmv infection was 54 percent and the overall mortality rate was 87 percent  
class6	2502	postoperative complications occurred in most patients and consisted mainly of systemic sepsis and pneumonia caused by pneumocystis carinii infection  
class6	2502	an increased awareness of this syndrome by physicians frequently called on to manage patients with aids is recommended  
class6	2503	anal ulcerations due to cytomegalovirus in patients with aids  report of six cases  
class6	2503	lesions due to cytomegalovirus  cmv  are frequent in the immunocompromised patient  
class6	2503	this is particularly the case in patients with aids  where the colon and rectum are the regions most often involved  
class6	2503	the authors report six cases of anal ulcerations due to cmv in patients with aids  
class6	2503	these lesions  confirmed histologically  were either isolated or associated with other localizations  
class6	2503	treatment is based on specific antiviral agents but resistance and recurrence can occur  
class6	2503	the current report underlines the importance of histologic examination of anal lesions in hiv infected subjects  
class6	2504	sexually transmitted diseases of the colon  rectum  and anus  the challenge of the nineties  
class6	2504	during the past two decades  an explosive growth in both the prevalence and types of sexually transmitted diseases has occurred  
class6	2504	up to 55 percent of homosexual men with anorectal complaints have gonorrhea  80 percent of the patients with syphilis are homosexuals  
class6	2504	chlamydia is found in 15 percent of asymptomatic homosexual men  and up to one third of homosexuals have active anorectal herpes simplex virus  
class6	2504	in addition  a host of parasites  bacterial  viral  and protozoan are all rampant in the homosexual population  
class6	2504	furthermore  the global epidemic of aids has produced a plethora of colorectal manifestations  
class6	2504	acute cytomegalovirus ileocolitis is the most common indication for emergency abdominal surgery in the homosexual aids population  
class6	2504	along with cryptosporidia and isospora  the patient may present to the colorectal surgeon with bloody diarrhea and weight loss before the diagnosis of human immunodeficiency virus  hiv  disease  
class6	2504	other patients may present with colorectal kaposi s sarcoma or anorectal lymphoma  and consequently will be found to have seropositivity for hiv  
class6	2504	however  in addition to these protean manifestations  one third of patients with aids consult the colorectal surgeon with either condylomata acuminata  anorectal sepsis  or proctitis before the diagnosis of hiv disease  
class6	2504	although aggressive anorectal surgery is associated with reasonable surgical results in some asymptomatic hiv positive patients  the same procedures in aids  symptomatic hiv positive  patients will often be met with disastrous results  
class6	2504	it is incumbent upon the surgeon  therefore  to recognize the manifestations of hiv disease and diagnose these conditions accordingly  
class6	2505	pearson s marrow pancreas syndrome  a multisystem mitochondrial disorder in infancy  
class6	2505	pearson s marrow pancreas syndrome  mckusick no  
class6	2505	26056  is a fatal disorder of hitherto unknown etiology involving the hematopoietic system  exocrine pancreas  liver  and kidneys  
class6	2505	the observation of high lactate pyruvate molar ratios in plasma and abnormal oxidative phosphorylation in lymphocytes led us to postulate that pearson s syndrome belongs to the group of mitochondrial cytopathies  
class6	2505	since rearrangements of the mitochondrial genome between direct dna repeats were consistently found in all tissues tested  our results show that this disease is in fact a multisystem mitochondrial disorder  as suggested by the clinical course of the patients  
class6	2505	based on these observations  we would suggest giving consideration to the hypothesis of a defect of oxidative phosphorylation in elucidating the origin of other syndromes  especially those associated with an abnormal oxidoreduction status in plasma  
class6	2506	extracellular matrix gene expression increases preferentially in rat lipocytes and sinusoidal endothelial cells during hepatic fibrosis in vivo  
class6	2506	whether parenchymal or nonparenchymal liver cells play a predominant role in the pathophysiology of hepatic fibrosis has not been firmly established in vivo  
class6	2506	we have addressed this question by quantitating the relative abundance of specific mrnas for collagen types i  iii  and iv  and laminin in purified populations of hepatocytes  sinusoidal endothelial cells  and lipocytes from normal and fibrotic rat liver  
class6	2506	in normal liver  type i collagen gene expression was minimal in all cell types  mrna for types iii and iv collagen were apparent in endothelial cells and lipocytes  but not in hepatocytes  
class6	2506	laminin mrna was present in all cell types  
class6	2506	induction of fibrogenesis by either bile duct ligation or carbon tetrachloride administration was associated with a substantial increase in mrna for types i and iii collagen in nonparenchymal cells  
class6	2506	lipocytes from fibrotic animals exhibited a greater than 30 fold increase in type i collagen mrna relative to normal lipocytes  and greater than 40 fold relative to hepatocytes  
class6	2506	type iii collagen mrna reached 5 times that in normal lipocytes and greater than 120 times that in hepatocytes  
class6	2506	endothelial cells exhibited an isolated increase in type i collagen mrna  reaching five times that in normal liver  
class6	2506	type iv collagen and laminin gene expression were not significantly increased in nonparenchymal cells during fibrogenesis  in fact  mrna for type iv collagen and laminin decreased by up to 50  in endothelial cells  
class6	2506	despite the pronounced changes that occurred in matrix gene expression in nonparenchymal cells during fibrogenesis  no change was noted in hepatocytes  
class6	2506	we conclude that nonparenchymal liver cells  particularly lipocytes  are important effectors of hepatic fibrosis in vivo  
class6	2507	adverse mortality experience of a southwestern american indian community  overall death rates and underlying causes of death in pima indians  
class6	2507	as part of an ongoing epidemiologic study  the death rate and causes of death during 1975 through 1984 were determined in pima indians who resided in the gila river indian community  gric  in 1965 and later  
class6	2507	death certificates were available for 677 of the 681 deaths  
class6	2507	in 78  of the deaths  the underlying cause recorded on the death certificate agreed with the cause determined after review of all available relevant records  
class6	2507	the age  and sex adjusted average annual death rate for the gric population  1639 100 000  was 1 9 times  95  ci 1 7 2 0  the 1980 rate for the u s  
class6	2507	all races  878 100 000   
class6	2507	in pima males  whose death rate was substantially higher than that of pima females  the age adjusted death rate was 2 3 times that in u s  
class6	2507	males  all races  
class6	2507	moreover among males 25 34 years of age  the pima death rate was 6 6 times that for the u s  
class6	2507	all races  
class6	2507	diseases of the heart and malignant neoplasms caused 59  of u s  
class6	2507	deaths in 1980  but only 19  of gric deaths  
class6	2507	by contrast  the age  and sex adjusted mortality rate in the gric pima was 5 9 times the rate of the u s  
class6	2507	all races for accidents  6 5 times for cirrhosis  7 4 times for homicide  4 3 times for suicide  and 11 9 times for diabetes  
class6	2507	tuberculosis and coccidioidomycosis were important causes of death in the pima  for whom infectious diseases was the tenth leading cause of death  
class6	2507	the findings indicate that programs to improve the adverse mortality experience of the gric population should emphasize factors related to fatal accidents  alcoholic cirrhosis  homicide  suicide  diabetes mellitus  and infectious diseases  
class6	2507	young pimas  especially the males  should be the primary focus of such preventive efforts  
class6	2507	these findings and recommendations probably apply to many native american populations  
class6	2508	pharmacology of pravadoline  a new analgesic agent  
class6	2508	pravadoline is a new chemical entity with analgesic activity in humans  
class6	2508	this report describes the pharmacology of pravadoline and compares the activity of pravadoline with that of two major classes of analgesics  the opioids and the nonsteroidal anti inflammatory drugs  nsaids   
class6	2508	like the nsaids  pravadoline inhibited the synthesis of prostaglandins  pgs  in mouse brain both in vitro  ic50  4 9 microm  and ex vivo  ed50  20 mg kg p o   and displayed antinociceptive activity in rodents subjected to a variety of chemical  thermal and mechanical nociceptive stimuli  
class6	2508	administration of pravadoline prevented the writhing response induced by i p  
class6	2508	administration of acetylcholine  ed50  41 mg kg p o   or pge2  ed50  24 mg kg p o   and prolonged the response latency induced by tail immersion in hot water at a temperature of 55 degrees c  minimum effective dose  100 mg kg s c    
class6	2508	in the rat  treatment with pravadoline prevented acetic acid induced writhing  ed50  15 mg kg p o    brewer s yeast induced hyperalgesia  randall selitto test   minimum effective dose  1 mg kg p o    the nociceptive response induced by paw flexion in the adjuvant arthritic rat  ed50  41 mg kg p o   and bradykinin induced head and forepaw flexion  ed50  78 mg kg  p o    
class6	2508	the antinociceptive activity of pravadoline cannot be explained by an opioid mechanism  because pravadoline induced antinociception was not antagonized by naloxone  1 mg kg s c   and pravadoline did not bind to opioid receptors at concentrations up to 10 microm  
class6	2508	however  like the opioid analgesics  pravadoline diminished the electrically induced twitch response of mouse vas deferens preparations  but  in contrast to opioids  this action of pravadoline was not attenuated by naloxone  
class6	2508	the possibility is discussed that this effect of pravadoline upon isolated tissues may contribute to its antinociceptive activity  
class6	2508	in contrast to nsaids  pravadoline was more potent ex vivo as an inhibitor of the formation of pgs in brain vs  
class6	2508	stomach  
class6	2508	in addition  pravadoline failed to produce gastrointestinal lesions when administered p o  
class6	2508	to rats or mice  and did not possess significant anti inflammatory activity at antinociceptive doses  
class6	2508	also unlike nsaids  pravadoline inhibited rat gastrointestinal transit when administered at doses similar to those which were antinociceptive  
class6	2508	the overall pharmacologic profile of pravadoline suggests that the compound may be capable of managing more diverse or more severe pain than is achieved by anti inflammatory analgesics  without producing side effects commonly associated with either the opioid or the nonopioid analgesics  
class6	2509	effect of the leukotriene b4 receptor antagonist sc 41930 on colonic inflammation in rat  guinea pig and rabbit  
class6	2509	inflammatory bowel disease is a chronic inflammatory disorder of the gastrointestinal tract that includes ulcerative colitis and crohn s disease  
class6	2509	leukotriene b4 is thought to be a prominent proinflammatory mediator in these diseases  in that leukotriene b4 levels are increased in the colonic mucosa of inflammatory bowel disease patients and there is increased polymorphonuclear leukocyte infiltration of these tissues  
class6	2509	we evaluated the efficacy of 7  3  4 acetyl 3 methoxy 2 propylphenoxy  3 4 dihydro 8 propyl  2h 1 benzopyran 2 carboxylic acid  sc 41930   a potent  orally active leukotriene b4 receptor antagonist  in a model of inflammatory bowel disease  
class6	2509	colonic mucosal inflammation was induced in rats  guinea pig and rabbits by rectal instillation of a dilute solution of acetic acid  
class6	2509	twenty four hours later  mucosal levels of myeloperoxidase  a marker enzyme for neutrophil infiltration  and extravasation of i v  
class6	2509	administered evans blue dye  a marker of vascular disruption and increased permeability  were measured  
class6	2509	tissues were also evaluated histologically  
class6	2509	the animals received either sc 41930 or vehicle  intrarectally  30 min after or 1 hr before and 1 hr after the acetic acid  
class6	2509	when given 30 min after acetic acid instillation sc 41930 prevented the rise in myeloperoxidase and dye extravasation observed in the acetic acid inflammed tissue  
class6	2509	the sc 41930 treated tissues were less edematous and had fewer neutrophils within the subepithelial space  
class6	2509	median effective dose  ed50  values for vascular protection were approximately 20 mg kg for both rat and guinea pig  
class6	2509	ed50 values for inhibition of granulocyte accumulation were 20 mg kg for rat  24 mg kg for guinea pig and 30 mg kg for rabbit  
class6	2509	these data indicate that sc 41930 is effective locally to prevent acute colonic inflammation  
class6	2510	mucocele of the cystic duct remnant in eight liver transplant recipients  findings at cholangiography  ct  and us  
class6	2510	the case histories and radiologic studies of eight liver transplant recipients who developed a mucocele of the allograft cystic duct remnant were retrospectively evaluated  
class6	2510	all patients had clinical and or laboratory evidence of biliary obstruction or cholangitis from 2 weeks to 3 3 years following transplantation  
class6	2510	cholangiographic  ultrasound  us   and computed tomography  ct  images were available for review in eight  five  and four patients  respectively  
class6	2510	cholangiograms demonstrated an extrinsic mass compressing the common hepatic duct in seven of eight patients  
class6	2510	us and ct showed fairly well  to well defined round fluid collections adjacent to the common hepatic duct in three and two patients  respectively  
class6	2510	the findings of this study suggest that the detection at cholangiography of an extrinsic mass compressing the common hepatic duct appears to be specific for a mucocele of the allograft cystic duct remnant  
class6	2510	ct and us images may offer confirmatory evidence  
class6	2511	colonic stenoses  use of oral barium when retrograde flow is completely obstructed on barium enema studies  
class6	2511	forty patients with complete obstruction to retrograde barium flow on barium enema examinations  without clinical or radiographic evidence of obstruction  were studied further with orally administered barium in the same session  
class6	2511	all patients had undergone aborted double contrast barium enema studies and had received antispasmodics intramuscularly before the examination  
class6	2511	the authors describe the technique  as well as the clinical and radiologic findings  that allows the safe ingestion of oral barium in patients with stenotic lesions of the colon  
class6	2511	in all patients  oral barium passed through the small bowel and the stenotic site in an average of 148 minutes  with no complications  
class6	2511	in seven patients  there were synchronous lesions in the colon and small bowel  and the findings were determined better with oral barium studies in 19 patients  
class6	2511	if a barium enema study is done and retrograde passage of barium is obstructed by a lesion in the left side of the colon  additional diagnostic information can be obtained by giving the patients oral barium  
class6	2511	this practice is safe if precise criteria are applied  
class6	2512	feasibility of digital teleradiology for imaging evaluation of patients with acute right upper quadrant abdominal pain  
class6	2512	to assess the utility of a commercially available digital teleradiology system in evaluating patients with acute pain in the right upper quadrant  hard copy images from 100 examinations  50 hepatobiliary scintigrams and 50 sonograms of the right upper quadrant  were digitized  transmitted via standard telephone lines  and viewed remotely on a video monitor  
class6	2512	video and hard copy interpretations were then compared for degree of concordance  
class6	2512	for the scintigraphic studies  hard copy and video images were equal in demonstrating gallbladder and bile duct activity  
class6	2512	video images failed to depict the presence of bowel activity in one case  
class6	2512	gallstones were depicted equally well on hard copy and video sonographic images  
class6	2512	the video interpreters overestimated the presence of abnormal hepatic parenchyma and overlooked one case of right hydronephrosis  
class6	2512	the video interpretations of the scintigrams and sonograms showed an overall error rate of 4   comparable to the rate obtained when radiographs are interpreted remotely with digital teleradiology systems  
class6	2513	extracorporeal cholecystolithotripsy without oral chemolitholysis  
class6	2513	one hundred thirty six patients completed extracorporeal biliary lithotripsy  ebl  for symptomatic cholecystolithiasis  
class6	2513	sonographic evidence of complete clearance of all stone fragments was the only criterion for treatment success  which occurred in 32 of the 71 patients  45   followed up for 24 weeks and in 36 of the 59 patients  61   followed up for 52 weeks  
class6	2513	the authors  protocol varied from protocols of other researchers primarily in that no adjuvant chemolitholysis was used  
class6	2513	however  the number of treatment sessions and total number of shock waves  a maximum of 4 000 shock waves per treatment session  12 000 shock waves in a patient demonstrating no significant fragmentation  and 20 000 shock waves in a patient whose stones responded well to fragmentation  was higher than those in other reports  
class6	2513	the results of treatment and complication rates in this study are comparable with those at centers using both shock wave lithotripsy and chemotherapy  
class6	2513	the authors conclude that ebl is developing into an important alternative to surgery  which was obviated in all patients with complete clearance of fragments from the gallbladder  
class6	2514	hypertrophic pyloric stenosis  volumetric measurement of nasogastric aspirate to determine the imaging modality 
class6	2514	the authors postulated that volumetric measurement of residual gastric aspirate in neonates and infants with nonbilious projectile vomiting could enable differentiation between patients with hypertrophic pyloric stenosis  hps  and those with gastroesophageal reflux  ger  and help to determine whether ultrasound  us  or fluoroscopy of the upper gastrointestinal tract would best confirm the diagnosis  
class6	2514	in the 38 patients  all but two of whom had been fasting for 3 4 hours   10 ml or more of nasogastric aspirate was considered indicative of obstruction  
class6	2514	hps occurred in 91 7  of patients with 10 ml of aspirate or more  whereas ger occurred in 85 7  of patients with less than 10 ml  
class6	2514	the differences between the two groups were statistically significant  
class6	2514	solely on the basis of residual volume  greater than or equal to 10 ml   the cause of vomiting could be differentiated  prior to standard radiologic studies  89 4  of the time  
class6	2514	it is concluded that patients with projectile vomiting who have 10 ml or more of residual aspirate in the stomach should undergo us for confirmation of hps  those with less than 10 ml should undergo fluoroscopy for confirmation of ger  
class6	2515	hilar malignancy  treatment with an expandable metallic transhepatic biliary stent  
class6	2515	an expandable metallic transhepatic biliary endoprosthesis was used to treat 20 patients with hilar malignancy and isolated right and left intrahepatic ducts  
class6	2515	in 12 patients  only one intrahepatic ductal system was drained  in eight patients  both systems were drained  
class6	2515	in five patients  both systems were drained through a single transhepatic track by arrangement of two stents in a t configuration  
class6	2515	the initial technical success rate in placing the stents and achieving internal drainage was 100   
class6	2515	complications necessitating further intervention occurred in two of the 20 patients  
class6	2515	short term clinical follow up was available for 19 of the 20 patients  
class6	2515	two months after stent insertion  two patients complained of persistent jaundice  two patients died without jaundice  and 15 patients were free of symptoms of biliary obstruction  
class6	2515	a variety of geometric configurations are possible with this endoprosthesis  
class6	2515	the relative merits of these stent arrangements are discussed  and a new technique for placing the stents in a t configuration is described  
class6	2516	emergency portosystemic shunt in patients with variceal bleeding  
class6	2516	thirty five patients for whom emergency sclerotherapy or conservative treatment  or both  failed to arrest variceal bleeding  or who had early rebleeding and required emergency portosystemic shunts  epss  were studied  
class6	2516	epss permanently controlled the variceal bleeding in all but one patient  
class6	2516	in this patient  the shunt was patent as demonstrated by angiography  
class6	2516	esophageal varices disappeared in 18 patients and were reduced in 14  
class6	2516	three patients died before the endoscopic examination could be performed  
class6	2516	the causes of death were hepatic failure in two and bleeding ulcerations of the gastric fundus in the other patient  
class6	2516	one patient was classified in child s category b and two in child s category c  
class6	2516	thirty two patients submitted to epss and were discharged alive  
class6	2516	twelve of these patients subsequently died  at an average of 11 2 months after undergoing the shunt procedure  
class6	2516	four of 12 patients died of hepatic failure  two patients died of hepatomas  two  other neoplasia  three  hemorrhaging duodenal ulcers  and one patient  renal failure  
class6	2516	analysis of actuarial survival rates showed that the five year survival rate was 43 per cent  
class6	2516	the long term survival rates were fewer for patients with child s category c than for those with combined child s categories a and b  five year survival rates were 21 versus 55 per cent  p less than 0 05   
class6	2516	during the follow up period  none of the patients had variceal bleeding  
class6	2516	chronic encephalopathy developed in six  which was mild in three  moderate in one instance and severe in two  
class6	2516	it developed soon after epss  with onset in the first month after discharge in three  
class6	2516	thus  when conservative treatment fails to arrest variceal bleeding  epss should be performed to guarantee definitive control of hemorrhage and prolong the survival period  
class6	2517	neoplastic changes in the stomach after gastrectomy  
class6	2517	partial gastric resection for benign ulcer disease has been associated with an increased incidence of mucosal dysplasia and invasive adenocarcinoma  particularly 15 to 20 years after resection  
class6	2517	these remnant carcinomas are particularly virulent with little hope of resection or cure once symptoms occur  
class6	2517	using a planned protocol of routine endoscopic surveillance with biopsy  the goal was to identify early markers of neoplasia  that is  dysplasia  and a diagnosis of adenocarcinoma of the gastric remnant  while both resection and cure were possible  
class6	2517	between july 1980 and august 1988  yearly flexible gastroscopic examination and random biopsy have been performed on 163 patients at least ten years after gastrectomy for benign ulcer disease  
class6	2517	all biopsy results were interpreted for findings of dysplasia and early gastric adenocarcinoma  
class6	2517	results of this ongoing screening program revealed dysplasia of the gastric remnant in nine patients with eventual findings of adenocarcinoma in four of this group  
class6	2517	these patients underwent total gastrectomy with findings of limited disease  
class6	2517	five patients with mucosal dysplasia continue to be observed at six month intervals  
class6	2517	three additional gastric carcinomas were found on initial gastroscopic screening  while one patient had adenocarcinoma diagnosed during a third yearly gastroscopic examination  
class6	2517	these eight asymptomatic patients with adenocarcinoma in the gastric remnant had a postgastrectomy interval which ranged from 15 to 29 years  mean of 26 5 years   
class6	2517	the results of this study support the concept of neoplastic change in the gastric remnant as a function of time from initial gastric resection  
class6	2517	findings of dysplasia on random biopsy indicate a greater likelihood of development of carcinoma of the gastric remnant and identify a subset of patients requiring aggressive endoscopic surveillance  
class6	2518	long term survival and severe rebleeding after variceal sclerotherapy  
class6	2518	of 197 consecutive patients with cirrhosis admitted because of bleeding from esophageal varices  133 were included in a prospective study of elective sclerotherapy  
class6	2518	we evaluated the incidence of extensive rebleeding and mortality rate  
class6	2518	the period of study was 54 months and the mean follow up period was 21 months  
class6	2518	forty one patients had severe rebleeding and a majority of the episodes occurred during the first year  
class6	2518	only four patients had more than five sessions of sclerosis when rebleeding occurred  
class6	2518	the probability rate for patients to be free of severe rebleeding after 48 months  according to pugh s classification  was 88 per cent for those with grade a  50 percent for grade b and 43 percent for grade c  
class6	2518	the over all mortality rate was 38 8 per cent  53 patients   with the highest rate noted during the first year  
class6	2518	the mortality rate of patients with severe rebleeding was much higher than that of those who did not rebleed  
class6	2518	kaplan meier survival analysis at four years was 52 per cent  and survival rates in relation to pugh s classification were 73 per cent for a  53 per cent for b and 34 per cent for c  
class6	2518	differences between the three groups were statistically significant  
class6	2518	therefore  because of the high mortality rate associated with patients with cirrhosis and extensive rebleeding during the first year  it is important to achieve  as soon as possible  eradication of esophageal varices  
class6	2519	the hazards of surgical glove dusting powders  
class6	2519	surgical contaminants of many kinds  including glove powder  constitute a source of formation of granulomas  
class6	2519	this is particularly well documented in the peritoneal cavity   starch peritonitis    but has been documented in most anatomic sites  
class6	2519	the production of starch free gloves should remove this hazard  but the surgeon should remain aware that most particulate substances introduced into the body inevitably set up an inflammatory response  
class6	2520	gallstones  cholecystitis and diabetes  published erratum appears in surg gynecol obstet 1991 jul 173 1  72  
class6	2520	findings from studies showing an increased incidence of gallstones in diabetic patients do not control for other variables  such as obesity  
class6	2520	there is no proof that diabetic patients have more gallstones  
class6	2520	gallstones do not cause diabetes mellitus  
class6	2520	the principal gallbladder pathologic feature in diabetic patients is a functional deficit of uncertain etiologic factors  creating a large  flaccid  poorly emptying organ  
class6	2520	bile acid and lipid composition are usually increased in diabetic patients  
class6	2520	cholecystitis seems to be a more serious disease in diabetic patients  with worse infectious sequelae and more rapid disease progression  
class6	2520	this conclusion has not been examined statistically  
class6	2520	even with modern care  the complication rate for operations upon the biliary tract in patients with diabetes is increased  
class6	2520	those with diabetes are generally older than other patients requiring cholecystectomy  
class6	2520	systemic changes of aging partly explain increased morbidity and mortality  
class6	2520	diabetic patients with symptomatic gallbladder disease usually require operation  
class6	2520	risk of cholecystectomy in diabetic patients is similar to that in nondiabetics  
class6	2520	prophylactic cholecystectomy for diabetic patients with  silent  gallstones was formerly recommended because of an apparent high risk of cholecystitis  
class6	2520	until the natural history of gallstones in those with diabetes has been defined  such patients should be considered in danger of serious illness  
class6	2520	the risk of acute cholecystitis in diabetic patients with stones is probably significant enough to warrant the performance of early cholecystectomy  
class6	2521	pathogenesis and treatment of intra abdominal infection  
class6	2521	intra abdominal infection is considered potentially life threatening  
class6	2521	such infection is frequently secondary to perforated viscera  trauma or inflammatory disease  
class6	2521	simple abscesses may be drained percutaneously with roentgenologic guidance  complex abscesses often require open surgical drainage  
class6	2521	secondary peritonitis is usually polymicrobial  broad spectrum antimicrobial therapy effective against aerobic and anaerobic gram negative bacteria  as well as gram positive organisms  is essential  
class6	2521	newer antibiotics  administered either singly or in combination  have been used successfully to treat intra abdominal infection while avoiding the toxicity of aminoglycosides  
class6	2522	a case of lisinopril induced lithium toxicity 
class6	2522	we describe a patient who developed lithium toxicity when lisinopril was substituted for clonidine  
class6	2522	possible mechanisms of angiotensin converting enzyme  ace  inhibitor induced lithium toxicity are discussed  
class6	2522	aggressive serum lithium concentration monitoring and a reduction in the dose of lithium is advised when using ace inhibitors because of disturbances and shifts in fluid and electrolyte balance  
class6	2523	genital and anal conditions confused with child sexual abuse trauma  
class6	2523	examination of a child with genital or anal disease may give rise to suspicion of sexual abuse  
class6	2523	dermatologic  traumatic  infectious  and congenital disorders may be confused with sexual abuse  
class6	2523	seven children referred to us are representative of such confusion  
class6	2524	a pitfall in azygos vein cannulation in cirrhotic patients  mistaken cannulation of the mammary vein  
class6	2524	azygos venous flow can be measured by a thermodilution catheter in patients with cirrhosis  
class6	2524	this is a useful technique since azygos flow is thought to reflect the superior portosystemic collateral flow in these patients  
class6	2524	the authors report 3 cases in which mistaken internal mammary vein cannulation mimicked azygos vein cannulation in the supine fluoroscopic view  
class6	2524	a lateral fluoroscopic view confirmed internal mammary cannulation  
class6	2524	they suggest that if the azygos arch is unpronounced or flow measurements are unexpectedly low in patients with portal hypertension due to cirrhosis  a lateral view be performed to rule out internal mammary vein cannulation  
class6	2525	lymphomatoid granulomatosis presenting as ulcerodestructive gastrointestinal tract lesions in patients with human immunodeficiency virus infection  a new association  
class6	2525	we describe cases of severe odynophagia  extensive oral ulcerations  and bowel perforation in patients with human immunodeficiency virus infection that were caused by lymphomatoid granulomatosis  
class6	2525	such presentations in human immunodeficiency virus infected individuals are usually ascribed to other causes and may be incorrectly treated on an empiric basis  
class6	2525	in addition  deep tissue specimens obtained at the margin of ulcerative lesions are often necessary for definitive diagnosis  
class6	2525	we review our limited treatment experience with zidovudine  interferon alfa  and h2 blockers in our patients  
class6	2525	based on the markedly increased frequency in which lymphomatoid granulomatosis is being diagnosed at our institution in the post human immunodeficiency virus era  we postulated an association between these two entities  
class6	2526	amelioration of cholinergic induced pancreatitis with a selective cholecystokinin receptor antagonist  
class6	2526	acute edematous pancreatitis follows excessive cholinergic stimulation in patients exposed to anticholinesterase containing insecticides  
class6	2526	we describe the role of cholecystokinin and the benefits of cholecystokinin receptor blockade in this form of pancreatitis  
class6	2526	a cholinergic mimetic  carbachol  was administered to rats weighing 300 to 350 g and produced a form of edematous pancreatitis that mimics that seen in humans  
class6	2526	animals received carbachol intraperitoneally  either alone  250 micrograms kg of body weight  or with cholecystokinin receptor antagonist devazepide  3 mg kg of body weight  and were killed 4 hours later  
class6	2526	carbachol administration resulted in a 19  increase in pancreatic weight  a fourfold increase in serum amylase levels  and a 14 fold increase in serum lipase levels  
class6	2526	plasma cholecystokinin levels  however  were not altered  
class6	2526	devazepide administered prior to cholinergic hyperstimulation blocked pancreatic weight increase and reduced elevations in serum amylase levels twofold and lipase levels fourfold  
class6	2526	although cholecystokinin levels are not elevated in this model of pancreatitis  blockade of even low  background concentrations of this regulatory peptide is beneficial  
class6	2527	percutaneous catheter drainage of infected pancreatic and peripancreatic fluid collections  
class6	2527	operative drainage is the cornerstone of therapy for pancreatic abscess  
class6	2527	recently it has been suggested that successful percutaneous catheter drainage of infected pancreatic and peripancreatic fluid collections may serve as definitive therapy  
class6	2527	we undertook therapeutic  computed tomography directed percutaneous drainage in a selected group of 29 patients with infected pancreatic and peripancreatic fluid collections  
class6	2527	twenty three patients  79   were successfully treated with percutaneous drainage  
class6	2527	of six patients  21   representing failures of percutaneous drainage  four died and two recovered after operative drainage  
class6	2527	the four patients who died had a mean apache  acute physiology and chronic health evaluation  ii score of 23 and five of ranson s prognostic signs  
class6	2527	ranson s signs and apache ii scores were predictive of success and mortality  
class6	2527	we conclude that in selected patients  infected pancreatic and peripancreatic fluid collections can be treated definitively with therapeutic percutaneous catheter drainage  
class6	2527	based on this experience  recommendations regarding patient selection are included  
class6	2528	does somatostatin analogue prevent experimental acute pancreatitis  
class6	2528	because somatostatin is a potent inhibitor of pancreatic secretion  we hypothesized that pretreatment with somatostatin analogue octreotide  sms 201 995  might prevent cerulein induced edematous pancreatitis  
class6	2528	we studied 18 rats prepared with jugular vein catheters  
class6	2528	the following agents were administered intravenously to groups of four rats for 6 hours  1 ml h  control  crystalloid solution  1 microgram kg bolus then 1 microgram kg per hour of octreotide  and 5 micrograms kg per hour of cerulein  also  in a fourth group of six rats  octreotide and cerulein were administered simultaneously  
class6	2528	at the end of experiments  blood was drawn for plasma amylase determinations  rats were killed and pancreata were examined  
class6	2528	supramaximal cerulein administration to conscious rats induced hyperamylasemia and edematous pancreatitis  confirming previous observations  in both groups of rats receiving cerulein  there was prominent interstitial edema  acinar vacuolization  and mild to moderate acute inflammation  
class6	2528	while octreotide pretreatment of rats with cerulein induced acute pancreatitis was associated with a lesser increase of wet pancreas weight and plasma amylase concentration  there was little overall benefit of octreotide pretreatment in this form of experimental acute pancreatitis  
class6	2529	calcium and calcium binding in human gallstone disease  
class6	2529	precipitation of calcium salts from bile is important in pigment gallstone formation and may serve as a nidus for cholesterol precipitation  
class6	2529	we compared gallbladder bile from patients with symptomatic gallstone disease  40 with cholesterol gallstones and 12 with pigment gallstones  with bile from 10 patients undergoing surgery for non biliary tract disease  
class6	2529	bile from patients with gallstone disease was less concentrated  with decreased sodium  bile salt  and phospholipid concentrations  but elevated biliary calcium concentrations were not observed  
class6	2529	the relationship between free ionized calcium and total calcium was similar in all groups  indicating no difference in calcium binding by gallstone containing bile  
class6	2529	we cannot exclude elevated biliary calcium level as a factor in gallstone pathogenesis  as it could be a transient event  
class6	2529	the importance of calcium precipitation was supported by our finding that more than half of the samples were saturated or supersaturated with at least one calcium salt  calcium carbonate  
class6	2530	surgical aspects of sclerosing encapsulating peritonitis  
class6	2530	sclerosing encapsulating peritonitis  sep  is associated with the administration of beta blocking agents as well as continuous ambulatory peritoneal dialysis  
class6	2530	the predisposing factors in the latter group are recurrent peritonitis  presence of acetate in the dialysate  and antiseptics used during bag exchanges  
class6	2530	we report a case of sep following chronic ambulatory peritoneal dialysis and review the literature on this benign yet potentially lethal condition  
class6	2530	sclerosing encapsulating peritonitis frequently leads to intestinal obstruction  small bowel necrosis  enterocutaneous fistulas  and malnutrition  
class6	2530	there is a high incidence of anastomotic failure when a resection and primary intestinal anastomosis is performed in patients with sep  
class6	2530	although sep is not commonly reported in the surgical literature  its importance to surgeons is indicated by the fact that the overall mortality rate is close to 60  in patients with sep who develop surgical complications  
class6	2531	ticlopidine treatment reduces the progression of nonproliferative diabetic retinopathy  the timad study group  
class6	2531	the ticlopidine microangiopathy of diabetes study  timad   a randomized  double masked  placebo controlled trial  assessed the effect of this antiplatelet agent  ticlopidine hydrochloride  in reducing the progression of nonproliferative diabetic retinopathy in 435 patients followed up for 3 years  
class6	2531	the mean yearly increase in definite microaneurysms on fluorescein angiograms was significantly higher  p    03  in the placebo group  1 44     4 67  than in the ticlopidine group  0 48     5 79   
class6	2531	significance was limited to primary analysis using a quality angiographic coefficient for definite microaneurysms in patients with at least three readable angiograms over a 3 year period  
class6	2531	ticlopidine was significantly beneficial to insulin treated diabetic patients  inducing a sevenfold reduction of the yearly microaneurysm progression  0 23     6 66  compared with the placebo  1 57     5 29   p    03   
class6	2531	among insulin treated diabetic patients  fewer had development of new vessels in the ticlopidine group than in the placebo group  at borderline statistical significance  p    056   
class6	2531	overall retinopathy progression was significantly less severe in the ticlopidine group  p    04   
class6	2531	adverse reactions associated with ticlopidine included neutropenia  severe in one patient  with no clinical complications  diarrhea  or rash  
class6	2531	this study demonstrated that ticlopidine slows down the progression of nonproliferative diabetic retinopathy  
class6	2532	piroxicam decreases postirradiation colonic neoplasia in the rat  
class6	2532	this study evaluated the effects of the nonsteroidal antiinflammatory agent piroxicam on chronic radiation proctitis in the rat  
class6	2532	forty female wistar rats received a 2250 cgy dose of irradiation to the distal 2 cm of the colon  
class6	2532	twenty received piroxicam 8 0 mg kg orally 30 minutes before exposure and 24 hours after exposure  20 rats served as irradiated controls  
class6	2532	all animals were evaluated by colonoscopy 1 and 3 weeks postexposure and every third week until death or killing at 1 year  
class6	2532	at killing  colons were removed for light microscopic examination  
class6	2532	one year postirradiation results showed no differences in mortality  vascular changes  acute inflammation  colitis cystica profunda  or rectal stricture between the control and piroxicam treated groups  
class6	2532	however  at 1 year postirradiation the control group demonstrated neoplasia in 15 of 19 animals compared with eight of 20 animals in the piroxicam treated group  
class6	2532	the first endoscopic appearance of colonic neoplasm occurred at 15 weeks postirradiation in one control irradiated rat whereas the first evidence of endoscopic neoplasm in the piroxicam treated group did not occur until 36 weeks postirradiation  
class6	2532	histologic examination documented a tendency toward a greater presence of adenocarcinomas in the control group compared with the piroxicam treated group  
class6	2532	the authors conclude that piroxicam treatment significantly decreased the incidence of colonic neoplasia in general as well as delayed the endoscopic appearance of colonic neoplasia in rats after pelvic irradiation  
class6	2533	clinicopathologic features of hepatocellular carcinoma in young patients  
class6	2533	to investigate clinicopathologic characteristics of hepatocellular carcinoma  hcc  in young adults  excised tumors from 21 patients younger than 45 years  young group  were compared with findings in tumors from 204 patients older than 45  old group   
class6	2533	in the young group hcc showed  1  a high incidence of positive hepatitis b virus surface antigen  hbsag   young 71 4  versus old 20 1     2  relatively well preserved hepatocellular function  indocyanine green test  young 10 7     8 8  versus old 20 6     10 8     3  low incidence of histologically verified concomitant cirrhosis  young 52 4  versus old 78 4    and  4  a more advanced stage of the disease in tnm classification  stage iii  young 52 4  versus old 18 1    
class6	2533	with respect to survival rates achieved by surgery  there was no statistically significant difference between the two groups  
class6	2533	thus  hepatitis b virus may relate to the occurrence of hcc in the young patients  
class6	2533	despite the advanced stage in the young group  survival rate after surgery was comparable with that achieved in the old group  
class6	2533	these observations mean that a close periodic surveillance of young adults with a positive hbsag is required to detect hcc at an early stage  
class6	2533	treatment of patients with hbsag using interferon or vidarabine and hepatitis b vaccine should be made to convert hbsag to negative in these individuals  
class6	2534	swallowing disorders in patients with prolonged orotracheal intubation or tracheostomy tubes  
class6	2534	eleven patients were tested for swallowing dysfunction after prolonged orotracheal intubation  
class6	2534	ten had a tracheostomy tube  
class6	2534	mean duration of orotracheal intubation was 19 9 days  mean age 65 yr  and no patient had a concomitant neurologic deficit  
class6	2534	all patients had a modified barium swallow with videofluoroscopy  
class6	2534	all patients had at least one defect of 11 defects characterized  
class6	2534	there was a mean of six defects patient  
class6	2534	the most common defects were delayed triggering of the swallow response  present in all patients  and pharyngeal pooling of contrast material  n   9   
class6	2534	follow up videofluoroscopy was performed in five patients  all had improved  with mean defects decreasing from 6 1 to 2 8 patient  
class6	2534	with one exception  no patient had any defect that was worse than mild in severity  
class6	2534	we concluded that prolonged orotracheal intubation with or without tracheostomy may cause prolonged and severe swallowing dysfunction  
class6	2534	the deficits improve with time  
class6	2534	the presence of a gag reflex does not confer protection against aspiration of pharyngeal contrast  
class6	2535	melanosis of the esophagus  an endoscopic  histochemical  and ultrastructural study  
class6	2535	endoscopic  histological  and ultrastructural features of 21 cases of esophageal melanosis are described  
class6	2535	these cases were detected during 1000 consecutive routine upper gastrointestinal endoscopies  
class6	2535	staining characteristics and ultrastructure of the pigment contained in the endoscopically visible lesions were found to be similar to those of true melanin  
class6	2536	enteric neuronal autoantibodies in pseudoobstruction with small cell lung carcinoma  
class6	2536	severe gastrointestinal dysmotility is a newly recognized paraneoplastic syndrome that occurs with small cell lung carcinoma  
class6	2536	thirty four patients with small cell carcinoma  of whom 5 had chronic intestinal pseudoobstruction and 29 had no digestive symptoms  were studied serologically  
class6	2536	four of the 5 patients with gut dysmotility had immunoglobulin g antibodies reactive with neurons of the myenteric and submucosal plexuses of jejunum and stomach in an indirect immunofluorescence assay  
class6	2536	antibodies of this type were not found in any of the 29 patients who had no gut dysmotility  nor were they found in patients with chronic idiopathic intestinal pseudoobstruction  n   8   ovarian cancer  n   20   or epilepsy  n   4  or in normal subjects  n   9   
class6	2536	in 4 of the patients with paraneoplastic pseudoobstruction  antibodies in highly diluted serum  1 4000 1 8000  bound selectively to nuclei and cytoplasm of neuronal elements in the gut  
class6	2536	this novel autoantibody activity suggests that intestinal pseudoobstruction occurring in patients with small cell carcinoma may have an autoimmune basis  
class6	2536	from a clinical standpoint  serological testing offers a simple means for determining which patients with gut dysmotility syndromes may have associated small cell carcinoma  thereby enabling earlier diagnosis and treatment of the tumor  
class6	2537	geographic variation of inflammatory bowel disease within the united states  
class6	2537	one approach to learn about possible environmental risks in inflammatory bowel disease relates to studying its geographic pattern of occurrence  
class6	2537	the geographic variation of inflammatory bowel disease within the united states was analyzed using the accumulated 17 5 million hospital discharges of all u s  
class6	2537	medicare beneficiaries during two consecutive years  
class6	2537	to validate the geographic pattern shown by the medicare data  hospitalization was compared with mortality from inflammatory bowel disease among different states  
class6	2537	mortality and hospitalization statistics both suggested that the occurrence of inflammatory bowel disease was determined by environmental factors that had a marked geographic variation within the united states  
class6	2537	both crohn s disease and ulcerative colitis appeared to be more frequent in northern parts of the united states than in southern and in urban more than rural parts  
class6	2537	these trends were observed for men and women and for blacks and whites alike  
class6	2537	similar geographic patterns of crohn s disease and ulcerative colitis suggested the influence of one or more identical risk factors for both diseases  
class6	2538	expression of leukocyte adhesion molecules by mucosal mononuclear phagocytes in inflammatory bowel disease  
class6	2538	leukocyte adhesion molecules are important in cell cell interactions of the immune system  
class6	2538	lymphocyte function associated antigen 1  cluster designation 11a  mediates interactions between t cells and mononuclear phagocytes through its ligand  the intercellular adhesion molecule 1  cd54   whereas complement receptors 3  cd 11b  and 4  cd11c  are involved in complement mediated phagocytosis  
class6	2538	expression of cd11 molecules and intercellular adhesion molecule 1 was studied in colonic biopsy specimens from 20 patients with inflammatory bowel disease and 10 normal controls  
class6	2538	in normal colon  few mononuclear phagocytes expressed lymphocyte function associated antigen 1 and intercellular adhesion molecule 1 at high densities  
class6	2538	the major adhesion molecule was cd11c  
class6	2538	thus  the largest population of normal colonic mononuclear phagocytes was represented by quiescent  resident macrophages with likely phagocytic function  
class6	2538	in inflammatory bowel disease  mononuclear phagocytes showed only a slight increase in cd11a expression and no significant change in expression of cd11b and cd11c  
class6	2538	by contrast  the percentage of mononuclear phagocytes expressing intercellular adhesion molecule 1 was increased from 6 9      3 9  in controls to 69 2      12 8  in ulcerative colitis  p less than 0 001  and to 45 7      22 8  in crohn s disease  p less than 0 01   showing a close relationship with histological activity  
class6	2538	the increased expression of intercellular adhesion molecule 1 in inflammatory bowel disease indicates a state of immunological activation induced by local release of inflammatory cytokines  
class6	2538	such induction of intercellular adhesion molecule 1 on mononuclear phagocytes may be important in the maintenance of chronic inflammation by facilitating interactions with t cells and t cell antigen recognition  
class6	2539	prevalence of spontaneous hepatofugal portal flow in liver cirrhosis  clinical and endoscopic correlation in 228 patients  
class6	2539	the prevalence of spontaneous reversal of flow in the portal venous system was non invasively evaluated by doppler ultrasound in 228 patients with liver cirrhosis and portal hypertension  
class6	2539	reversed flow was detected in the portal vein in 7 patients  3 1    in the splenic vein in 7 patients  3 1    and in the superior mesenteric vein in 5 patients  2 1    with an overall prevalence of 8 3   19 228   
class6	2539	this prevalence did not differ in relation to the etiology of liver cirrhosis  whereas hepatofugal flow was found in more patients classified as child s c  15 4   and b  12 5   than those classified as child s a  2 7    p less than 0 02  and was associated with a higher frequency of hepatic encephalopathy  21  vs  
class6	2539	7 2   p less than 0 05   
class6	2539	endoscopic evaluation of esophageal varices did not reveal any correlation between the presence and size of varices and hepatofugal flow  whereas red signs were detected more frequently in patients with this hemodynamic pattern  42 1  vs  
class6	2539	24 4   ns   
class6	2539	the rate of previous variceal bleeding was not significantly different in patients with and without hepatofugal flow  30 8  vs  
class6	2539	24 4   ns   
class6	2539	conversely  the prospective evaluation of 15 patients with hepatofugal flow and 29 matched patients with hepatopetal flow  derived from the group of 228 patients  followed up for a period of 12 18 months  showed that variceal bleeding occurred in 9 of 29 patients with hepatopetal flow and in none of the 15 patients with hepatofugal flow  p less than 0 02   
class6	2539	however  no statistical difference was found in the survival rates  
class6	2539	this study indicates that the actual prevalence of reversed flow in the portal  splenic  and superior mesenteric veins in a nonselected cirrhotic population is 8 3   
class6	2539	from a clinical point of view  the data suggest that this finding might be considered an important prognostic factor because  while occurring in cirrhotic patients with more severe functional impairment  it might play a protective role against the risk of bleeding  
class6	2540	detection and direct sequencing of hepatitis b virus genome by dna amplification method  
class6	2540	hepatitis b virus  hbv  dna was detected with amplification by the polymerase chain reaction method  
class6	2540	cloned hbv dna equivalent to one virus genome  3 x 10  6  pg  was detectable by ethidium bromide staining after 50 cycles of polymerase chain reaction  
class6	2540	by applying this method  presence of hbv dna was studied in 23 hepatitis b surface antigen  hbsag  positive and 11 hbsag negative sera from patients with chronic liver disease  
class6	2540	hepatitis b virus dna was positive in 8 of 8 hepatitis b e antigen  hbeag  positive  in 2 of 2 hbeag  and anti hbe negative  and in 12 of 13 anti hbe positive sera  
class6	2540	hepatitis b virus dna was undetectable in all hbsag negative sera even with amplification  
class6	2540	to confirm specificity  the amplified product was directly sequenced  
class6	2540	sequences around 122nd and 160th codon of hbs gene  which determines subtypes d y and w r  respectively  were analyzed  
class6	2540	the results were compatible with recent reports regarding the relation between hbv subtypes and hbv dna sequence at those codons  
class6	2540	hepatitis b virus dna could be detected at the level of one virion by gene amplification method  and its sequence could be determined by direct sequencing in a few days  
class6	2541	effects of short term pancreatic duct obstruction in rats  
class6	2541	the short term effects of rat pancreatic duct obstruction were evaluated and compared with those recently reported to follow obstruction of the rabbit pancreatic duct  
class6	2541	in both species pancreatic edema and hyperamylasemia are noted  and the lysosomal hydrolase cathepsin b is redistributed from the lysosome enriched to the zymogen granule enriched subcellular fraction  
class6	2541	theoretically  this redistribution phenomenon might lead to digestive enzyme activation because cathepsin b is known to be capable of activating trypsinogen  
class6	2541	the hyperamylasemia and pancreatic edema  but not the cathepsin b redistribution  that follow rat pancreatic duct obstruction were increased by infusion of a submaximally stimulating dose of the cholecystokinin analogue cerulein  
class6	2541	administration of the cholecystokinin receptor antagonist l 364 718 reduced the hyperamylasemia but did not alter the pancreatic edema or cathepsin b redistribution  
class6	2541	these observations indicate that cholecystokinin may modulate some but not all of the effects of duct obstruction  
class6	2541	secretin administration increased the degree of pancreatic edema and had no demonstrable protective effect  
class6	2541	the rat duct obstruction model described in this report may prove particularly useful in future studies designed to clarify the early events underlying the development of acute pancreatitis  
class6	2542	conjugates of ursodeoxycholate protect against cholestasis and hepatocellular necrosis caused by more hydrophobic bile salts  in vivo studies in the rat  
class6	2542	the protective effect of ursodeoxycholate conjugates against bile salt hepatotoxicity was studied in chronic bile fistula rats  
class6	2542	taurochenodeoxycholate or taurodeoxycholate  infused intraduodenally at 24 or 16 mumols 100 g rat per hour  respectively  caused cholestasis and severe hepatocellular necrosis within 8 hours  
class6	2542	in contrast  tauroursodeoxycholate or taurocholate at 48 mumols 100 g rat per hour were choleretic  
class6	2542	tauroursodeoxycholate was not hepatotoxic  whereas taurocholate produced moderate hepatocellular necrosis  
class6	2542	simultaneous infusion of tauroursodeoxycholate to rats receiving taurochenoxycholate or taurodeoxycholate preserved bile flow and ameliorated hepatic injury in a dose dependent manner  
class6	2542	tauroursodeoxycholate protected equally by intravenous and intraduodenal routes  
class6	2542	intravenous glycoursodeoxycholate also was protective  
class6	2542	the hydrophobicity index of infused bile salts correlated well with their toxicity  
class6	2542	concurrent administration of ursodeoxycholate conjugates did not reduce biliary recovery of intraduodenally infused  24 14c  taurocholate  
class6	2542	biliary alkaline phosphatase secretion was stimulated by infusion of taurocholate  taurodeoxycholate  or taurochenodeoxycholate  simultaneous infusion of ursodeoxycholate conjugates failed to prevent this increase  
class6	2542	we conclude that ursodeoxycholate counteracts hepatoxicity of more hydrophobic bile salts via a direct effect at the level of the liver  
class6	2543	physicochemical determinants of in vitro shock wave biliary lithotripsy  
class6	2543	human gallstones were studied by visual inspection  computerized tomographic imaging  and chemical analysis to assess physicochemical characteristics that may determine the outcome of in vitro shock wave fragmentation  
class6	2543	eighty five stones  mean diameter  13 2     5 mm  were each collected from different patients  
class6	2543	fifty five  65   calculi were angular and 30  35   round or oval shaped  
class6	2543	three easily obtained measures were derived from each stone s optimal computerized tomographic image including the mean stone density  a measure corresponding to the standard deviation of the mean stone density value which we termed the stone density distribution index and which may reflect the physicochemical heterogeneity of a given gallstone  as well as the density range  
class6	2543	after the administration of 2500 shock waves using an electrohydraulic generator  fragmentation was noted in 68 calculi  80   and was satisfactory in 27  32    where the largest resulting fragment diameters were all less than or equal to 5 mm   
class6	2543	strong determinants of satisfactory fragmentation on multivariate analysis included a stone diameter of less than or equal to 15 mm  the presence of an angular stone shape  and a stone density distribution index of greater than or equal to 60 hounsfield units  
class6	2543	the other parameters did not independently determine satisfactory fragmentation  
class6	2543	prospective clinical trials are needed to assess whether these findings result in a better prediction of the success of extracorporeal biliary lithotripsy and a broadening of its indications  
class6	2544	intrahepatic cholesterol stones  a rationale for dissolution therapy  
class6	2544	a case of primary cholesterol hepatolithiasis is reported  
class6	2544	stone composition was documented by infrared spectroscopy  and the presence of cholesterol saturated bile was demonstrated using standard biochemical techniques  
class6	2544	the patient was treated with operative stone extraction  choledochoscopy  biliary enteric anastomosis  and oral dissolution therapy  
class6	2544	the administration of oral dissolution agents has altered the composition of the patient s bile and may prevent further stone formation  
class6	2544	we advocate the use of both stone and biliary biochemical analysis for patients with primary hepatolithiasis to facilitate optimal therapy  
class6	2545	insulin resistance in noncirrhotic idiopathic portal hypertension  
class6	2545	to explore further the pathogenesis of glucose intolerance and insulin resistance observed in patients with cirrhosis and portal hypertension  we studied a 35 year old woman with presinusoidal portal hypertension without cirrhosis due to nodular regenerative hyperplasia of the liver  
class6	2545	after oral glucose ingestion  glucose tolerance remained normal  however  this occurred at the expense of a markedly hyperinsulinemic plasma response  suggesting the presence of insulin resistance  
class6	2545	to examine this question more directly  we performed a stepwise euglycemic insulin clamp study in combination with an infusion of  6 3h glucose and  1 14c palmitate and indirect calorimetry  
class6	2545	the ability of insulin to promote total body  primarily muscle  glucose uptake was markedly impaired  whereas its effect to suppress hepatic glucose production was normal compared with results obtained in nine healthy subjects  
class6	2545	moreover  insulin failed to normally suppress plasma free fatty acid turnover and oxidation in this patient  
class6	2545	this informative case demonstrates that portal hypertension alone  without hepatic dysfunction from cirrhosis  is associated with impaired insulin mediated glucose and plasma free fatty acid metabolism and may also play a predominant role in the development of insulin resistance in many cirrhotic patients  
class6	2546	persistent hepatitis b virus following interferon alfa therapy and liver transplantation  
class6	2546	a 44 year old man with chronic hepatitis b virus infection and cirrhosis was treated with recombinant human interferon alfa for 67 days immediately before orthotopic liver transplantation and immunoprophylaxis with hyperimmune globulin to hepatitis b virus in the peritransplant period  
class6	2546	dot blots for hepatitis b virus dna demonstrated marked reduction in viremia after 41 days of interferon alfa treatment  
class6	2546	southern analysis for hepatitis b virus in liver showed a pronounced decrement in actively replicating forms in the explant  although hepatic infection was still detectable  
class6	2546	after liver transplantation  tests for serum hepatitis b virus dna and hepatitis b surface antigen remained negative  
class6	2546	the patient died 32 days after transplantation of causes unrelated to hepatitis b virus  
class6	2546	dna isolated from liver and other visceral organs at autopsy showed infection of the engrafted liver and the persistence of monomeric relaxed circular forms of hepatitis b virus dna in pancreas  kidney  and spleen  
class6	2546	thus  graft reinfection occurred despite aggressive antiviral therapy and immunoprophylaxis combined with liver transplantation  
class6	2546	existing viral serological markers appear insufficiently sensitive to assess residual infectivity  
class6	2547	hepatic fibrin ring granulomas in a patient with hepatitis a  
class6	2547	hepatic fibrin ring granulomas were found in a 30 year old patient with serologically confirmed hepatitis a  
class6	2547	other causes associated with the presence of fibrin ring granulomas in the liver  such as hodgkin s and non hodgkin s lymphoma  cytomegalovirus infection  visceral leishmaniasis  and consumption of allopurinol  were ruled out  
class6	2547	it is suggested that hepatitis a must be included in the differential diagnosis of a patient with hepatic fibrin ring granulomas  
class6	2548	light microscopic diagnosis of human microsporidiosis and variable response to octreotide  
class6	2548	microsporida are protozoan parasites that have recently been identified as a cause of human disease in immunocompromised patients  
class6	2548	because of their small size  they have been recognized primarily by electron microscopy  
class6	2548	this has limited the study of their prevalence  incidence  and association with large volume diarrhea  
class6	2548	the present report describes two cases of enterocytozoon bieneusi infection of the small intestine in patients with intractable diarrhea in whom the diagnosis was made by light microscopy and confirmed by electron microscopy  
class6	2548	both patients were treated with octreotide  and one had a good response  
class6	2549	expression of class ii molecules on intestinal epithelial cells in humans  differences between normal and inflammatory bowel disease  
class6	2549	expression of class ii antigens on human intestinal epithelial cells was assessed using a sensitive avidinbiotin peroxidase technique  
class6	2549	hla dr was present predominantly in the normal small bowel with diminished but evident expression in the colon  
class6	2549	hla dp staining was less prominent  and hla dq was absent  
class6	2549	in inflammatory bowel disease the expression of both hla dr and hla dp was increased  but that for hla dq remained absent  suggesting an inherent defect in the ability of intestinal epithelial cells to express hla dq  
class6	2549	in related experiments  an interferon gamma treated malignant epithelial cell line t84 also failed to stain for hla dq and hla dp despite the presence of hla dr  
class6	2549	isolated rnas for all three subclasses of hla d were detectable by slot blot analysis  suggesting that the lack of hla dq expression relates to posttranscriptional defects in intestinal epithelium  
class6	2549	these and other differences with conventional class ii antigen positive accessory cells  macrophages b cells  may help to explain the unique properties of intestinal epithelial cells as antigen presenting cells  
class6	2550	injection or heat probe for bleeding ulcer  
class6	2550	a prospective randomized trial was performed to compare the efficacy of endoscopic epinephrine injection and heat probe treatment in actively bleeding peptic ulcers  
class6	2550	emergency endoscopy in 1758 patients over an 18 month period identified 132 patients with active ulcer bleeding  
class6	2550	they were randomized to receive either endoscopic epinephrine injection or heat probe treatment  
class6	2550	after endoscopy  the patients were transferred to the surgical gastroenterology ward and were managed by surgeons unaware of the treatment option  
class6	2550	bleeding was initially controlled in 96  by epinephrine injection and in 83  by heat probe  p less than 0 05   
class6	2550	there was no significant difference in outcome as measured by transfusion requirement  4 5 units vs  
class6	2550	3 8 units   emergency surgery  20  vs  
class6	2550	22    hospital stay  8 days vs  
class6	2550	7 days   and mortality  2 vs  
class6	2550	4  between the injection group and the heat probe group  
class6	2550	two patients in the heat probe group experienced perforation  
class6	2550	we conclude that both endoscopic epinephrine injection and heat probe treatment are effective in stopping bleeding from actively bleeding ulcers  
class6	2550	epinephrine injection is technically easier to perform and has a higher initial success rate  
class6	2551	screening colonoscopy in asymptomatic average risk persons with negative fecal occult blood tests  
class6	2551	colonoscopy was performed on 210 asymptomatic average risk persons  aged 50 75 years  who had negative fecal occult blood test results  
class6	2551	colonoscopy was complete to the cecum in 209 subjects  
class6	2551	fifty three subjects  25   had adenomas and two had cancer  
class6	2551	all of the adenomas greater than or equal to 1 cm in size and both cancers occurred in subjects aged greater than or equal to 60 years  
class6	2551	fifty one percent of subjects with adenomas and one with cancer had no neoplasms distal to the sigmoid descending colon junction  
class6	2551	one subject had a major postpolypectomy hemorrhage that stopped spontaneously  
class6	2551	screening colonoscopy  therefore  has a high yield for detection of neoplasms in asymptomatic average risk persons aged greater than or equal to 60 years with negative fecal occult blood test results  
class6	2551	the yield is low in persons aged 50 54 years and intermediate in persons aged 55 59 years  
class6	2552	airway responsiveness to inhaled methacholine in patients with irritable bowel syndrome  
class6	2552	we examined whether patients with irritable bowel syndrome have increased airway responsiveness by measuring forced expiratory volumes in 1 second  fev1  after inhalation of increasing concentrations of methacholine  
class6	2552	responses obtained in 11 ibs patients were compared with those obtained in 11 normal subjects and in 11 subjects with organic disease of the gut or its related organs  
class6	2552	all subjects were selected so that other factors that might contribute to increased airway responsiveness were excluded  
class6	2552	the methacholine concentration that caused a 20  fall in the fev1  pc20   as well as the reduction in fev1 induced by each methacholine concentration  were used to assess airway responsiveness  
class6	2552	the geometric mean pc20 was 197 6 mg ml   sem  1 15  for normal subjects  83 9 mg ml   sem  1 51  for subjects with organic bowel disease  p   0 012   and only 12 8 mg ml   sem  1 74  for ibs patients  p less than 0 0001   
class6	2552	the 22 5      2 5  decrease in fev1 induced by 64 mg ml of methacholine in ibs patients was significantly greater than that of 12 3      1 5  observed in healthy subjects  p   0 003   
class6	2552	in contrast  the 15 7      2 0  decrease in fev1 observed in patients with organic disease was not different from that seen in normal subjects  p   0 189   
class6	2552	we conclude that ibs is associated with increased airway responsiveness following challenge with methacholine  
class6	2553	plasma vasoactive intestinal polypeptide concentration determination in patients with diarrhea  
class6	2553	determination of plasma levels of vasoactive intestinal polypeptide  vip  has been used for screening patients with chronic diarrhea to identify potential neuroendocrine tumors  
class6	2553	this 6 year blinded study from 1981 to 1986 examines the causes of elevated vip levels in patients  
class6	2553	in healthy volunteers   n   144   vip concentrations ranged from 14 to 76 pg ml  mean     se  28     12   whereas in chronic renal failure  4 of 34 patients or 12   serum creatinine 4 5   9 0 mg dl  397 795 mumols l   had an elevation to greater than 100 pg ml  
class6	2553	no patient with idiopathic hepatic cirrhosis  n   12  had elevation of serum concentration of this peptide  
class6	2553	among 588 consecutive unselected patients undergoing evaluation for chronic diarrhea  n   362  62   or possible neuroendocrine tumor  n   214  36    23 patients  3 9   had concentrations greater than 76 pg ml  
class6	2553	in this group  5 patients had functioning  vip  160 5975 pg ml  and 5 had nonfunctioning  vip  80 120 pg ml  pancreatic islet cell carcinomas  all 10 patients had hepatic metastases  
class6	2553	other known cases of elevated levels of vip  ranging from 80 to 340 pg ml  included other neurogenic tumors  n   3   small  bowel resection  n   2   inflammatory bowel disease  n   2   chronic renal failure  n   1   and prolonged fasting  n   1   
class6	2553	patients with diarrhea in which vip secreting tumors were identified had plasma vasoactive intestinal peptide concentrations greater than 140 pg ml  
class6	2553	in patients with chronic diarrhea  determination of plasma vasoactive intestinal peptide levels did identify tumors secreting this peptide  but the results from this referral institution did not show identification of these tumors early in their clinical course  
class6	2554	pathogenesis and therapy of peptic ulcer disease  
class6	2554	the epithelial cells of the stomach and duodenum are normally protected from the damaging effects of acid and pepsin by a balancing mechanism of mucosal resistance  
class6	2554	if an imbalance occurs  peptic ulcer may result  
class6	2554	traditional teaching has emphasized the importance of acid  and pepsin  as the cause of this imbalance  however  it is clear that acid and pepsin are not the only important factors in the pathogenesis of peptic ulcer  
class6	2554	more recent investigative efforts have been directed at what constitutes mucosal resistance and how it can be disrupted to produce  in the presence of gastric acid  a peptic ulcer  
class6	2554	depletion of endogenous prostaglandins and helicobacter pylori gastritis have emerged as prominent theories  
class6	2554	as evidence exists both to support and refute these theories in humans  any definitive conclusions cannot be made at this time  
class6	2554	the acute management of peptic ulcer disease is directed at relieving pain  accelerating ulcer healing  and preventing complications  
class6	2554	peptic ulcers can be healed with antisecretory agents  i e   h2 receptor antagonists  omeprazole   antacids  prostaglandins  and sucralfate  
class6	2554	because they are effective  safe  and convenient  the h2 receptor antagonists are the most widely used agents for the management of peptic ulcer disease  
class6	2554	because the h2 receptor antagonist agents are equally effective in their indicated uses and are equally safe based on scientifically valid data  selection should be based primarily on cost  
class6	2554	omeprazole is the newest antisecretory agent  a single morning dose of 20 mg suppresses acid secretion for 24 h  
class6	2554	the agent offers little advantage over h2 receptor antagonists for the majority of patients with peptic ulcer  
class6	2555	nsaid induced gastrointestinal damage  a critical review of prophylaxis and therapy  
class6	2555	nonsteroidal anti inflammatory drugs  nsaids  cause acute diffuse injury to the gastroduodenal mucosa  and also cause chronic focal ulcers that may bleed or perforate without warning symptoms  
class6	2555	acute and chronic lesions are distinct  are pathogenetically different  respond differently to drugs  and require different management strategies  
class6	2555	the principal rationale for antiulcer therapy in nsaid users is to prevent or reduce potentially fatal outcomes  to date no evaluated drug meets this criterion for efficacy  
class6	2555	antacids and h2 receptor antagonists  based on open uncontrolled studies  appear to heal both gastric and duodenal ulcers  and maintain them healed during continued nsaid use  larger gastric ulcers show delayed healing with conventional doses of h2 receptor antagonists during nsaid therapy  
class6	2555	no such delay occurs with omeprazole therapy  
class6	2555	the suggests that if nsaid associated gastric ulcers are treated with h2 receptor antagonists  larger doses should be given for longer periods  
class6	2555	in patients with no pre existing ulcer disease  h2 receptor antagonists given prophylactically prevent duodenal but not gastric ulcers  sucralfate does the same  
class6	2555	in individuals without peptic ulcer disease taking nsaids  misoprostol  given as prophylaxis  reduces the development of gastric ulcers  its beneficial effects on ulcer healing or symptoms during continued nsaid therapy  or its ability to prevent duodenal ulcers or ulcer complications  are not established  
class6	2555	because of diarrhea  the 400 micrograms day dosage is recommended  especially in the elderly  
class6	2556	gastroesophageal reflux disease  an update on management  
class6	2556	gastroesophageal reflux is commonplace  all humans experience it  
class6	2556	for many patients  gastroesophageal reflux disease  gerd  is a manageable condition  
class6	2556	for others  gerd can progress to severe symptoms  inflammation  and disruption of the mucosal lining  
class6	2556	effective therapy calls for a clear understanding of the pathogenesis of gerd  
class6	2556	the final common denominator to gerd is a lower esophageal sphincter mechanism that relaxes or is incompetent and allows gastroesophageal reflux to occur  
class6	2556	key factors associated with gerd are  a  gastric content   b  potency of refluxate   c  esophageal clearance   d  tissue resistance  and  e  disruption of the anatomic hiatus  
class6	2556	gerd is generally a chronic condition characterized by recurrent symptoms  
class6	2556	treatment goals for the gerd patient need to be defined  is therapy directed toward eliminating the symptoms or is therapy designed to eliminate gastroesophageal reflux  unfortunately  effective therapy for gerd usually does not affect the mechanism s  underlying the problem  
class6	2556	the broad goals of therapy in gerd are to decrease gastroesophageal reflux and neutralize it  to enhance esophageal clearance  and to protect esophageal mucosa  
class6	2556	the therapeutic modalities related to each of these situations are numerous and overlap  but treatment strategies for managing the gerd patient can be used in clinical  stages  or as the clinical situation dictates  
class6	2556	h2 receptor antagonist therapy has become the  keystone  in management of gerd  
class6	2556	unfortunately  not all gerd patients respond to conventional h2 receptor antagonist dosage treatment  high dose h2 receptor antagonist therapy recently has been demonstrated to be more effective in a greater number of gerd patients with severe esophagitis  
class6	2557	cimetidine 800 mg twice daily for healing erosions and ulcers in gastroesophageal reflux disease  
class6	2557	although h2 receptor antagonists have been the mainstay of therapy for gastroesophageal reflux disease  gerd   none of these agents has been approved by the fda as effective in healing lesions  
class6	2557	since proton pump inhibitors may be associated with long term disadvantages  a healing regimen with cimetidine would be useful clinically  
class6	2557	this multicenter  randomized  double blind study was conducted to evaluate the efficacy of cimetidine 800 mg b i d  
class6	2557	in healing lesions and in providing symptomatic relief in patients with ulcerative or erosive esophagitis  
class6	2557	patients with greater than or equal to 8 heartburn episodes during a 1 week screening period  reflux confirmed by esophageal ph monitoring  and esophageal ulcers or erosions confirmed by endoscopy were randomized to treatment with placebo or cimetidine for 12 weeks  
class6	2557	cimetidine provided significantly greater  p less than 0 01  improvement  74  vs  
class6	2557	51   and complete healing  67  vs  
class6	2557	36   of esophageal lesions than did placebo  
class6	2557	in these patients with erosive or ulcerative esophagitis  the median time to achieve 24 h without heartburn was 13 days with cimetidine and 30 days with placebo  p   0 01   
class6	2557	the mean heartburn severity score in the cimetidine group decreased rapidly during the first week and was consistently lower than in the placebo group  
class6	2557	cimetidine  800 mg twice daily  is effective in promoting healing of esophageal ulcers and erosions and in providing heartburn relief in patients with symptomatic erosive ulcerative gerd  
class6	2558	stress related mucosal damage  review of drug therapy  
class6	2558	the increased awareness of stress related mucosal damage  srmd  that accompanied the widespread use of fiberoptic endoscopy and the increased incidence of srmd that accompanied the advances in caring for critically ill patients resulted in the recognition that the majority of patients in the intensive care unit  icu  setting wil develop mucosal damage  
class6	2558	complications of gastrointestinal hemorrhage in these patients may contribute significantly to their morbidity and mortality  and the consequences of this bleeding may be more severe than the underlying predisposing conditions  
class6	2558	because of the importance of gastric acid in the pathogenesis of srmd  therapy has focused on reduction of the intraluminal acid concentration  
class6	2558	acid neutralization  while effective  is laborious and associated with side effects  
class6	2558	h2 receptor antagonists have been used successfully in the prophylaxis and treatment of srmd and offer the potential for an effective parenteral as well as oral agent  
class6	2558	they obviate the need for frequent antacid administration and eliminate some of the troubles and side effects that accompany an intensive antacid regimen  
class6	2558	of the available h2 receptor antagonists  cimetidine has been the most thoroughly evaluated  
class6	2558	it is equivalent to antacids in the prevention of overt bleeding and offers the advantage of dosing flexibility  ease of administration  and a remarkable safety profile  
class6	2558	cimetidine has also been shown to be effective when administered by intermittent bolus infusions given every 8  6  or 4 h or by primed continuous infusion  which has proven to be the most successful method of controlling intragastric ph  
class6	2559	should safety concerns with available ulcer treatment influence drug selection  
class6	2559	with the identification of the parietal cell receptors for gastric acid secretion coupled with the introduction of cimetidine in 1977  treatment of acid peptic diseases was transformed from empiric therapy to an approach based on a clearer understanding of human physiology  
class6	2559	today  physicians are confronted with an array of antiulcer agents that differ within their drug class  e g   the h2 receptor antagonists  as well as in their mechanisms of action  e g   neutralize acid  alter mucosal defensive factors  or suppress acid secretion   
class6	2559	with minor exceptions  the clinical efficacy of the available antiulcer drugs can be regarded as comparable  
class6	2559	thus  the safety profile becomes the next consideration when choosing among similarly effective drug products  
class6	2559	of the available antiulcer agents  the h2 receptor antagonists as a class have an excellent safety profile  as indicated by more than 25 years of cumulative clinical experience and postmarketing surveillance  
class6	2559	important safety issues with currently available antiulcer drugs  i e   h2 receptor antagonists  sucralfate  prostaglandin e analogues  and the newest antiulcer agent  omeprazole  are reviewed to place them into perspective for the clinician  
class6	2560	the clinical importance of drug interactions with antiulcer therapy  
class6	2560	the overall safety of a given drug is determined by its toxicity  side effects  and drug drug interactions  
class6	2560	thus  a clarification of the mechanisms  importance  and clinical implications of any drug drug interaction with antiulcer therapy is critical to the use of antiulcer medications  
class6	2560	drug drug interactions may occur as a result of changes in absorption  metabolism  distribution  or excretion  
class6	2560	fortunately  drug distribution or protein binding is unchanged by antiulcer therapy  
class6	2560	antiulcer drugs may affect absorption by several mechanisms  
class6	2560	ionized medications may bind to the divalent cations of antacids and sucralfate to result in poorly absorbed complexes  
class6	2560	reduced gastric acid may decrease the absorption of medications that are weak bases while enhancing the absorption of weak acids  
class6	2560	drug absorption may be impaired by delayed gastric emptying  
class6	2560	several h2 receptor antagonists  including cimetidine and to a lesser extent ranitidine  and the proton pump inhibitor  omeprazole  may reduce the hepatic degradation of drugs metabolized by the cytochrome p450 system  
class6	2560	the degree to which such agents alter drug metabolism is determined by the patient s age  genetics  duration of therapy  degree of cytochrome p450 binding  and the regimen  
class6	2560	because the clinical importance of this interaction cannot always be predicted  caution is recommended whenever drugs metabolized by this system are used concurrently  
class6	2560	development of an understanding of the ways in which drug metabolism interactions occur may lead to more effective and safe use of these medications  
class6	2561	the gastrin hypothesis  implications for antisecretory drug selection  
class6	2561	newer potent and long acting inhibitors of acid secretion  such as the proton pump inhibitor omeprazole  are becoming available for general use  
class6	2561	these drugs promise to control acid peptic disease effectively in patients who do not respond adequately to conventional short acting h2 receptor antagonists  
class6	2561	the safety of chronic administration of these drugs has come into question  however  
class6	2561	lifelong profound inhibition of acid secretion in rats induced by superpotent inhibitors of acid secretion or subtotal fundectomy is associated with the development of carcinoid tumors of enterochromaffin like  ecl  cells in the gastric corpus  
class6	2561	available evidence supports a role of gastrin  which becomes chronically elevated in animals subjected to prolonged and profound hypochlorhydria  
class6	2561	in humans  hypergastrinemic states such as zollinger ellison syndrome and atrophic gastritis are associated with an increased risk of ecl cell carcinoid tumors  
class6	2561	such observations have raised concern that humans may also be susceptible to carcinoid tumor formation in response to potent inhibitors of acid secretion  
class6	2561	to date  however  no cases of carcinoid tumor have been attributed to the use of omeprazole in humans  
class6	2561	if achlorhydric doses are not used  significant hypergastrinemia can be avoided while effectiveness of treatment is maintained  
class6	2561	such measures should minimize any risk of ecl cell carcinoid tumors in humans taking potent long term antisecretory drugs  
class6	2562	requirement of endogenous tumor necrosis factor cachectin for recovery from experimental peritonitis  
class6	2562	by intrasplenic immunization we raised a rat mab  mab v1q  igg2a  kappa  with a potent neutralizing activity against natural mouse tnf  1 microgram ml mab v1q 100 u ml tnf   
class6	2562	mab v1q was used to study the role of endogenous tnf in experimental peritonitis induced by sublethal cecal ligation and puncture  
class6	2562	mab v1q persisted for over 5 days in the serum of mice injected with 100 micrograms of the antibody and  therefore  proved useful for in vivo experiments  
class6	2562	as little as 20 micrograms mab v1q mouse prevented lethal shock of the animals by 400 micrograms lps mouse  
class6	2562	in sublethal cecal ligation and puncture i p  
class6	2562	injection of mab v1q directly and up to 8 h after induction of experimental peritonitis lead to death of the animals within 1 to 3 days  
class6	2562	the lethal effect of mab v1q was compensated by injection of recombinant mouse tnf  
class6	2562	similar mab v1q effects as in immunocompetent mice were shown in severe combined immune deficiency mice deficient of mature functional b and t cells  
class6	2562	taken together  these data suggest that during the early phase of peritonitis endogenous tnf may stimulate nonlymphoid cells such as granulocytes  macrophages  platelets  and fibroblasts to ingest bacteria and to localize inflammation  respectively  
class6	2562	these beneficial effects of tnf may determine survival  
class6	2562	thus  our data may have implications for the therapeutic management of a beginning peritonitis  
class6	2563	glutathione s transferase  novel vaccine against fasciola hepatica infection in sheep  
class6	2563	the potential of gst as a vaccine candidate against liver fluke infection in ruminants was studied by vaccinating sheep  n   9  with gst purified from adult worms of fasciola hepatica and challenging with 500 f  
class6	2563	hepatica metacercariae  
class6	2563	the immunization induced a high antibody response to gst in contrast to the poor or undetectable response to this ag observed in naturally infected sheep  
class6	2563	throughout the trial  the progress of the fluke infection was monitored by measuring rbc hemoglobin levels  the extent of liver damage and the fecal egg output in the sheep  
class6	2563	this analysis indicated that a subpopulation  n   4  of the gst vaccinated animals exhibited no anemia  reduced liver damage and a lower mean fecal egg count relative to the infected control group suggesting a lower fluke burden in these animals  
class6	2563	worm burdens in the livers of the gst vaccine group  107     22  were 57  lower than in the infected control group  250     25   
class6	2563	the subpopulation of the gst vaccine group demonstrated a 78  reduction in mean worm burdens relative to the control group  
class6	2563	these results show that gst of adult f  
class6	2563	hepatica is a novel ag that can significantly protect sheep against liver fluke infection  
class6	2563	the results suggest that the immune response to gst is directed to the juvenile worm reducing the number of worms that can establish in the liver of the vaccinated animals  
class6	2564	liver disease in alpha 1 antitrypsin deficiency  prognostic indicators  
class6	2564	we reviewed the clinical presentation  subsequent course  and outcome of 98 patients with alpha 1 antitrypsin deficiency seen at our institution during the past 20 years to obtain answers to the following questions   1  what prognostic factors aid in determining the course of liver disease in affected patients   2  when is the appropriate time for referral to a liver transplant center   3  does breast feeding prevent chronic liver disease   4  what is the incidence of severe liver disease in family members  our analysis revealed that the initial values of alanine aminotransferase  prothrombin time  and trypsin inhibitory capacity may have prognostic value  
class6	2564	during clinical follow up the recurrence or persistence of hyperbilirubinemia along with deteriorating results of coagulation studies indicated the need for liver transplantation because of imminent poor outcome  
class6	2564	girls had a worse prognosis than boys  
class6	2564	initial breast feeding versus feeding of commercial formulas did not influence overall overcome  
class6	2564	the incidence of significant liver disease among  at risk  siblings was 21   3 14   if one assumes mendelian inheritance from heterozygous parents  the overall risk for siblings in our families was 5   
class6	2565	effect of extracorporeal membrane oxygenation on survival of infants with congenital diaphragmatic hernia  
class6	2565	to determine the effect of extracorporeal membrane oxygenation  ecmo  on the survival of infants with congenital diaphragmatic hernia  we undertook a retrospective review of 31 infants with congenital diaphragmatic hernia treated at children s national medical center  
class6	2565	infants were categorized by means of the bohn quadrant analysis to determine the impact of ecmo on infants with congenital diaphragmatic hernia and a  poor prognosis   all infants assigned to the bohn 100  mortality quadrant required ecmo  
class6	2565	the survival rate in this group was 86   6 7  when assessed preoperatively and 67   6 9  when assessed postoperatively  
class6	2565	comparison of the change occurring in ventilation index and arterial carbon dioxide pressure demonstrated that after repair the clinical condition of 48  of infants deteriorated  40  improved  and 12  remained unchanged  
class6	2565	of the 12 infants whose condition was worse after surgery  11 eventually required ecmo  
class6	2565	our review demonstrates that ecmo improved survival significantly in infants with congenital diaphragmatic hernia who had a  poor prognosis  by the criteria of bohn et al  
class6	2565	we recommend consideration of ecmo for all infants with congenital diaphragmatic hernia for whom maximal medical therapy has failed  
class6	2566	prochlorperazine and transdermal scopolamine added to a metoclopramide antiemetic regimen  a controlled comparison  
class6	2566	cisplatin induced nausea and vomiting occurs both acutely and over a prolonged period of time  
class6	2566	these symptoms may be incapacitating and are frequently given as a reason to discontinue therapy  
class6	2566	we compared prochlorperazine and transdermal scopolamine when added to a standardized metoclopramide antiemetic regimen  
class6	2566	twenty seven patients receiving cisplatin at 100 mg m2 were randomly assigned to one of the two treatment arms  
class6	2566	patients were observed during chemotherapy and answered a standard questionnaire 24 26 hours later  
class6	2566	among similar treatment groups no differences were seen regarding the number of emetic events  level of nausea  degree of sedation or overall acceptability of one treatment arm or another  
class6	2566	while not superior to prochlorperazine  transdermal scopolamine is a useful antiemetic agent and can be combined with metoclopramide in an attempt to reduce cisplatin induced nausea and vomiting  
class6	2566	further evaluation of this approach is needed  
class6	2567	laparoscopic tubal sterilization  the potential for thermal bowel injury  
class6	2567	one of the most severe complications of laparoscopic tubal sterilization is bowel burns  although they often go undetected at the time of laparoscopy  
class6	2567	controversy remains over whether these injuries are caused directly by operator error or indirectly from a hot oviduct s or instrument s inadvertently touching and burning the intestine  
class6	2567	a study was performed to determine the potential for direct or indirect bowel burns using bipolar electrocoagulation in rabbits  
class6	2567	the results indicate that neither a hot tube nor hot  recently used  forceps could cause injuries to the serosal surface of the intestine  
class6	2567	that was true both of immediate injury and after one to five days of recovery  
class6	2567	it was observed that the hot uterine tube caused significant bowel adhesions by five days after the procedure  
class6	2567	direct electrocoagulation of the bowel using 40 w for three seconds caused a minor  noticeable blanch on the bowel that was not detectable with gross or histologic means after one day of recovery  
class6	2567	a direct bowel injury did result when 80 w was used for three seconds  the bowel became perforated after one day  
class6	2567	these findings indicate that it is unlikely that one can produce a bowel burn indirectly from a hot uterine tube or instrument and that only a direct insult to the bowel appears to cause an injury  
class6	2567	however  adhesions could be a complication of the procedure and should be considered  
class6	2568	diagnostic significance of carcinoembryonic antigen in the differential diagnosis of malignant mesothelioma  
class6	2568	the histologic and cytologic distinction of malignant mesothelioma from carcinomas metastatic to the pleura or peritoneum is often problematic  
class6	2568	for this reason immunologic methods are being increasingly used as diagnostic adjuncts  
class6	2568	this review summarizes 40 studies on the expression of carcinoembryonic antigen in mesotheliomas and in lung and other carcinomas involving the pleura or peritoneum  
class6	2568	carcinoembryonic antigen was identified immunohistochemically in 11  of mesotheliomas and in 84  of carcinomas examined and immunocytochemically  in serous effusions  in 4  and 58   respectively  
class6	2568	in serum and in pleural or ascitic fluid  significantly elevated levels of carcinoembryonic antigen are commonly associated with  lung  carcinomas but rarely with mesotheliomas  
class6	2568	thus  together with identification of the antigen in serum  pleural fluid  or ascitic fluid  immunohistochemical and immunocytochemical techniques for detecting carcinoembryonic antigen provide a valuable aid for distinguishing malignant mesothelioma from metastatic carcinomas  
class6	2569	genital herpes simplex virus infections  
class6	2569	there has been a dramatic increase in patient visits to physicians for evaluation and treatment of genital herpes infections  
class6	2569	this has resulted in part from an increase in genital herpes infections  particularly severe  first episode genital herpes infections in adults without prior hsv 1 infection  
class6	2569	virus culture remains the most sensitive and specific method for diagnosis  and use of viral cultures is encouraged  
class6	2569	type specific antibody tests have been employed in studies documenting the role of asymptomatic shedding of hsv in transmission of genital infections  the role of genital hsv in transmission of hiv  the predominance of asymptomatic and unrecognized infections in those infected with hsv 2  and the presence of past asymptomatic or unrecognized acquisition of hsv 2 in 25  of persons presenting with first episode genital herpes  
class6	2569	unfortunately  commercially available serologic tests do not reliably differentiate between antibody to hsv 1 and hsv 2  
class6	2569	recent studies suggest that the annual risk of transmission from a sexual partner with genital herpes is about 10  in heterosexual couples  
class6	2569	currently  promotion of  safe sex  is the only available approach for prevention of transmission  
class6	2569	however  ongoing research is focused on the development of an effective vaccine  
class6	2569	acyclovir should be used routinely in persons with first episode genital herpes  but careful evaluation is needed in persons with recurrent genital herpes to determine whether episodic or suppressive treatment is indicated  
class6	2569	acyclovir should also be used routinely for episodic or suppressive treatment of hsv infections in persons with aids  
class6	2569	additional antiviral agents are needed for more effective suppressive therapy and for treatment of acv resistant hsv infections in the immunocompromised host  
class6	2570	the emergence of hepatitis b as a sexually transmitted disease  
class6	2570	in the united states  approximately 300 000 cases of hepatitis b virus infection occur annually  and heterosexual activity is one of the most commonly reported risk factors for acquiring disease  
class6	2570	until the number of infections transmitted through heterosexual contact can be reduced through hepatitis b vaccination  there is little chance of controlling this infection  
class6	2571	sexually transmitted arthritis syndromes  
class6	2571	sexually transmitted infections may provoke a wide variety of rheumatic lesions  
class6	2571	disseminated n  
class6	2571	gonorrhoeae infection leads to septic arthritis  which may be rapidly destructive but which responds promptly to appropriate antibiotic therapy  
class6	2571	in contrast  both gonococcal and nongonococcal infections may lead to aseptic  reactive  arthritis or reiter s syndrome  
class6	2571	inheritance of hla b27 confers a relative risk of 30 to 50 times for the development of this condition  
class6	2571	the demonstration of c  
class6	2571	trachomatis antigen in joint material from a minority of patients suggests that direct interaction between microbial components and class i hla antigens in the joint may be central to the pathogenesis of this disease  
class6	2571	arthralgia and arthritis occur in up to 50  of individuals in the prodrome of hepatitis b infection  
class6	2571	joint symptoms may be accompanied by urticarial or cutaneous vasculitic lesions  especially on the legs  both features resolve with the onset of jaundice  
class6	2571	hepatitis b infection is also a major cause of necrotizing vasculitis  which may or may not be associated with overt hepatitis  
class6	2571	seronegative arthritis  including reiter s syndrome  psoriatic arthritis  and undifferentiated arthritis  a sjogren s like syndrome  vasculitis  and myopathies have been described in association with hiv infection  
class6	2571	it is clear that synovitis occurs in those patients despite the fact that hiv is present in immune cells within the joint during inflammatory arthritis and that both antigen presentation and lymphocyte responsiveness within the joint are impaired  
class6	2571	nevertheless  synovitis may occur in the presence of marked cd4 positive lymphocyte depletion  
class6	2571	rheumatic syndromes  including arthralgia  inflammatory arthritis  and neuropathic arthritis  may occur during any stage of congenital or acquired syphilis  
class6	2571	syphilitic synovitis responds well to antibiotic therapy  but neuropathic lesions cannot be treated effectively  
class6	2571	septic arthritis has rarely been described as a complication of disseminated mycoplasma or urea plasma infections  and joint lesions sometimes associated with erythema nodosum have also been reported in lymphogranuloma venereum and granuloma inguinale  
class6	2572	sexually transmitted causes of gastrointestinal symptoms in homosexual men  
class6	2572	the possible etiologic agents that may cause gastrointestinal complaints in homosexually active men are multiple  and their diagnosis is complex  
class6	2572	this article presents a logical approach to the work up and diagnosis of gastrointestinal complaints in homosexually active men and to discuss their treatment and disease intervention  
class6	2573	acute axonal polyneuropathy associated with anti gm1 antibodies following campylobacter enteritis  
class6	2573	we report 2 patients with guillain barre syndrome  gbs  following campylobacter jejuni enteritis  
class6	2573	electrophysiologic studies indicated that the predominant process was axonal degeneration of motor nerves  and clinical recovery was poor  
class6	2573	serum testing by thin layer chromatography and enzyme linked immunosorbent assay revealed that the sera from both patients contained high titers of igg antibody against gm1 ganglioside  
class6	2573	these cases may represent a subgroup of gbs as acute axonal polyneuropathy following c jejuni enteritis associated with anti gm1 antibodies  
class6	2574	pathogenesis of gallstones  
class6	2574	the many developments in nonoperative methods for the treatment of gallstone disease underscore the importance of understanding the pathogenesis of these stones  
class6	2574	elucidation of the factors responsible for nucleation of crystals and the mechanism by which it occurs would appear to be the challenge if we are to define the cascade of events that results in gallstone formation  
class6	2575	gallstone dissolution  
class6	2575	many methods are available for gallstone dissolution  including oral bile salts  cholesterol solvents such as mono octanoin or methyl tert butyl either  and calcium or pigment solvents such as edta and polysorbate  
class6	2575	which of these approaches will be appropriate for an individual patient depends on the type of stones  whether they are in the gallbladder or the bile ducts  whether access to the biliary tree is available  the patient s age and general medical condition  and the availability of necessary expertise  
class6	2575	in the us  both chenodeoxycholate and ursodeoxycholate are now available  
class6	2575	ursodeoxycholate is more expensive but appears to produce fewer side effects and may be more efficacious  
class6	2575	these agents are most effective in thin women with small floating  radiolucent cholesterol stones in a functioning gallbladder  
class6	2575	only about half of the small subset of patients will experience partial or complete dissolution of stones within a year  
class6	2575	stone recurrence and the potential toxicity of long term therapy are problems with this approach  
class6	2575	therefore  for most patients  cholecystectomy  either in the traditional fashion or using a laparoscopic approach  see article later in this issue by gadacz et al   is the most cost effective and perhaps the safest option  
class6	2575	intragallbladder instillation of methyl tert butyl ether probably will be applicable only to a small subset of patients  and treatment is likely to be followed by a high recurrence rate  
class6	2575	in patients with retained common duct cholesterol stones and access to the biliary tree  mono octanoin therapy is advantageous in that it can be initiated as soon as cholangiography demonstrates no extravasation  
class6	2575	in properly selected patients  a 90  success rate with this technique can be expected within 7 days  
class6	2576	extracorporeal shock wave lithotripsy for biliary stones  
class6	2576	extracorporeal shock wave lithotripsy is a noninvasive technique for treatment of patients with gallbladder and bile duct stones  
class6	2576	selected patients with gallbladder stones can be treated on an outpatient basis without general anesthesia and may return to full activity within 1 or 2 days  
class6	2576	stone free rates of 40  to 60  at 6 months have been achieved in most reported series with minimal morbidity  
class6	2576	bile duct stone lithotripsy has achieved stone clearance in 80  of patients in whom conventional methods were unsuccessful and therefore constitutes a valuable second line treatment for these patients  
class6	2577	surgery for acute and chronic cholecystitis  
class6	2577	cholecystostomy and cholecystectomy remain appropriate and effective therapy for acute and chronic cholecystitis  
class6	2577	cholecystectomy is the gold standard against which all alternative methods of treatment of inflammatory biliary stone disease should be judged  
class6	2577	the pathogenesis  diagnosis  and surgical treatment of acute and chronic cholecystitis have been described  
class6	2577	techniques of cholecystostomy  cholecystectomy  and intraoperative cholangiography used by the author have been given  
class6	2577	our results and those generally described in the literature indicate that the overall mortality rate for cholecystectomy  in all age groups  is approximately 0 5   
class6	2577	this rate increases slightly in patients with acute cholecystitis and in those over the age of 65 years  
class6	2577	cholecystectomy remains the most effective and the definitive treatment for acute and chronic cholecystitis  
class6	2578	gallstone pancreatitis  
class6	2578	gallstone pancreatitis is caused by transient obstruction of the ampulla of vater by a migrating gallstone  
class6	2578	intraglandular activation of pancreatic enzymes occurs  by an unclear mechanism   and their entry into the circulation causes most of the local and systemic events of pancreatitis  
class6	2578	the diagnosis is based on history and physical examination  an elevation of serum amylase above 1000 iu l  and ultrasound and ct scans  
class6	2578	endoscopic retrograde cholangiopancreatography can be used in less certain cases to confirm the presence of common bile duct stones  
class6	2578	because of the absence of an agent that can abort progression of the disease  therapy should consist of adequate resuscitation  nutritional support  and careful monitoring to detect early complications  
class6	2578	in patients with mild pancreatitis  surgery usually can be performed within 48 or 72 hours of admission or as soon as symptoms and amylase levels return to normal  
class6	2578	for patients with severe disease  endoscopic sphincterotomy is emerging as the therapeutic modality of choice  
class6	2578	elective treatment of the associated biliary disease should be performed during the same hospitalization after the acute phase of the disease has subsided  
class6	2579	acute cholangitis  
class6	2579	cholangitis is an infection of the biliary ductal system that results from the combination of bactibilia and biliary obstruction  
class6	2579	choledocholithiasis has been the leading cause of cholangitis  
class6	2579	however  in recent years  especially at tertiary referral centers  nonoperative biliary manipulations  often in patients with unresectable malignancies  have become the most common cause of cholangitis  
class6	2579	as a result  the complete triad of fever and chills  jaundice  and abdominal pain  as originally described by charcot  is now seen less frequently  
class6	2579	most patients still have leukocytosis and abnormal liver function tests  but many patients with indwelling tubes may develop cholangitis without significant jaundice  
class6	2579	e  
class6	2579	coli  klebsiella species  and the enterococci remain the most frequently isolated organisms  and anaerobes including bacteroides fragilis are recovered in 15  to 30  of patients  
class6	2579	however  enterobacter and pseudomonas species  as well as yeasts  are now being isolated more frequently from patients with indwelling tubes  who often have been treated previously with antibiotics  
class6	2579	computed cholangiography usually is necessary to determine the cause and site of biliary obstruction  
class6	2579	in the majority of patients with cholangitis  cholangiography can be delayed until the patient has been afebrile for a minimum of 24 to 48 hours  
class6	2579	initial therapy includes bowel rest  intravenous fluids  and antibiotics  
class6	2579	many antibiotic regimens are now available to cover the gram negative aerobes  the enterococcus  and the anaerobes that are likely to be causing the biliary infection  
class6	2579	the combination of a penicillin and an aminoglycoside has been the gold standard  
class6	2579	however  recent studies suggest that the newer broad spectrum penicillins provide adequate therapy for these patients  
class6	2579	only a small percentage  5  10   of patients with toxic cholangitis require emergency biliary decompression  
class6	2579	the choice of percutaneous or endoscopic drainage should be made on the basis of the presumed site and cause of obstruction as well as local expertise  
class6	2579	the nature of the biliary obstruction may be the most important determinant of outcome  
class6	2579	at present  patients with end stage malignant obstruction account for most of the deaths  whereas approximately 95  of patients survive an episode of cholangitis  
class6	2580	nonoperative management of bile duct stones  
class6	2580	the treatment of choice for most retained bile duct stones is by nonoperative means  
class6	2580	if a t tube is in place  percutaneous techniques via the t tract are indicated  
class6	2580	percutaneous access via puncture of a roux en y loop is also practical  
class6	2580	in the absence of a t tube  retrograde endoscopic techniques should be used  
class6	2580	both techniques are very effective and safe  
class6	2580	stones in the intrahepatic and extrahepatic ducts also can be treated nonoperatively  
class6	2580	endoscopic sphincterotomy has a role in the treatment of selected patients with gallstone pancreatitis  acute cholangitis  and choledocholithiasis with in situ gallbladders  
class6	2580	in difficult cases  endoscopic and percutaneous techniques are employed in combination  
class6	2581	surgical management of bile duct stones  
class6	2581	the biliary surgeon in the 1990s must be familiar with all of the available techniques for the treatment of bile duct stones  
class6	2581	experience and judgment are important in the successful management of the individual patient with intrahepatic or extrahepatic stones  
class6	2581	knowledge of the nonsurgical methods of stone removal is important in the decision making process  
class6	2581	however  the biliary surgeon must resist the temptation to do less than a thorough removal of all stones at the operation lest the patient be subjected to additional procedures  which carry their own risks of morbidity and death  
class6	2581	the goal should be to clear the stones from the biliary system with the fewest procedures offering the lowest morbidity and mortality risks to the patient  
class6	2582	stenosis of the sphincter of oddi  
class6	2582	 stenosing papillitis  is a descriptive term for an anatomic deformity of the papilla of vater that is characterized by narrowing of the lower end of the bile duct and the proximal end of the duct of wirsung  
class6	2582	the defect is secondary to inflammation and fibrosis from the chronic passage of gallstones  episodes of acute pancreatitis  chronic pancreatitis  sclerosing cholangitis  peptic ulcer disease  and cholesterolosis  
class6	2582	patients with papillary stenosis from gallstones may present with episodes of severe upper abdominal pain several years after cholecystectomy  
class6	2582	the pain is often incapacitating  and patients are often addicted to narcotic analgesics  
class6	2582	the work up includes abdominal ultrasonography and ct scanning and endoscopic retrograde cholangiopancreatography even though the findings usually are normal  
class6	2582	liver and pancreatic enzymes are not frequently elevated with the painful episodes  
class6	2582	transendoscopic manometry may reveal elevated pressures within the papillary portion of the distal bile duct  
class6	2582	some patients are relieved of their pain by transduodenal sphincteroplasty and transampullary septectomy  thereby ablating the sphincter of oddi around the bile and pancreatic ducts and enlarging their openings  
class6	2583	primary sclerosing cholangitis  
class6	2583	primary sclerosing cholangitis is a rare disease of unknown etiology  
class6	2583	sclerosis of the bile ducts may actually be the final result of multiple factors such as autoimmune  bacterial  congenital  drug  or viral injury  
class6	2583	the most commonly associated diseases are ulcerative colitis and chronic pancreatitis  
class6	2583	except in the earliest stages of the disease  liver histologic findings are not specific  
class6	2583	most patients present with jaundice  pain  and pruritus  although an increasing number of asymptomatic patients with inflammatory bowel disease and abnormal liver function are being identified  
class6	2583	cholangiography is key to the diagnosis and is usually pathognomonic except in the unusual case where primary sclerosing cholangitis is confused with cholangiocarcinoma  
class6	2583	many forms of medical therapy have been tried  including antibiotics  azathioprine  cholestyramine  colchicine  cyclosporine  d penicillamine  steroids  and ursodeoxycholic acid  
class6	2583	to date  none of these medications has been proved to alter the course of this disease  
class6	2583	recent reports of ursodeoxycholic acid trials have been encouraging  but long term results of ongoing randomized trials have yet to be published  
class6	2583	in recent years  balloon dilatation of biliary strictures has been accomplished via endoscopic and percutaneous transhepatic approaches  
class6	2583	however  in patients with primary sclerosing cholangitis  these nonoperative manipulations must be done repeatedly  may entail multiple general anesthetics  and are difficult to perform  
class6	2583	we believe that a direct surgical approach to the biliary tree with long term transhepatic stenting is indicated in selected patients with severe hilar or extrahepatic stricturing  persistent jaundice or recurrent cholangitis  and no evidence of cirrhosis  
class6	2583	hepatic transplantation should be reserved for patients with primary sclerosing cholangitis who have well established cirrhosis and have not responded to other therapeutic measures  
class6	2584	congenital biliary tract disease  
class6	2584	jaundice in the pediatric patient requires prompt and directed evaluation  
class6	2584	this dictum is highlighted in infants with biliary atresia  in whom the progressive sclerosing process results in complete obliteration of patent but microscopic hilar biliary structures by 4 months of age  
class6	2584	kasai s operation  if done before that time  will re establish bile drainage in 90  of infants  
class6	2584	one fourth to one third of patients achieve long term jaundice free survival  
class6	2584	complications of cholangitis  portal hypertension  and fat malabsorption are experienced by many patients  
class6	2584	in children with early or late operative failure  liver replacement now offers legitimate hope for extended survival  
class6	2584	choledochal cyst is a conglomerate of pancreaticobiliary anomalies consisting of a choledochal cyst  a common channel type pancreaticobiliary junction  intrahepatic cystic disease  and partial obstruction of the distal common bile duct  
class6	2584	many patients have one or more of these malformations  
class6	2584	it is now widely accepted that the preferred treatment of choledochal cyst is total excision of the diseased biliary duct with reconstruction by roux en y choledochojejunostomy  
class6	2584	 internal  excision avoids injury to other structures in the hepatoduodenal ligament  particularly if pericystic inflammation is present  
class6	2584	congenital perforation of the common bile duct responds in most cases to simple peritoneal drainage of the perforation  
class6	2584	retention of the tube cholecystostomy is useful for subsequent cholangiographic follow up  
class6	2584	tube cholecystostomy may also be useful for irrigation of the biliary tract in infants with inspissated bile syndrome  
class6	2585	carcinoma of the gallbladder  
class6	2585	gallbladder cancer remains difficult to diagnose preoperatively  
class6	2585	however  recent work suggests that ultrasound may be effective  
class6	2585	gallbladder cancer remains highly lethal despite aggressive therapy  
class6	2585	extension of the disease beyond the mucosa predicts a poor chance of long term survival  
class6	2586	acute urinary retention in a child with appendiceal abscess  diagnostic dilemma  
class6	2586	rarely do children with appendiceal abscess present with acute urinary retention as the only sign or symptom  
class6	2586	this presentation may delay diagnosis and definitive therapy  thereby causing additional morbidity and possible mortality  
class6	2586	we report the eighth case of acute urinary retention in a child associated with an appendiceal abscess  
class6	2587	persistent mullerian duct syndrome  
class6	2587	persistent mullerian syndrome is rare  
class6	2587	a case of phenotypically normal male with persistent mullerian structures that consisted of a bicornuate uterus  fallopian tubes  and upper third of the vagina is reported  
class6	2587	these unusual structures were found in association with bilateral cryptorchidism and a right inguinal hernia  and were diagnosed while repairing the hernia in the neonatal period  
class6	2587	the uterus and fallopian tubes were removed via laparotomy when the child was eighteen months old  at the same time a bilateral orchiopexy was performed  
class6	2587	to avoid damage to the vas deferens  which lay in closely to the mullerian structures and could not be separated from the vaginal wall  a small segment of the upper third of the vagina was retained  
class6	2587	the testicles  although normal on pathologic examination  have shown poor response to hormonal stimulation with human chorionic gonadotropin  
class6	2587	long term follow up for these patients is necessary because they have an increased risk of testicular tumors developing  
class6	2588	asymptomatic rhabdomyolysis of unknown etiology  
class6	2588	a 7 year old boy developed rhabdomyolysis with a peak creatine phosphokinase level of 261 400 iu l after his appendectomy  
class6	2588	these abnormalities occurred following a 2 3 day illness consisting of upper respiratory tract symptoms  fever  and abdominal pain mimicking acute appendicitis  
class6	2588	at the time of operation  a normal appendix was removed  and mesenteric lymphadenitis was noted  
class6	2588	the myoglobinuria and elevation of creatine phosphokinase were transient  and the patient remained asymptomatic  
class6	2588	we review various causes of right lower quadrant pain and rhabdomyolysis and address the roles of malignant hyperthermia and infectious agents  
class6	2588	the possible cause of the phenomena observed in this patient is discussed  
class6	2589	penetration of the pericardium by a gastric ulcer  survival after pericardiocentesis  
class6	2589	elderly patients often have unusual manifestations of common illnesses  
class6	2589	we describe a geriatric patient having a pneumopericardium from pericardial penetration by a gastric ulcer  
class6	2589	benign gastric ulceration causing perforation of the pericardium or other cardiac structures was recognized as early as 1854  however  until 1964  the condition was invariably fatal  
class6	2589	our patient survived the episode after early pericardiocentesis and medical treatment  
class6	2589	aspects of this uncommon clinical entity and a brief review of the literature are described  
class6	2590	cimetidine suppresses chemically induced experimental hepatic porphyria  
class6	2590	the ability of cimetidine to reduce the activity of hepatic aminolevulinic acid synthase  ala s  was examined in allylisopropyl acetamide  aia  treated porphyric adult rats  
class6	2590	a dose of 20 mg cimetidine 100 gm body weight resulted in a 50  decrease in the aia induced hepatic ala s activity compared to rats treated with aia alone  
class6	2590	heme oxygenase activity was decreased 25  compared to rats treated with aia alone  
class6	2590	the effects of aia and cimetidine on cytochrome p 450 were not additive  suggesting competition for a common site of interaction  
class6	2590	the results suggest that cimetidine may prove to be useful in treating porphyria in humans  
class6	2591	treatment of chronic liver disease caused by 3 beta hydroxy delta 5 c27 steroid dehydrogenase deficiency with chenodeoxycholic acid  
class6	2591	deficiency of 3 beta hydroxy delta 5 c27 steroid dehydrogenase  the second enzyme in the sequence that catalyses the synthesis of bile acids from cholesterol  leads to chronic liver disease in childhood as well as to malabsorption of fat and fat soluble vitamins  
class6	2591	a 4 year old boy with this condition has been successfully treated by oral administration of a bile acid  chenodeoxycholic acid  
class6	2591	he had been jaundiced since birth  grew poorly because of rickets  and had severe pruritus  
class6	2591	plasma transaminase activities were persistently raised  
class6	2591	chenodeoxycholic acid 125 mg twice daily for two months  and then 125 mg daily  cured his jaundice and pruritus  returned his transaminase activities to normal  and eliminated the need for calcitriol for prevention of rickets  
class6	2591	on this treatment he has so far remained well for two years  
class6	2591	a diagnosis of 3 beta hydroxy delta 5 c27 steroid dehydrogenase deficiency should be considered in any child with unexplained chronic hepatitis or cirrhosis  especially if the liver disease is accompanied by a clinically obvious malabsorption of fat soluble vitamins  
class6	2591	a simple colorimetric test of the urine confirms the diagnosis and effective treatment can be started  
class6	2592	normal small bowel biopsy followed by coeliac disease  
class6	2592	we report four patients  two children  one adolescent  and one adult  having normal small bowel mucosa shown on a biopsy specimen taken before the initial diagnosis of coeliac disease was made  
class6	2592	the first biopsy was undertaken in two cases because of suspected malabsorption  in the third because of suspected dermatitis herpetiformis  and in the fourth as part of a coeliac disease family study  
class6	2592	after a further 2 6 to 9 years on a diet containing gluten  small bowel villous atrophy with crypt hyperplasia compatible with coeliac disease was found on a second biopsy specimen  
class6	2592	the hla type of the patients was that typical for coeliac disease  all were dr3 positive  
class6	2592	within the families three other patients with coeliac disease have been diagnosed  two earlier and one at the time the first biopsy was undertaken  
class6	2592	four other hla dr3 positive haploidentical first degree relatives were found and had biopsies  
class6	2592	all four had normal small bowel villous architecture  one had an increased intraepithelial cell count  and another was positive for reticulin and endomysium antibodies  
class6	2592	coeliac disease may exist latent in patients having normal mucosa when eating a normal diet containing gluten  
class6	2593	helicobacter pylori and associated duodenal ulcer  
class6	2593	twenty three children with coexistent duodenal ulcer and helicobacter pylori infection were treated with either two weeks of amoxycillin  25 mg kg day  in addition to six weeks of cimetidine  or cimetidine alone  
class6	2593	endoscopy with antral and duodenal biopsies for urease test  microaerophilic culture  and histological studies were performed at entry  six weeks  12 weeks  and at six months  
class6	2593	children with persistent h pylori infection at six weeks were given a further two weeks  course of amoxycillin  
class6	2593	h pylori persisted in all children not receiving amoxycillin treatment but cleared in six of the 13 children  46   treated with amoxycillin  
class6	2593	with failure of h pylori clearance at six months  only two out of six  33   ulcers had healed and 50  of patients had experienced ulcer recurrence  
class6	2593	in contrast  when h pylori remained cleared all ulcers healed and no ulcer recurred  
class6	2593	persistent h pylori infection was associated with persistent gastritis and duodenitis despite endoscopic evidence of ulcer healing  
class6	2593	detection and eradication of h pylori deserves particular attention in the routine management of duodenal ulceration in children  
class6	2594	severe hypertension after liver transplantation in alpha 1 antitrypsin deficiency  
class6	2594	five children with alpha 1 antitrypsin deficiency and terminal liver disease received liver grafts  all five became hypertensive and four developed hypertensive encephalopathy  
class6	2594	there was evidence of renal disease preoperatively and renal biopsy specimens showed variable glomerulonephritic histology with iga nephropathy in one  mesangial proliferative changes in two  and mesangio capillary glomerulonephritis type i in two  
class6	2594	four hypertensive episodes were preceded by a fall in creatinine clearance  
class6	2594	the association of glomerulonephritis with alpha 1 antitrypsin deficiency in children is more common than has been recognised  
class6	2594	affected patients are prone to severe hypertension of probable renal origin after liver transplantation and the renal lesion may affect long term prognosis  
class6	2595	perianal appearances associated with constipation  
class6	2595	the perianal appearances were studied prospectively of 136 constipated children  mean age 3 9 years  67 boys  69 girls   
class6	2595	anal dilatation  fissures  tags  warts  perianal oedema  redness  blueness  and veins were recorded  
class6	2595	it was noted whether dilatation occurred immediately or at 30 and 60 seconds with the buttocks minimally separated  and on subsequent firm lateral traction of the buttocks  
class6	2595	the degree of faecal loading was assessed in all children  
class6	2595	anal dilatation was found in 24  18   and first appeared on lateral traction in eight  6    
class6	2595	in three quarters of the children with dilatation faecal loading or perianal signs were present  
class6	2595	fissures were found in 35  26   children and tags in seven  5    
class6	2595	perianal redness was more likely to be associated with fissures  and blueness with dilatation  
class6	2595	we conclude that there are no pathognomonic perianal signs in childhood constipation and that the technique of anal examination should be standardised  
class6	2596	reproducibility of 24 hour oesophageal ph studies in infants  
class6	2596	thirteen infants who had undergone 24 hour oesophageal ph monitoring to diagnose gastro oesophageal reflux had a second study carried out to see if the results were reproducible  
class6	2596	the studies were done without restricting the babies  activities  
class6	2596	appreciable differences were found  the percentage of the total time during which the ph was less than 4 varying by up to 3 7 fold between the two tests  
class6	2596	the differences were largely the result of biological rather than technical variability  
class6	2596	from these results estimates were made of the reliability of a single diagnostic study and the size of changes that would be necessary to show the effect of treatment  
class6	2596	these findings have a considerable impact on the diagnosis of abnormal gastro oesophageal reflux and its response to treatment whether using 24 hour ph monitoring or any other method of measurement  
class6	2597	bronchial asthma and acid reflux into the distal and proximal oesophagus  
class6	2597	the prevalence of pathological gastro oesophageal reflux in children and adolescents with asthma was studied by 24 hour two level oesophageal ph monitoring in 42 subjects aged 9 20 years with moderate or severe bronchial asthma  
class6	2597	the importance of oesophagobronchial nerve reflexes and of aspiration of gastric acid as triggers in asthma was assessed by studying whether episodes of reflux into the distal and into the proximal oesophagus were followed by asthma attacks  
class6	2597	twenty one subjects  50   had a pathological total reflux time in the distal oesophagus and six  16   in the proximal oesophagus  
class6	2597	nine patients had pathological gastro oesophageal reflux into the distal oesophagus together with symptoms of asthma during the day on which the recording took place  
class6	2597	in three of them the episodes of asthma symptoms were significantly correlated with preceding episodes of reflux into the distal oesophagus  and in one subject to reflux into the proximal oesophagus  
class6	2597	we conclude that pathological gastro oesophageal reflux is common in children and adolescents with asthma  but it seems to provoke symptoms of asthma in only a few  
class6	2597	symptoms of asthma were more often elicited by exposure of the distal oesophagus to gastric acid  possibly by a vagal reflex  than by aspiration of gastric juice  
class6	2598	crohn s disease of the lung 
class6	2598	two years after developing colonic crohn s disease  a 17 year old boy presented with focal pulmonary consolidation  
class6	2598	a lung biopsy specimen showed areas of non caseating epithelioid granuloma  
class6	2598	although some respiratory abnormalities appear to be associated with inflammatory bowel disease  granulomatous disease affecting the lung has not previously been reported in a child  
class6	2599	treatment of severe acne with isotretinoin in patients with inflammatory bowel disease  
class6	2599	four patients with inflammatory bowel disease and severe cystic acne were treated with isotretinoin  
class6	2599	two patients had a successful course of treatment without any gastrointestinal side effects  
class6	2599	one patient had two episodes of profuse rectal bleeding that were probably related to pre existing haemorrhoids  
class6	2599	the fourth patient had a flare up of his crohn s disease after starting isotretinoin  
class6	2600	aerobic work capacity in patients with chronic fatigue syndrome 
class6	2600	objective  to determine the aerobic work capacity of patients with the chronic fatigue syndrome and compare it with that of two control groups  and to assess the patients  perception of their level of activity before and during illness  
class6	2600	design  a symptom limited exercise treadmill test with on line gas analysis and blood sampling was used  
class6	2600	subjects were assessed by one investigator  who was blind to the group which they were in  
class6	2600	setting  department of medicine  royal victoria hospital  belfast  
class6	2600	subjects  13 patients  10 women  three men  who fulfilled the diagnostic criteria for chronic fatigue syndrome  
class6	2600	two control groups of similar age  sex  and body weight  13 normal subjects  10 women  three men  and seven patients  five women  two men  with the irritable bowel syndrome  
class6	2600	main outcome measures  aerobic work capacity as assessed by several variables such as length of time on treadmill  heart rate  and biochemical measurements  borg score  and visual analogue scores of perceived level of physical activity  
class6	2600	results  the patients with the chronic fatigue syndrome had a reduced exercise capacity compared with that of the other subjects  spending a significantly shorter time on the treadmill  
class6	2600	they had a significantly higher heart rate at submaximal levels of exertion and at stage iii exertion had significantly higher blood lactate concentrations  
class6	2600	using a borg score  they showed a significantly altered perception of their degree of physical exertion with a mean score of 8 2 compared with 6 6 and 5 3 for the normal subjects and patients with the irritable bowel syndrome respectively  
class6	2600	using a visual analogue scale they indicated that they had a greater capacity for activity before illness than had the patients with the irritable bowel syndrome  but the scores were not significantly different between the two groups  
class6	2600	both groups of patients indicated reduced activity at the time of testing  
class6	2600	normal controls and patients with the irritable bowel syndrome aspired to a greater level of activity than their current level  but the patients with the chronic fatigue syndrome aspired to a level similar to that which they had had before their illness  
class6	2600	conclusions  patients with the chronic fatigue syndrome have reduced aerobic work capacity compared with normal subjects and patients with the irritable bowel syndrome  
class6	2600	they also have an altered perception of their degree of exertion and their premorbid level of physical activity  
class6	2601	serial prothrombin time as prognostic indicator in paracetamol induced fulminant hepatic failure  
class6	2601	objective  to find out whether changes in the daily prothrombin time are of prognostic importance in patients with paracetamol induced fulminant hepatic failure  
class6	2601	design  retrospective study  
class6	2601	setting  the liver unit  king s college hospital  london  
class6	2601	patients  150 consecutive patients with paracetamol induced fulminant hepatic failure admitted between october 1986 and february 1989  
class6	2601	main outcome measure  death  
class6	2601	results  of the 150 patients  72  48   died  
class6	2601	in all  34 of the 37  92   patients with a peak prothrombin time of greater than or equal to 180 seconds died as did 20 of the 41  49   with a time of 130 179 seconds  nine of the 25  36   with a time of 90 129 seconds  and nine of the 47  19   with a time of less than 90 seconds  
class6	2601	of the 42 patients with a continuing rise in prothrombin time between days 3 and 4 after overdose  39 died  93   compared with 21 of the 96  22   in whom the prothrombin time fell  
class6	2601	conclusions  these data indicate that a continued increase in prothrombin time on day 4 after overdose and a peak prothrombin time of greater than or equal to 180 seconds identify at an early stage those patients with a less than 8  chance of survival  
class6	2601	liver transplantation should be considered in patients meeting either of these criteria  
class6	2602	response to treatment of detrusor instability in relation to psychoneurotic status  
class6	2602	a total of 53 females who entered a double blind crossover trial of oxybutynin and placebo for idiopathic detrusor instability were questioned about life events and associated medical disorders and were given a psychometric test  
class6	2602	their response to treatment was studied in relation to these factors  
class6	2602	it was found that 11  of patients had nocturnal enuresis beyond age 8 and 25  had irritable bowel syndrome  their response to treatment was generally poor  
class6	2602	life events were not consistently related to treatment response  
class6	2602	the mean psychoneurotic score of  poor responders   43 7  was similar to that of female psychoneurotic out patients  47 7   although one third of poor responders were normal  
class6	2602	patients who responded well to simple anticholinergic treatment had a mean score  30 7   which was similar to that of normal urban females  33 5   
class6	2602	most good responders and one third of poor responders showed little evidence of psychoneuroticism  a further search for neurophysiological abnormality in idiopathic detrusor instability is needed  
class6	2603	helicobacter pylori and gastric carcinoma  serum antibody prevalence in populations with contrasting cancer risks  
class6	2603	this investigation examined the correlation between helicobacter pylori  hp  infection  as reflected in immunoglobulin g serum antibodies  and the risk of gastric cancer  
class6	2603	serum samples were obtained from populations with contrasting gastric cancer risks  
class6	2603	the highest prevalence of hp infection  93   was observed in the adult population at highest gastric cancer risk  the residents of pasto  colombia  
class6	2603	in the lower risk colombian city of cali  a 63  overall prevalence rate was found  
class6	2603	both children and adults were sampled in new orleans  louisiana  where gastric cancer rates are high for blacks but not for whites  
class6	2603	the prevalence of hp infection was significantly higher in black than in white adults  70  versus 43   p   0 0001  
class6	2603	a higher prevalence was also detected in black compared with white children  49  versus 32   p   0 01  however  an even greater disparity was noted when comparing children from two hospitals  regardless of race  which serve different socioeconomic groups  
class6	2603	a prevalence rate of 54  was found at charity hospital compared with 24   p   0 0001  at children s hospital  
class6	2603	our findings indicate that socioeconomic conditions  known to influence gastric cancer risk  are also important determinants of hp infection  
class6	2604	xipamide disposition in liver cirrhosis  
class6	2604	the pharmacokinetics of the sulfonamide type diuretic xipamide was studied in patients with liver cirrhosis and ascites and compared with healthy control subjects  
class6	2604	after oral administration of 40 mg xipamide  the diuretic was rapidly distributed in the blood and the ascites  
class6	2604	the ratio of the area under the concentration time curve  auc  of plasma and ascitic fluid was 7 2  as was the protein content in the respective compartments  
class6	2604	the auc in plasma of cirrhotic patients was significantly greater than in control subjects  p less than 0 001   
class6	2604	the most striking finding was the increase of the amount  ae  of parent drug and main metabolite excreted into the urine  p less than 0 001   
class6	2604	the renal clearance of xipamide was only moderately reduced in patients with liver cirrhosis  
class6	2604	both auc and ae were positively correlated to the plasma concentration of direct bilirubin of the patients  p less than 0 05   
class6	2604	we concluded that nonrenal drug clearance in patients with liver cirrhosis was reduced as a result of the blockade of hepatobiliary excretion during cholestatic conditions  
class6	2605	approaches to the patient with aspiration and swallowing disabilities  
class6	2605	aspiration  or soiling of the tracheobronchial tree  can produce life threatening pulmonary disease  
class6	2605	intermittent or persistent aspiration may cause symptoms including cough  intermittent fever  recurrent tracheobronchitis  atelectasis  pneumonia  and or empyema  
class6	2605	the pulmonary disease may be associated with weight loss  cachexia  and dehydration  
class6	2605	in many cases the aspiration is caused by laryngeal dysfunction  allowing pulmonary contamination by swallowed material  
class6	2605	in other cases the aspiration is caused by a dysfunction of the oral  pharyngeal  or esophageal phases of swallowing  
class6	2605	in some cases the aspiration is caused by a combination of laryngeal and swallowing dysfunction  
class6	2605	geriatric patients are more likely to experience aspiration  since muscle weakness causing mechanical disability and neurologic impairment are more common in this age group  
class6	2605	therefore  with the ever increasing aging of our population  these disabilities will be on the rise  with an associated increase in pulmonary disease and death  
class6	2605	the approach to evaluation and management of these disorders must be based on an understanding of the underlying functional impairment  
class6	2606	esophageal motility in an adult with a congenital h type tracheoesophageal fistula  
class6	2606	congenital h type tracheoesophageal fistulas  tef  are rare  
class6	2606	long standing respiratory symptoms are the most common presenting complaints  
class6	2606	patients with these fistulas have a congenital esophageal motor abnormality characterized by uncoordinated  low amplitude peristalsis of the esophageal body  both low and normal lower esophageal sphincter pressures have been described  
class6	2606	these findings persist despite fistula repair  
class6	2606	a case history of an adult patient with congenital tef is presented and the literature is reviewed  
class6	2606	this patient is unusual in that esophageal symptoms  dysphagia  were more prominent than the usual respiratory symptoms  
class6	2607	effects of a multidisciplinary management program on neurologically impaired patients with dysphagia  
class6	2607	dysphagia is a major problem in patients with neurologic disorders  
class6	2607	aspiration pneumonia and impaired nutritional status are consequences of dysphagia that result in high morbidity and mortality rates  
class6	2607	assessment and treatment of the dysphagic patient by a multidisciplinary team have been advocated but to date the effects of such an approach have not been demonstrated quantitatively  
class6	2607	this prospective study was conducted to determine if a dysphagia program would improve patients  caloric intake and body weight  decrease the instances of aspiration pneumonia  or improve patients  feeding ability  
class6	2607	patients were referred from a 26 bed neurology neurosurgery unit  
class6	2607	a time series design was utilized  
class6	2607	the control group consisted of 15 patients  mean age   46 1 years   managed according to the existing ward routine  
class6	2607	subsequently  nursing staff attended a dysphagia training program  
class6	2607	following this  the treated group of 16 patients   mean age   49 3 years  was assessed by the dysphagia team  using bedside and videofluoroscopic examinations to determine the specific swallowing disorder  
class6	2607	an individualized treatment program was designed for each patient  
class6	2607	the groups were compared on the basis of deviation from their baseline weight  deviation from ideal energy intake  and the incidence of aspiration pneumonia  
class6	2607	statistical analysis revealed that the groups were comparable in age  number of days on the study  and glasgow coma scale score  and that a significant weight gain and increase in caloric intake occurred in the treated group  
class6	2607	no incidence of aspiration pneumonia was reported in either group  
class6	2607	we speculate that this may have been influenced by the meticulousness of the care delivered in an acute unit as well as greater attention to prevention given in both groups  
class6	2608	motility changes in primary achalasia following pneumatic dilatation  
class6	2608	the changes in esophageal motility after pneumatic dilatation were evaluated prospectively in 51 patients with achalasia  
class6	2608	the patients were evaluated for a median of 14 months  
class6	2608	pneumatic dilatation led to a clinical improvement in 41 patients  
class6	2608	on manometric evaluation  a significant decrease in lower esophageal sphincter pressure was observed  28 4     14 9 mmhg vs  
class6	2608	13 5     7 2 mmhg  p   0 001   the resting pressure of the esophageal body dropped from 4 8     4 2 mmhg above gastric baseline to 0 1     3 9 mmhg below gastric baseline  
class6	2608	after therapy  peristaltic activity was present in 10 51  20   patients  in 1 case  complete relaxation of the lower esophageal sphincter was recorded  
class6	2608	treatment induced motility changes could not be predicted by clinical history or the lower esophageal sphincter pressure before or after therapy  
class6	2608	however  the resting pressure of the esophageal body before and after therapy was significantly lower in these patients in whom peristalsis recurred after therapy than in patients with an unchanged motility pattern  
class6	2608	the reappearance of peristaltic activity after pneumatic dilatation was unrelated to lower esophageal sphincter pressure  
class6	2608	in conclusion  motility disturbances of the esophageal body in patients with achalasia do not simply reflect the functional obstruction of the lower esophageal sphincter  
class6	2608	these findings support the hypothesis that achalasia is not a distinct motility disturbance but should be regarded as part of a broad spectrum of different interrelated esophageal motility disorders  
class6	2609	breast feeding and diarrheal morbidity  
class6	2609	this study used a unique longitudinal survey of more than 3000 mother infant pairs observed from pregnancy through infancy  
class6	2609	the sample is representative of infants from the cebu region of the philippines  
class6	2609	the sequencing of breast feeding and diarrheal morbidity events was carefully examined in a longitudinal analysis which allowed for the examination of age specific effects of feeding patterns  
class6	2609	because the work controlled for a wide range of environmental causes of diarrhea  the results can be generalized to other populations with some confidence  
class6	2609	the addition to the breast milk diet of even water  teas  and other nonnutritive liquids doubled or tripled the likelihood of diarrhea  
class6	2609	supplementation of breast feeding with additional nutritive foods or liquids further increased significantly the risk of diarrhea  most benefits of breast feeding alone or in combination with nutritive foods liquids became small during the second half of infancy  
class6	2609	benefits of breast feeding were slightly greater in urban environments  
class6	2610	high fat semielemental diet in the treatment of protracted diarrhea of infancy  
class6	2610	the capacity for greater fat absorption relative to carbohydrate absorption in protracted diarrhea of infancy was studied in a developed and a developing country  buffalo  ny  and bangkok  thailand   
class6	2610	fifty patients with protracted diarrhea in the first year of life  defined as liquid stools of more than 20 ml kg per day with more than a 14 day duration  were randomly assigned to receive either a standard semielemental diet  pregestimil  or a high fat semielemental diet that contained 40  more fat  
class6	2610	the increased fat was largely in the form of medium chain triglycerides  with the new diet providing 60  of the fat as medium chain triglycerides compared with 40  in the standard diet  
class6	2610	tolerance to both diets was good in both studies  
class6	2610	both groups showed adequate weight gain and an improvement in anthropometric and biochemical parameters  
class6	2610	the patients receiving the high fat diet showed no initial weight loss  however  and their weight gain was initiated earlier  
class6	2610	cumulative weight gain was also higher in the group receiving the high fat semielemental diet  
class6	2610	fecal fat analyses were performed after 1 week of therapy  
class6	2610	there was no difference observed in the coefficient of fat absorption between the groups receiving the two formulas  indicating that infants with protracted diarrhea may be able to tolerate a higher fat intake than is normally provided  
class6	2610	as carbohydrate intolerance is known to be a complicating factor when using semielemental enteral feeds for infants with protracted diarrhea  a higher fat semielemental diet may be the most appropriate way to provide adequate caloric intake  
class6	2611	angiodysplasia  characterization  diagnosis  and advances in treatment  
class6	2611	gastrointestinal bleeding accounts for 2  of all adult hospital admissions each year  
class6	2611	angiodysplasia is one of the most frequently reported causes of lower gastrointestinal bleeding  
class6	2611	in 80  of patients with bleeding angiodysplasia  the bleeding will stop spontaneously  but will often recur  
class6	2611	although angiography may detect bleeding in 86  of actively bleeding patients  the bleeding rate must be at least 0 5 ml min  
class6	2611	the treatment of choice for control of bleeding has been resection of the suspected segment of bowel  but this procedure is associated with a 10  rebleeding rate and 7  to 8  mortality  
class6	2611	superselective catheterization with infusion of vasoconstrictors has been used to control bleeding  but effects are short lived  
class6	2611	superselective embolization occludes an offending vessel  but is difficult to perform accurately and is associated with risk of infarction  
class6	2611	laser photocoagulation controls bleeding in 84  of patients  with a 6  complication rate  
class6	2611	this method of controlling bleeding offers distinct advantages  especially for the hemodynamically unstable patient  
class6	2611	except for cases in which surgical resection is indicated  nd yag laser photocoagulation is the safest  least invasive  and probably most effective means of treating angiodysplasia  
class6	2612	complete jejunoileal necrosis due to torsion of the superior mesenteric artery  
class6	2612	we have reported a case of small bowel volvulus in which complete jejunoileal necrosis resulted from torsion of the superior mesenteric artery  
class6	2612	this case was unusual not only because of the extent of necrosis but also because primary small bowel volvulus is rare in adults  
class6	2612	despite nearly total small bowel resection  the patient continues to do well 6 months postoperatively  
class6	2613	helicobacter pylori infection  a simplified diagnostic approach  
class6	2613	we evaluated the diagnostic accuracy of endoscopic finding of nodular antritis and rapid urease test  rut  in order to simplify the approach to the diagnosis of helicobacter pylori  h  
class6	2613	pylori  infection  
class6	2613	forty four consecutive patients  mean age 7 9 yr  range 6 13 yr  referred because of recurrent abdominal pain as the main symptom  were prospectively investigated for the presence of h  
class6	2613	pylori  
class6	2613	h  
class6	2613	pylori positivity or negativity was defined as the concordance of two of the following tests  rut  microbiologic culture  and histologic examination on bioptic samples  
class6	2613	rut sensitivity was 100   whereas specificity was 87 5   
class6	2613	the presence of nodular antritis had a sensitivity of 96 4  and specificity of 87 5  in h  
class6	2613	pylori infection diagnosis  
class6	2613	the predictivity value of combined rut and nodular antritis  whether positive or negative  was 100   
class6	2613	only in case of discordance do we suggest the utilization of other expensive tools for diagnosis of h  
class6	2613	pylori infection  
class6	2614	helicobacter pylori infection in patients with acquired immune deficiency syndrome  
class6	2614	a controlled study was conducted on patients with human immunodeficiency virus  hiv  infection referred for upper endoscopy to evaluate the prevalence of helicobacter pylori  h  
class6	2614	pylori  infection  
class6	2614	four different stains and culture for h  
class6	2614	pylori were performed on biopsy specimens from the gastric antrum  
class6	2614	sixteen  40   of 40 patients with acquired immune deficiency syndrome  aids  or aids related complex  arc  were diagnosed to be infected with h  
class6	2614	pylori versus 14  39   of 36 age matched control patients  
class6	2614	eight of 15 aids arc patients without aids related esophagogastroduodenal findings  53   were infected with h  
class6	2614	pylori versus 8 25  32   with endoscopic findings typical of aids  
class6	2614	no invasion of the lamina propria by h  
class6	2614	pylori was noted in any patient  
class6	2614	active chronic gastritis was present in 60  of aids arc patients and 61  of controls  
class6	2614	fifty eight and 59   respectively  of active chronic gastritis cases were infected with h  
class6	2614	pylori  
class6	2614	all the h  
class6	2614	pylori infections  except one  were found in patients with chronic gastritis  
class6	2614	in aids arc patients  h  
class6	2614	pylori infection and active chronic gastritis are as common as in other patients referred for upper endoscopy  
class6	2614	they may play a pathogenic role  especially when endoscopic aids related findings are lacking  
class6	2614	cell mediated immune deficiency does not appear to increase the risk of infection with h  
class6	2614	pylori  
class6	2615	incidence and prevalence of ulcerative colitis in the upper galilee  northern israel  1967 1986  
class6	2615	an epidemiological study of ulcerative colitis was performed in the upper galilee  israel  over a 20 yr period  1967 1986   
class6	2615	the average annual incidence of ulcerative colitis was 2 23 per 100 000 population  and the prevalence on december 31  1986  was 44 58 per 100 000  
class6	2615	considering the fact that strict steps were taken to include only definite cases  these figures are probably an underestimation  
class6	2615	an increase of the average annual incidence from 0 88 in the period 1967 1976 to 3 79 in 1977 1986 was found  
class6	2615	when the data were stratified according to ethnic groups  the highest average annual incidence and the highest point prevalence was found in israeli born jews  6 9 and 138 2 per 100 000 population  respectively   
class6	2615	when jewish residence patterns were compared  the highest average annual incidence and point prevalence were found among kibbutz members  5 52 and 110 39  respectively   and the lowest  1 94 and 38 76  among moshav inhabitants  
class6	2615	there were 10 arab patients with an average annual incidence of 0 96 and a point prevalence of 19 27  
class6	2615	there were 25 women and 28 men  female male ratio of 0 89   
class6	2615	among the jews  the female male ratio was 1 04  
class6	2615	peak incidence was found in the 25  to 34 yr old range  
class6	2615	no second peak was noticed  
class6	2615	anemia was demonstrated in 66 6  of the women and 27 5  of the men in our study  
class6	2615	we suggest that the increase in uc incidence and prevalence in israeli and asia africa born jew and in arabs in the upper galilee points toward environmental factors in the etiology of this disease  
class6	2616	failure of hepatitis b immunization in liver transplant recipients  results of a prospective trial  
class6	2616	twenty patients with advanced liver disease  in need of transplantation  were given three injections of 20 micrograms and three injections of 40 micrograms hepatitis b vaccine to see if an antibody response could be obtained  
class6	2616	only 20  of patients developed measurable anti hbs  
class6	2616	one who failed to develop anti hbs developed chronic hepatitis b after exposure to her infected sexual partner  
class6	2616	type of liver disease in the native liver  age  sex  sexual preference  timing of immunization  before or after transplantation   and dosage of hepatitis b vaccine did not seem to explain the lack of immunologic response to hepatitis b vaccine  
class6	2616	it is presumed that immunosuppression  both from the underlying disease and from immunosuppressive medications  best explains our findings  
class6	2616	liver transplantation patients infrequently benefit from hepatitis b vaccine  
class6	2616	it is possible that other vaccines given to prevent viral and bacterial illness may also fail to elicit immunologic response in such patients  
class6	2617	increasing prevalence of gallstones in male veterans with alcoholic cirrhosis  
class6	2617	cases of alcoholic cirrhosis identified at necropsy were studied for the prevalence and type of gallstones  compared with age  and race matched autopsy controls  
class6	2617	data were examined from 1970 1977 and 1980 1987  
class6	2617	in the early sample of 460 cirrhotic patients  33  had gallstone disease  contrasted with 12  in the controls  
class6	2617	in the 1980s  among 299 patients  46  had gallstone disease  whereas it was present in 13  of the controls  
class6	2617	the prevalence of stones was significantly greater in the patients than in the controls for both time periods and  among the patients  was significantly greater in the 1980s than in the 1970s  p less than 0 05   
class6	2617	a comparison of cirrhotic patients with and without gallstones indicated a significantly higher incidence of ascites in the patients with gallstones  
class6	2617	the gallstones in cirrhotics were more frequently pigmented than in the controls in both time periods  
class6	2617	in 100 living patients with advanced cirrhosis studied by sonography during 1987 and 1989  the prevalence of gallstones was 43   almost the same as the autopsy sample from 1980 1987  
class6	2617	in these cirrhotics  ascites  encephalopathy  and varices were more prevalent in the patients with stones than those without  
class6	2617	we conclude that pigmented gallstones are increasing in cirrhosis of the liver related to the severity of the liver disease  
class6	2618	plasma fatty acid profile in advanced cirrhosis  unsaturation deficit of lipid fractions  
class6	2618	fatty acid  fa  profile of plasma total lipids  phospholipids  pl   cholesteryl esters  ce   and triglycerides  tg  were measured in 101 patients with advanced liver cirrhosis and in 44 age  and sex matched healthy controls  
class6	2618	plasma levels of lipidic phosphorus  esterified cholesterol  and tg also were measured  and the unsaturation index  ui  was calculated for each fraction  
class6	2618	total plasma concentrations of saturated fa  linoleate  and polyunsaturated fa  pufa  were lower in cirrhotics than in controls  
class6	2618	this profile was also found in plasma levels of pl  and ce associated fa  
class6	2618	no detectable amounts of c20 3n9 were found in cirrhotic patients  
class6	2618	percent fa distribution of lipid fractions showed a lower percentage of linoleate and pufa and a higher relative amount of saturated and monoenoic fa in cirrhotics than in controls  
class6	2618	as a consequence  the ui of pl and ce was diminished in liver cirrhosis  
class6	2618	linoleate and pufa deficiency was more marked in ce than in pl  as shown by the number of patients with values below the 5th percentile of the control group  suggesting an attempt to maintain the unsaturation of pl as the most important component of cell membranes  
class6	2618	hepatic failure  poor essential fa intake  and malnutrition are some of the possible etiologic factors for pufa deficiency in cirrhosis  
class6	2618	their relative contribution to plasma fa abnormalities  as well as the clinical and pathophysiological consequences of pufa deficit in cirrhotic patients  requires further investigation  
class6	2619	comparison of two ascitic fluid culture methods in cirrhotic patients with spontaneous bacterial peritonitis  
class6	2619	the conventional method of ascitic fluid culture detects bacteria in only 50  of cirrhotic patients with neutrocytic ascites and suspected spontaneous bacterial peritonitis  sbp   
class6	2619	we have prospectively compared two ascites culture methods in cirrhotic patients with spontaneous bacterial peritonitis  1  conventional  on chocolate agar  blood agar  mac conkay agar  and thioglycolate broth   and 2  modified  inoculation of 10 ml of ascites in a tryptic soy broth  tsb  blood culture bottle at the patient s bedside   
class6	2619	in a 21 month period  70 episodes of sbp were diagnosed according to our criteria in 60 cirrhotic patients  
class6	2619	both culture methods were performed simultaneously  
class6	2619	the conventional grew bacteria in 40 episodes  57    whereas the modified grew bacteria in 54 episodes  77    a significantly higher sensitivity  p   0 0001   
class6	2619	in 16 cases  23    ascitic culture was negative by both methods  
class6	2619	the mortality rate was higher among patients with culture positive sbp than those with culture negative sbp  46  vs 37    but did not reach statistical significance  
class6	2619	we conclude that ascitic fluid inoculated into a tsb blood culture bottle at the patient s bedside should be used routinely for ascites culture in cirrhotic patients  
class6	2620	hemodynamic changes in splenic blood flow during and after distal splenorenal shunt  
class6	2620	the purpose of this study was to examine the hemodynamic changes of the spleen and the subsequent influence on the numbers of blood cells both during and 1 month after distal splenorenal shunt  dsrs  with splenopancreatic disconnection in 20 patients with portal hypertension  
class6	2620	the intraoperative splenic blood flow  measured with an electromagnetic flowmeter  significantly increased after shunt insertion  the mean percentage increases within the splenic vein and artery were 60   p less than 0 01  and 37   p less than 0 05   respectively  
class6	2620	the splenic venous blood flow  measured with a pulsed doppler flowmeter  had not changed significantly 1 month postoperatively  676     501 to 540     306 ml min   
class6	2620	the wbc and platelet counts significantly  p less than 0 05 and p less than 0 01  respectively  increased 1 month postoperatively  whereas there was a small  but significant  p less than 0 05   decrease in rbc count  
class6	2620	we concluded that splenic blood flow increases immediately after dsrs with splenopancreatic disconnection  but this increase may be only short term  
class6	2620	the influence of the postoperative hemodynamic changes on blood cell count is uncertain  
class6	2621	peritoneal mesothelioma  an unusual cause of esophageal achalasia  
class6	2621	secondary esophageal achalasia due to malignancy is a rare condition  only 53 such cases have been reported to date  
class6	2621	sixty two percent of the cases were due to gastric adenocarcinoma  
class6	2621	mesothelioma of the peritoneum is an uncommon neoplasm  
class6	2621	the usual presenting symptoms are abdominal pain  abdominal mass  or abdominal distention  
class6	2621	the patient we are reporting had peritoneal mesothelioma which presented with dysphagia and weight loss  in addition to the radiological and manometric picture of achalasia  
class6	2621	secondary achalasia was suspected clinically  and was confirmed by computed tomography and laparotomy  
class6	2621	the diagnosis of peritoneal mesothelioma was made only by histopathological examination  
class6	2621	we are not aware of any other report documenting the association of peritoneal mesothelioma and achalasia  
class6	2622	primary adrenal insufficiency  a new cause of reversible gastric stasis  
class6	2622	primary adrenal insufficiency is known to cause a wide spectrum of sometimes severe upper gastrointestinal symptoms  however  it has not previously been shown to be the cause of reversible gastric stasis  
class6	2622	we have documented such a case in which the symptoms and physiologic abnormalities associated with gastric stasis were reversed by steroid replacement  
class6	2622	a follow up radionuclide gastric emptying study after physiologic steroid replacement showed complete normalization of gastric emptying  
class6	2622	although gastric stasis has long been suspected of being present with primary adrenal insufficiency  this represents the first case in which it has been documented  and so should be included in the differential diagnosis of patients presenting with chronic nausea and vomiting  
class6	2623	reversal of chronic hepatic encephalopathy by colonic exclusion  poor correlation with blood gaba levels  
class6	2623	previous studies have suggested that the inhibitory neurotransmitter gamma aminobutyric acid  gaba  is a key factor in the syndrome of portasystemic encephalopathy  
class6	2623	we report the case of a patient with medically intractable portasytemic encephalopathy after portacaval shunt who had marked clinical improvement after creation of an end ileostomy  
class6	2623	plasma gaba and serum ammonia levels were measured before and after ileostomy  
class6	2623	although the clinical syndrome and the eeg improved markedly after the ileostomy  the plasma gaba levels remained markedly elevated  
class6	2623	preoperative and postoperative gaba levels were 865 and 633 pmol ml  respectively  nl   100 180 pmol ml   
class6	2623	our findings confirm previous reports of the efficacy of colonic exclusion in patients with intractable portasystemic encephalopathy  
class6	2623	however  our results conflict with the hypothesis that gaba itself is the key mediator of the syndrome  
class6	2624	maternal feeding behavior and child acceptance of food during diarrhea  convalescence  and health in the central sierra of peru  
class6	2624	feeding patterns by mothers and child acceptance of food were measured in a peruvian village to determine changes on days when children had diarrhea as compared to days of convalescence and health  
class6	2624	morbidity surveillance identified 40 children  aged 4 36 months  with diarrhea  
class6	2624	children were followed using twelve hour in home structured observations during two to four days each of diarrhea  convalescence  and health  
class6	2624	using scales of maternal encouragement to eat and child acceptance of food and cumulative logistic regression analyses  maternal encouragement to eat decreased significantly during convalescence compared to diarrheal days  or  0 54  90  ci  0 35  0 82  and health compared to diarrhea  or  0 65  90  ci  0 46  0 93   
class6	2624	in contrast  child acceptance of food increased during health compared to diarrhea  or  1 55  90  ci  1 02  2 35   
class6	2624	results illustrate the importance of carefully examining the behavioral aspects of nutritional intake  
class6	2624	decreases in intake during diarrhea are due to anorexia and not withdrawal of food by mothers  
class6	2624	in response to reductions in child appetite during illness  mothers are more likely to encourage children to eat  while they tend to become more passive feeders after the diarrhea has stopped  
class6	2624	program efforts should focus on messages to feed children more actively especially after diarrhea episodes  when appetite levels increase  
class6	2625	the course of the hiv epidemic among intravenous drug users in amsterdam  the netherlands  
class6	2625	to determine if behavioral changes in intravenous drug users in amsterdam have retarded the hiv  human immunodeficiency virus  epidemic in this group in recent years  we report that  hiv antibody seroprevalence in annual samples of injectors has been constant over the years 1986 89  hiv antibody incidence in a cohort of injectors appears to have decreased from 1986 to 1987 and stabilized after that until 1989  acute hepatitis b incidence in all drug users in amsterdam declined rapidly between 1985 89  
class6	2625	it is concluded that changes in drug use behavior so far appear to have resulted in a stabilization of the epidemic among injectors  at a level with a still disturbingly high incidence rate of 5 6 per 100 person years  
class6	2626	antibiotic use among children in an urban brazilian slum  a risk factor for diarrhea   published erratum appears in am j public health 1991 apr 81 4  417  
class6	2626	among a cohort of children in a poor urban setting in brazil  the relative risk for the occurrence of a new episode of diarrhea in the two weeks following antibiotic use vs all other weeks was 1 44  95  confidence interval  ci    1 33  2 45   
class6	2626	among children ever  corrected  exposed to antibiotics  the odds ratio was 1 34  95  ci   0 84  2 16  after stratifying by individual child and controlling for previous diarrhea  
class6	2626	further research is needed to confirm whether antibiotics are a risk factor for diarrhea in such settings  
class6	2627	surgical complications of continuous ambulatory peritoneal dialysis  
class6	2627	surgical experience with 260 consecutive patients with chronic renal failure receiving continuous ambulatory peritoneal dialysis  capd  at one medical center from 1980 to 1989 is reviewed  
class6	2627	patients received capd for a mean of 24 2 months  range  3 days to 91 months   
class6	2627	catheter longevity consistently improved in all but 1 year from 1984 to 1989  as did exit site and tunnel infections  
class6	2627	of 311 catheters inserted  151  49   required removal  of which 111  74   were attributed to peritonitis  
class6	2627	cumulative patient survival was 80   60   and 53  at 1  2  and 3 years  respectively  
class6	2627	diabetic patients had statistically significant lower survival rates  
class6	2627	additional complications including catheter leakage  catheter malposition  catheter obstruction  and abdominal wall hernias were negligible  
class6	2627	although capd is not free from serious complications  our data show remarkable improvement since 1980 in catheter longevity  hospital stay  and infection rates  
class6	2628	acute appendicitis in the pregnant patient  
class6	2628	acute appendicitis is the most common surgical problem in pregnancy requiring emergent intervention  
class6	2628	to establish a contemporary patient profile and formulate an effective management strategy  a retrospective review was conducted of 84 pregnant patients who underwent laparotomy with a preoperative diagnosis of acute appendicitis  
class6	2628	gestational stage at presentation included the first trimester in 27 patients  32    the second trimester in 37 patients  44    the third trimester in 13 patients  16    and the puerperium in 7 patients  8    
class6	2628	fifty four patients  64   had pathologically proven acute appendicitis  the incidence did not vary by trimester  
class6	2628	other intra abdominal conditions were detected in 15 patients  18    
class6	2628	there were no significant differences between patients with positive and negative laparotomies  or among trimesters  regarding frequency of presenting symptoms and signs or laboratory results  
class6	2628	operation occurred within 24 hours of symptom onset in 19 of 54  35   instances of proven acute appendicitis  
class6	2628	perforation occurred in 23 of 54 patients  43    all of whom had symptoms exceeding 24 hours  p less than 0 0005   
class6	2628	five instances of perinatal death and one case of extreme perinatal morbidity were associated with negative laparotomies  only one of these was attributed to operation itself  
class6	2628	no adverse long term maternal morbidity or mortality occurred  
class6	2628	wound infection developed in seven cases of acute appendicitis  six perforated  and two negative explorations  
class6	2628	we conclude that  1  gestational physiologic changes obscure the accurate diagnosis of acute appendicitis   2  the natural history of acute appendicitis is not affected by trimester of presentation  and  3  adverse sequelae of acute appendicitis are obviated by prompt operative exploration and prevention of appendiceal perforation  
class6	2629	current status of duplex doppler ultrasound in the examination of the abdominal vasculature  
class6	2629	duplex doppler ultrasound has come to play a central role in the diagnosis of a broad spectrum of vascular diseases such as carotid artery occlusive disease and deep vein thrombosis  
class6	2629	the role of duplex doppler in the evaluation of intra abdominal vascular disease remains unclear  
class6	2629	this article summarizes the current status of duplex scanning in the investigation of the mesenteric arteries  the renal arteries  and the portal venous system  
class6	2629	the examination is technically demanding  operator dependent  time consuming  and frequently unsatisfactory due to bowel gas  obesity  complex anatomy  or postoperative alterations in the normal anatomic patterns  
class6	2629	its advantages reside primarily in the absence of toxicity and in the generation of physiologic as well as anatomic information  
class6	2629	in centers with the proper instrumentation and a skilled technician  duplex examination can be useful in the diagnosis and management of abdominal vascular disease and avoids the inherent dangers of contrast angiography  
class6	2630	choledochotomy for calculous disease in the elderly  
class6	2630	to determine the risk of operations on the biliary tract in the elderly  we retrospectively examined 56 patients 80 years of age or older undergoing choledochotomy for calculous disease and compared their outcomes with those of a contemporary group of 257 patients undergoing similar surgery  
class6	2630	thirty of 56 elderly patients  54   required urgent surgery for acute cholangitis  acute cholecystitis  or obstructive jaundice  serum bilirubin greater than 5 mg dl   compared with 97 of 257 younger patients  38    p   0 029   
class6	2630	mortality in elderly patients was significantly higher  5 of 56  than in younger  6 of 257  patients  p   0 015   
class6	2630	in three of the five patients who died  urgent surgery was performed for obstructive jaundice  reflecting the higher mortality experienced by jaundiced patients in the entire series  9 4    
class6	2630	biliary cultures grew organisms in 25 of 27 elderly patients  93    
class6	2630	this is in contrast to findings of bactibilia in 62 of 118 patients  53   under the age of 80  p   0 001   
class6	2630	similarly  preoperative blood cultures were positive more often in elderly  63   than in younger patients  26    p   0 007   
class6	2630	mean postoperative hospital recovery was longer in the elderly group  16 2     8 5 days  than in the younger group  12 2     9 3 days   p   0 002   
class6	2630	in conclusion  elderly patients  particularly those with obstructive jaundice  are at higher risk for complicated biliary tract disease necessitating choledochotomy  
class6	2630	they appear to be more susceptible to bactibilia and bacteremia  and require longer hospital recovery than younger patients  
class6	2631	when is polypectomy sufficient treatment for colorectal cancer in a polyp  
class6	2631	eighty seven patients with a carcinoma in a polyp were reviewed over a 12 year period  
class6	2631	ten histologic criteria were analyzed for an association with the presence of residual carcinoma  
class6	2631	four factors were identified as having prognostic value  size greater than 1 5 cm  sessility  cancer of at least 50  of the adenoma volume  and invasive carcinoma  
class6	2631	polypectomy alone is adequate treatment unless the carcinoma invades deeper to the muscularis mucosa and is associated with one or more of these characteristics  
class6	2632	aggravation of myasthenia gravis by erythromycin  
class6	2632	erythromycin is not currently recognized as causing clinical aggravation of myasthenia gravis  
class6	2632	we report the case of a patient who experienced exacerbations of myasthenia gravis subsequent to each of several doses of intravenous erythromycin  
class6	2632	we suggest that erythromycin can cause clinical worsening in patients with disease of the neuromuscular junction  
class6	2633	hepatic cyst associated with peutz jeghers syndrome  
class6	2633	a solitary hepatic cyst  associated with peutz jeghers syndrome  is described  
class6	2633	to our knowledge  this association has not been previously reported  
class6	2633	a developmental anomaly or hamartomatous nature of this lesion is suggested  
class6	2633	knowledge of this association may be helpful in the clinical diagnosis of this benign entity  
class6	2634	cholangiocarcinoma in association with multiple biliary microhamartomas  
class6	2634	the rarity of cholangiocarcinoma occurring in von meyenburg complexes is well appreciated  
class6	2634	we describe the case of a 35 year old man found to have cholangiocarcinoma in association with multiple biliary microhamartomas of the liver  
class6	2634	areas of ductal proliferation and atypia within the bile duct hamartomas suggest malignant transformation to cholangiocarcinoma  
class6	2635	palliative treatment of bile duct tumoral compression by an endoprosthesis  clinical results  
class6	2635	the palliative therapy of stenoses of the biliary tract is a difficult choice  
class6	2635	because percutaneous or endoscopic drainage methods are fraught with complications  an endoprosthesis for surgical intubation of the biliary tract has been developed  
class6	2635	thirty patients were treated by this method  
class6	2635	after choledochotomy  the endoprosthesis is positioned surgically above the sphincter of oddi  thereby avoiding ascending cholangitis  
class6	2635	twenty nine patients  13 with gallbladder cancer  11 with cholangiocarcinomas  5 with metastases  presented with neoplastic compression  and one patient had an early postoperative stricture with loss of substance after right hepatectomy for hepatic metastases  
class6	2635	the operative mortality was 3 3   one pulmonary complication   
class6	2635	resolution of jaundice was obtained in all but two patients  and pruritus always resolved  
class6	2635	the mean survival time for the patients with cholangiocarcinoma was 12 2 months and 6 33 months for those with gallbladder cancer  
class6	2635	indices of satisfaction  bismuth s method  were 71   gallbladder cancer   93 5   hilar cholangiocarcinoma   and 92   metastatic compressions   
class6	2635	this new type of surgical endoprosthesis is an alternative in the palliative treatment of neoplastic hilar compression because it is well tolerated  has a low rate of operative mortality or morbidity  and affords an acceptable quality of life for the patients  
class6	2636	 a typical symptoms during single needle dialysis  
class6	2636	in 5 elderly patients  an abnormally high occurrence of some symptoms was noted during dialysis  
class6	2636	all patients were dialyzed with biocompatible membranes  bicarbonate dialysate  and a blood flow of 250 to 300 ml min by a single needle system  on a fistula 14 gauge catheter needle  
class6	2636	these symptoms were  1   angina   resistant to o2 and nitrates  with biochemical stigmata of infarction  but without electrocardiogram  ecg  localization  2  intractable persistent hypotension  not hypovolemic  lasting 1 or 2 days  3  esophagal spasms  with inability to swallow solid food  
class6	2636	because we knew that these symptoms were compatible with hemolysis  biochemically proven by the increase in serum ldh during dialysis and by a fall in haptoglobin  due to red cell fragmentation  rcf   we switched these patients from fistula dialysis  a  to central catheter dialysis  b   with the same apperture  blood flow  etc  
class6	2636	the total number of sessions of a versus b were 512 and 891  the mean ldh ratios  serum ldh postdialysis divided by predialysis  were 1 8 and 1 0    no rcf   angina events were 132  26   for a  and 25  3   for b  persistent hypotension was seen 37  7   times in a and 5  0 6   times in b  esophagal spasms were noted 65  13   times for a  and 0 times for b  
class6	2636	this clinical improvement was so overwhelming that 3 patients refused to be dialyzed again using their well functioning fistulae  
class6	2636	this study also proved the need for a better designed and manufactured peripheral dialysis catheter needle  
class6	2637	peritoneal macrophage beta 2 microglobulin production and bacterial peritonitis in capd patients  
class6	2637	to evaluate the role of bacterial peritonitis in peritoneal macrophage  pm  beta 2 microglobulin  b2m  production  and its relationship with pm interleukin 1  il 1  and leukotriene b4  ltb4  release  the authors studied 20 capd patients  10 with peritonitis   1  
class6	2637	in vivo plasma and peritoneal dialysis effluent  pde  b2m  il 1  and ltb4 levels  2  
class6	2637	in vitro b2m  il 1  and ltb4 release by pm  
class6	2637	values were compared with those seen in the plasma or with peripheral blood monocytes of 30 hemodialysis  hd  patients  10 treated with cuprophan  cu   10 with polyacrylonitrile  pan   and 10 with cellulose acetate  ca    
class6	2637	results showed that in capd patients with bacterial peritonitis b2m  il 1 and ltb4 concentrations in the pde were significantly higher than those seen in capd patients without peritonitis  or in the plasma of hd patients treated with pan or ca  but were similar to those seen in hd patients treated with cu  
class6	2637	at the same time  in vitro pm from capd patients with bacterial peritonitis produced more b2m  il 1  and ltb4  than did pm from capd patients without peritonitis  or peripheral blood monocytes from hd patients treated with pan or ca  
class6	2637	the authors conclude that in capd patients  bacterial peritonitis is able to induce pm b2m production  probably via a cytokine mediated process  which may be analogous to what occurs with peripheral blood monocytes of hd patients treated with cu  
class6	2638	a prospective randomized evaluation of chronic peritoneal catheters  insertion site and intraperitoneal segment  
class6	2638	the insertion site  midline or through the lateral rectus muscle  and type of chronic dialysis catheter  straight or spiral intraperitoneal segment  were evaluated in a prospective randomized trial  
class6	2638	dialysis catheter complications and catheter survival were the endpoints of evaluation  
class6	2638	eighty five first catheters were evaluated  
class6	2638	neither race  gender  renal diagnosis  type of catheter  nor insertion site was a determinant of dialysis catheter survival  
class6	2638	overall median catheter survival was 308 days  
class6	2638	there were 40 catheter complications  70   n   28  that occurred during the first 61 days following insertion  
class6	2638	median time to the first complication occurring within the first 61 days was 3 days  
class6	2638	late catheter removals were due to peritonitis episodes that failed to resolve  
class6	2638	complications are frequent with peritoneal dialysis catheters  and care of the peritoneal dialysis catheters requires constant vigilance  
class6	2639	complications of tenckhoff catheters post removal  
class6	2639	complications due to tenckhoff catheters can occur at prolonged intervals after their removal  
class6	2639	from january 1979 to october 1989  431 patients at our center began continuous ambulatory peritoneal dialysis  capd   278 of whom subsequently transferred to another form of renal replacement therapy  
class6	2639	we identified 12 patients  4 3  or 12 278  with post removal catheter complications  
class6	2639	there were 14 post removal complications  two each in two patients  and one in each of 12 others  
class6	2639	the mean time to complication was 541     143 days  27 2 040   
class6	2639	in 71   10 14  of the complications  an abscess was found at the site of the previously removed tenckhoff catheter  
class6	2639	in 29   4 14  of the complications  foreign body material consistent with a retained cuff was recovered  
class6	2639	documentation at the time of tenckhoff catheter removal should include a statement regarding the presence of the tenckhoff catheter cuffs  and patients with retained cuffs should be monitored closely for the development of abscesses or other complications  
class6	2639	immunocompromised patients are at high risk for these complications  
class6	2640	pancreatic ischaemia in experimental acute pancreatitis  mechanism  significance and therapy  
class6	2640	much clinical and experimental evidence suggests that pancreatic ischaemia in the early phase of acute pancreatitis is important in the development of pancreatic necrosis  
class6	2640	while depletion of intravascular volume has often been assumed to be the main circulatory defect  an additional disturbance of pancreatic microcirculation has been demonstrated experimentally  
class6	2640	possible contributory mechanisms include chemical induced vasoconstriction  direct injury of vessel wall  intravascular coagulation and increased endothelial permeability resulting in pancreatic oedema  haemoconcentration and impaired venous drainage  
class6	2640	pancreatic ischaemia as a consequence of these local effects seems to be responsible for the transition of mild pancreatitis to parenchymal necrosis  
class6	2640	in experimental models the beneficial effect of various drugs and of sympathetic blockade has been ascribed to an improvement in pancreatic perfusion  
class6	2640	although effective volume therapy is generally accepted as the mainstay of conservative treatment in acute pancreatitis  the efficacy of different fluid preparations is still controversial  and simple fluid resuscitation has not been shown to prevent the development of parenchymal necrosis  
class6	2640	the specific impairment of pancreatic microcirculation cannot be prevented merely by replenishment of intravascular volume with crystalloids  albumin or plasma despite normalization of macrohaemodynamics  
class6	2640	in contrast  partial replacement of blood by dextran preparations has been shown to increase pancreatic perfusion by improving blood fluidity  
class6	2640	isovolaemic haemodilution in conjunction with conventional fluid therapy may provide a new and effective means of protecting the pancreas from secondary injury due to the early ischaemic phase of acute pancreatitis  
class6	2641	impaired polymorphonuclear leucocyte function in patients undergoing hepatectomy  adenylate energy charge and superoxide anion production in relation to hepatic mitochondrial redox state  
class6	2641	patients undergoing hepatectomy have an increased susceptibility to infection  
class6	2641	we therefore studied the energy metabolism of the polymorphonuclear leucocyte  pmn   focusing on energy charge and function  especially superoxide anion  o2   generation  in relation to the hepatic mitochondrial redox state  
class6	2641	by labelling the pmn adenine nucleotide pool with radioactive adenine and by superoxide dismutase inhibitable reduction of ferricytochrome c  the energy charge and o2  production was measured in 18 patients with hepatoma  non cirrhotic  seven  cirrhotic  11  undergoing hepatectomy  
class6	2641	their arterial ketone body ratios  kbrs   reflecting the hepatic mitochondrial redox potential  were above 0 7 before operation  
class6	2641	after surgery  the 18 patients were divided into two groups  group a  kbr greater than 0 7  n   10  and group b  kbr less than 0 7  n   8  
class6	2641	the energy charge and o2  release in group b decreased significantly from preoperative values  p less than 0 001 and p less than 0 01 respectively  and when compared with group a  p less than 0 05 and p less than 0 01 respectively   
class6	2641	these results suggest that impaired hepatic energy metabolism  kbr less than 0 7  in hepatectomized patients leads to impaired energy charge and o2  production in the pmns  
class6	2642	effective intraperitoneal antiprotease therapy for taurocholate induced pancreatitis in rats 
class6	2642	in canine pancreatitis  irreversible hypotension and death follow saturation of the antiprotease molecules in peritoneal exudate by activated proteolytic enzymes which are released from the pancreas  
class6	2642	this study has examined  in rats with taurocholate induced pancreatitis  the efficacy of removal of the peritoneal exudate by aspiration and a single lavage  followed by instillation of an exogenous antiprotease solution  
class6	2642	instillation of human fresh frozen plasma  containing alpha 2 macroglobulin and alpha 1 antiprotease  was associated with the longest median survival  
class6	2642	aprotinin  although possessing a much greater trypsin inhibitory capacity  just failed to significantly improve the median survival time compared with the control group  
class6	2642	intraperitoneal antiprotease therapy is simple to perform  has a beneficial effect on survival time in this model and merits investigation in man  
class6	2643	free radical inhibition and serial chemiluminescence in evolving experimental pancreatitis  
class6	2643	oxygen free radical activity and inhibition were examined in experimental pancreatitis  
class6	2643	twenty five rats were randomized to five groups  controls received intravenous saline  to simulate pancreatitis one group received intravenous caerulein  5 micrograms kg 1 h 1   and three groups received sodium taurocholate via the pancreatic duct  0 2 ml  5 per cent   either alone  following allopurinol or immediately before superoxide dismutase  
class6	2643	chemiluminescence  a phenomenon based on the emission of light during chemical reactions and which is dependent on oxygen free radical activity  was used as an index of oxygen free radical activity and was measured in tissue samples at 5 min intervals following induction of pancreatitis  
class6	2643	the control mean s e m   serum amylase level 1 h after induction of pancreatitis was 635 13  units  
class6	2643	it was significantly elevated in caerulein induced pancreatitis  1833 118  units  p less than 0 05  and exceeded 3000 units in all taurocholate infused animals  
class6	2643	mean s e m   chemiluminescence ranged from 44  8  mv 100 mg 1 at time zero to 404 113  mv 100 mg 1 at 1 h in controls  
class6	2643	in caerulein induced pancreatitis mean s e m   chemiluminescence peaked at 20 min  1399 239  mv 100 mg 1  p less than 0 02  and in taurocholate induced pancreatitis at 15 min  2316 95  mv 100 mg 1  p less than 0 004   
class6	2643	superoxide dismutase significantly reduced chemiluminescence and hyperamylasaemia in taurocholate groups  
class6	2643	increasing oxygen free radical activity paralleled evolving pancreatitis  
class6	2643	superoxide dismutase may have a therapeutic role in pancreatitis  
class6	2644	prediction of outcome in acute pancreatitis  a comparative study of apache ii  clinical assessment and multiple factor scoring systems  
class6	2644	the apache ii severity of disease classification system has been examined prospectively in 160 patients with acute pancreatitis  
class6	2644	using clinical and simple laboratory data apache ii was able to provide useful discrimination between uncomplicated  complicated and fatal attacks within a few hours of admission  
class6	2644	peak apache ii scores  recorded during the first 3 days  had a prognostic accuracy similar to the multiple factor scoring systems  but then incurred a similar delay  
class6	2644	patients could be graded according to their risk of death or of developing a major complication  no deaths occurred in patients with a peak apache ii score less than 10  
class6	2644	apache ii can be repeated daily  uncomplicated attacks demonstrating falling scores in association with clinical improvement  in contrast to the rising scores associated with clinical deterioration in those dying early  
class6	2644	apache ii appears to reflect any continuing disease activity and may prove a useful means of monitoring the course of the illness and response to therapy  
class6	2645	gallstone clearance  a randomized study of extracorporeal shock wave lithotripsy and chemical dissolution 
class6	2645	following extracorporeal shock wave lithotripsy it is not known whether gallstone fragments are cleared from the gallbladder without the use of oral dissolution therapy  
class6	2645	to assess the efficacy of lithotripsy and dissolution therapy  alone or in combination  35 patients were randomized to one of three treatment groups  lithotripsy alone  dissolution therapy alone or combined lithotripsy and dissolution therapy  
class6	2645	all patients had symptomatic gallstones  functioning gallbladders and comparable stone profiles  
class6	2645	lithotripsy was administered using a piezoelectric lithotripter  
class6	2645	dissolution therapy consisted of combined bile acid and terpene  
class6	2645	clearance was assessed at 6 months using ultrasound and oral cholecystography  
class6	2645	patients with less than 50 per cent stone clearance at the end of 6 months were considered failures  
class6	2645	the number of patients with total or partial clearance in the combined group  7 10  was significantly greater than those in the lithotripsy alone group  0 10  p less than 0 002   
class6	2645	gallstone clearance following lithotripsy appears to be dependent upon dissolution therapy  
class6	2646	gallbladder surgery following cholecystlithotripsy  suggested guidelines for treatment 
class6	2646	twenty three of 229 symptomatic patients undergoing cholecystlithotripsy underwent surgical intervention  22 of the patients had cholecystectomy performed  five also undergoing choledochotomy  and one patient had a cholecystostomy  
class6	2646	of these 23 patients  five were lithotripsy failures  five developed acute pancreatitis  one had acute cholecystitis  and one had cholangitis  
class6	2646	one patient had her gallbladder removed incidentally at the time of surgery for a bleeding gastric ulcer  
class6	2646	ten patients underwent surgery for recurrent biliary pain  probably related to fragment passage via the cystic duct  
class6	2646	we suggest that up to 16 of these 23 patients did not necessarily require cholecystectomy  i e  
class6	2646	five patients with pancreatitis  one patient with cholangitis and ten patients with recurrent biliary colic  
class6	2646	conservative and or endoscopic management may be successful in the first instance to allow further treatment with lithotripsy in the majority of patients  
class6	2646	if  however  the expertise to perform endoscopic sphincterotomy is not available or the patient declines further lithotripsy  then resort to surgery may be necessary  
class6	2646	we propose that it is the responsibility of the management team in charge of the lithotripsy unit to inform both the patient and the referring clinicians of the possible side effects and outcome of treatment in an attempt to avoid unnecessary surgical procedures  
class6	2647	surgical presentation of kawasaki disease  mucocutaneous lymph node syndrome   
class6	2647	five patients with kawasaki disease  mucocutaneous lymph node syndrome  are reported whose varied presentations included acute abdominal pain  peripheral arterial aneurysms  digital gangrene and sterile pyuria and whose presenting pathology ranged from hydrops of the gallbladder to enteric pseudo obstruction  
class6	2647	as the complications of the disease can usually be managed without resort to surgery  which is associated with a mortality rate of up to 25 per cent  the recognition of kawasaki disease will prevent hazardous and unnecessary laparotomy  
class6	2648	intraluminal pressure adjacent to left colonic anastomoses  
class6	2648	a cumulative total of 89 h of pressure data was acquired from both sides of a left colonic anastomosis in 15 patients over a median period of 7 postoperative study days  
class6	2648	patients had a colonic ileus lasting 3 10 days and during this proximal and distal inactivity the intraluminal pressure remained within 6 mmhg of atmospheric pressure  
class6	2648	after recovery of activity  pressures proximal to the anastomosis in excess of 10 mmhg occurred during less than 1 per cent of the recording time  
class6	2648	distal peak pressures were significantly elevated with respect to the proximal site  p less than 0 001   
class6	2648	two thirds of the distal pressures recorded were between 10 and 20 mmhg and 98 per cent were less than 50 mmhg  the peak distal pressure was 90 mmhg  
class6	2648	four patients had distal repetitive tonic contractions creating a pressure difference across the anastomosis with a mean of 20 mmhg and a peak of 45 mmhg  
class6	2648	each contraction persisted for 15 20 min  
class6	2648	intraluminal pressures are unlikely to play a role in anastomotic dehiscence  
class6	2649	duodenogastric reflux and gastric histology after cholecystectomy with or without sphincteroplasty  
class6	2649	sixteen patients who had undergone cholecystectomy plus sphincteroplasty  14 cholecystectomized patients and ten control patients were studied to evaluate whether differences existed in duodenogastric reflux and whether these were related to morphological damage of the gastric mucosa  
class6	2649	duodenogastric bile reflux during fasting was evaluated by measuring the concentration of total bile acids  by an enzymatic method  and single bile acids in the gastric juice by high performance liquid chromatography  
class6	2649	the damage was evaluated histologically by systematic endoscopic biopsy of the antrum and body of the stomach  
class6	2649	there was a statistically significant difference in fasting bile reflux between the three groups  kruskal wallis test  p less than 0 001   and the group that underwent cholecystectomy plus sphincteroplasty had a significantly higher median value than the cholecystectomized group  p less than 0 05  and the control group  p less than 0 01   
class6	2649	the distribution of chronic antral atrophic and superficial gastritis was different in the three groups  chi 2 test  p less than 0 005   
class6	2649	chronic atrophic gastritis was associated with cholecystectomy plus sphincteroplasty  p less than 0 01   while chronic superficial gastritis was more frequent in cholecystectomized patients  
class6	2649	these results suggest that there may be more duodenogastric reflux after cholecystectomy plus sphincteroplasty than after cholecystectomy alone  and that there may be a correlation between the amount of duodenogastric reflux and the severity of mucosal damage  
class6	2650	success of a program of routine prenatal screening for hepatitis b surface antigen  the first 2 years  
class6	2650	prenatal screening for hepatitis b surface antigen  hbsag  restricted to women with defined risk factors for chronic hepatitis b virus  hbv  infection fails to identify many carriers  
class6	2650	a centralized program of routine hbsag screening for all pregnant women in alberta was introduced in 1985  
class6	2650	we collected and analysed data for the first 2 years of the program in edmonton to determine the frequency of risk factors for hbsag positivity  the proportion of multiparous hbsag positive women not identified in previous pregnancies  the efficiency and cost effectiveness of providing immunoprophylaxis to infants at risk of hbv infection and the degree of success in inducing adequate protection  
class6	2650	a total of 149 women  158 pregnancies  were found to be hbsag positive  
class6	2650	risk factors were readily ascertainable for 85  of the women  the remaining 15  would not have been identified through risk selective screening  
class6	2650	the most common risk factors were oriental ethnic origin  history of hepatitis  jaundice or multiple transfusions of blood or blood products  and occupational exposure to blood  
class6	2650	although 86  of the multiparous hbsag positive women had risk factors  only 7  had been identified in previous pregnancies  
class6	2650	the alberta program appears to be cost effective  
class6	2650	we conclude that only routine prenatal screening will identify all infants at risk of perinatal hbv infection and that a comprehensive public health program involving central laboratories  private physicians and public health staff can be highly effective and efficient in protecting infants against hepatitis b  
class6	2651	amyloidosis associated bleeding diatheses in the surgical patient  
class6	2651	the coagulopathies associated with amyloidosis have not been widely appreciated  
class6	2651	we encountered a patient with amyloidosis and mildly abnormal coagulation studies who presented for an emergency laparotomy for acute bowel obstruction  
class6	2651	upon gentle manipulation of the bowel  an unexpected bleeding diathesis was manifested by the formation of several large haematomas resulting in a large amount of blood loss  approximately 800 ml   
class6	2651	numerous defects of platelet function and coagulation have been associated with amyloidosis  including abnormal platelet aggregation  increased vascular fragility  factor ix and x deficiencies  decreased levels of alpha 2 plasmin inhibitor  and increased levels of plasminogen  
class6	2651	intraoperative therapy for our patient included the rapid administration of four units of fresh frozen plasma and ten units of platelet concentrate  
class6	2651	a review of the pathology and therapeutic modalities for this potentially life threatening complication is presented  
class6	2652	the indian experience with hypertrophic pyloric stenosis  
class6	2652	a study of 58 consecutive indian infants operated for congenital hypertrophic pyloric stenosis revealed an accentuated male predominance in the incidence of the disease and far less preoperative hemetemesis as compared to that in their western counterparts  
class6	2652	 pyloric tumor  was palpable in 89  of cases  
class6	2652	only 34 5  of these infants were first born  
class6	2652	postoperative vomiting occurred in 13 8  of patients and wound sepsis was not encountered  
class6	2652	air contrast radiography confirmed the diagnosis in clinically doubtful cases  
class6	2653	edrophonium provocative test in noncardiac chest pain  evaluation of testing techniques  
class6	2653	edrophonium chloride is used frequently as a provocative agent in the assessment of noncardiac chest pain  nccp   
class6	2653	however  the optimum dose and most appropriate method of interpreting test results is controversial  
class6	2653	we studied 150 consecutive nccp patients and 50 age matched controls who alternately received either 80 micrograms kg or 10 mg intravenous bolus doses of edrophonium preceded by saline placebo injections  
class6	2653	distal esophageal pressures were measured before and after drug injection in response to ten 5 cc wet swallows  
class6	2653	following 10 mg of edrophonium  33  of patients and 4  of controls reported chest pain  while 29  of patients and no controls receiving the 80 micrograms kg dose complained of chest pain  
class6	2653	amplitude changes after either dose were not significantly different for all comparisons  but the duration of response did distinguish the two doses in patients with chest pain  
class6	2653	a significantly greater  p   0 01  increase in distal contraction duration occurred after 10 mg  74     12       se  compared to 80 micrograms kg dose  43     6    
class6	2653	however  individual responses to the two doses overlapped considerably  
class6	2653	if a positive test is redefined to include both chest pain and manometric changes that are significantly different from controls  the positivity rate changes drastically  33  to 9  in the 10 mg group and 30  to 3  in the 80 micrograms kg group  
class6	2653	side effects were similar between doses  but there was a significant  p   0 02  linear relationship between intensity of side effects and the edrophonium dose per kilogram of body weight  
class6	2654	pyloric deformation from peptic disease  radiographic evidence for incompetence rather than obstruction  
class6	2654	we have used double contrast radiographic techniques to clarify what changes in the configuration and movements of the gastroduodenal junction result when peptic lesions involve the distal gastric segment between the proximal  ppl  and the distal pyloric muscle loop  dpl   
class6	2654	among 50 cases of pyloric ulceration diagnosed during a four year study period  18 cases fulfilled all study criteria  
class6	2654	ulcers maintained a consistent location with regard to the muscular structures of the pylorus  and by affecting these structures  led to many strange deformations of the gastric outlet including permanent pseudodiverticula and reversal of pyloric angulation  
class6	2654	the most common site for peptic lesions in the pyloric segment was the protuberance of the lesser curvature called the pyloric torus  many torus lesions extended into and destroyed the dpl  
class6	2654	this led to widening of the gastric outlet and radiographic evidence of increased duodenogastric reflux  
class6	2654	pyloric closure was further impaired in this setting because the mucosa no longer prolapsed into the gastric outlet and did not occlude the pyloric lumen as it normally does  
class6	2654	less common lesions involved the greater curvature and the ppl  
class6	2654	in one patient  scarring of the ppl led to an antral web and gastric hyperperistalsis  
class6	2654	this was the only patient who required operation for chronic gastric outlet obstruction  
class6	2654	one third of the 18 patients had reflux esophagitis in addition to peptic pyloric disease  
class6	2654	in most patients without additional ulcerogenic risk factors  treatment with antisecretory agents led to the healing of ulcer craters  
class6	2654	we conclude that the morphologic and functional changes of the gastric outlet caused by peptic lesions depend  in part  on the effect the ulcer has on the underlying pyloric musculature  
class6	2655	antimony and glass ph electrodes can be used interchangeably in 24 hour studies of gastric acidity  
class6	2655	antimony and glass ph electrodes show almost identical experimental errors in continuously measuring buffer solutions at constant temperature over 24 hr  
class6	2655	these errors are lower than the nominal quantization error of the instruments and are not properly described by the 24 hr drift determination  
class6	2655	the addition of food particles to the solutions can induce severe reading artifacts  
class6	2655	the longer response time reported in vitro of antimony electrodes when moving from ph 1 to ph 7  3 4 sec vs 0 8 sec with glass electrodes  is irrelevant during in vivo ph metry studies  because we found that the greatest absolute difference between raw fast acquired  4 6 sec  consecutive ph readings of two commonly used devices was 0 7 ph units in circadian profiles obtained from 413 subjects with various clinical conditions  
class6	2655	in our in vivo studies  gastric acidity was monitored continuously with two side by side minielectrodes  which were variously combined  antimony glass  a g  antimony antimony a1 a2  glass glass  g1 g2  and applied on groups of 27 subjects matched for clinical condition  
class6	2655	the 24 hr ph means and the 24 hr  h   means calculated from the acidity profiles obtained with the three electrode combinations  lie on the identity line in each group  
class6	2655	using the bland altman technique for assessing measurement agreement  the differences between the 24 hr ph means and the 24 hr  h   means obtained with the three combined systems are similar  p    903 and p   0 824  respectively  and their 95  confidence limits are comprised within the range       of the reading error of the measuring systems  namely      0 3 ph units and     12 mmol liter in terms of  h     
class6	2656	cigarette smoking  gastric acidity and peptic ulceration  what are the relationships  
class6	2656	the influence of cigarette smoking on intragastric acidity was assessed in duodenal ulcer patients in symptomatic remission and in healthy volunteers in a retrospective study  
class6	2656	continuous 24 hr ph recordings in 150 nonsmokers and 174 smokers receiving placebo treatment were compared  
class6	2656	daytime intragastric acidity was higher in smokers with a median ph  interquartile range  of 1 56  1 34 1 80  than in nonsmokers  who had a median ph of 1 70  1 45 1 97   p less than 0 001   
class6	2656	there was no difference in 24 hr and nighttime median ph between the two groups  
class6	2656	the small difference in daytime intragastric acidity in smokers and nonsmokers is unlikely to account for the increased prevalence of peptic ulcer disease in smokers  
class6	2656	the analysis of smoking status in duodenal ulcer patients and healthy controls and males and females supports the general trend towards higher daytime acidity in smokers  
class6	2656	again  no differences in ph during the 24 hr or night period were found between the groups  
class6	2656	the epidemiological and clinical correlation between smoking and duodenal ulcer disease is not adequately explained by increased intragastric acidity  
class6	2657	endoscopic comparison of cimetidine and sucralfate for prevention of naproxen induced acute gastroduodenal injury  effect of scoring method  
class6	2657	nonsteroidal antiinflammatory drug induced gastroduodenal mucosal damage observed endoscopically is usually categorized as hemorrhages  erosions  or ulcerations  
class6	2657	we undertook this study to determine whether the injury produced by a commonly prescribed nsaid  naproxen  could be reduced by cotherapy with sucralfate or cimetidine and to determine how dependent the differences in the degree of protection against mucosal injury measured were on the scoring system used  
class6	2657	four groups of 20 healthy volunteers with endoscopically normal gastric and duodenal mucosa received naproxen  500 mg twice a day  plus cimetidine  300 mg four times a day or 400 mg twice a day   sucralfate  1 g four times a day   or placebo for seven days  
class6	2657	after seven days of therapy  a second endoscopy was performed  
class6	2657	separate scoring systems were used for the presence of hemorrhages  erosions  and a combination of both types of injury  
class6	2657	there were significantly fewer mucosal hemorrhages present when naproxen and cimetidine were administered than when naproxen was administered with placebo or sucralfate  placebo vs 300 mg cimetidine  p   0 04  and placebo vs 400 mg cimetidine  p   0 006  placebo vs sucralfate  p   0 26   
class6	2657	both cimetidine dosages resulted in significantly fewer hemorrhages than were present following cotherapy of naproxen and sucralfate  p less than 0 05   
class6	2657	in contrast  there was no discernible difference in the mucosal injury between placebo and any drug or between any two active therapies when the injury was evaluated based on the presence of gastric erosions  
class6	2658	primary peritoneal sarcoidosis  
class6	2658	a 14 year old male was admitted for the evaluation of tense exudative ascites  
class6	2658	despite thorough evaluation  the diagnosis remained cryptic until peritoneoscopy revealed diffuse studding of the entire visualized peritoneum with multiple miliary nodules  and peritoneal biopsy demonstrated multiple noncaseating epithelioid granulomas  
class6	2658	after other causes were excluded  a diagnosis of sarcoidosis was considered and confirmed with classic endobronchial findings at bronchoscopy  
class6	2658	involvement of the peritoneum with sarcoidosis is rare and  to our knowledge  only one other case describes this as the initial manifestation of this disease  
class6	2659	esophageal adenocarcinoma in a patient with surgically treated achalasia  
class6	2659	although squamous cell carcinoma of the esophagus occurs with increased incidence in primary achalasia  esophageal adenocarcinoma has been considered rare in this condition  
class6	2659	we report a patient with long standing achalasia in whom adenocarcinoma of the esophagus occurred many years after heller esophagomyotomy  presumably related to barrett s esophagus complicating gastro esophageal reflux disease  
class6	2660	development of acute myelocytic leukemia in patients with crohn s disease  
class6	2660	in our hospital within one year two patients with crohn s disease were seen who developed an acute myelocytic leukemia  
class6	2660	a review of the literature reveals eight previously reported patients with both crohn s disease and leukemia  
class6	2660	six of the reported 10 patients have had acute myelocytic leukemia and  interestingly  three of them  including our two patients  have shown monocytic differentiation  fab type m4   
class6	2660	it has been suggested that the relative risk of leukemia  especially acute myelocytic leukemia  is increased in patients suffering from ulcerative colitis  
class6	2660	more data of patients with crohn s disease and acute leukemia are needed to evaluate the possible association between these diseases  
class6	2661	closure of refractory perineal crohn s lesion  integration of hyperbaric oxygen into case management  
class6	2661	a case is reported in which a comprehensive program of hyperbaric oxygen  hbo   surgical debridement and reconstruction  and continuing medical management resulted in complete and sustained closure of an extensive perineal crohn s lesion refractory to conventional medical and surgical management  
class6	2661	it is emphasized that in this case healing occurred in the setting of previous removal of all diseased intestinal tissue and only with the combined use of all three treatment modalities  
class6	2661	hbo may be a useful adjunct in the therapy of large nonhealing perineal lesions post proctocolectomy in patients who are unresponsive to metronidazole or to immunosuppressant therapy or who experience limiting side effects from continued medical therapy  
class6	2662	epstein barr virus associated oesophageal ulcers in aids  
class6	2662	epstein barr virus  ebv  associated ulceration has not previously been included in the differential diagnosis of oesophageal ulcers in aids  
class6	2662	we report five cases of oesophageal ulceration in homosexual men with advanced human immunodeficiency virus infection in whom this was considered to be the most likely cause  
class6	2662	dna in situ hybridisation studies showed ebv in biopsy material from three of four patients with oesophageal ulcers and in none of three controls  
class6	2662	of other viruses studied  only human papillomavirus was present  and this was found in both patients and control subjects  
class6	2662	these findings support the hypothesis that ebv is an aetiological factor in some cases of aids associated oesophageal ulceration  
class6	2663	relation of helicobacter pylori to the human gastric mucosa in chronic gastritis of the antrum  
class6	2663	the spatial relations between bacteria and the affected tissues can indicate pathogenic mechanisms  
class6	2663	this study was undertaken to define the spatial relation of helicobacter pylori to the human gastric mucosa  
class6	2663	antibodies against gastric mucus and ruthenium red were used to stabilise the glycoprotein structure of the mucus and glycocalyces in antral biopsy specimens from eight patients infected with h pylori  
class6	2663	the location of organisms and ultrastructural features were assessed using systematic scanning and transmission electron microscopy  92  2    mean  se  of h pylori were in the pit mucus  and 7  3   were in the surface mucus  60  12   of h pylori were close to epithelial cells  with only 5  2   located near the epithelial intercellular junctions  
class6	2663	fine filamentous strands extended between organisms and nearby epithelial cells  with few organisms in membrane to membrane contact  
class6	2663	h pylori were not observed between  beneath  or within cells of the gastric mucosa  
class6	2663	the preferred location of h pylori in the gastric antrum is within the pit mucus close to the epithelial cell surface  with no evidence that they have a direct toxic effect on the mucosa  
class6	2664	paf acether synthesis by helicobacter pylori  
class6	2664	clinical studies suggest that helicobacter pylori may play a role in the pathogenesis of gastroduodenal ulcers in man but direct evidence of mucosal injury by this microorganism is still lacking  
class6	2664	paf acether  paf  causes a number of disorders including ischaemic bowel necrosis and gastroduodenal ulceration  
class6	2664	since paf is produced by escherichia coli  we investigated whether it could be synthesised by h pylori  
class6	2664	five h pylori isolates were collected from antral biopsy specimens from patients with gastritis and duodenal ulcer and cultured with selective antibiotics  
class6	2664	colonies obtained from both blood agar and brucella broth medium were used  
class6	2664	paf was determined by platelet aggregation assay after ethanolic extraction and subsequent purification by high performance liquid chromatography  
class6	2664	paf was detected in h pylori in blood agar plates  680  390  pg paf 1 x 10 6  organisms  but not in bacteria cultured on brucella broth medium  
class6	2664	supplementation of the latter medium with lyso paf and acetyl coa  two paf precursors present in high amounts in the mammalian intestine  induced paf production in three of five isolates  
class6	2664	the platelet aggregating material extracted from h pylori exhibited biological and physiochemical characteristics identical to those of paf released from eukaryotic cells  
class6	2664	these findings suggest that h pylori may add to the local production of paf in inflamed gastric mucosa  
class6	2665	cathepsins d and e in normal  metaplastic  dysplastic  and carcinomatous gastric tissue  an immunohistochemical study  
class6	2665	immunohistochemical distributions of cathepsins d and e were determined in normal mucosa  metaplastic  dysplastic  and cancerous lesions of the human stomach  
class6	2665	cathepsins d and e were localised in the foveolar epithelium and parietal cells of the normal gastric mucosa  but their intracytoplasmic distributions were different   cathepsin e distribution was even and diffuse in the cytoplasm while cathepsin d was found in coarse intracytoplasmic granules  
class6	2665	chronic inflammation and ulcer did not influence the distribution of these enzymes  
class6	2665	no positive staining was obtained in the incomplete type of intestinal metaplasia  dysplasia  and well differentiated adenocarcinoma  
class6	2665	tumour cells of signet ring cell carcinoma and poorly differentiated adenocarcinoma cells  however  gave strong and diffuse stainings for cathepsins d and e in the cytoplasm  
class6	2665	the results suggest that the distribution of cathepsins d and e is related to each specialised function of the foveolar epithelium and the parietal cells  and that their disappearance is associated with development of well differentiated adenocarcinoma from intestinal metaplasia  
class6	2666	modulation of fluid absorption and the secretory response of rat jejunum to cholera toxin by dietary fat  
class6	2666	to study the effects of dietary fat on jejunal water and ion absorption and on cholera toxin induced secretion  3 week old sprague dawley rats were fed isocaloric diets  
class6	2666	forty per cent of the total calories were given as fat  as butter  high saturated fat   olive oil  high monounsaturated fat   or corn oil  high polyunsaturated fat   with one group on low fat  10  of calories  standard laboratory diet as controls  
class6	2666	during in vivo jejunal perfusion studies we found that  i  a polyunsaturated fat  corn oil  supplemented diet improves jejunal absorption of water and electrolytes and these changes are independent of the observed concentrations of luminal prostaglandins   ii  high dietary fat appreciably reduced the secretory response to cholera toxin  probably without fundamentally changing the mechanism by which cholera toxin induces secretion  
class6	2666	we conclude that dietary fat composition altered the permeability and transport characteristics of the small intestine  
class6	2666	this observation might have relevance to some human diarrhoeal disorders  
class6	2667	crohn s disease in the city of derby  1951 85  
class6	2667	an epidemiological survey of crohn s disease in the city of derby showed that the incidence of the condition increased from 0 7 10 5  per year between 1951 and 1955 to 6 67 10 5  per year between 1981 and 1985 but seemed to reach a plateau between 1976 and 1985  
class6	2667	large bowel crohn s disease was more common in patients presenting aged 60 79 years than in those aged 20 39 years  
class6	2667	the increase in incidence was not solely due to the detection of milder disease  
class6	2667	there was no evidence that the asian  indian subcontinent  population of derby was resistant to the development of crohn s disease  
class6	2668	microspectrophotometric dna analysis in ulcerative colitis with special reference to its application in diagnosis of carcinoma and dysplasia  
class6	2668	the deoxyribonucleic  dna  content was measured by microspectrophotometry in 100 specimens from 60 patients with ulcerative colitis  including six patients in whom the colitis was associated with carcinoma  
class6	2668	some 23 of 30  77   specimens of dysplastic tissue showed aneuploidy or polyploidy  whereas 50 of 53  94   specimens of non dysplastic tissue showed diploidy  
class6	2668	the difference was statistically significant  p less than 0 001   
class6	2668	polyploidy was often observed in non dysplastic mucosa from patients who had carcinoma or dysplasia  
class6	2668	in the non dysplastic patients all samples of inflamed tissue showed diploidy  
class6	2668	some 10  of samples without inflammation  however  also showed polyploidy  
class6	2668	a good correlation was found between the frequency of polyploid cells and the grade of dysplasia  
class6	2668	microspectrophotometric measurement of dna content proved useful in the assessment and diagnosis of dysplasia in ulcerative colitis and could be considered for screening high risk patients  
class6	2669	disposition of 5 aminosalicylic acid by olsalazine and three mesalazine preparations in patients with ulcerative colitis  comparison of intraluminal colonic concentrations  serum values  and urinary excretion  
class6	2669	to compare the disposition of 5 aminosalicylic acid  5 asa  and its acetylated metabolite during treatment with olsalazine and mesalazine  14 patients with inactive ulcerative colitis were randomly assigned to olsalazine  1 g twice daily  and the mesalazines  asacol  800   400   800 mg daily   pentasa  750   500   750 mg daily   and salofalk  750   500   750 mg daily  in a crossover design trial so that all received each drug for seven days  
class6	2669	intraluminal colonic concentrations of 5 asa were estimated after five days by the method of equilibrium in vivo dialysis of faeces  
class6	2669	a predose serum sample and a 24 hour urine collection were obtained on day seven  
class6	2669	the 5 asa and acetyl 5 aminosalicylic acid  ac 5 asa  values were determined by high performance liquid chromatography  
class6	2669	olsalazine almost doubled the colonic concentrations  mean 23 7  sem   1 9  mmol l  of its therapeutically active ingredient  5 asa  compared with equimolar doses of pentasa  12 6  2 2  mmol l  p less than 0 0003  and salofalk  15 0  2 0  mmol l  p less than 0 003   
class6	2669	at the same time  olsalazine treatment was associated with lower serum concentrations and urinary excretions  p less than 0 05  of 5 asa and ac 5 asa compared with the mesalazine preparations  
class6	2669	the low systemic load of 5 asa provided by olsalazine reduces the potential risk of nephrotoxicity during long term treatment  
class6	2670	role of upper gastrointestinal investigations in a screening study for colorectal neoplasia  
class6	2670	should patients with positive faecal occult blood screening tests who are free of colorectal neoplasia undergo upper gastrointestinal investigation  altogether 16 985 faecal occult blood tests were completed in a group of 18 818 asymptomatic patients  45 75 years  offered screening at two yearly intervals  
class6	2670	a total of 447  2 6   were positive and underwent large bowel investigations  
class6	2670	no neoplastic disease was identified in 283  63   of them  
class6	2670	fourteen  5   also underwent gastroscopy for upper gastrointestinal symptoms  benign conditions were identified in five and a gastric carcinoma in one  
class6	2670	no further investigations were instituted in the remaining 269 subjects who have now been followed up for a median period of 5 years  2 8 years   
class6	2670	five have been referred for benign upper gastrointestinal conditions  but none for upper gastrointestinal malignancy  
class6	2670	thirty one subjects have died   one from gastric cancer  a patient who had undergone a previous partial gastrectomy for a duodenal ulcer and who had persistent upper gastrointestinal symptoms   
class6	2670	the remaining deaths were unrelated to the upper gastrointestinal tract  
class6	2670	nineteen people who have left the trial area have been monitored for the development of malignant disease  none have presented with upper gastrointestinal malignancy  
class6	2670	these data support the view that upper gastrointestinal investigations need not be performed routinely in this group of subjects  but may be reserved for those with relevant symptoms  
class6	2671	incidence of large oesophageal varices in patients with cirrhosis  application to prophylaxis of first bleeding  
class6	2671	because several studies have suggested that beta blockers are effective in the prophylaxis of first variceal bleeding in cirrhosis  screening for oesophageal varices might be appropriate  
class6	2671	we prospectively studied 84 cirrhotic patients without obvious evidence of large oesophageal varices and previous bleeding during a mean follow up of 16 months  
class6	2671	at entry to the study 41 patients had no oesophageal varices and in 43 these were grade 1  
class6	2671	the subsequent percentages of patients without large oesophageal varices were 74  at one year and 52  at two years  
class6	2671	univariate analysis showed that a longer duration of cirrhosis  p less than 0 05  and grade 1 oesophageal varices at entry  p less than 0 001  were predictive factors for the occurrence of large oesophageal varices  whereas  multivariate analysis showed that the initial size of the oesophageal varices  p less than 0 001   a high initial child pugh score  and a smaller improvement in child pugh score during the study were independent risk factors  
class6	2671	among patients with grades 0 and 1 oesophageal varices at the start of the study the proportions with large oesophageal varices at two years were 31  and 70  respectively  
class6	2671	we have calculated that  accepting a maximum risk of first bleeding of 10  without prophylactic treatment  a patient without oesophageal varices should be screened endoscopically every other year  while a patient with grade 1 disease should benefit from one annual upper gastrointestinal endoscopy  
class6	2672	lipid peroxidation and hepatic antioxidants in alcoholic liver disease  
class6	2672	the generation of hepatic liver peroxidation by free radicals has been proposed as a mechanism for ethanol induced hepatotoxicity  
class6	2672	to investigate this hypothesis  lipid extracts from hepatic needle biopsy specimens from alcoholic subjects were examined for evidence of lipid peroxidation by measuring total conjugated dienes by derivative spectroscopy and  after hydrolysis of hepatic lipid extract and reverse phase high performance liquid chromatography  the molar ratio between a diene conjugated linoleic acid isomer  18 2  9 11   and the parent linoleic acid isomer  18 2 9 12    
class6	2672	changes were related to hepatic histology  iron deposition  glutathione and vitamin e values  
class6	2672	derivative spectroscopy minima suggestive of diene conjugation were identified at 233 and 242 nm and correlated weakly  suggesting these two minima may represent different classes of lipid dienes  
class6	2672	there was a weak relation with inflammatory histological changes in the biopsy specimen but no correlation with hepatic iron grade  glutathione  or vitamin e lipid ratio  
class6	2672	the proportion of 18 2 9 11  linoleic acid in hepatic lipids correlated significantly with inflammatory histological features and inversely with hepatic glutathione  
class6	2672	furthermore  hepatic glutathione was lower in biopsy specimens with greater iron staining  
class6	2672	the ratio of vitamin e to lipid was not related to histological group  inflammation  or iron grade  
class6	2672	these findings suggest that excess alcohol consumption leads to hepatic inflammation and lipid peroxidation  
class6	2673	monitoring enzyme replacement treatment in exocrine pancreatic insufficiency using the cholesteryl octanoate breath test  
class6	2673	the cholesteryl 14c octanoate breath test was used to monitor the intraluminal enzymatic activity of pancreatin preparations in six patients with severe pancreatic insufficiency  
class6	2673	conventional enzyme replacement  with cimetidine as an adjunct  was compared to supplementation with enteric coated microspheres  
class6	2673	in healthy control subjects  14co2 excretion rose rapidly and peaked at 90 120 minutes  mean  sd  cumulative recovery at four hours was 51  8    
class6	2673	in patients with pancreatic insufficiency on no treatment mean  sd  cumulative recovery was only 6  4    
class6	2673	after pancreatin  with previous administration of cimetidine  it increased to 27  11   with a time course resembling that in controls  
class6	2673	with 2 mm enteric coated microspheres  14co2 excretion did not rise significantly before 120 minutes and cumulative recovery after four hours was 15  11    
class6	2673	in a control study  2 mm radio opaque microspheres did not empty from the stomach until two hours after ingestion  
class6	2673	the results suggest that the cholesteryl octanoate breath test can be successfully used to monitor the intraluminal enzymatic activity after treatment with different forms of enzyme replacement in pancreatic insufficiency  
class6	2673	in contrast to treatment with conventional pancreatin and cimetidine as an adjunct  2 mm enteric coated microspheres did not show in vivo enzymatic activity until two hours after administration  
class6	2674	stomal adenocarcinoma in crohn s disease  
class6	2674	malignant change occurring at the site of a stoma in two patients with proved crohn s disease is described  
class6	2674	patients with ulcerative colitis have an increased risk of colonic malignancy and crohn s disease is also associated with both small and large bowel carcinoma  
class6	2674	most previous reports of stomal carcinoma have been associated with ulcerative colitis although crohn s disease seems to carry a greater risk of associated small bowel carcinomas  
class6	2674	this is the first report of stomal carcinoma complicating crohn s disease  
class6	2674	epithelial dysplasia is associated with gastrointestinal carcinomas in both ulcerative colitis and crohn s disease and a dysplasia carcinoma sequence has been suggested as the origin of these tumours  
class6	2674	in both our patients with stomal adenocarcinoma  dysplasia was identified in adjacent tissues  which suggests a similar mechanism  
class6	2674	malignant change should be suspected if epithelial dysplasia is discovered in a biopsy specimen from the mucosa of an ileostomy in crohn s disease  and this risk is increased if the dysplasia is of a high grade  
class6	2675	squamous carcinoma in the liver  
class6	2675	squamous carcinoma of the liver has only rarely been reported  
class6	2675	we present a case which highlights not only the difficulties in diagnosis but also how it can closely mimic sclerosing cholangitis  
class6	2676	metabolic studies of radioiodinated serum amyloid p component in normal subjects and patients with systemic amyloidosis  
class6	2676	125i serum amyloid p component  sap   injected intravenously into 10 normal subjects  remained predominantly intravascular with mean  sd  t1 2  half time  in plasma of 24 5  5 9  h  
class6	2676	the fractional catabolic rate of 68  19   of the plasma pool per day was more rapid than other reported human plasma proteins  
class6	2676	all radioactivity was excreted in the urine by 14 d  
class6	2676	in 16 patients with monoclonal gammopathy or chronic inflammatory diseases  but without amyloidosis  125i sap metabolism was normal  
class6	2676	however  among 45 patients with biopsy proven systemic amyloidosis  25  amyloid a type  20  amyloid l type   125i sap was cleared from the plasma more rapidly  accumulated in the amyloid deposits  and persisted there  
class6	2676	the t1 2 in amyloid  measured directly with 131i sap  was 24 d  
class6	2676	repeat studies after 6 18 mo were notably consistent in normals but changed significantly in amyloid patients  generally correlating with clinical signs of disease progression  
class6	2676	measurements of 125i sap turnover may thus be of value for diagnosis and monitoring of amyloidosis  
class6	2676	analysis of sap metabolism in amyloidosis suggests that plasma sap is in dynamic equilibrium with a very large amyloid pool  and in two autopsies the total mass of sap in the amyloid deposits was 2 100 and 21 000 mg  respectively  
class6	2677	carbohydrate malabsorption  its measurement and its contribution to diarrhea  
class6	2677	the major purpose of this research was to gain insight into the effect of carbohydrate malabsorption on fecal water output  
class6	2677	to do this we measured daily fecal output of total carbohydrate  reducing sugars  and organic acids  a product of bacterial fermentation   
class6	2677	normal subjects were studied in their native state and when diarrhea was induced by mechanisms that did and did not involve carbohydrate malabsorption  
class6	2677	patients with malabsorption syndrome were also studied  
class6	2677	we concluded that   a  excretion of carbohydrate and its breakdown products can be expressed as a single number by converting organic acids to their monosaccharide equivalents  
class6	2677	 b  diarrhea per se causes only a trivial increase in fecal carbohydrate excretion  
class6	2677	 c  the molar output of osmotic moieties in feces due to unabsorbed carbohydrate can be determined by adding fecal reducing sugars to organic acids and their obligated cations  
class6	2677	this expression parallels almost exactly the effect of increasing doses of lactulose  a nonabsorbable sugar  on fecal water output  one excreted millimole obligates 3 5 g of stool water  
class6	2677	this relationship can be used to predict the effect of carbohydrate malabsorption on stool water output in patients with diarrhea  
class6	2677	 d  12 of 19 patients with malabsorption syndrome due to various diseases had excessive fecal excretion of carbohydrate and its breakdown products  of the diseases that cause malabsorption syndrome  combined small and large bowel resection is most likely to result in excessive fecal excretion of carbohydrate and monosaccharide equivalents  
class6	2677	in 6 of these 19 patients carbohydrate malabsorption appeared to be the major cause of diarrhea  
class6	2678	prevention of a false diagnosis of sexually acquired reactive arthritis by synovial lymphocyte responses  
class6	2678	three cases are reported in which a diagnosis of sexually acquired reactive arthritis might have been made erroneously from the history  but the enteric origin of the reactive arthritis was evident from synovial lymphocyte responses  
class6	2678	the importance of making the correct diagnosis and the avoidance of unwarranted spousal dysharmony is stressed  
class6	2679	septic streptococcus milleri spondylodiscitis  
class6	2679	we describe 2 patients presenting lumbar spondylitis due to streptococcus milleri  
class6	2679	in both cases origin was related to preexistent intestinal pathology  
class6	2679	surgical drainage of a collection of pus was necessary in one case  
class6	2679	longterm antibiotic therapy led to full recovery  
class6	2679	despite confused nomenclature streptococcus milleri must be considered a serious pathogen mainly associated with purulent infection with osteoarticular affinity  
class7	2680	salivary gland cancer  a case control investigation of risk factors  
class7	2680	unlike most upper aerodigestive tract cancers  salivary gland cancers are relatively infrequent  are characterized by a diversity of histologic subtypes  and have never been etiologically associated with tobacco exposure  
class7	2680	we present the results of a case control study of risk factors for these cancers  with risk estimates derived from self administered comprehensive risk factor questionnaires distributed to patients at the university of texas m  
class7	2680	d  
class7	2680	anderson cancer center  houston  
class7	2680	cases were 64 patients with histologically confirmed salivary gland cancer  
class7	2680	control subjects  randomly selected from the same patient population excluding patients with cancer of the head and neck or nonmelanoma skin cancer  were frequency matched to the cases by age  sex  and ethnicity to achieve a 2 1 control subjects cases ratio  
class7	2680	on multivariate analysis  prior radiotherapy was a significant risk factor for both men  odds ratio  or    2 1  and women  or   2 3   
class7	2680	among women  higher educational attainment  or   2 4   alcohol use  or   2 0   and hairdye use  or   2 5  were also significantly associated with risk  
class7	2680	there were no significant differences between cases and control subjects with respect to tobacco exposure or specific occupational or leisure time exposures  
class7	2680	there is biological plausibility for associations with hairdye use and alcohol exposure  
class7	2681	periodontal disease and niddm in pima indians  
class7	2681	the goal of this study was to determine the prevalence and incidence of periodontal disease and its relationship with non insulin dependent diabetes mellitus  niddm   
class7	2681	two thousand two hundred seventy three pima indians  949 men  1324 women  aged greater than or equal to 15 yr from the gila river indian community in arizona were examined between 1983 and 1989  
class7	2681	periodontal disease was diagnosed by tooth loss and by percentage of interproximal crestal alveolar bone loss ascertained from panoramic radiography  
class7	2681	subjects with little or no evidence of periodontal disease were classified as nondiseased  
class7	2681	thus  the incidence of advanced periodontal disease was determined  
class7	2681	the age  and sex adjusted prevalence of periodontal disease at first dental examination was 60  in subjects with niddm and 36  in those without  
class7	2681	twenty two new cases developed in a subset of 701 subjects  272 men  429 women  aged 15 54 yr who initially had little or no evidence of periodontal disease and had at least one additional dental examination  
class7	2681	the incidence of periodontal disease in this group was similar in men and women  incidence rate ratio 1 0  95  confidence interval  cl  0 5 1 9  controlled for age and diabetes   
class7	2681	higher age predicted a greater incidence of periodontal disease  chi 2   30 6  df   3  p less than 0 001  controlled for sex and diabetes   
class7	2681	the rate of periodontal disease in subjects with diabetes was 2 6 times  95  cl 1 0 6 6  controlled for age and sex  that observed in those without  
class7	2681	although periodontal disease was common in nondiabetic pima indians  in whom most of the incident cases occurred  diabetes clearly conferred a substantially increased risk  
class7	2681	thus  periodontal disease should be considered a nonspecific complication of niddm  
class7	2682	cutaneous lesions of disseminated histoplasmosis in human immunodeficiency virus infected patients  
class7	2682	disseminated histoplasmosis is being diagnosed more frequently in persons infected with the human immunodeficiency virus and is often the initial manifestation of the acquired immunodeficiency syndrome  aids   
class7	2682	disease related cutaneous features of hiv associated disseminated histoplasmosis are defined as mucocutaneous lesions from which fungal organisms were either cultured or demonstrated histopathologically  
class7	2682	we report four hiv seropositive patients with disseminated histoplasmosis who had culture positive skin or oral lesions of histoplasmosis and review the specific cutaneous manifestations of hiv associated disseminated histoplasmosis  
class7	2682	including our patients  disease related skin and or mucosal lesions were present in 11  of patients  26  of 239  with hiv associated disseminated histoplasmosis  
class7	2682	the possibility of disseminated histoplasmosis should be considered in all hiv infected persons and in persons with aids risk factors who have fever  weight loss  hepatosplenomegaly  and new cutaneous lesions  
class7	2682	an early skin or mucosal biopsy specimen for crushed tissue preparation  histologic evaluation  and fungal culture is a simple  rapid diagnostic procedure  
class7	2683	treatment of aggressive keratoacanthomas by radiotherapy  
class7	2683	keratoacanthomas infrequently are treated by radiotherapy  
class7	2683	however  keratoacanthomas that are recurrent after surgical excision or whose resection would result in cosmetic deformity may benefit from radiotherapy  
class7	2683	between january 1970 and june 1988  29 such keratoacanthomas in 18 patients were irradiated  
class7	2683	doses ranged from 3500 cgy in 15 fractions to 5600 cgy in 28 fractions  
class7	2683	measured end points of therapy were  1  initial response   2  freedom from recurrence  and  3  quality of the subsequent cosmetic appearance  scored as good  fair  or poor   
class7	2683	no lesion progressed and all eventually regressed completely  
class7	2683	cosmetic results generally were considered good by both the patient and the referring dermatologist  none of the results was considered poor  
class7	2683	our results demonstrate that radiation is an effective means of treating keratoacanthomas  
class7	2684	multiple oral and skin lesions occurring after treatment with penicillin  
class7	2684	a case of erythema multiforme has been presented  
class7	2684	erythema multiforme may be a self limiting or chronic disease  of varying severity  
class7	2684	the disease is of significance to dental practitioners who may be called on to establish a diagnosis and provide appropriate referral or treatment  especially when lesions are limited to the mouth  
class7	2684	the prognosis is generally good  although recurrence is common  
class7	2685	diagnosing periodontal diseases  
class7	2685	at present  the diagnosis of periodontal disease requires a clinical evaluation of the patient including visual findings  the use of the periodontal probe  and radiographs  
class7	2685	no test is available to evaluate disease activity  
class7	2685	in specific cases  adjunctive procedures may also be useful  
class7	2685	the identification of pathogenic microorganisms may aid in evaluating the periodontal status of special patients  
class7	2685	however  these are not required for an adequate diagnosis of the common adult form of chronic periodontitis  
class7	2686	reviewing nonsurgical periodontal therapy  
class7	2686	selection of the appropriate case and clinical competency in treatment modalities results in success in nonsurgical periodontal therapy  
class7	2686	the patient with early periodontitis with significant local factors in the form of professionally accessible plaque and calculus is the most receptive to nonsurgical periodontal treatment  
class7	2686	the clinician must make decisions centering around the important question   can the patient  or moreover  can the therapist delivering the debridement  gain access to the microbial subgingival plaque on a frequent basis below the host defense threshold of the respective patient   if the answer is  yes   nonsurgical periodontal therapy will be rewarding  
class7	2686	if the answer is  no   other modalities such as periodontal surgery must be instituted  
class7	2687	surgical pocket reduction  
class7	2687	it is not possible within the scope of this paper to describe in any detail each of the aforementioned procedures  
class7	2687	these can be found in the various textbooks and journals on clinical periodontology  
class7	2687	instead  the objectives of treatment  the spectrum of techniques available  and the rationale for their use have been described  
class7	2687	periodontal surgery should be performed only under certain conditions  the patient must be physically and mentally competent to undergo any type of surgery  and should understand and agree to the procedure and to postoperative management  
class7	2687	finally  periodontal surgery should only be considered when nonsurgical therapy will not accomplish the desired result  
class7	2687	when periodontal surgery for pocket elimination is performed for selected defects that have been properly evaluated after a debridement and healing period  and is executed with technical competence and proper postoperative care  it can preserve the dentition affected by periodontal disease  
class7	2688	using periodontal plastic surgery techniques  
class7	2688	in the 1980s  mucogingival surgery evolved into periodontal plastic surgery with various techniques designed to produce root coverage in areas of marginal tissue recession  to augment deficient ridges  and to lengthen crowns in cases of excessive gingival display  
class7	2688	periodontal plastic surgery not only enables the dentist to reconstruct but also to regenerate lost tissues  
class7	2689	maintaining periodontal treatment  
class7	2689	dental maintenance  or supportive periodontal treatment  spt   can keep the periodontium and peri implant tissues healthy after active therapy  
class7	2689	patients who comply to suggested spt fare better periodontally and keep their teeth longer  
class7	2689	data should be gathered by examinations  talking with patients  and reviewing personal oral hygiene  
class7	2689	then sub  and supra gingival deposits should be removed  
class7	2689	the average spt visit should last 1 hour and should be scheduled every 3 months  
class7	2689	supportive periodontal treatment for patients with more advanced periodontal or peri implant destruction should be the responsibility of the periodontist  
class7	2690	regenerating bone in clinical periodontics  
class7	2690	bone autografts and allografts  various alloplastic materials  and guided tissue regeneration are used to reconstruct lost periodontal tissues  
class7	2690	this paper focuses on controversies related to these therapeutic modalities as well as their role in periodontal regeneration  
class7	2691	dental implants used for periodontal patients  
class7	2691	for those performing implant treatment  continued research and reports of long term successful results are essential to evaluating the validity of implants  especially when variables such as design and surface treatment are introduced  
class7	2691	the dental profession has enthusiastically embraced the clinical results of implant treatment and its benefits to the patient  
class7	2691	however  just as patients who undergo periodontal and restorative treatment must continue a regular long term routine of maintenance therapy to ensure their dental health  so must those patients who receive dental implants  
class7	2691	both the periodontist who places the implants and the dentist who fabricates the prosthetic replacement must work cooperatively to deliver a healthy restoration that will function for many years  
class7	2692	premolarization of a fractured maxillary first molar  a multidisciplinary treatment  
class7	2692	the diagnosis and treatment of a fractured maxillary first molar are described in this case report of a 28 year old male  
class7	2692	successful treatment of the retained palatal root of the fractured molar  referred to as premolarization  ensued from integration of endodontic  orthodontic  periodontic  and fixed prosthodontic care  
class7	2693	an esthetic approach to vertical root extrusion in a patient with an anterior open bite  report of case  
class7	2693	a previous attempt to locate the root canal system in the maxillary left central incisor with a bur created a perforating root defect at the level of the alveolar crest  
class7	2693	the patient received root canal therapy  
class7	2693	next  vertical root extrusion was chosen to expose sound tooth structure apical to the defect so that a crown could be constructed  
class7	2693	with an anterior open bite  the natural crown was left intact and it was possible to position the anchor bar in an incisal and lingual position  maintaining esthetics for the patient during both the extrusive and stabilization phases of treatment  
class7	2694	type 2 diabetes mellitus and periodontal disease  
class7	2694	the relationship between type 2 diabetes mellitus and periodontal disease was evaluated in 2 878 pima indians of the southwestern united states  
class7	2694	two independent measures of periodontal disease  probing attachment loss and radiographic bone loss  were used to compare prevalence and severity of periodontal disease in diabetic and nondiabetic subjects  
class7	2694	in all age groups studied  subjects with diabetes had a higher prevalence of periodontal disease  indicating that diabetes may be a risk factor for periodontal disease  
class7	2695	proliferative mass found in the gingiva  
class7	2695	the clinical course of peripheral ossifying fibroma is slow and the growth of most lesions is limited in size  usually up to 1 5 cm  
class7	2695	complaints are rare unless the surface becomes ulcerated  or the lesion compromises oral function or esthetic appearance  
class7	2695	treatment is surgical excision with close postoperative follow up  
class7	2695	tooth extraction is seldom necessary  
class7	2695	proper surgical intervention  which includes excision of reactive tissue down to periosteum  affords a low recurrence rate of 14  to 16   
class7	2696	needle aspiration biopsy in salivary gland lesions  
class7	2696	the value of needle aspiration biopsy in the evaluation and management of salivary gland pathology is controversial  
class7	2696	the major reasons for this controversy are the difficulty in cytologic evaluation and the fact that the extent of surgery can be easily defined based on clinical judgement  
class7	2696	however  a preoperative diagnosis is helpful in discussions with patients regarding the extent and type of surgery  
class7	2696	apart from the fact that needle biopsy can distinguish benign from malignant conditions  it is also very useful in distinguishing between salivary and other nonsalivary pathology  
class7	2696	over the past 7 1 2 years  we have performed 160 needle aspirations of parotid  submandibular  and submucosal lesions  
class7	2696	adequate specimens for cytologic evaluation were obtained in 155 patients  97    
class7	2696	a total of 84 parotid lesions  70 submandibular lumps  and 6 submucosal abnormalities were detected  
class7	2696	a cytologic diagnosis of benign pathology was made in 120 patients  
class7	2696	twelve patients had lymphoma and the diagnosis was suspected based on needle aspiration  
class7	2696	there were 10 patients with tuberculosis and 30 patients with hyperplastic lymph nodes or benign lymphoepithelial disease of the parotid  
class7	2696	there were three false positive and two false negative reports  
class7	2696	no complications such as hematoma  nerve injury  or infection developed  
class7	2696	the major difficulty was in distinguishing between malignancy and obstructive sialadenitis in the submandibular region  
class7	2696	needle aspiration was helpful in evaluating lesions in the tail of the parotid and submandibular area  
class7	2696	the cytologic distinction between salivary and nonsalivary pathology was useful in planning the appropriate surgery and the extent of surgical resection  
class7	2696	from a clinical standpoint  the distinction between benign and malignant salivary and nonsalivary pathology was very helpful  
class7	2696	preoperative diagnosis of warthin s tumor  lymphoma  or benign lymphoepithelial disease was essential to the correct management of these patients  
class7	2697	whole organ sectioning of mixed parotid tumors  
class7	2697	a pathologic study involving 15 standard formal parotidectomy specimens was carried out using the whole organ sectioning technique  
class7	2697	histopathologic characteristics noted included the presence of exposed capsule  breaks of the capsule  capsular incompleteness  tumor ingrowth and thickness  cellularity  and lymphocytic infiltration  
class7	2697	tracings of histopathology slides were used to reconstruct the three dimensional configuration of each tumor as viewed from different angles  
class7	2697	no tumor had a smooth surface  
class7	2697	at the extreme  two tumor lumps were connected by just a narrow waist  
class7	2697	separated tumors were not seen  
class7	2697	in only one specimen did a lymph node contain an additional tumor in the form of an adenolymphoma  
class7	2697	all tumors showed some exposed capsule or  bare area  to a degree affected mainly by the position of the tumor  
class7	2697	capsular damage was occasionally seen and was usually minor  
class7	2697	capsular incompleteness and tumor ingrowth make global capsular dissection unsafe  
class7	2697	it is concluded that formal parotidectomy remains the operation of choice for pleomorphic adenoma of the parotid gland  although capsular dissection  otherwise termed enucleation  cannot be entirely avoided during the procedure  
class7	2698	early facial reanimation following radical parotid and temporal bone tumor resections  
class7	2698	a retrospective study of 35 patients who underwent early facial reanimation following extirpative parotid and temporal bone surgery requiring facial nerve sacrifice was performed  
class7	2698	regional facial reanimation performed immediately or within several days included 16 patients who underwent temporalis muscle transposition and 27 who underwent gold weight or eyespring lid reanimation with lower lid tightening  
class7	2698	simultaneous nerve grafts or nerve crossover procedures were performed in 22 patients  
class7	2698	the authors  favored approaches to facial reanimation are discussed  with an emphasis on the value of early reanimation using properly selected techniques  
class7	2699	reconstruction of mandibular defects in irradiated patients  
class7	2699	in this prospective study  mandibular reconstruction using titanium plates was evaluated in 31 patients treated between july 1988 and january 1990  
class7	2699	sixteen patients had prior surgery  13 had prior radiotherapy  
class7	2699	in 11 patients  prior radiation and surgery had failed  
class7	2699	sixteen patients received postoperative radiotherapy either in standard or accelerated fractions  
class7	2699	twelve patients had complications of either intraoral  8   extraoral  5   or combined  1  plate exposure or fistula formation  2   
class7	2699	factors significantly related to complications were poor nutrition  accelerated radiation  and recurrence  
class7	2699	sixty one percent of all patients healed uneventfully  
class7	2699	when patients with complications secondary to recurrence who subsequently died were excluded  the success rate was 73   
class7	2699	only one patient had an unacceptable result that produced a cosmetic and functional deformity despite secondary repair  
class7	2700	long term fate of the vascularized iliac crest bone graft for mandibular reconstruction  
class7	2700	vascularized bone grafts  such as the iliac crest  have become a major tool for mandibular reconstruction  
class7	2700	due to the growing trend toward immediate bone replacement followed by implant osseointegration and dental rehabilitation  further understanding of the long term characteristics of these grafts is essential  
class7	2700	early postoperative bone scans demonstrate increased activity within the vascularized graft relative to surrounding bone  
class7	2700	this study addressed the use of bone spect  single photon emission computed tomography  scintigraphy as a long term method of evaluating the integrity of vascularized bone grafts  
class7	2701	sequential connection of flaps  a logical approach to customized mandibular reconstruction  
class7	2701	microsurgery has improved the success rate for reconstruction of composite defects in the head and neck  
class7	2701	restoration of mandibular continuity alone is not adequate for reconstruction  
class7	2701	replacement of the oral lining with thin tissue is necessary to improve tongue mobility and to set the stage for later dental restoration  
class7	2701	there is currently no ideal osteocutaneous free flap that provides unlimited length of bone  can undergo multiple osteotomies to produce the proper curve to the reconstructed mandible  and provides thin skin for oral lining  
class7	2701	combining free flaps can take advantage of the strengths of the individual donor sites and eliminate some of the problems with current osteocutaneous flaps  
class7	2701	in six patients  a fibular osseous free flap was combined with either a radial forearm flap or a lateral arm flap to provide bone and oral lining in reconstruction of mandibular composite defects  
class7	2701	in these selected patients  the fibula provided the blood supply for the second free flap  which was placed sequentially  
class7	2701	the distal peroneal vessels were used to anastomose to the radial forearm vessels or the lateral arm pedicle  
class7	2701	this approach allows the surgeon to customize the defect by improving both the functional and aesthetic aspects of reconstruction and is of use in cases where vascular access is limited  such as following head and neck surgery and radiation  
class7	2702	treatment selection for carcinoma of the base of the tongue  
class7	2702	between 1974 and 1984  173 patients were treated for squamous cell carcinoma of the tongue base  
class7	2702	fifty four patients had t1 or t2 primaries  while 115 patients had t3 or t4 tumors  4 were not staged   
class7	2702	lymph node metastasis was present in 120 patients  
class7	2702	early primary tumors treated with surgery or radiotherapy had a control rate of 83   5 of 6 tumors  and 89   40 of 45 tumors   respectively  
class7	2702	for advanced primary tumors  definitive radiotherapy produced a local control rate of 55   42 of 76 tumors   compared with 79   23 of 29 tumors  for surgery and postoperative radiotherapy  
class7	2702	if primary control was obtained  the regional failure rate was less than 10   
class7	2702	tumor growth patterns were predictive of the response to radiotherapy  
class7	2702	the primary control rate at 2 years for 21 patients with exophytic tumors was 84  as opposed to 58  for 62 patients with ulcerative infiltrative tumors  p   0 04   
class7	2702	radiotherapy is effective for early stage or exophytic tumors  whereas for advanced or deeply invasive tumors combined therapy enhances local control  
class7	2703	histopathologic grading of salivary gland neoplasms  i  mucoepidermoid carcinomas  
class7	2703	histopathologic grading of salivary gland neoplasms has been done with various degrees of success and hence various degrees of acceptance among pathologists and otolaryngologists head and neck surgeons  
class7	2703	given their histopathologic diversity  three carcinomas  mucoepidermoid  adenoid cystic  and acinic cell  would seem to be suitable candidates for grading  
class7	2703	in this  the first of a three part series  the authors present a three level grading scheme for mucoepidermoid carcinomas  
class7	2703	it combines histocytologic and growth features of the carcinomas that independently or together  in other grading proposals  have shown prognostic value  
class7	2704	intravenous pulse cyclophosphamide therapy in myositis and sjogren s syndrome  
class7	2704	we describe a patient with primary sjogren s syndrome who developed myositis  
class7	2704	the results of muscle pathologic analysis before and after treatment with monthly pulses of cyclophosphamide  intravenously   are presented  
class7	2705	characterization of a macrophage tropic hiv strain that does not alter macrophage cytokine production yet protects macrophages from superinfection by vesicular stomatitis virus  
class7	2705	macrophages  unlike cd4  t cells  can be productively infected by human immunodeficiency virus  hiv  without prior cellular activation  
class7	2705	cytopathic infection ensues without the induction of tumor necrosis factor alpha  tnf alpha   interleukin 1 beta  il 1 beta   interleukin 6  il 6   or tissue factor genes  
class7	2705	in detailed studies on tnf alpha  hiv infection did not affect the regulation of tnf alpha in response to bacterial lipopolysaccharide  
class7	2705	in an effort to examine the interferon responsiveness of hiv infected macrophages  the cells were challenged with vesicular stomatitis virus  vsv  with or without interferon pretreatment  
class7	2705	surprisingly  hiv infected macrophages were completely resistant to vsv induced lysis even in the absence of interferon  however  no interferon was detected in the supernatants of these infected cells  
class7	2705	the resistance of hiv infected macrophages to superinfection with vsv indicates a previously undescribed effect of hiv upon macrophage cellular metabolism  
class7	2706	expression of major histocompatibility complex class ii antigens and interleukin 1 by epithelial cells of warthin s tumor  
class7	2706	the immunoreactivity for class ii antigens of the major histocompatibility complex and interleukin 1  il 1  in warthin s tumor  wt  cells was studied  
class7	2706	in addition to macrophages  dendritic cells  and capillary endothelia  the luminal tumor cells and some keratinocytes in the metaplastic squamous foci exhibited immunoreactivity for both class ii antigens and il 1  
class7	2706	the distribution of the class ii antigens in the luminal tumor cells was limited to their basolateral membrane  
class7	2706	these data  together with previous findings  strongly suggest that the luminal tumor cells of wt introduce the luminal antigen to the underlying lymphoid tissue and  thus  act as an antigen presenting cell  
class7	2707	intraoral adenoid cystic carcinoma  the presence of perineural spread in relation to site  size  local extension  and metastatic spread in 22 cases  
class7	2707	twenty two patients with an intraoral adenoid cystic carcinoma  acc   initially treated by surgery with or without postoperative radiotherapy  were examined for the presence of perineural spread in relation to primary site  size  local extension  histologic status of the surgical margins  and metastatic spread of the tumor  
class7	2707	there seems to be no correlation between perineural spread and the primary site or size of the tumor  
class7	2707	however  perineural spread occurred more often in tumors with local extension and in cases with surgical margins with positive results  
class7	2707	there seems to be no statistically significant correlation between perineural invasion and distant metastatic disease  
class7	2708	repair of salivary fistulae after laryngectomy  
class7	2708	a new surgical technique is described for the repair of salivary fistulae  
class7	2708	it has been used in three patients  
class7	2708	the fistulae occurred after laryngectomy and had been unsuccessfully treated with local and regional flaps  
class7	2708	the principle of the technique is to use a bipedicled jejunal patch as a free microvascular transfer  
class7	2708	one patch is used for reconstruction of the pharynx and after excising the mucosa the skin defect is closed with the other patch  
class7	2708	the mucosa is excised to expose the muscle and to create a recipient site for a split skin graft  
class7	2709	balancing dental service requirements and supplies  epidemiologic and demographic evidence  
class7	2709	as a counterpoint to negative interpretations of recent trends  this article presents a positive picture of dentistry in the 1990s and 21st century  
class7	2709	reported trends show large increases in older dentate adults who are retaining more of their natural dentition  new diagnosis and treatment technologies  increased incidence of dental caries in older adults  increased awareness of periodontal diseases  greater interest in esthetic dentistry  and generally higher expectations for health and fitness in our society  
class7	2709	all of these factors point to a greater need for adult dental services  
class7	2709	therefore  in the next 30 years  the dental profession should be prepared to provide increased amounts of diagnostic  preventive  adult operative  fixed prosthodontic  and endodontic and orthodontic services  
class7	2709	declines in need should be expected in children s operative dentistry  extractions  and complete dentures  
class7	2710	life threatening hemorrhage after placement of an endosseous implant  report of case 
class7	2710	this article reports an unusual but dangerous complication of implant surgery  
class7	2710	minimal perforations of the lingual plate and inferior border of the mandible had been considered previously to be benign occurrences  
class7	2710	this report demonstrates the importance of managing acute airway problems resulting from perforations  
class7	2711	evaluating tooth eruption on sealant efficacy  
class7	2711	for patients aged 5 to 9 and 11 to 14  100 occlusal surfaces on newly erupting permanent molars were treated with a self curing pit and fissure sealant  
class7	2711	all teeth were categorized according to stage of eruption and sealant thickness of the coating applied  
class7	2711	after 36 months  75 surfaces were examined for a final evaluation  52 surfaces  70   did not need retreatment  
class7	2711	of the 23 surfaces retreated as a result of sealant loss or marginal deterioration  18 were retreated only once in the six recall evaluations  
class7	2711	those molars treated originally with the operculum covering the distal marginal ridge of the occlusal surface had twice the probability for retreatment as teeth not treated until the entire marginal ridge was exposed  
class7	2711	the thickness of the sealant coating did not affect the early signs of sealant failure  
class7	2712	the prevalence of periodontitis in a military treatment population  
class7	2712	a group of 1 984 males and females  age range 13 to 84  at a military dental clinic were given oral examinations with full mouth circumferential periodontal probing  
class7	2712	diagnoses were made both for individual quadrants and for the entire mouth using clearly defined diagnostic criteria  
class7	2712	the results showed 37  of the subjects had gingivitis only  33  had early periodontitis  14  had moderate periodontitis  15  had advanced periodontitis  0 5  had juvenile periodontitis  and 0 5  had necrotizing gingivitis  
class7	2712	the prevalence of periodontitis increased with age to a peak in the 45  to 50 year age group  
class7	2712	the proportion of periodontitis affected quadrants  although initially lagging behind the overall case diagnoses  also increased with age  
class7	2713	periodontics in general practice  professional plaque control 
class7	2713	traditionally the primary emphasis of preventive periodontics was daily patient performed plaque control  
class7	2713	recent studies indicate that frequent professional subgingival toothcleaning is a mandatory treatment for prevention of recurrent periodontitis  
class7	2713	pathogenic subgingival bacterial complexes are disrupted by frequent cleaning and require time to reestablish  
class7	2713	disease progression is prevented if the recall interval does not exceed the time required for reestablishment of a pathogenic plaque  
class7	2713	legally  patients have acquired the duty to comply with the prescribed recall interval  
class7	2713	both the patient and the practitioner will benefit from a preventive program that includes frequent professional subgingival toothcleaning  
class7	2714	lip paresthesia associated with a jaw mass  
class7	2714	a case is reported in which mandibular swelling and lower lip numbness were the first signs of a metastatic adenocarcinoma of the lung  
class7	2714	the development of paresthesia  with or without other oral symptoms  requires that a diagnosis of malignancy be considered until confirmed or ruled out by tissue biopsy  
class7	2714	a thorough head and neck examination in all patients  especially in those whose history or habits may indicate increased risk of malignancy is necessary  
class7	2715	rhinosporidiosis associated with squamous cell carcinoma in the tongue  
class7	2715	the peritumoural region of a squamous cell carcinoma of the tongue when examined with light and electron microscope showed nodular bodies in the submucosa with all the distinctive features of  sporangium and  spores  of rhinosporidiosis  
class7	2715	the occurrence of rhinosporidiosis in the tongue along with malignancy has not been reported hitherto  
class7	2715	some interesting observations and causal relationships are discussed  
class7	2716	malignant adenolymphoma of the parotid gland  report of carcinomatous transformation  
class7	2716	malignant transformation of an adenolymphoma  warthin s tumour  is a rare event  
class7	2716	this paper presents a case of carcinoma arising in an adenolymphoma of the parotid gland  
class7	2717	benign parotid tumour enucleation  a reliable operation in selected cases  
class7	2717	the method of surgical treatment for benign tumours of the parotid gland had not yet been rationalized  but many authors recommend parotidectomy as the most appropriate procedure  
class7	2717	a series of 289 operations for parotid swelling is reported  the majority of mixed and warthin s tumours underwent enucleation without either complications or recurrence  
class7	2717	the rationale of parotidectomy versus enucleation is discussed but in fast growing  deeply infiltrating and recurrent tumours  parotidectomy appears to be the best choice  
class7	2717	in the other group of more commonly occurring tumours  enucleation represents a reliable time saving option  
class7	2718	unusual lymphoproliferative oropharyngeal lesions in heart and heart lung transplant recipients  
class7	2718	three unusual cases of oropharyngeal lympho proliferative lesions were seen in recipients of heart and heart lung transplants  
class7	2718	two caused acute upper respiratory obstruction necessitating urgent ent intervention  
class7	2718	all patients were receiving immunosuppressive drugs including cyclosporin  
class7	2718	the two obstructive cases were adenotonsillar enlargement in a 6 year old  and a tumour of the tonsil and tongue base with cervical lymph node enlargement in a 32 year old male  
class7	2718	both were caused by epstein barr virus associated lymphoproliferative disorder  
class7	2718	the third patient  a 32 year old female  had a presumed low grade t cell lymphoma that regressed spontaneously  
class7	2718	histopathological diagnosis of these lympho proliferative disorders after transplantation usually requires immunocytochemistry to distinguish polyclonal proliferative disorders from true lymphoma  
class7	2718	polyclonal lymphoproliferative disorders after transplantation do not usually require aggressive cytoreductive therapy  but respond to simple measures such as the reduction of immunosuppression  
class7	2719	the problem of the bifid mandibular condyle  
class7	2719	in a survey of 1 882 prehistoric and historic skulls with 2 077 condyles  7 double  bifid  mandibular condyles were found  
class7	2719	one mandible with bilaterally bifid condyles is presented in detail  
class7	2719	possible causes and consequences of the anomaly are discussed  
class7	2719	it is assumed that bifid mandibular condyles with anteroposteriorly situated heads are caused by early childhood fractures  whereas those with mediolaterally situated heads are caused by the persistence of connective tissue septa  
class7	2720	speech  velopharyngeal function  and hearing before and after orthognathic surgery  
class7	2720	articulation  voice  resonance  hearing sensitivity  and middle ear function were examined in 34 patients before and 3  6  9  and 12 months after orthognathic surgery  
class7	2720	thirty of the 34 patients had articulation errors before surgery  
class7	2720	errors on the sibilants  s  and  z  occurred most frequently  followed by those on  j zh ch  and  sh   
class7	2720	errors were predominantly distortions with both visual and acoustic components  
class7	2720	after surgery  articulation improved spontaneously in the absence of intervention  
class7	2720	most of the preoperative articulation errors were eliminated by 3 months postoperative  but  thereafter  a gradual decline was noted so that by 12 months  errors occurred on  s  and  z   
class7	2720	voice  resonance  velopharyngeal port area  and hearing sensitivity were not altered by surgery  
class7	2720	this study suggests that severe skeletal malocclusions requiring surgical correction have deleterious effects on the patients  articulation of consonants and that surgical alteration leads to the correction of most of these errors  
class7	2721	pedunculated soft tissue mass on the alveolar gingiva  clinical conference  
class7	2721	a case of peripheral ameloblastoma  a rare intraoral neoplasm  has been presented  
class7	2721	the lesion appears most commonly as a mass on the mandibular lingual gingiva of patients in their fifth and sixth decades of life  
class7	2721	the peripheral ameloblastoma does not share the aggressive nature of the intraosseous variant  
class7	2721	the lesion has been overtreated in the past and warrants only a local supraperiosteal excision  
class7	2722	central adenoid cystic carcinoma of the mandible  
class7	2722	a patient with adenoid cystic carcinoma arising centrally within the mandible  a rare location for this malignant salivary gland tumor  is described  
class7	2722	current concepts regarding the etiology  diagnosis  histology  and treatment of central intramandibular salivary gland tumors are discussed and the literature is reviewed  
class7	2723	parotid gland and facial nerve trauma  a retrospective review  
class7	2723	included in this study are all patients with trauma to the parotid region seen at our center from 1979 to 1989  
class7	2723	there was a total of five patients with injury to the parotid area  two patients with isolated facial nerve injury  one with isolated parotid duct injury  two with combined duct and nerve injury  
class7	2723	there were four males and one female  with a mean age of 34 years  range  16 to 62 years   
class7	2723	the three patients with parotid duct injury required other procedures for associated trauma  
class7	2723	a total of eight nerve branches were severed in four patients  
class7	2723	seven of the eight nerve branches  82 5   were primarily repaired  with excellent functional results  
class7	2723	two of the three ductal injuries were repaired primarily over a stent  and one was ligated  
class7	2723	no complications resulted from either treatment  
class7	2723	based on our clinical experience and review of the literature  we suggest that the treatment of parotid region injuries should include  1  a complete initial assessment  2  primary repair of parotid duct transection within 24 hours when possible  3  primary repair of all facial nerve injuries  although delayed nerve repair remains a viable alternative  and 4  nonsurgical treatment of sialoceles and fistulae  
class7	2724	association of group c beta hemolytic streptococci with endemic pharyngitis among college students 
class7	2724	throat cultures were performed throughout 2 school years to determine whether non group a beta hemolytic streptococci  nga bhs  could be isolated more frequently in 232 college students who had symptomatic pharyngitis than from 198 age matched controls with noninfectious problems  
class7	2724	duplicate throat swabs were inoculated onto plates that contained sheep blood agar  one plate being incubated in a 5  co2 atmosphere and the other in an anaerobic environment  
class7	2724	the bhs were grouped using latex agglutination  
class7	2724	among the nga bhs  only those from group c were isolated significantly more often among the patients compared with the controls  26  vs 11    
class7	2724	quantitative colony counts of isolates of group c bhs were generally higher among patients than controls  
class7	2724	patients with group c bhs had fever  exudative tonsillitis  and anterior cervical adenopathy significantly more frequently than did patients who had throat cultures that were negative for group c bhs  
class7	2724	group c bhs were epidemiologically associated with endemic pharyngitis in this college student population  
class7	2725	angioedema from angiotensin converting enzyme inhibitors  a cause of upper airway obstruction  
class7	2725	angiotensin converting enzyme  ace  inhibitors have several side effects of concern to the otolaryngologist  
class7	2725	angioedema is a rare  but potentially lethal adverse effect when associated with upper airway obstruction  
class7	2725	four cases of ace inhibitor induced angioedema  three with significant upper airway obstruction  are reported  
class7	2725	angioedema secondary to ace inhibition appears to be mechanism based  
class7	2725	the probable link is the potentiation of bradykinin  which results in vasodilation  increased vascular permeability  and angioedema  
class7	2725	since angioedema can progress to upper airway obstruction  otolaryngologists must be aware of this association  
class7	2725	the differential diagnosis and treatment of this adverse effect is discussed  as well as a review of ace inhibitors and other causes of angioedema  
class7	2726	a study of the comparative efficacy of four common analgesics in the control of postsurgical dental pain  
class7	2726	four common oral analgesics were tested in a single blind trial to determine their relative efficacy in the management of postsurgical pain in 103 patients who had their impacted third molars surgically removed under general anesthesia  
class7	2726	the analgesics tested were acetylsalicylic acid  26 patients   ibuprofen  26 patients   a paracetamol codeine caffeine combination  solpadeine   25 patients   and dihydrocodeine  26 patients   
class7	2726	the paracetamol codeine caffeine combination  ibuprofen  and acetylsalicylic acid preparations produced equally effective analgesia  
class7	2726	dihydrocodeine was found to be a poor analgesic in this pain model  
class7	2726	there were no adverse reactions to any of the preparations  
class7	2727	comprehensive dental care and general anesthetic management of hereditary epidermolysis bullosa  a review of fourteen cases  
class7	2727	dental management of persons with epidermolysis bullosa remains challenging because of the severe hard and soft tissue manifestations of these diseases  
class7	2727	this study reviews the dental treatment of 14 cases requiring 24 general anesthetics  
class7	2727	twenty three of the cases were managed with oral tracheal intubation to accomplish full mouth dental rehabilitation  
class7	2727	dental therapy consisted of preventive  restorative  and surgical procedures  with extractions and stainless steel crowns being the most common treatment modalities  
class7	2727	there were no serious postoperative complications  and no airway problems were experienced  
class7	2727	although extensive intraoral mucosal blistering did occur in several cases  postoperative healing progressed normally  
class7	2727	soft tissue trauma may be lessened through the use of small suction tips  flat tissue retractors  and extensive lubrication of all tissues requiring manipulation  
class7	2727	this study provides further evidence that even the most severely affected patients with epidermolysis bullosa can receive comprehensive dental treatment directed at maintaining a functional dentition  
class7	2728	the myelodysplastic syndromes  case report and review  
class7	2728	the myelodysplastic syndromes are a heterogenous group of hematologic disorders of myeloid progenitor cells  
class7	2728	oral manifestations may be among the first signs and often reflect degrees of neutropenia or neutrophil dysfunction  
class7	2728	a patient with persistent herpes labialis and severe oral mucosal ulceration in myelodysplastic syndrome is reported  
class7	2728	the features of myelodysplasia are reviewed and their oral manifestations and significance to dental management outlined  
class7	2729	propolis allergy  a cause of oral mucositis with ulceration  
class7	2729	propolis has been used since ancient times in folk medicine for its alleged beneficial effects  
class7	2729	it is a potent sensitizer and is well recognized as a cause of occupational allergic eczematous contact dermatitis in apiarists  
class7	2729	recently  there has been an increase in allergic eczematous contact dermatitis because of nonoccupational exposure to propolis in  natural products  and biocosmetics  
class7	2729	this report describes a patient who had acute oral mucositis with ulceration as a result of using propolis containing lozenges  
class7	2730	multiple myeloma and bullous lichenoid lesions  an unusual association  
class7	2730	many associations of lichenoid reactions have been described but this case appears to be a previously unreported association  with multiple myeloma  
class7	2730	this case also demonstrates the necessity of a mucosal biopsy with adequate hematologic and serologic investigations to obtain a definitive diagnosis  
class7	2731	nitrendipine induced gingival hyperplasia  first case report  
class7	2731	drug induced gingival hyperplasia is well documented within the literature  
class7	2731	it has been associated with phenytoin  cyclosporine  and calcium channel blocking agents  
class7	2731	nitrendipine is an experimental calcium channel blocking agent that also appears to cause the side effect of drug induced gingival hyperplasia  
class7	2731	the clinical and histologic presentation of this side effect and possible biochemical mechanisms of pathogenesis are discussed  
class7	2732	thermally induced  nicotine  stomatitis  a case report  
class7	2732	a palatal lesion resembling  nicotine  stomatitis was found in a woman who did not smoke  
class7	2732	however  the patient frequently drank extremely hot beverages  
class7	2732	after she was instructed to reduce the temperature of the beverages  the lesion almost completely resolved  
class7	2732	this suggests that heat was the primary cause of this lesion and also implicates heat as the major cause of nicotine stomatitis  
class7	2733	diagnosis of oral hairy leukoplakia by ultrastructural examination of exfoliative cytologic specimens  
class7	2733	lingual exfoliative cytologic specimens  scrapings  were obtained from 18 patients positive for human immunodeficiency virus with clinical oral hairy leukoplakia  
class7	2733	buccal mucosal scrapings were obtained from 12 of these patients  
class7	2733	the specimens were processed for examination by transmission electron microscopy  tem   
class7	2733	sixteen  89   of the lingual specimens revealed infection of keratinocytes by herpes type virus  
class7	2733	there was no evidence of virus infection in the 12 buccal mucosal scrapings  
class7	2733	fungal hyphae were seen by tem in 14  78   of the lingual scrapings and two  17   of the buccal scrapings  
class7	2733	one exfoliative specimen and two biopsy specimens were stained for epstein barr virus dna with a dna probe  
class7	2733	the demonstration of herpes type virions by tem in keratinocytes from a lesion clinically suspected to be hairy leukoplakia provides direct  objective diagnosis  
class7	2733	furthermore  use of exfoliative cytologic specimens provides a clinically simple  noninvasive technique  
class7	2734	the cellular composition of basal cell adenoma of the parotid gland  an immunohistochemical analysis  
class7	2734	four cases of basal cell adenoma of the parotid gland were examined immunohistochemically to characterize their cellular composition  
class7	2734	in all cases epithelial membrane antigen and keratin were detected in the inner luminal cells  some cells also showed positive staining for secretory functional markers  indicating their differentiation toward secretory epithelium  
class7	2734	in tubular and trabecular types the outer cells consistently displayed an intense staining for vimentin and some were also positive for actin  indicating their myoepithelial nature  
class7	2734	in the solid type  most tumor cells resembled the ductal cells or basal cells of larger ducts in normal gland with regard to their immunoreactivity  
class7	2734	our results may suggest that the proportion and arrangement of heterogeneous tumor cells are responsible for different histologic patterns of the salivary basal cell adenoma  
class7	2735	primary malignant melanoma in the parotid gland  
class7	2735	reports of primary malignant melanoma arising from the parotid salivary gland are extremely rare and  to date  have been sporadic  
class7	2735	we report a pertinent case  and tabulate and correlate the clinical findings of the 13 cases reported thus far in the literature  
class7	2735	the most common symptom is a progressively enlarging  asymptomatic  firm  and fixed mass  
class7	2735	total excision has been the established treatment of choice  
class7	2735	the contribution of radiotherapy  chemotherapy  and immunotherapy remains unclear  and it is not possible at present to predict the outcome of treatment in individual patients  
class7	2735	although rare  primary malignant melanoma should be considered in the differential diagnosis of parotid tumors  
class7	2735	the clinical significance of establishing the diagnosis of primary malignant melanoma of the parotid gland is emphasized  
class7	2736	oral histoplasmosis as a presenting disease in acquired immunodeficiency syndrome  published erratum appears in oral surg oral med oral pathol 1991 jan 71 1  76  
class7	2736	a 43 year old homosexual man visited his dentist with painful  nodular  ulcerated lesions on the soft palate  right buccal mucosa  and right posterior maxillary gingiva  
class7	2736	serologic studies for exposure to human immunodeficiency virus  performed before biopsy  were positive  
class7	2736	biopsy of the maxillary gingiva demonstrated sheets of histiocytes containing small intracellular yeasts  which on culture were identified as histoplasma capsulatum  
class7	2736	bilateral leukoplakic lesions with some vertical furrowing involving the lateral borders of the tongue were also noted  
class7	2736	histologically  hyperkeratosis and fungal hyphae were identified  
class7	2736	the patient was treated for histoplasmosis with amphotericin b  which resulted in significant improvement of the oral lesions  
class7	2736	he was subsequently hospitalized for fatigue and dyspnea and was found to have pneumocystis carinii pneumonia  
class7	2736	pulmonary status deteriorated within a 3 week period  and the patient died  
class7	2736	autopsy findings were negative for histoplasmosis but positive for necrotizing and cavitary p  
class7	2736	carinii pneumonia  pulmonary and hepatic herpes simplex infections  and pulmonary and intestinal cytomegalovirus infection  
class7	2737	epithelial rests  function in replantation  is splinting necessary in replantation  
class7	2737	the problem of resorption during replantation in relationship to the epithelial rests and a lack of splinting was studied  
class7	2737	ten mongrel dogs were used  
class7	2737	two dogs served as control subjects  while eight had their mandibular incisors intentionally replanted and studied histologically  
class7	2737	it was observed that where rests of malassez were present we did not see resorption  and the lack of splinting did not result in resorption or loss of teeth  
class7	2737	it appears we can stain epithelial rests of malassez with immunofluorescent antibodies and use this technique for further study of this tissue  
class7	2738	replantation  an analysis of 29 teeth  
class7	2738	the results of replantation of 29 teeth are described  
class7	2738	maxillary incisors constituted 85  of 27 permanent teeth  
class7	2738	the period between avulsion and replantation ranged from within an hour to 86 days  but the actual extraoral period was within 5 hours in all but one case  
class7	2738	nineteen of the 27 permanent teeth were functioning for 7 months to 6 years and 7 months postoperatively  
class7	2738	root resorption was the cause of tooth loss in five cases  
class7	2738	the incidence of root resorption seemed to increase with the increase of the extraoral period  but it was not affected by the period between avulsion and replantation  the condition of supporting tissues  the degree of root formation  and the type and period of splinting  indicating multiple factors involved in determining the prognosis of replanted teeth  
class7	2738	in conclusion  every effort should be made to preserve avulsed teeth even in unfavorable conditions  
class7	2739	apical closure of mature molar roots with the use of calcium hydroxide  
class7	2739	calcium hydroxide may induce apical root closure in affected mature teeth as well as in immature teeth  
class7	2739	once an apical hard tissue barrier is formed  a permanent root canal filling can be safely condensed  
class7	2739	two cases are described in which calcium hydroxide induced apical root closure in mature molar teeth where the apical constriction was lost because of chronic inflammatory process  
class7	2740	when a patient with a bleeding disorder needs dental work  how you can work with the dentist to prevent a crisis 
class7	2740	patients with bleeding disorders need close cooperation between their physician and their dental practitioner to receive safe  comprehensive dental care  
class7	2740	when indicated  physicians must advise a compromised treatment plan to avoid deep injections or surgical procedures that may initiate a bleeding crisis in patients at risk  
class7	2740	the conditions most commonly seen that require special consideration are long term use of antithrombotic agents  platelet dysfunction caused by chronic renal failure  and congenital clotting factor deficiencies  
class7	2740	even these patients may undergo a high risk procedure  such as periodontal surgery  with adequate precautions and preparation  
class7	2741	improved primary surgical and dental treatment of clefts  
class7	2741	the improved combination of surgical and dental teamwork in the primary treatment of clefts presented here is consistent with principles  
class7	2741	in fact  this is a staged design for correction of classic clefts of the lip and palate that  based on biological principles  facilitates the continuance of the failed embryonic  migrations  toward a normal end point  
class7	2741	positioning of the alveolar segments  dissection of mucoperiosteum out of the cleft  and union of mucoperiosteum across the alveolar and anterior hard palate cleft make it possible to create a periosteal tunnel across the bony gap and set up a condition conducive to bone formation and eventual tooth eruption in the cleft area  
class7	2741	lip closure by adhesion reduces the tension of the primary lip closure and allows gentle molding until solidification of the arch occurs  
class7	2741	thus a complete cleft has been rendered an incomplete cleft  
class7	2741	with a balanced  stabilized maxillary platform  the definitive lip and nose corrections can be carried to completion early  by 2 to 4 years of age   
class7	2741	these planned actions bypass a persistent cleft  fistulas  raw areas  malposition of alveolar segments  and probably the necessity for later bone grafting  
class7	2741	the only question not totally answered is the effect of this approach on final growth  
class7	2741	although most reports seem to indicate that growth has and will proceed within normal limits  another 10 years of careful follow up is indicated and  in fact  is in progress  
class7	2742	experience with the functional cleft lip repair  
class7	2742	the first 12 functional cleft lip repairs performed on unselected consecutive patients immediately following the completion of training by the author are presented  
class7	2742	previous reports on this cleft lip repair have shown excellent results but have always been based on patients operated on by the originator of the procedure  
class7	2742	this report gives credence to the ease with which a cleft lip repair that gives reproducible good results can be taught and learned even by plastic surgeons with limited experience  
class7	2742	it reviews the technical steps of the procedure  which emphasizes wide undermining and release of the orbicularis oris muscle on the lateral side of the cleft to allow redraping and lengthening of the lip skin  step by step layered closure of the mucosa  muscle  and skin  and further vertical lengthening of the lip with a z plasty skin closure  
class7	2742	three elements that are difficult to achieve or restore with cleft lip revision are evaluated   1  achievement of a good skin scar   2  maintenance of the alar facial groove  and  3  achievement of adequate lip height without sacrificing horizontal lip length  
class7	2742	ten of the 12 patients had a satisfactory scar  9 patients had a good alar facial groove  and all patients had a normal appearing horizontal lip length  
class7	2742	nine patients required secondary surgery  however  in six patients  this included correction of the nasal deformity that was not corrected at the time of cleft lip repair  
class7	2743	primary repair of the bilateral cleft lip nose  a 15 year review and a new treatment plan  
class7	2743	for 15 years a forked flap has been used for columella reconstruction in primary repair of the bilateral cleft lip nose  
class7	2743	with the adolescent growth spurt  three unfavorable features have become apparent   1  the columella may grow too long and the nostrils too large   2  often the nasal tip remains broad  and  3  there is a drift of the columellar base and the lip columellar angle is transgressed by scar  
class7	2743	this procedure has therefore been discontinued  
class7	2743	a new treatment plan is presented in which the columella is reconstructed from tissues in the splayed out nasal tip  
class7	2744	secondary correction of the unilateral cleft lip nose using a conchal composite graft  
class7	2744	the secondary deformity of the unilateral cleft lip nose has many components  
class7	2744	one is the dorsal dislocation of the lateral crus of the alar cartilage  
class7	2744	we used a conchal composite graft positioned between the piriform aperture and the lateral crus and the upper lateral cartilage to correct this dislocation in nine patients  
class7	2744	we believe that this graft is effective because it elevates the lateral crus of the alar cartilage off the depressed piriform aperture  
class7	2744	this technique is very simple to perform  and it is easy to achieve nasal symmetry  
class7	2744	our results have been quite satisfactory  with no recurrence of dorsal dislocation  
class7	2744	the donor site was covered by a subcutaneous pedicled flap from the cephaloauricular sulcus  leaving an inconspicuous deformity  
class7	2745	arteriovenous malformation of the tongue  
class7	2745	polyvinyl alcohol particles used to embolize an arteriovenous malformation of the tongue were only temporarily successful  
class7	2745	additional embolization therapy was necessary and was complicated by ischemic ulcers of the tongue  
class7	2745	we conclude that embolization therapy can be used  but the efficacy of this therapy in the longer term remains to be determined  
class7	2746	nasolaryngoscopy for family physicians  
class7	2746	nasolaryngoscopy is easy to learn and safe and convenient to perform  
class7	2746	it is readily accepted by patients and is a rich source of clinical information  
class7	2746	the flexible nasolaryngoscope allows the physician to directly observe the anatomy of the nasal passages  pharynx and larynx  
class7	2746	the procedure is helpful for identifying the etiology of chronic nasal complaints and hoarseness  
class7	2746	other possible indications for nasolaryngoscopy include suspected nasal foreign body  recurrent nasal or pharyngeal bleeding  and epiglottitis  
class7	2746	with the use of this instrument  treatment of otolaryngologic conditions may be more specific  thereby reducing unnecessary referral or delay in treatment  
class7	2747	toxic streptococcal syndrome  
class7	2747	the streptococcal toxic shocklike syndrome is a recently recognized  multisystem disorder that shares many of the features of staphylococcal toxic shock syndrome  but is caused by toxins elaborated by group a beta hemolytic streptococcus  
class7	2747	we describe a patient who fulfilled the major criteria for the clinical diagnosis of toxic shock syndrome  fever  hypotension  multisystem dysfunction  and diffuse macular erythroderma followed by desquamation  and who demonstrated serologic evidence suggesting streptococcal infection  
class7	2747	in patients presenting with clinical findings consistent with a toxic shocklike syndrome  the emergency physician should consider streptococcal infection as a potential etiology  
class7	2748	occipital condyle fracture presenting as retropharyngeal hematoma  
class7	2748	reported is the case of a 30 year old male motorcycle accident victim who was found on plain cervical spine radiography to have prevertebral soft tissue swelling  
class7	2748	although subsequent computed tomography demonstrated no cervical spine fracture  it did reveal a fracture of one occipital condyle  
class7	2748	the mechanism  diagnosis  and treatment of occipital condyle fractures are reviewed  as is the ligamentous and fascial anatomy of the cervicocranium  
class7	2748	dissection of fracture hematoma inferiorly along vertically oriented tissue planes is hypothesized as the pathogenesis of our patient s retropharyngeal hematoma  
class7	2748	in addition to being a sign of potential cervical spine injury  post traumatic prevertebral soft tissue swelling may also indicate occipital condyle fracture  
class7	2748	to avoid overlooking such fractures  computed tomography undertaken to investigate upper cervical spine prevertebral soft tissue swelling should always include slices up to the level of the basal skull so as to visualize the condyles  
class7	2749	histopathologic grading of salivary gland neoplasms  ii  acinic cell carcinomas  
class7	2749	acinic cell carcinomas display varied cytoarchitectural patterns of growth that should allow for formulation of histopathologic grading  
class7	2749	grading of these carcinomas may serve to identify subsets whose biologic behavior is more aggressive than the usually accepted low grade behavior of acinic cell carcinomas as a group  
class7	2749	to that end  a three level histopathologic grading scheme is presented  
class7	2750	activation of t cell subsets in the peripheral blood of patients with sjogren s syndrome  multicolor flow cytometric analysis  
class7	2750	using 3 color flow cytometry  we determined the proportions of activated t cells  dr    including cd4  cells  cd8  cells  and their subsets  in the peripheral blood of 17 patients with sjogren s syndrome  ss   
class7	2750	activated t cells were significantly increased in cd4  cells  cd8  cells  and t suppressor inducer  cd4   leu 8    t helper  cd4   leu 8    and t cytotoxic  cd8   cd11   subsets  but not the t suppressor natural killer subset  cd8   cd11    in patients with ss as compared with the controls  
class7	2750	furthermore  the proportions of activated t cells in the cd4   leu 8  subset  the cd8  subset  or the cd8   cd11  subset showed a positive correlation with serum gamma globulin levels in the ss patients  
class7	2750	our findings suggest that a certain immunoregulatory balance between t helper and t suppressor activities is maintained in ss patients  although this balance seems to occur at highly activated levels  and that quantitative changes of some lymphocyte subsets are important factors in maintaining this balance  
class7	2750	we discuss the possibility that cd4   leu 8  cells recirculate into peripheral lymph nodes  while cd4   leu 8  cells migrate into inflammatory tissues such as salivary glands  since the leu 8 antigen is reported to be a homing receptor in peripheral lymph nodes  
class7	2750	this process might be accelerated in ss  and each t cell subset may further participate in immunologic activation in the lymph nodes or target tissues  
class7	2751	association of labial salivary gland histopathology with clinical and serologic features of connective tissue diseases  
class7	2751	focal sialadenitis is now widely accepted as an objective criterion for the oral component of sjogren s syndrome  xerostomia   
class7	2751	we investigated the association between labial salivary gland histopathologic changes and the clinical and serologic features of 192 patients with suspected connective tissue disorders  
class7	2751	a retrospective review of the medical records of all patients was performed  and historical  physical  laboratory  histologic  and roentgenographic data were abstracted  
class7	2751	each patient had undergone labial salivary gland biopsy as part of a rheumatologic evaluation  
class7	2751	there were significant associations between positive findings on lip biopsy and the presence of keratoconjunctivitis sicca  p   0 013   positive antinuclear antibodies  titer greater than or equal to 1 80   p   2 x 10  8    and positive ro antibodies  p   1 x 10  8    
class7	2751	however  sicca symptoms and glandular enlargement were not statistically associated with positive findings on lip biopsy  
class7	2751	features predictive of a positive lip biopsy included ro antibodies  p   0 914   keratoconjunctivitis sicca  p   0 700   and positive antinuclear antibodies  p   0 590   
class7	2752	family cancer syndrome  a study of the kindred of a man with osteogenic sarcoma of the mandible  
class7	2752	several familial cancer syndromes have been identified  
class7	2752	the syndrome of sarcomas  breast cancer and other neoplasms  known as li fraumeni syndrome  is characterized by several different neoplasms presenting at young ages with autosomal dominant transmission and a high incidence of second primaries  
class7	2752	in this paper  we studied six generations  51 people  of the family of a 24 year old man with osteogenic sarcoma of the mandible  
class7	2752	twelve malignancies in 11 people  including several rare tumors  were revealed  
class7	2752	mean age of presentation was 24 years old  
class7	2752	nine of the 11 patients died of disease  
class7	2752	one developed a second primary  
class7	2752	two tumors presented in the head and neck  
class7	2752	transmission was autosomal dominant  
class7	2752	the karyotypes of two family members were normal  
class7	2752	identification of li fraumeni syndrome in a family is important in determining appropriate follow up for the patient and family  
class7	2752	such families are models for studying carcinogenesis  
class7	2753	the surgical management of chronic parotitis  
class7	2753	chronic parotitis is a disorder characterized by recurrent painful swelling of the gland with purulent sialorrhea  
class7	2753	occasionally  the condition fails to respond to medical management and definitive surgical therapy is necessary  
class7	2753	sialolithiasis is the usual etiology in cases of parotitis  although occasionally severe recurrent parotid infections are superimposed on underlying sjogren s disease  
class7	2753	total parotidectomy with facial nerve dissection has been used in such cases in our department and has proved to be an excellent way to manage this disease  
class7	2753	a summary of our results indicate that the recurring infections were eradicated and that the complication rate is tolerable  considering the magnitude of the problem  
class7	2753	we feel that it is better to use surgical management early rather than wait for the formation of fistulae or abscesses  
class7	2754	calvarial sutural abnormalities  metopic synostosis and coronal deformation  an anatomic  three dimensional radiographic  and pathologic study  
class7	2754	the purposes of this study were  1  to evaluate the histologic differences between synostotic versus deformational suture abnormalities and  2  to correlate these histologic findings with anatomic and three dimensional computed tomographic  ct  scans  
class7	2754	we examined three infants with premature metopic synostosis  one infant also had microcephaly trisomy 13 and curious overriding of the coronal sutures  
class7	2754	the three dimensional ct scans demonstrated obliteration of the metopic suture inferiorly  
class7	2754	histologic sections of this suture showed complete bony stenosis  
class7	2754	the same pattern was found in all three infants  including the two infants with trigonocephaly who did not have trisomy 13 or microcephaly  
class7	2754	in the trisomy 13 infant  the overlapped inferior coronal suture was obliterated on ct examination  
class7	2754	however  histologic sections in this region showed a merging of bone  there was no synostosis  
class7	2754	in summary  three dimensional ct re formation correlated with metopic suture histology  
class7	2754	 stenotic  fusion existed in all infants with trigonocephaly  those with normal and abnormal karyotypes  with and without microcephaly  
class7	2754	however  three dimensional ct re formation of the trisomic infant showed opacification of the coronal suture in the areas of greatest overlap  whereas histology revealed a curious bone remodeling pattern  possibly a precursor to  deformational  craniosynostosis  
class7	2755	parotid gland  plain and gadolinium enhanced mr imaging  
class7	2755	the purpose of this study was to show the typical appearance of lesions of the parotid gland with plain mr imaging and mr imaging enhanced with gadopentetate dimeglumine  
class7	2755	seventeen patients with inflammatory changes and 43 with benign and malignant tumors were studied  
class7	2755	the examinations were carried out with plain t1 weighted sequences with a repetition time  tr  of 500 msec and an echo time  te  of 25 msec  tr te   500 25   t2 weighted sequences  1 600 90   and gadolinium enhanced t1 weighted sequences in axial  coronal  and sagittal orientations  
class7	2755	for identifying normal anatomic structures such as the facial nerve and the main duct  the administration of gadopentetate dimeglumine was helpful  
class7	2755	in inflammatory changes  gadolinium enhanced images showed no diagnostic advantages  
class7	2755	gadopentetate dimeglumine proved helpful in delineating tumorous lesions and in differentiating benign and malignant lesions  
class7	2755	however  an exact differentiation of the different histologic types was not possible  
class7	2755	post operative fibrosis could be differentiated from recurrent tumors after administration of gadolinium  
class7	2755	if a question regarding infiltration or definition of the boundaries of a lesion cannot be answered with non enhanced mr imaging  gadopentetate dimeglumine administration is advised  
class7	2755	however  for routine imaging of the parotid gland  its use is not recommended  
class7	2756	controversies in the treatment of streptococcal pharyngitis 
class7	2756	an increasing number of cases of sore throat caused by group a beta hemolytic streptococci occur with concomitant colonization by organisms that may  protect  the streptococci through beta lactamase inactivation of penicillin at the site of infection  
class7	2756	the failure of penicillin to eradicate many of these bacteria  which include staphylococcus aureus  haemophilus influenzae  moraxella  branhamella  catarrhalis and a multitude of pharyngeal anaerobes  may help to explain why penicillin is sometimes ineffective for acute and recurrent group a streptococcal infections  
class7	2756	therapeutic alternatives currently include cephalosporins  erythromycin  rifampin combined with penicillin  amoxicillin clavulanate potassium and others  
class7	2757	myofibroblastoma of the tongue  an immunohistochemical  ultrastructural  and flow cytometric study  
class7	2757	a case of myofibroblastoma arising in the tongue of a 77 year old man is described  
class7	2757	the patient presented with a submucosal tongue mass without other associated symptoms  
class7	2757	the tumor was 2 cm in diameter  well circumscribed  and composed of uniform spindle cells arranged in fascicles  
class7	2757	electron microscopic examination and immunohistochemistry demonstrated a myofibroblastic origin for the tumor cells  
class7	2757	dna flow cytometric analysis showed a diploid dna content of this tumor  
class7	2757	to the authors  knowledge  this is the first report of myofibroblastoma occurring in the tongue  
class7	2758	histopathologic grading of salivary gland neoplasms  iii  adenoid cystic carcinomas  
class7	2758	histopathologic grading of adenoid cystic carcinomas can provide valuable prognostic information  particularly when the presence or absence of a solid growth architecture is noted  
class7	2758	other growth patterns  exemplified by a tubuloductal or cribriform cylindromatous differentiation  are associated with a more protracted biologic course and less rapid mortality  
class7	2758	a three tiered grading system based on the three growth patterns of the carcinoma is presented  
class7	2759	histologic study of eustachian tube cartilage with and without congenital anomalies  a preliminary study  
class7	2759	we investigated histopathologically the development of the eustachian tube  et  cartilage at a cellular level in individuals with and without congenital anomalies  
class7	2759	fourteen specimens were obtained from 14 individuals ranging in age from 24 weeks  gestation to 3 years who had cleft palate or trisomy 21  down  syndrome  the 49 specimens in the nonanomaly  control  group were from 49 individuals ranging from 26 weeks  gestation to 85 years of age  
class7	2759	all temporal bone specimens included the et and its accessory structures  and all were processed and stained with hematoxylin and eosin for histologic study in a routine manner  
class7	2759	the number of cartilage cells in the midcartilaginous portion of the et was determined by light microscopy  
class7	2759	in all groups  cartilage cell density of the et decreased with increasing age  
class7	2759	however  cell density tended to be higher at all ages for individuals with cleft palate and microtia versus controls  and tended to be lower at all ages for individuals with down syndrome  
class7	2760	lymphomatoid granulomatosis presenting as ulcerodestructive gastrointestinal tract lesions in patients with human immunodeficiency virus infection  a new association  
class7	2760	we describe cases of severe odynophagia  extensive oral ulcerations  and bowel perforation in patients with human immunodeficiency virus infection that were caused by lymphomatoid granulomatosis  
class7	2760	such presentations in human immunodeficiency virus infected individuals are usually ascribed to other causes and may be incorrectly treated on an empiric basis  
class7	2760	in addition  deep tissue specimens obtained at the margin of ulcerative lesions are often necessary for definitive diagnosis  
class7	2760	we review our limited treatment experience with zidovudine  interferon alfa  and h2 blockers in our patients  
class7	2760	based on the markedly increased frequency in which lymphomatoid granulomatosis is being diagnosed at our institution in the post human immunodeficiency virus era  we postulated an association between these two entities  
class7	2761	the role of herpes simplex virus in the development of oral mucositis in bone marrow transplant recipients  
class7	2761	herpes simplex virus  hsv  has been implicated as a major etiologic factor in the development of ulcerative mucositis in bone marrow transplant  bmt  recipients  
class7	2761	in this study  60 patients who received bmts were evaluated for at least 30 days post transplant for ulcerative mucositis and the presence of culturable hsv  
class7	2761	fifty nine patients received prophylactic acyclovir  
class7	2761	forty six patients developed ulcerative lesions and 45 of these were culture negative for hsv  
class7	2761	neither the source of transplant  autologous versus allogenic  nor the hsv antibody status of the patient affected the frequency of mucositis  
class7	2761	the conditioning regimen appeared to be the most significant factor contributing to the severity of ulcerative mucositis  
class7	2761	while the majority of ulcers occurred on movable nonkeratinized mucosa in bmt recipients  the usual sites of reactivation of intraoral hsv are nonmovable  keratinized mucosa  
class7	2761	we conclude that hsv is probably not a major etiologic agent of mucositis in bmt recipients and that acyclovir is an effective agent in preventing hsv reactivation  
class7	2762	complete spontaneous regression of multiple basal cell carcinomas in the basal cell nevus syndrome  the possible role of transepithelial elimination  
class7	2762	a 36 year old latin american man with the basal cell nevus syndrome had multiple  soft  hairless  depressed scars of the face  scalp  neck  and back  ranging in size from 0 3 x 0 5 cm to 3 5 x 3 9 cm  
class7	2762	these areas had never been treated and previously were sites of basal cell carcinomas that underwent complete spontaneous regression 4 5 years from the date of onset  
class7	2762	pathology of these spontaneously regressed sites was consistent with the criteria established by curson and weedon  1979   
class7	2762	type iii transepithelial elimination was demonstrated for a basal cell carcinoma  
class7	2762	type iii transepithelial elimination may play a role in the spontaneous regression of basal cell carcinomas  
class7	2763	new primary basal cell carcinomas arising in skin flaps following mohs micrographic surgery for primary and recurrent basal cell carcinoma  
class7	2763	two patients developed new primary basal cell carcinomas  bccs  in skin flaps used to reconstruct wounds that followed an earlier primary bcc and a recurrent bcc treated by mohs micrographic surgery  
class7	2763	criteria for distinguishing a new primary bcc arising in a skin flap or full thickness skin graft at a previous treatment site for bcc from a truly recurrent bcc are presented  
class7	2763	the distinction between a new primary bcc and true tumor recurrence is important for accurate clinical assessment and may have a dramatic impact on the type of subsequent treatment  
class7	2763	in addition  there may be less medicolegal liability in the case of a new primary bcc arising at the site of a previously treated bcc than for a bcc that is determined to be recurrent  
class7	2764	the association of xerostomia and inadequate intake in older adults  
class7	2764	recent studies indicate that nearly one in five older adults has xerostomia  dry mouth   
class7	2764	salivary gland dysfunction and or inadequate saliva increases the difficulty of these older adults in obtaining proper nutrition  
class7	2764	problems in lubricating  masticating  tolerating  tasting  and swallowing food contribute notably to the complex physiological and psychological manifestations of aging  
class7	2764	to our knowledge  the literature has not demonstrated an association between xerostomia and malnutrition in the elderly  
class7	2764	we randomly selected 67 older adults from institutionalized and free living geriatric populations  
class7	2764	nutritional intake analysis was performed on both groups of study subjects  who were found to have xerostomia by use of sialometry  and on control subjects matched for age  sex  and physical status  
class7	2764	intake of total energy  protein  dietary fiber  total fat  saturated fat  cholesterol  sodium  potassium  vitamin a  vitamin c  thiamin  riboflavin  vitamin b 6  calcium  iron  and zinc was compared with the 1989 recommended dietary allowances  
class7	2764	subjects  intakes were also compared with that of a control group  
class7	2764	medical systemic information and number and types of medications were compared among the groups  
class7	2764	statistical analysis of the data indicated significant  p less than  001  inadequacies in the nutritional intake patterns of institutionalized and free living older adults with xerostomia  
class7	2764	subjects with xerostomia  more than 75  of the free living and institutionalized seniors  had significant deficiencies of fiber  potassium  vitamin b 6  iron  calcium  and zinc  
class7	2764	taste and food perception were significantly reduced in the elders with xerostomia  
class7	2764	our study indicates the potential contribution of xerostomia to the high prevalence of geriatric malnutrition in the united states  
class7	2765	oral diseases in older adults  clinical conference  
class7	2765	in the case presented  a 65 year old man with multiple dental  medical  and social problems benefited from interdisciplinary assessment and treatment  
class7	2765	despite his poor oral health status and oral health behaviors upon admission  patient education and dental therapy resulted in improved daily oral hygiene  elimination of oral diseases  and improved oral function  
class7	2765	the overall quality of life of any individual  particularly an older one  can be enhanced through oral disease prevention  health promotion  and  when indicated  dental therapy  
class7	2765	this patient was treated in a hospital environment with a well established team approach to geriatric care  
class7	2765	however  regardless of the care setting  the physician can play a key role in improving the oral health status and quality of life of older adults by including an oral screening examination as part of the periodic comprehensive geriatric assessment  recognizing oral pathology  requesting dental consultations and encouraging appropriate dental service utilization  
class7	2766	mapping of epitopes on the la ss b  autoantigen of primary sjogren s syndrome  identification of a cross reactive epitope  
class7	2766	autoepitopes on the ribonucleoprotein la ss b  were identified by using recombinant la ss b  polypeptides and sera from 166 patients with the antinuclear autoantibody anti la ss b   
class7	2766	the la ss b  polypeptides were encoded by polymerase chain reaction derived overlapping or nonoverlapping fragments of the la ss b  gene  which encodes a protein of 408 amino acids  aa   
class7	2766	of the 166 sera tested  99  reacted with a fusion protein comprising the first 107 n terminal aa  laa   91  reacted with a fusion protein comprising aa 111 to 242  lac   and 91  reacted with a fusion protein comprising aa 346 to 408  lal2 3  at the c terminus of la ss b   
class7	2766	the order of immunodominance as assessed by the number of sera reacting with each epitope and the strength of the reactivity was laa  aa 1 to 107  greater than lac  aa  111 to 242  much greater than lal2 3  aa 346 to 408   
class7	2766	cross reactivity was observed between antibodies eluted from lac  aa 111 to 242  and lal2 3  aa 346 to 408   but there was no significant primary sequence homology between the two regions  
class7	2766	the lac region contained at least two epitopes  one encompassing a putative rna binding motif  aa 112 to 187  which was recognized by 83  of patient sera  
class7	2766	serial serum samples from three patients showed that the antibody response to la ss b  was initially directed to the n terminus  laa  aa 1 to 107   but over a period of time all three major epitopes  including that encompassing the putative rna binding motif  were recognized  
class7	2766	this result suggests that the primary immune response to la ss b  is restricted to an immunodominant epitope  
class7	2766	as the specificity of the autoantibody response broadens  it includes the rna binding motif  which may have important implications for the expression of disease  
class7	2767	monomorphic adenomas of the major salivary glands  clinicopathological study of 44 cases  
class7	2767	we report 44 cases of monomorphic adenoma  ma  of the major salivary glands observed during the years 1979 1989  
class7	2767	all of these tumours were reviewed and classified on the basis of the world health organisation  who  criteria  
class7	2767	histological type  site  sex and age were considered  
class7	2767	34 cases of adenolymphoma were observed  all of them located in the parotid glands  10 ma without lymphoid stroma were located in both parotid and submandibular glands  
class7	2767	distinctive histological and clinico pathological features of the latter group of tumours are discussed  as well as the diagnostic criteria in distinguishing these tumours from pleomorphic adenoma and adenoid cystic carcinoma  
class7	2768	giant enterocystoma within an infant s tongue  
class7	2768	a rare developmental cyst within the tongue and submandibular triangle of a male infant containing heterotopic gastric and intestinal epithelium  enterocystoma  is described and its derivation discussed  
class7	2768	this cyst was of such a size as to cause feeding difficulties and partial airway obstruction during sleep  
class7	2768	following c t  
class7	2768	scanning  total obstruction necessitated an emergency tracheostomy  
class7	2768	successful enucleation via a median labiomandibulotomy was performed without further complication and two years later there is no sign of recurrence  
class7	2769	temporal arteritis presenting as a submandibular swelling  
class7	2769	temporal arteritis  giant cell arteritis  is a disease of protean manifestation  
class7	2769	a case which presented as a submandibular swelling is reported  
class7	2770	parapharyngeal abscess and torticollis  
class7	2770	the combination of a parapharyngeal abscess and torticollis in an adult  due to a spastic contraction of the sterno cleido mastoid muscle is an extremely rare condition  
class7	2770	we have recently been exposed to such case  in which it was very difficult to make the diagnosis and where ct of the neck gave us the answers without any difficulty  
class7	2770	the indication for ct at an early stage in unexplained neck infections is stressed  
class7	2771	parotid duct communicating with a labial pit and ectopic salivary cyst  
class7	2771	labial pits are usually described as blind epidermal invaginations of lip mucosa with occasional drainage of minor salivary gland secretions  
class7	2771	a case of an aberrant parotid duct in communication with both a unilateral  commissural labial pit and an interposed salivary cyst is presented  
class7	2771	a 7 year old boy who had experienced lifelong clear drainage from a congenital pit at his right oral commissure developed fever  pain  and a submucosal mass of the right cheek over a 6 week period  
class7	2771	a preoperative sialogram through the pit demonstrated a communication between the oral commissure fistula  an intervening salivary cyst  and a proximal tract from the cyst to the parotid gland  
class7	2771	an en bloc resection of the pit  fistula tract  and cyst was performed through a transoral approach  
class7	2771	the dissection was medial to the buccinator muscle  
class7	2771	there has been no recurrence of the cyst after 1 year follow up  
class7	2771	a description of labial pits and parotid duct anomalies is presented  however  to our knowledge  this combination of anomalies has not been previously described  
class7	2772	radiobiological studies in the naevoid basal cell carcinoma syndrome  
class7	2772	the naevoid basal cell carcinoma syndrome is described in a 43 year old male  
class7	2772	the response of dividing fibroblasts from this patient to the lethal effects of ionizing radiation was indistinguishable from that of a normal control  mean inactivation dose  d    1 74 gy and 1 68 gy  respectively  
class7	2772	however  these cells were defective in the repair of potentially lethal damage  d   2 36 gy and 3 26 gy  respectively   
class7	2772	the response to radiation of go t lymphocytes derived from the patient was similar to that of the control  
class7	2772	the frequency of mutant circulating t lymphocytes resistant to 6 thioguanine was 17 x 10  6  which was elevated when compared with age matched controls  
class7	2772	these results suggest an abnormality in the response of the fibroblasts to ionizing radiation damage  
class7	2773	oxybutynin hydrochloride  3 mg  in the treatment of women with idiopathic detrusor instability  
class7	2773	oxybutynin hydrochloride  3 mg  was compared with placebo by randomised  double blind crossover trial in 53 females with idiopathic detrusor instability  
class7	2773	symptoms were cured or markedly improved in 60  of patients on oxybutynin and 2 3  on placebo  
class7	2773	during the first treatment period  oxybutynin reduced the frequency of voiding by 35   compared with 9  for placebo  
class7	2773	oxybutynin gave a significantly greater improvement than placebo in volume at the first desire to void  70 ml increase versus 7 7 ml   maximum filling phase detrusor pressure  17 cm h2o reduction versus no benefit  and cystometric capacity  104 ml increase versus 7 0 ml   
class7	2773	a marked oxybutynin carry over effect was seen during the second treatment period  
class7	2773	side effects from the 3 mg dose of oxybutynin caused 7 5  of subjects to discontinue therapy  
class7	2774	dentofacial development in long term survivors of acute lymphoblastic leukemia  a comparison of three treatment modalities  
class7	2774	ninety seven children who were diagnosed with acute lymphoblastic leukemia before 10 years of age and treated with chemotherapy alone  chemotherapy plus 1800 cgy cranial irradiation  rt   or chemotherapy plus 2400 cgy rt were evaluated for effects of therapy on dentofacial development  
class7	2774	all patients were seen at least 5 years postdiagnosis  
class7	2774	dental abnormalities were determined from panoramic radiographs  and craniofacial evaluations were made from lateral cephalometric radiographs  
class7	2774	ninety one  94   of all patients and 41  100   of patients younger than 5 years of age at diagnosis had abnormal dental development  
class7	2774	the severity of these abnormalities was greater in children who received treatment before 5 years of age and in those who received rt  
class7	2774	observed dental abnormalities included tooth agenesis  arrested root development  microdontia  and enamel dysplasias  
class7	2774	craniofacial abnormalities occurred in 18 of 20  90   of those patients who received chemotherapy plus 2400 cgy rt before 5 years of age  
class7	2774	mean cephalometric values of this group showed significant deficient mandibular development  
class7	2774	the results of this study suggest that the severity of dentofacial developmental abnormalities secondary to antileukemia therapy are related to the age of the patient at the initiation of treatment and the use of cranial rt  
class7	2775	causes  diagnosis  and treatment of pharyngitis  
class7	2775	pharyngitis is a common disease of the respiratory tract that can be caused by several different viruses and bacterial organisms  
class7	2775	clinically speaking  the most important causative agent is group a streptococcus  streptococcus pyogenes   
class7	2775	although rare  postpharyngitis complications arise as a result of disease caused almost exclusively by group a streptococcus  
class7	2775	because group a streptococcal pharyngitis usually responds well to antimicrobial treatment  it is important to diagnose it  
class7	2775	penicillin  erythromycin  and peroral first generation cephalosporins have been documented to be effective  
class7	2775	in addition to group a streptococcus  c  
class7	2775	pneumoniae and m  
class7	2775	pneumoniae have also been detected in patients with pharyngitis  
class7	2775	the possibility of diagnosing these organisms is limited at the present  
class7	2775	clinical surveys are still needed  moreover  to evaluate the effect of antimicrobial treatment on the disease caused by these organisms  
class7	2775	although routine viral diagnostic methods do not help primary care physicians in treating patients with pharyngitis  information on bacteria and viruses in the immediate environment could prove to be of great help in daily clinical work  
class7	2776	detection of a human intracisternal a type retroviral particle antigenically related to hiv  
class7	2776	sjogren s syndrome is an autoimmune disease that is characterized by dryness of the mouth and eyes  
class7	2776	the loss of salivary and lacrimal gland function is accompanied by lymphocytic infiltration  
class7	2776	because similar symptoms and glandular pathology are observed in certain persons infected with human immunodeficiency virus  hiv   a search was initiated for a possible retroviral etiology in this syndrome  
class7	2776	a human intracisternal a type retroviral particle that is antigenically related to hiv was detected in lymphoblastoid cells exposed to homogenates of salivary tissue from patients with sjogren s syndrome  
class7	2776	comparison of this retroviral particle to hiv indicates that they are distinguishable by several ultrastructural  physical  and enzymatic criteria  
class7	2777	postoperative sore throat  topical hydrocortisone 
class7	2777	forty patients undergoing tracheal intubation and controlled ventilation of the lungs for elective surgical procedures were studied  
class7	2777	they were allocated randomly into one of two groups  
class7	2777	the tracheal tubes used for group a patients were lubricated before insertion with water soluble 1  hydrocortisone cream  
class7	2777	those for group b patients were lubricated with ky jelly  
class7	2777	the incidence of postoperative sore throat was found to be significantly greater in group a  
class7	2777	topical 1  hydrocortisone cream is therefore ineffective in the prevention of postoperative sore throat  
class7	2778	basis for defective proliferation of peripheral blood t cells to anti cd2 antibodies in primary sjogren s syndrome  
class7	2778	anti cd2 induced t cell proliferation was analyzed in the peripheral blood samples of 31 primary and 8 secondary untreated sjogren s syndrome patients  
class7	2778	anti cd2 stimulated pbmc proliferation was very low in about one third of primary sjogren s syndrome samples  despite the number of cd2  cells being similar in primary and secondary sjogren s syndrome and normal pbmc samples  
class7	2778	the depressed response to anti cd2 was mainly found in anti ro  la  patients  
class7	2778	experiments on purified t cells demonstrated that a defect at the t cell level was responsible for the anti cd2 unresponsiveness  
class7	2778	cell proliferation failure was associated with poor il 2 and il 2 receptor mrna expression and  consequently  il 2 and il 2 receptor synthesis  
class7	2778	since defective anti cd2 induced mitogenesis could be reversed by phorbol myristate acetate  but not calcium ionophore a23187  it is probably correlated with impaired protein kinase c activation  
class7	2778	comparison of anti cd2 triggered pbmc proliferation in treated and untreated patients and a long term study of nine patients showed that the defect is a stable characteristic in primary sjogren s syndrome patients  but that it can be reversed by pharmacological immunosuppression  
class7	2779	sialolithiasis  case studies and review  
class7	2779	three cases of sialolithiasis are presented  each representative of acute and chronic presentations of this problem  
class7	2779	the evaluation and treatment of salivary gland and duct stones are outlined  
class7	2779	the primary axiom is   treat the gland  not the stone   and the essential aspects of emergency medical management are antibiotics  sialogogues  warm compresses  mechanical stimulation  and appropriate referral to an otolaryngologist  
class8	2780	functional upper airway obstruction in adolescents  
class8	2780	functional upper airway obstruction is an uncommon manifestation of a conversive reaction characterized by recurrent stridor attacks caused by adduction of the vocal cords during inspiration  
class8	2780	the oxygen saturation never drops to pathologic levels  
class8	2780	the stridor is not accompanied by an appropriate degree of anxiety and is not associated with other symptoms  
class8	2780	patients benefit from verbal reassurance and speech therapy  but stridor attacks tend to recur and psychiatric consultation seems necessary in most cases  
class8	2780	we present the case histories of three adolescent patients with nonorganic upper airway obstruction and describe the features that may facilitate the diagnosis of this condition  
class8	2780	early diagnosis and intervention may prevent unnecessary and potentially harmful investigations and therapy  
class8	2781	influence of doppler sample volume location on the assessment of changes in mitral inflow velocity profiles  
class8	2781	previous studies that have validated doppler indexes of mitral inflow have used pulsed wave sample volume locations either at the level of the mitral valve anulus or at the tips of the mitral valve leaflets  
class8	2781	although significant differences between absolute values for peak velocities and velocity time integrals at these sample volume locations have previously been reported  no information exists that has compared changes in inflow profiles after an intervention to improve left ventricular filling  
class8	2781	to address this question  13 patients with severe pulmonary hypertension  mean pulmonary artery pressure  50     13 mm hg  caused by chronic thromboembolic disease were studied with use of doppler echocardiography immediately before and after surgical reduction of pulmonary hypertension  pulmonary vascular resistance decreased from 916     413 to 233     89 dynes sec cm5   
class8	2781	this clinical model has been shown to have abnormal mitral inflow velocity profiles that improve markedly after surgery  
class8	2781	doppler measures of early and late peak velocities were significantly lower both before and after surgery when sampling at the mitral anulus compared with the leaflet tips  although late filling parameters and the deceleration of early flow velocity tended to differ little  
class8	2781	with surgery  the significant increase in peak early velocity and the ratio of early to late velocity was present regardless of the sample volume location  peak e at leaflet tips  47 1     16 0 to 68 9     15 4  p less than 0 001   and at anulus  40 7     11 3 to 56 2     14 6 cm sec  p less than 0 001   peak e a at leaflet tips  0 95     0 4 to 1 55     0 9  and at anulus  0 78     0 3 to 1 32     0 7  both p less than 0 02    
class8	2782	hyponatraemia secondary to an inappropriately high release of antidiuretic hormone in cardiac tamponade  
class8	2782	a spontaneous intrapericardial haemorrhage caused cardiac tamponade in a 29 year old paraplegic man who was being treated with warfarin  
class8	2782	the associated persistent hyponatraemia  which was believed to be caused by an inappropriately high release of antidiuretic hormone  rapidly resolved after pericardiocentesis  
class8	2783	reproduction of transfusion related acute lung injury in an ex vivo lung model 
class8	2783	leukoagglutinins are implicated in transfusion related acute lung injury  trali   
class8	2783	in the present study  severe lung vascular leakage was reproduced by application of a leukoagglutinating antibody of anti 5b specificity in an ex vivo lung model  
class8	2783	the antibody originated from a multiparous donor plasma  observed to cause noncardiogenic edema during transfusion therapy  
class8	2783	heated full plasma  anti 5b titer 1 128  or purified immunoglobulin g fraction was used for the studies  
class8	2783	ex vivo isolated rabbit lungs were perfused with albumin buffer  and human granulocytes  pmn  were admixed to the recirculating perfusate  
class8	2783	in presence of anti 5b antibody plus 5b positive pmn plus rabbit plasma as complement source  severe lung edema occurred after a latent period of 3 to 6 hours  
class8	2783	pulmonary artery pressure was only transiently and moderately increased  and the leakage reaction could be traced back to a several fold increase in lung vascular permeability  
class8	2783	in contrast  no vascular leakage was noted in lungs perfused in the absence of anti 5b antibody  pmn  or rabbit plasma  
class8	2783	moreover  no permeability increase occurred on use of 5b negative pmn  
class8	2783	this reproduction of trali in an ex vivo lung model corroborates the role of leukoagglutinating antibodies in initiating pmn dependent respiratory distress and suggests a contribution of concomitant complement activation  
class8	2784	human t cell leukemia virus type 1 associated with small cell lung cancer  
class8	2784	a patient with small cell lung cancer  sclc  whose serum contained high levels of soluble interleukin 2 receptors is reported  
class8	2784	soluble interleukin 2 receptors in the supernatant of cultured sclc cells obtained from the patient s pleural effusion while he had malignant pleuritis  increased almost linearly from the time of cell seeding  
class8	2784	the expression of interleukin 2 receptors  tac  on the sclc cells were demonstrated by an immunofluorescence study  
class8	2784	however  other lymphocytic markers  including okt 11  okt 4  okt 8  b 1  and b 4  were not found on the cells with the exception of the natural killer cell marker  nkh 1  
class8	2784	southern blot analysis indicated the rearrangement of the t cell receptor of the cancer cells  
class8	2784	moreover  monoclonal integration of human t cell leukemia virus type 1  htlv 1  provirus in dna from the cancer cells was also demonstrated  
class8	2784	these observations suggest that some sclc in htlv 1 endemic areas are associated with htlv 1  
class8	2785	immunocytochemical characterization of lung tumors in fine needle aspiration  the use of cytokeratin monoclonal antibodies for the differential diagnosis of squamous cell carcinoma and adenocarcinoma  
class8	2785	in the current study  immunocytochemical typing of intermediate filaments was used for a differential diagnosis of human lung tumors from transthoracic fine needle aspiration biopsies  tfnab   
class8	2785	the authors have compared the cytologic diagnosis of 53 lung cancer cases with the immunofluorescence patterns obtained using a panel of monoclonal antibodies  five of which  kg 8 13  km 4 62  ks b 17  ks 8 12  kk 8 60  react with specific cytokeratin polypeptides and one with vimentin  vim 13 2   
class8	2785	only in six of 23 samples cytologically diagnosed as squamous cell carcinoma did the immunocytochemical typing of cytokeratins  ictc  confirm the cytologic diagnosis  
class8	2785	in seven cases some of the tumor cells stained positively with antibody ks b 17 specific for simple epithelial keratin  no  18   suggesting the presence of some cells of glandular origin  
class8	2785	in ten additional cases the ictc was in conflict with the cytologic diagnosis of squamous cell carcinoma  i e   antibodies ks 8 12 and kk 8 60 were negative  and antibody ks b 17  positive  supporting a diagnosis of adenocarcinoma  
class8	2785	in 14 of 18 cases cytologically diagnosed as adenocarcinoma  the ictc confirmed the diagnosis whereas in four cases additional presence of some squamous cells was noticed  
class8	2785	the ictc labeling of cases cytologically diagnosed as undifferentiated and large cell carcinomas was similar to that of the group of adenocarcinomas  
class8	2785	thus  the application of cytokeratin typing for tfnab samples seems to provide a vital complementation to routine cytologic study  especially for cases cytologically diagnosed as squamous carcinoma  
class8	2786	low dose sufentanil in major surgery  
class8	2786	the purpose of this study was to assess the efficacy of sufentanil 1 micrograms kg 1 during n2o o2 and intermittent isoflurane anaesthesia in major non cardiac surgery  
class8	2786	thirty one patients  18 females  13 males  mean age 47 yr   undergoing cholecystectomy received a 1 microgram kg 1 bolus of sufentanil before the induction of anaesthesia with thiopentone  
class8	2786	on average  three sufentanil increments were administered  to a total  bolus   maintenance  dose of 1 5 micrograms kg 1  
class8	2786	cardiovascular stability was not achieved in eleven patients who then were given isoflurane  
class8	2786	the arterial pressure decreased after sufentanil  p less than 0 05   reaching a nadir  mean 108 65 mmhg  heart rate 63 bpm  at one minute post incision  
class8	2786	clinically important hypertension or hypotension did not occur in any patient  
class8	2786	one patient  receiving beta blocker therapy  required atropine to control bradycardia  
class8	2786	postoperative respiratory depression did not occur in patients who received less than one micrograms kg 1 hr 1 with the last increment being given more than 20 minutes before the end of anaesthesia  
class8	2786	slight respiratory depression in the recovery room was reported in one patient  who had received a total of 1 3 micrograms kg 1 hr 1 of sufentanil  and the last sufentanil increment 24 min before the end of surgery  
class8	2786	the most frequently reported side effects were nausea  35 per cent  and vomiting  23 per cent   
class8	2786	induction  maintenance and recovery from anaesthesia were rated as  good  in 87  87  and 74 per cent of the cases  respectively  and  satisfactory  in the remainder  
class8	2786	we conclude that this technique is valuable to assure good protection of the cardiovascular system without undue respiratory depression during recovery  
class8	2787	epidural morphine for analgesia after caesarean section  a report of 4880 patients 
class8	2787	this retrospective study was undertaken to assess the efficacy and safety of epidural morphine in providing analgesia following caesarean section under epidural anaesthesia  
class8	2787	the morphine was administered as a single bolus  following delivery  in doses ranging from 2 to 5 mg  
class8	2787	the charts of 4880 caesarean sections  performed on 4500 patients  were reviewed  
class8	2787	the duration of analgesia and the occurrence of any symptoms which might be side effects of the epidural morphine were recorded  
class8	2787	the duration of analgesia was 22 9     10 1 hr and was not correlated with the dose of epidural morphine  
class8	2787	eleven per cent of the patients required no supplemental analgesia during the first 48 hr  
class8	2787	twelve patients  0 25 per cent  had respiratory rates less than 10 breaths per minute  on at least one occasion  
class8	2787	no serious sequelae resulted from these periods of bradypnoea  
class8	2787	pruritus occurred in 58 per cent of patients  nausea and vomiting in 39 9 per cent and dizziness in ten per cent  
class8	2787	herpes simplex labialis was recorded in 3 5 per cent of patients  
class8	2787	epidural morphine is thus confirmed as an effective analgesic technique post caesarean section with 3 mg being the optimal dose  
class8	2787	even in this young healthy patient population  clinically detectable respiratory depression occurs so clinical respiratory monitoring is indicated  
class8	2788	pulmonary edema induced by phagocytosing neutrophils  protective effect of monoclonal antibody against phagocyte cd18 integrin  
class8	2788	we studied the changes in pulmonary hemodynamics and lung wet weight induced with opsonized zymosan  oz  in isolated guinea pig lungs perfused with ringer albumin solution containing neutrophils  pmns   
class8	2788	addition of oz to the pmn perfused lungs caused pulmonary vasoconstriction and weight gain  neither oz nor pmns added individually to the perfusate altered pulmonary vasomotor tone or wet weight  
class8	2788	the steady gain in lung weight by 1 588     464 mg over the 45 minute study period was associated with pulmonary capillary hypertension and an increase in the capillary filtration coefficient  indicative of increased lung vascular permeability  
class8	2788	these responses may not be due to generation of oxygen radicals  because the alterations in pulmonary hemodynamics and lung weight were not reduced by addition of superoxide dismutase  catalase  or superoxide dismutase plus catalase  
class8	2788	we examined the basis of the pmn mediated effects by layering pmns on bovine pulmonary artery endothelial monolayers  
class8	2788	challenge with oz resulted in increased endothelial permeability to 125i albumin  
class8	2788	the monoclonal antibody ib4  directed against cd18  the common beta subunit of structurally related adhesion receptors on phagocytes  lfa 1  mac 1  and p150 95  prevented the oz mediated increase in pmn adherence to endothelial cells and the increase in endothelial permeability to 125i albumin  
class8	2788	ib4 also inhibited the lung weight gain mediated by the oz stimulated pmns in intact lungs  
class8	2788	the protective effect of ib4 could be ascribed neither to inhibition of uptake of oz by pmns nor to inhibition of release of oxygen radicals  myeloperoxidase  and elastase  
class8	2789	flow and volume dependence of respiratory system mechanics during constant flow ventilation in normal subjects and in adult respiratory distress syndrome  
class8	2789	seven control subjects and seven patients with adult respiratory distress syndrome  ards  were artificially ventilated and flow  volume  and tracheal pressure were monitored  
class8	2789	respiratory system resistance  rrs max  was partitioned into its homogeneous  rrs min  and uneven  rrs u  components  
class8	2789	respiratory system elastance  ers  was also measured  
class8	2789	in both groups ers did not vary with different inspiratory flows and volumes  but was significantly higher in ards  
class8	2789	with increasing volume  isoflow maneuvers   rrs max and rrs u increased but rrs min remained unaltered in ards  
class8	2789	in control patients  however  resistances did not vary but rrs max and rrs u were smaller and rrs min equaled their corresponding values in ards  
class8	2789	hence  stress relaxation seems to be increased in ards  
class8	2789	during isovolume maneuvers rrs max and rrs u decreased with increasing flows  both groups   although they were significantly higher in ards  
class8	2789	rrs min was not modified by different flows and was similar in both groups  
class8	2789	thus  pendelluft is also increased in ards  
class8	2789	in conclusion  the mechanical profile of ards is characterized by increased ers and rrs max  the latter being secondary to augmented mechanical unevenness within the system  
class8	2790	role of prostaglandin e1 in reducing pulmonary vascular resistance in an experimental model of acute lung injury  
class8	2790	to determine the role and efficacy of prostaglandin e1  pge1  on the cardiopulmonary derangements induced by glass bead embolism  two studies were performed  
class8	2790	in the first study  a dose response of pge1 was tested in six animals that were first embolized with sufficient glass beads to double the pulmonary artery pressure  pap   
class8	2790	this study demonstrated that pge1 reduced pap and cardiac output by a preload mediated mechanism  as evidenced by a reduction in the right ventricular  rv  end diastolic segment length  at doses of 15 and 30 ng kg min  
class8	2790	the second study was performed in two groups of animals  the control group  n   6   and the treated group  n   6   which were given pge1 at 15 ng kg min after the pap had been doubled by glass bead embolism  
class8	2790	rv preload was kept constant  
class8	2790	this study demonstrated that there was no difference in pulmonary vascular resistance between either the treated group or the control group  
class8	2790	there were no other significant differences between the two groups  
class8	2790	the results of both of these studies suggest that there is little afterload reducing effect of pge1 in this model and at these dose ranges  
class8	2790	part of the mechanism of pge1 that improves pulmonary edema and gas exchange may be the reduction of filtration surface area and hydrostatic pressures in the lungs  
class8	2791	aspiration and the elderly  
class8	2791	aspiration is prevalent in the elderly but its association with impairment of oral intake and gastroesophageal reflux is often misunderstood  
class8	2791	this paper describes the causes  pathophysiology  and consequences of aspiration and their unique features in aged persons  
class8	2791	it also explains how videofluoroscopic evaluation can assess current function while limiting factors that result in misinformation  
class8	2791	the management of aspiration is discussed  emphasizing the importance and difficulties in maintaining functional well being and possible complications of therapy  
class8	2792	transient neuromuscular impairment resulting from prolonged inhalation of halothane and enflurane  
class8	2792	inhalation anesthesia first with halothane followed by enflurane relieved a patient with status asthmaticus who was refractory to conventional therapy including mechanical ventilation  
class8	2792	after 13 days of anesthesia while on mechanical ventilation and employing nondepolarizing muscle relaxants  significant neuromuscular impairment  manifested by tetraplegia and sensory disturbance  developed  
class8	2792	anesthesia was discontinued on day 14  and the patient was weaned from mechanical ventilation on day 16  
class8	2792	over the next two months  the neuromuscular impairment markedly improved  
class8	2792	halothane was associated with cardiac arrhythmias and hepatitis necessitating replacement by enflurane  
class8	2792	enflurane appeared to be as effective a treatment for refractory asthma as halothane  
class8	2792	the most probable cause of the neuromuscular impairment in our patient was the long term use of inhalation anesthetics or nondepolarizing muscle relaxants  
class8	2793	mucoid impaction of upper lobe bronchi in the absence of proximal bronchiectasis  
class8	2793	mucoid impaction is a complication of asthma and is frequently recurrent in patients with allergic bronchopulmonary aspergillosis  abpa   
class8	2793	this report describes a patient with asthma and recurrent bilateral well circumscribed densities on chest roentgenogram in the absence of abpa  
class8	2793	recognition of this clinical presentation may avoid the need for invasive diagnostic procedures or steroid therapy  
class8	2794	confluence of pulmonary veins simulating a pulmonary mass  
class8	2794	confluence of the pulmonary veins commonly appears on the frontal view of the chest and generally is easily recognized as such  
class8	2794	on plain film tomography  computerized tomography  and pulmonary angiography  the anatomy of convergence of pulmonary veins prior to common entry into the left atrium is clearly displayed  
class8	2794	in this report  attention is called to the occasional appearance of confluence of the pulmonary veins on the lateral view of the chest as a clearly circumscribed round opacity mimicking a lung or mediastinal mass  
class8	2795	cyclosporine and chronic sarcoidosis  
class8	2795	two patients with progressive sarcoidosis who had poor responses and side effects from corticosteroid therapy were treated with cyclosporine  
class8	2795	cyclosporine suppressed conventional markers of inflammation and there was clinical improvement in one patient  but the disease recurred when therapy was discontinued  
class8	2795	the second patient who had diabetes mellitus developed unstable glucose metabolism when given cyclosporine  
class8	2795	this unstable diabetes mellitus together with side effects of nausea and vomiting resulted in weight loss and inadequate serum therapeutic levels that was associated with a poor therapeutic response to the cyclosporine  
class8	2795	the major side effects in both patients were headache and gastrointestinal symptoms  but there was no renal dysfunction  
class8	2795	we conclude that while corticosteroids remain the mainstay of sarcoid therapy  when these drugs have not been successful for the skin manifestations of the disease  a trial of cyclosporine may be justified  
class8	2796	resolution of the adult respiratory distress syndrome following colectomy and liver transplantation  
class8	2796	a 32 year old woman with liver failure from end stage cirrhosis and ulcerative colitis developed septicemia and severe ards  
class8	2796	subtotal colectomy and a successful liver transplantation resulted in complete resolution of the ards  
class8	2797	cytomegalovirus pneumonia in allogeneic bone marrow transplantation  an immunopathologic process  
class8	2797	recent literature suggests that cmv pneumonia is an immunopathologic process  
class8	2797	this case report summarizes the clinical course of a patient which supports this hypothesis  
class8	2797	the patient is the recipient of an allogeneic bmt who recovered from an episode of cmv pneumonia that occurred about two months after the transplant  
class8	2797	despite recovery from the viral infection  follow up bals revealed persistent lymphocytosis in an apparent asymptomatic patient  
class8	2797	he subsequently developed boop about four months after the initial cmv infection  
class8	2797	these observations suggest that the viral infection may have resulted in the activation of the host s cell mediated response and provides evidence to support the hypothesis that cmv pneumonia is an immune mediated process  
class8	2798	pathologic involvement of the left ventricle in chronic cor pulmonale  
class8	2798	to determine whether or not the left ventricle is pathologically involved in patients with chronic cor pulmonale  right and left ventricular weights  wall thickness  myocyte diameters  and percentage of fibrosis in 18 autopsied hearts were examined in patients with chronic pulmonary disease  cpd   ten had right ventricular hypertrophy on their electrocardiograms  and eight were without right ventricular hypertrophy  
class8	2798	five with extracardiopulmonary disease were used as controls  
class8	2798	the weight of the right ventricle was significantly increased in cpd when compared to control subjects  
class8	2798	walls of both ventricles were significantly thicker in cpd  
class8	2798	myocyte diameters of both ventricles were significantly greater in cpd  
class8	2798	the percentage of fibrosis in the right ventricle was significantly greater in cpd  
class8	2798	the percentage of fibrosis in the left ventricle was significantly greater only in patients with right ventricular hypertrophy  
class8	2798	we concluded that the left ventricle was also involved pathologically in patients with chronic cor pulmonale in the end stage of the disease  
class8	2799	pulmonary alveolar proteinosis associated with pneumocystis carinii  ultrastructural identification in bronchoalveolar lavage in aids and immunocompromised non aids patients  
class8	2799	pneumocystis carinii  pc  has been recognized as frequently responsible for most opportunistic pulmonary infections occurring in immunocompromised aids and non aids patients  
class8	2799	moreover  these patients can be considered at risk for secondary pulmonary alveolar proteinosis  
class8	2799	therefore  we have investigated the occurrence of associated secondary alveolar proteinosis and pc pneumonitis in aids and non aids immunocompromised patients  
class8	2799	in a series of 26 bronchoalveolar lavages  bal  in patients with pc pneumonitis  19 aids and seven non aids patients   we observed on light microscopy  in addition to the honeycombed material  areas of an extracellular material that had a different pattern which was suggestive of that described in alveolar proteinosis  
class8	2799	a systematic ultrastructural study of these 26 bal fluid samples demonstrated in each of them an accumulation of phospholipid surfactantlike extracellular material mixed or not with the pc cysts  
class8	2799	in nine cases  the observation of lipoproteinaceous material on light microscopy and abundant phospholipid material with myelinlike and myelin tubular laminated structures on electron microscopy was highly suggestive of an associated pulmonary alveolar proteinosis  pap   
class8	2799	such an accumulation of extracellular material was not observed in the 11 bal fluid samples collected in immunocompromised patients  seven aids and four non aids patients  without pc pneumonitis  
class8	2799	these findings demonstrated a particular frequency of associated pap with pc pneumonitis  
class8	2799	these results raise important questions concerning  1  the consequence of such an alveolar accumulation of lipoproteinaceous material on the clinical status and prognosis of the pneumonitis  and  2  the mechanisms responsible for this accumulation  
class8	2800	differential therapy with calcium antagonists in pulmonary hypertension secondary to copd  hemodynamic effects of nifedipine  diltiazem  and verapamil  
class8	2800	in 53 patients with copd and precapillary pulmonary hypertension  we investigated the effect of three typical calcium antagonists on hemodynamics at rest and during bicycle ergometer exercise  
class8	2800	in the responders  the decrease in pulmonary vascular resistance following nifedipine was 23 percent at rest  p less than 0 0005  and 35 percent during exercise  p less than 0 0005   following diltiazem  it was 10 percent at rest  p less than 0 05  and 23 percent during exercise  p less than 0 025   following verapamil  it was 22 percent at rest  p less than 0 005  and 11 percent during exercise  p less than 0 025   
class8	2800	the cardiac index rose significantly at rest and under exercise only after the administration of nifedipine   16 percent and  8 percent  resp   
class8	2800	nifedipine caused the most distinctive peripheral vasodilation  
class8	2800	the heart rate increased slightly following nifedipine and decreased slightly following diltiazem and verapamil  
class8	2800	after long term therapy with nifedipine  13     5 months   the decrease in pulmonary artery pressure and pulmonary vascular resistance was no longer significant  
class8	2800	in our opinion  the different hemodynamic action profiles will have consequences for the differential therapy in patients with copd and pulmonary hypertension  
class8	2801	diagnostic value of nonfluoroscopic percutaneous lung needle aspiration in patients with pneumonia  
class8	2801	in forty one patients  mean      sd  age 51     19 years  range  11 to 88 years  seven female and 34 male  with clinical signs and symptoms of pneumonia  we performed a nonfluoroscopic percutaneous lung needle  22 gauges  aspiration  plna  to investigate the diagnostic yield of this technique  
class8	2801	all the patients were receiving antibiotics at the time of the study  and plna was performed either because of a lack of response to empiric antibiotic treatment or because of the severity of the pneumonia or the underlying condition of the patient  
class8	2801	eight patients were mechanically ventilated  mv  due to acute respiratory failure  
class8	2801	the plna was performed at bedside and without fluoroscopic guidance  
class8	2801	twenty two microorganisms were identified by means of stains and or cultures of plna samples  
class8	2801	sensitivity of plna was 43 percent  18 41   
class8	2801	we detected three false positive cultures probably due to contamination from the skin area punctured  
class8	2801	in the eight mv patients studied  the sensitivity of plna was 37 5 percent  and the microbiologic findings turned out to be crucial for the outcome of the patients  
class8	2801	pneumothorax developed in three patients  7 percent  after plna  
class8	2801	none of these three patients developed a pleural infection but two of them required thoracostomy drainage  
class8	2801	none of the mv patients presented complications  
class8	2801	our results showed that nonfluoroscopic plna is a technique with moderately good sensitivity and with a low rate of false positive cultures  8 percent  to diagnose pulmonary infections in patients with unresponsiveness to empiric antibiotic treatment or with severe pneumonia  
class8	2801	further evaluation of its diagnostic value and complications in mv patients is needed  although our preliminary results suggest that plna can be an alternative technique to other methods for diagnosing pulmonary infections in patients receiving artificial ventilatory support  
class8	2802	intravenous and oral corticosteroids for the prevention of relapse after treatment of decompensated copd  effect on patients with a history of multiple relapses 
class8	2802	to determine if a regimen of intravenous and oral corticosteroids reduces the relapse rate after treatment of decompensated copd in the ed  30 patients were studied  
class8	2802	forty five visits in which intravenous and oral corticosteroids were given  t visits  were compared with an equal number of matched visits in which they were withheld  n visits   
class8	2802	no differences were noted between t and n visits with respect to clinical findings  laboratory results and other forms of therapy  
class8	2802	treatment with corticosteroids reduced the relapse rate within 24 h of discharge  
class8	2802	at 48 h  the cumulative relapse rate for t visits  8 9 percent  was significantly lower than for n visits  33 3 percent  p   0 005   
class8	2802	for patients with a history of multiple relapses  a regimen consisting of intravenous and oral corticosteroids reduces the risk of relapse after ed treatment of decompensated copd  
class8	2803	predicting failure following shunting of pleural effusions  
class8	2803	we placed 43 shunts in 34 patients in five years  
class8	2803	twenty four had malignant effusions and ten had benign effusions  
class8	2803	thirty one patients had unilateral shunts  three had bilateral shunts and six required revisions for shunt failure  
class8	2803	two patients died after shunt placement from disease progression  
class8	2803	of the nine patients who experienced poor results  one was noncompliant in operating the shunt and eight had occluded shunts  
class8	2803	in the 30 patients  who were compliant and had adequate length of follow up  five had excellent results  12 had good results  and five had fair results  
class8	2803	two of the patients with occluded shunts had good results after shunt revision  24 patients had some symptomatic relief with shunting  
class8	2803	evaluation of factors including a history of prior abdominal surgery  performance status  and pleural fluid cell counts  differential  chemistries  and cytology revealed no significant differences between the patients who experienced shunt failure and those who had patent shunts  
class8	2803	shunting of pleural effusions is well tolerated and has good success rates in properly selected patients  
class8	2804	quality of life in elderly patients with chronic nonspecific lung disease seen in family practice  
class8	2804	we studied the quality of life of elderly patients with chronic nonspecific lung disease  cnsld  in family practice  
class8	2804	we also investigated the relationship between patients  somatic condition and their quality of life  
class8	2804	seventy patients  aged 40 years or older  with a diagnosis or symptoms of cnsld completed the sickness impact profile  sip  and the list of daily activities  dal   
class8	2804	pulmonary function  fev1  ivc  and respiratory symptoms were assessed  
class8	2804	the results indicated that patients were more impaired in their physical and psychosocial functioning than healthy control subjects  
class8	2804	most lung function parameters showed no correlation with the sip scores  
class8	2804	the respiratory symptoms of wheezing and dyspnea were related to patients  quality of life  
class8	2804	patients with chronic obstructive pulmonary disease  copd  were more restricted in their daily functioning than patients with asthma  
class8	2804	since the relationship between patients  somatic condition and their quality of life is weak  we recommend comprehensive care that encompasses psychosocial as well as somatic interventions  
class8	2805	acute pulmonary effects of aerosolized pentamidine  a randomized controlled study  toronto aerosolized pentamidine study  taps  group  
class8	2805	from june 1988 to february 1989  we enrolled 36 patients with human immunodeficiency virus into a randomized double blind placebo controlled trial assessing the efficacy and toxicity of aerosolized pentamidine  ap  as secondary prophylaxis for pneumocystis carinii pneumonia  
class8	2805	each patient underwent spirometric evaluations before and after aerosolized treatment  
class8	2805	there was no significant difference in the results of baseline pulmonary function tests between the two groups  
class8	2805	eleven patients  65 percent  in the ap group developed cough but only four demonstrated significant reduction in the forced expiratory flow rates after ap  four patients  21 percent  in the placebo group developed cough  but no significant change in the expiratory flow rates was noted  
class8	2805	all bronchospastic episodes were self limited and symptomatically responded to remedial inhaled albuterol  salbutamol  treatment  
class8	2805	we conclude that ap treatment is frequently associated with coughing attacks  65 percent   but the actual incidence of bronchospasm on spirometry is much lower  24 percent  and is generally quite mild  
class8	2806	neutrophilia in bronchoalveolar lavage fluid of diffuse panbronchiolitis  
class8	2806	the clinical and pathologic features of diffuse panbronchiolitis  dpb  have been well reported to date  although its pathogenesis remains unknown  
class8	2806	in the present study  we performed bronchoalveolar lavage  bal  on three patients with biopsy specimen proven dpb and eight patients with highly probable dpb  six women and five men  one smoker and ten nonsmokers   nine patients with chronic bronchitis  all men  five smokers and four nonsmokers   and nine normal control subjects  six women and three men  all nonsmokers  to clarify the cell populations in the lower respiratory tract  
class8	2806	neutrophils comprised 55 3     24 4 percent of recovered cells by bal in dpb patients but only 6 6     6 4 percent in chronic bronchitis patients  and 1 8     1 5 percent in normal control subjects  p less than 0 001  all comparisons   
class8	2806	the dpb patients also exhibited a decreased percentage of alveolar macrophages  34 9     23 5 percent  compared with chronic bronchitis patients and normal control subjects  p less than 0 001  all comparisons   
class8	2806	the percentage of lymphocytes of the recovered lavage cells in dpb patients did not differ from that in chronic bronchitis patients and normal control subjects  
class8	2806	these results indicate that neutrophils play an important role in the pathogenesis of dpb  
class8	2806	they also suggest that neutrophilia of bal recovered fluid is a common finding in diseases associated with bronchiolar inflammation despite some clinical and pathophysiologic differences  
class8	2807	pulmonary lipid peroxidation in cigarette smokers and lung cancer patients  
class8	2807	lipid peroxidation  lpo  was studied in lung tissues of patients with lung cancer  lc  n   37  or nonlung cancer  nlc  n   13  and its relationships with the smoking habits and the degree of airway obstruction were investigated  
class8	2807	specimens of peripheral lung parenchyma  free of tumor tissue  were taken and the malondialdehyde  mda  content was measured in the s 12 fractions  
class8	2807	airway obstruction was assessed by flow volume curves  and data were expressed as percentage of the predicted values  
class8	2807	cigarettes smoked were expressed as pack years  
class8	2807	the patients with lc and nlc did not differ by mda content  age  and number of pack years  
class8	2807	on the contrary  fef75 85 and mef75 were significantly lower in lc than in nlc patients  p less than 0 05   
class8	2807	the mda content was inversely correlated to number of days patients had refrained from smoking  r    0 66  p less than 0 001   
class8	2807	the mda content was higher in recent smokers  ie  people smoking during the last 30 days before surgery  than in the other patients  0 136     0 007 vs 0 116     0 007 mumol g of tissue  p less than 0 05  and  by considering only recent smokers  mda content was higher in lc patients  0 144     0 008 mumol g of tissue  than in nlc patients  0 113     0 014 mmol g tissue  p   0 059   
class8	2807	when patients were divided into  high mda  and  low mda  groups  mef75 was much lower in the high mda group  35 1     3 4 percent  than in the low mda group  55 1     8 1 percent   p less than 0 01   
class8	2807	these results suggest the following   1  enhanced level of prooxidant state in the lungs is associated with recent cigarette smoking   2  lc patients may be more prone than respective nlc patients to oxidative stress   3  mda level and degree of small airway obstruction were associated and differed between lc and nlc patients even though these groups did not differ in the percentage of recent smokers  and  4  a common free radical mediated pathway may be active for both lc and small airway obstruction  
class8	2808	three mixed venous saturation catheters in patients with circulatory shock and respiratory failure 
class8	2808	thirty one critically ill patients with acute respiratory failure and circulatory shock were divided into three groups  
class8	2808	group 1 included 11 patients with an inserted mixed venous saturation  svo2  catheter using three reference wavelengths and characterized by one transmitting and one detecting fiberoptic filament  oximetrix opticath catheter   group 2 included eight patients with an inserted svo2 catheter using two reference wavelengths and characterized by one transmitting and one detecting fiberoptic filament   edwards sat one catheter   group 3 included 12 patients with an inserted svo2 catheter using two reference wavelengths and characterized by one transmitting and two detecting fiberoptic filaments  
class8	2808	once calibration procedures were performed  svo2 measured by the catheter and by an hemoximeter osm 3  reference value  were compared following each therapeutic intervention  
class8	2808	over a period of 1 5 to 6 hours during which the hematocrit value remained unchanged  119 measurements were obtained in group 1  91 in group 2 and 181 in group 3  
class8	2808	the dispersion of svo2 values was much more pronounced with the two reference wavelength systems using either one or two detecting fiber optic filaments  and the correlation coefficient was significantly higher with the three reference wavelength system  r   0 970 for the oximetrix catheter vs r   0 855 for the edwards catheter and r   0 826 for the spectramed catheter  p less than 0 001   
class8	2808	after 24 hours  the spontaneous drifts in the two reference wavelength systems  using either one or two detecting fiber optic filaments  expressed as the svo2 value measured by the catheter minus the reference svo2 value  were significantly higher than the spontaneous drift in the three reference wavelength system  9 3     7 percent for the edwards catheter and     6     4 1 percent for the spectramed catheter vs 3 3     3 1 percent for the oximetrix catheter  p less than 0 05   
class8	2808	this study shows that a three wavelength system is more accurate than a two wavelength system for measuring acute changes in svo2  
class8	2808	the addition of a second detecting fiber optic filament does not seem to improve the accuracy of the system when svo2 changes occur in conditions of stable hematocrit  
class8	2809	lactate levels as predictors of the relationship between oxygen delivery and consumption in ards  
class8	2809	we reviewed the changes in do2 and vo2 in 58 patients with ards after interventions which included fluid loading  blood transfusion  and peep  
class8	2809	after a significant change in do2  patients with lactic acidosis  lactate level greater than 2 4 mmol l  exhibited significant corresponding changes in vo2  p less than 0 001   however  no change in vo2 was observed in patients without lactic acidosis  1 beta greater than 0 8   
class8	2809	we conclude that a biphasic pattern of oxygen utilization in patients with ards emerges when subsets of patients with and without lactic acidosis are compared  
class8	2809	lactic acidosis  a marker of anaerobic metabolism  may be a characteristic of patients with ards who exhibit changes in vo2 that are dependent on changes in do2  
class8	2810	mechanical disruption of pulmonary emboli in dogs with a flexible rotating tip catheter  kensey catheter   
class8	2810	pulmonary embolism was induced in 11 dogs by the injection of three  to four day old allogeneic blood clots  
class8	2810	the clots were made radiopaque by soaking them in contrast material  
class8	2810	the resulting clots were firm  3 to 4 cm long  and 1 cm in diameter  
class8	2810	injection of the clots into the external jugular vein consistently produced occlusion of at least one of the lobar pulmonary arteries  
class8	2810	in every instance in which the tip of the catheter could be positioned at the clot embolus  six dogs   the clots were readily fragmented with a number 8 french  2 67 mm od  flexible rotating tip catheter  kensey catheter  activated at 80 000 rpm  
class8	2810	overall perfusion was shown by posttreatment angiograms to be markedly improved  
class8	2810	these studies show that catheter tip fragmentation of pulmonary emboli with a kensey catheter has excellent potential for therapeutic application in patients with pulmonary embolism  
class8	2811	relationship between blood plasma prostaglandin e2 and liver and lung metastases in colorectal cancer  
class8	2811	the relationship of prostaglandin e2  of which a large amount is produced in various neoplasms  and hematogenous distant metastases was investigated in a total of 44 colorectal cancer patients because of its varied pathophysiologic potentials  
class8	2811	the authors found significantly high levels of pge2 in local venous blood draining the carcinoma and in peripheral blood in cases with liver or lung metastasis  as well as a significantly large amount of pge2 production in the carcinoma tissue  
class8	2811	the results suggest that increased local blood pge2 could enhance the metastasis formation  and increased peripheral blood pge2 may be useful in the detection of such metastasis in colorectal cancer  
class8	2812	endoscopic palliative intubation of the esophagus invaded by lung cancer  
class8	2812	thirty two patients with esophageal involvement by lung cancer were managed by endoscopic intubation  
class8	2812	in 22 patients with extrinsic esophageal strictures  the success rate of intubation was 91   and 82  were discharged with their dysphagia relieved and esophageal patency restored  
class8	2812	the mean survival rate was 4 4 months  
class8	2812	in 10 patients with esophago bronchial fistulas  3 had the fistulous tract obliterated and lived a mean of 5 months  
class8	2812	this low success rate of closing fistulas is due to failure to seal off the space between the stent and the fistula because of absence of tumor associated stenosis  
class8	2812	the overall morbidity rate was 28 1   18 8  perforation  6 3  hemorrhage  and 3 1  tracheal obstruction   
class8	2812	the overall mortality rate was 18 8   
class8	2812	although complications were more frequent than in primary esophageal tumors  endoscopic intubation was the only way to palliate this desperate condition and provided 66 6  of patients with relief of symptoms  nutritional improvement  and a mean survival time of 4 5 months  
class8	2813	pneumonia syndromes  a clinical approach in the elderly  
class8	2813	important in the pathogenesis of pneumonia in the elderly patient are chronic diseases  including diabetes mellitus  coronary artery disease  congestive heart failure  chronic obstructive pulmonary disease  and cerebrovascular disease  
class8	2813	also vital are the changes that take place in the immune system and mucociliary clearance mechanisms of the lung  
class8	2813	the clinician should be aware of these risk factors  especially since the mortality rate of lower respiratory infections approaches 40  in these elderly patients  
class8	2813	treatment guidelines are included  
class8	2814	changes in self concept during pulmonary rehabilitation  part 1  
class8	2814	the purpose of this two part study was to describe changes in self concept during and after a formal pulmonary rehabilitation program  
class8	2814	a 20 item semantic meaning differential scale was administered to 37 patients with severe chronic obstructive pulmonary disease who were participating in a multidisciplinary pulmonary rehabilitation program  
class8	2814	patients were asked to evaluate their past  present  and future selves on program admission  on program discharge  and 2 to 6 months after home discharge  
class8	2814	mean total self concept score for the present self significantly increased between program admission and home discharge 3 weeks later  mean change 31 32     22 04  p less than 0 0001   
class8	2814	no significant declines in self concept were found 2 to 6 months after home discharge  p   0 39   
class8	2814	men showed a significantly higher change in total self concept score than women during the 3 week program  p   0 03   
class8	2814	however  the men s change score dropped significantly after home discharge  p   0 02   suggesting a need for more intensive follow up care than with women  
class8	2814	the self concept tool in this study provided an easy way to monitor subjective changes in psychologic status  
class8	2815	changes in self concept during pulmonary rehabilitation  part 2  
class8	2815	this two part study describes changes in self concept during pulmonary rehabilitation  
class8	2815	a 20 item semantic meaning differential scale was administered to 37 patients with severe chronic obstructive pulmonary disease who were participating in a multidisciplinary pulmonary rehabilitation program  
class8	2815	patients were asked to evaluate their past  present  and future self concepts on program admission  on program discharge  and 2 to 6 months after home discharge  
class8	2815	in this part of the study item level quantitative data as well as qualitative data from the counseling session at program discharge are reported  
class8	2815	the quantitative data documented detailed changes in self concept at various stages of pulmonary rehabilitation  
class8	2815	counseling session results indicated that patient involvement in item level analysis greatly facilitates psychosocial intervention  
class8	2815	findings from this study establish clinical indications for use of the self concept evaluation tool in adult patients with chronic obstructive pulmonary disease  
class8	2815	use of this tool is recommended early in the rehabilitation process  
class8	2816	ligation of the superficial femoral vein in prevention of pulmonary embolism  an old fashion procedure  
class8	2816	from 1974 to 1988  interruption of the superficial femoral vein  sfv  was performed to prevent pulmonary embolism  pe  in 73 patients  
class8	2816	the mean age of the patients was 62 years  
class8	2816	phlebography showed thrombi in the following localizations  calf veins  67 3    superficial femoral or popliteal veins  56 6    common femoral veins  19 5   and iliac veins  2 7    
class8	2816	a floating thrombus in the popliteal or femoral vein was the main indication for surgery in 97 3  of patients  
class8	2816	pulmonary embolism had occurred in 76 7  and was associated with neoplasm in 13 7   
class8	2816	ligation of the sfv was performed in 93 limbs and completed iliac or femoral thrombectomy in 32 3   
class8	2816	the procedure was performed under locoregional anesthesia in 82 9  of the cases  
class8	2816	hospital mortality was 1 4  and 3 year survival  considering only pe related deaths was 95 3     2 7   
class8	2816	follow up was complete for all patients and averaged 3 0 years  for a 3 years pe free rate of 90 8     3 6   
class8	2816	persistent symptoms included increased limb tenseness in 12 5  and mild ankle edema in 25   
class8	2816	bilateral strain gauge plethysmography  sgp  was obtained in 65 limbs  
class8	2816	the time necessary to obtain a 50  75 and 100  decrease in calf volume  respectively t1 2  t3 4 and tt  was calculated for the operated limb and compared with the untreated limbs used as controls  
class8	2816	a prolongation of t1 2 from 2 5     0 3 sec in controls to 4 3     0 4 sec in the operated limb  p less than 0 01  was found  
class8	2816	thus  our experience with ligation of the superficial femoral vein is favourable since long term ill effects have been minimal and strain gauge plethysmography  sgp  showed only mildly altered venous drainage  
class8	2817	platelet derived growth factor in idiopathic pulmonary fibrosis  
class8	2817	fibrosis is a complex process involving an inflammatory reaction  fibroblast proliferation  and abnormal accumulation of interstitial collagens  
class8	2817	mononuclear cells are usually present in lung fibrosis  
class8	2817	activated monocytes and macrophages in culture have been shown to produce several growth factors including platelet derived growth factor  pdgf   
class8	2817	pdgf is a potent mitogen and chemoattractant for fibroblasts and smooth muscle cells and a stimulator of collagen synthesis  
class8	2817	we have studied the expression of c sis pdgf 2 mrna in lung tissues derived from five patients with idiopathic pulmonary fibrosis  ipf  and from four control individuals without ipf  
class8	2817	northern blot analysis of specimens obtained from four patients with ipf revealed the expression of the c sis pdgf 2 protooncogene  
class8	2817	a control lung tissue without ipf did not express the c sis protooncogene  
class8	2817	in situ hybridization extended these studies demonstrating the expression of the c sis mrna in the five specimens with ipf but not in the four control specimens without ipf  
class8	2817	the expression of c sis mrna was localized primarily in the epithelial cells  
class8	2817	invading alveolar macrophages also expressed c sis mrna  
class8	2817	the expression of c sis mrna was accompanied by the expression of pdgf like proteins in lung specimens with ipf but not in control lung specimens  
class8	2817	these findings demonstrate the in vivo expression of the c sis pdgf 2 protooncogene and the production of pdgf like proteins in the epithelial cells and macrophages of the fibrotic tissue  
class8	2817	this localized and sustained production of pdgf like mitogen may constitute an important contributing factor in the abnormal fibroblast proliferation and collagen production  events associated with pulmonary fibrosis  
class8	2818	itraconazole therapy in aspergillosis  study in 49 patients  
class8	2818	itraconazole  200 to 400 mg once daily  was administered to 49 patients with different types of aspergillosis  pulmonary aspergilloma  14 patients   chronic necrotizing pulmonary aspergillosis  14   and invasive aspergillosis  21   
class8	2818	itraconazole was prescribed alone or in combination or after treatment with amphotericin b and flucytosine  
class8	2818	of 14 aspergilloma patients  2 were cured and 8 had symptomatic improvement  
class8	2818	in chronic necrotizing pulmonary aspergillosis  7 of 14 patients were cured and 6 improved significantly  
class8	2818	in invasive aspergillosis treatment failed in 6 patients and 15 were cured  
class8	2818	itraconazole can be an alternative to amphotericin b in the treatment of invasive aspergillosis and chronic necrotizing pulmonary aspergillosis  
class8	2818	in aspergilloma itraconazole may be useful in inoperable cases  
class8	2819	repeated exposure of asthmatic airways to inhaled adenosine 5  monophosphate attenuates bronchoconstriction provoked by exercise  
class8	2819	inhaled adenosine 5  monophosphate  amp  induces bronchoconstriction in subjects with asthma  probably caused by histamine release from airway mast cells  and repeated amp bronchial challenge leads to attenuation of the bronchoconstrictor response  
class8	2819	since exercise induced bronchoconstriction may be mediated by hypertonic mast cell degranulation  we postulated that repeated amp bronchial challenge should reduce the response to subsequent exercise challenge  
class8	2819	eight atopic subjects with asthma took part in an unblinded  randomized trial  
class8	2819	on the control study day  a treadmill exercise test previously demonstrated to induce a greater than 20  fall in fev1 was performed  
class8	2819	on the amp study day  three amp dose response bronchial challenges were performed at 1 hour intervals  
class8	2819	each amp challenge was continued until either a provocative concentration causing a 20  fall in fev1 had been achieved  pc20  and the pc20 was calculated  or the maximum concentration of amp  400 mg ml  had been administered  
class8	2819	after recovery of the fev1 from amp challenge  a treadmill exercise test identical to the test on the control study day was performed  
class8	2819	on the amp study day  the geometric mean pc20 was 15 3  7 9 to 29 5  mg ml for the first test  and 28 2  10 7 to 77 4  mg ml for the third test  not significant   
class8	2819	on the control study day  the mean maximum percentage fall in fev1 after exercise was 28 0      2 7   whereas on the amp study day  it was reduced to 13 0      4 3   p less than 0 01   
class8	2819	a significant correlation was found between the change in responsiveness to amp induced by repeated challenge and the attenuation of the subsequent exercise response  p less than 0 05   
class8	2820	therapeutic embolization  enhanced radiolabeled monitoring  
class8	2820	radiolabeling of ivalon  polyvinyl alcohol sponge  particles permits localization of injected particles during embolization through the use of a portable gamma camera and provides a means to prevent potentially fatal complications such as pulmonary embolization  
class8	2820	a more efficient technique of labeling ivalon particles with technetium 99m sulfur colloid was developed  
class8	2820	an increase in labeling efficiency allowed more accurate determination of the distribution of injected ivalon particles  
class8	2820	scanning electron microscopy demonstrated the stability of the ivalon particles during this new labeling process  
class8	2820	two patients with arteriovenous malformations underwent therapeutic embolization with radiolabeled ivalon particles  gamma camera imaging of the lesion and chest was performed throughout the procedure  
class8	2821	mr imaging of the bird s nest filter  
class8	2821	the appearance of the bird s nest inferior vena cava filter on magnetic resonance  mr  images of 11 patients is described  
class8	2821	no complication or symptomatic filter displacement was encountered as a result of mr imaging performed at 1 5 t  
class8	2821	the filters created significant local artifact and distortion on mr images  
class8	2821	however  diagnostic mr images of the pelvis  spine  and brain may still be obtained  
class8	2822	intra abdominal palpation of a nasogastric tube in the stomach does not assure appropriate placement  
class8	2822	improperly placed nasogastric  ng  tubes have been associated with considerable morbidity  
class8	2822	the only reliable indicator of correct ng tube placement appears to be the aspiration of gastric contents  
class8	2822	we have reported a case of major morbidity from an improperly placed ng tube that perforated the cervical esophagus  dissected the mediastinum  and terminated in the omental bursa  
class8	2822	no gastric aspirate was obtained by suctioning of the tube  but correct placement was presumed based upon the surgeon s direct intraoperative palpation of the tip of the tube  
class8	2822	failure to aspirate gastric contents should alert the practitioner to the possibility of improper ng tube placement  
class8	2823	disseminated strongyloidiasis in aids and non aids immunocompromised hosts  diagnosis by sputum and bronchoalveolar lavage  
class8	2823	in conclusion  disseminated strongyloidiasis is a fatal disease that commonly affects the lungs  
class8	2823	the disease should be suspected in an immunocompromised host who came from an area endemic for s stercoralis even years before the onset of symptoms or in patients with unexplained gram negative bacteremia or meningitis  
class8	2823	treatment should be started promptly and should be maintained for a long time  
class8	2824	early tracheostomy for primary airway management in the surgical critical care setting  
class8	2824	during a 12 month period  264 patients with multiple injuries who required mechanical ventilation were admitted to the surgical intensive care unit  
class8	2824	one hundred twenty patients  46   were disengaged from the ventilator  and 38 patients  14   died  
class8	2824	of the remaining 106 patients  40   51 patients  group i  were to receive tracheostomy within 1 to 7 days  and 55 patients  group ii  underwent late  8 or more days after admission  tracheostomy  
class8	2824	multiple variables in four categories  admission  operative  ventilatory  and outcome  were analyzed prospectively to define the impact that early tracheostomy had on duration of mechanical ventilation  intensive care stay  and hospital stay  
class8	2824	morbidity and mortality rates of the procedures were assessed  
class8	2824	early tracheostomy  in a homogeneous group of critically ill patients  is associated with a significant decrease in duration of mechanical ventilation  as well as shorter intensive care unit and hospital stays  compared with translaryngeal endotracheal intubation  
class8	2824	there were no deaths attributable to tracheostomy  and overall morbidity of the procedures was 4   
class8	2824	we conclude that early tracheostomy has an overall risk equivalent to that of endotracheal intubation  
class8	2824	furthermore  early tracheostomy shortens days on the ventilator and intensive care unit and hospital days and should be considered for patients in the intensive care unit at risk for more than 7 days of intubation  
class8	2825	trends in lung cancer  chronic obstructive lung disease  and emphysema death rates for england and wales 1941 85 and their relation to trends in cigarette smoking 
class8	2825	trends in smoking associated respiratory diseases in england and wales during 1941 85 have been studied  with careful attention to problems caused by changes in classification of cause of death  
class8	2825	three diseases were selected for analysis  lung cancer  emphysema  and chronic obstructive lung disease  
class8	2825	during 1971 85 deaths that would previously have been certified under chronic bronchitis have increasingly tended to be classified under chronic airways obstruction  
class8	2825	the definition of chronic obstructive lung disease that was used includes both terms to avoid the artificial decline caused by consideration of chronic bronchitis in isolation  
class8	2825	age specific rates for all three diseases show a pronounced cohort  period of birth  pattern  rates for men rising up to the rates for those born shortly after the turn of the century and then declining  and rates for women peaking in the cohort born 20 25 years later  
class8	2825	for chronic obstructive lung disease  but not for lung cancer and emphysema  the cohort peak is superimposed on a sharply declining downward trend  
class8	2825	in both sexes cohort patterns of cumulative cigarette consumption peak at a time broadly similar to those seen for the three diseases  
class8	2825	trends in cigarette consumption  however  cannot explain the underlying steeply declining rate of chronic obstructive lung disease  
class8	2825	nor can they fully explain the declining trends in lung cancer and emphysema rates in younger men and women  
class8	2826	use of biological glue to control pulmonary air leaks  
class8	2826	biological glue is a natural adhesive generated by the interaction between fibrinogen  pre glue  and thrombin to produce fibrin  
class8	2826	the pre glue is prepared from a single donor  to avoid the problems of pooled plasma  and stored as cryoprecipitate  
class8	2826	before being used it is thawed  dissolved in saline  and activated into an adhesive by the addition of topical thrombin  
class8	2826	biological glue was used prophylactically to prevent air leaks from bronchial suture lines and raw lung surfaces after pulmonary resections in six patients  
class8	2826	in addition two new methods of using biological glue have been developed for the control of persisting air leaks  
class8	2826	in selective intrabronchial tamponade the glue is instilled into the bronchial tree through a flexible bronchoscope  and in therapeutic pleurodesis it is instilled into the pleural cavity through a chest drainage tube  
class8	2826	the air leaks were resolved in all cases  
class8	2826	seven procedures using selective intrabronchial tamponade were carried out in six patients  
class8	2826	four were immediately successful but three were not and required further interventions  
class8	2826	therapeutic pleurodesis alone was successfully carried out in one patient and as an adjunct to selective intrabronchial tamponade on two occasions  
class8	2826	a thoracotomy was eventually needed in one of the seven patients  
class8	2827	effects of inflammation and fibrosis on pulmonary function in diffuse lung fibrosis  
class8	2827	to investigate the relation between lung function and inflammation and fibrosis in patients with diffuse lung fibrosis  a study was made of untreated patients without appreciable airway obstruction  14 patients with cryptogenic fibrosing alveolitis and seven with pneumoconiosis   
class8	2827	quantitative assessment of inflammatory infiltration and fibrosis was carried out on open lung biopsy specimens and compared with lung volumes  carbon monoxide transfer factor  tlco   tlco corrected for alveolar volume  tlco va   and arterial blood gases at rest and during exercise  
class8	2827	the degree of fibrosis and the degree of cellular infiltration were positively correlated  
class8	2827	lung volumes and tlco were correlated with the grades of fibrosis and cellular infiltration of alveoli  arterial blood gases during exercise tended to correlate with both fibrosis and infiltration  p less than 0 06   
class8	2827	in contrast  morphological data were not correlated with gas exchange at rest or with tlco va  
class8	2827	it is concluded that  in untreated patients with diffuse lung fibrosis  lung volumes  tlco  and arterial blood gases during exercise reflect the lung lesions  and that the pulmonary function tests used cannot discriminate between fibrosis and infiltration of the lung by inflammatory cells  
class8	2828	appropriate and inappropriate neuroendocrine products in pulmonary tumourlets  
class8	2828	pulmonary tumourlets are focal aggregates of neuroendocrine cells that occur in the periphery of the lung and may be associated with chronic inflammation and scarring  
class8	2828	six such lesions were seen in five lungs from a series of 35 pairs of lungs studied at necropsy  
class8	2828	all were immunoreactive for neurone specific enolase  protein gene product 9 5  and a range of neuroendocrine products  
class8	2828	of the peptides found in neuroendocrine cells in normal human lungs  gastrin releasing peptide was present in all tumourlets and calcitonin in all but one  none contained leucineenkephalin  
class8	2828	of a series of peptide and protein hormones not present in the neuroendocrine cells of healthy human lungs  growth hormone was present in all six tumourlets and adrenocorticotrophin in two  
class8	2828	identical patterns of peptide expression were displayed by neuroendocrine cells in the airway associated with the tumourlets in two cases  
class8	2828	such cells were increased in number and abnormally clustered  
class8	2828	aberrant expression of peptides might accompany the morphological changes in the pulmonary neuroendocrine cells seen in diseased lungs  their florid focal proliferation occasionally resulting in the formation of a tumourlet  
class8	2829	plasma cross linked fibrin degradation products in pulmonary embolism  
class8	2829	plasma concentrations of cross linked fibrin degradation products  a marker of intravascular thrombosis and fibrinolysis  were measured in 495 patients with suspected pulmonary embolism referred for ventilation perfusion lung scanning to determine whether concentrations are increased in pulmonary embolism and their potential use in diagnosis  
class8	2829	lung scans were described as normal  n   66  or as showing a low  n   292   indeterminate  n   58   or high probability  n   79  of pulmonary embolism  
class8	2829	there was a difference between the mean levels of cross linked fibrin degradation products in each scan category  normal scans  142 ng ml  low probability scans  295 ng ml  indeterminate probability scans  510 ng ml  high probability scans  952 ng ml  p less than 0 001   
class8	2829	of the patients with high probability scans  96  had raised concentrations  
class8	2829	explanations for discrepant low results include incorrect scan diagnosis  delay in blood sampling  and anticoagulation  
class8	2829	of the patients with a low or indeterminate probability of pulmonary embolism  43  had increased concentrations of cross linked fibrin degradation products that could be attributed in most cases to another illness  
class8	2829	owing to the wide range of values in each lung scan diagnostic category  raised concentrations of these fibrin degradation products cannot be used without reference to the patient s clinical state as a discriminatory test for pulmonary embolism  
class8	2829	further evaluation of the significance of normal concentrations in excluding a diagnosis of pulmonary embolism appears to be warranted  
class8	2830	external detection of pulmonary accumulation of indium 113m labelled transferrin in the guinea pig  
class8	2830	accumulation of radioisotope labelled transferrin in the lungs of guinea pigs was determined with an external detection system  
class8	2830	the method is based on the intravascular and extravascular distribution of indium 113m labelled transferrin compared with the intravascular distribution of technetium 99m labelled red blood cells  
class8	2830	guinea pigs were given iloprost  a prostacyclin analogue and potent pulmonary vasodilator  and noradrenaline  a pulmonary vasoconstrictor  in an attempt to increase and decrease respectively the blood volume in the lungs  
class8	2830	neither agent altered transferrin accumulation in the lung by comparison with a saline infusion  
class8	2830	iloprost infused before and after oleic acid infusion reduced macro molecular leakage when compared with oleic acid alone  
class8	2830	these data suggest that the double isotope method can distinguish between hydrostatic and injury induced pulmonary oedema  
class8	2831	prostaglandin f2 alpha enhancement of capsaicin induced cough in man  modulation by beta 2 adrenergic and anticholinergic drugs  
class8	2831	the effect of inhaled prostaglandin  pg  f2 alpha on the response to the inhaled tussive agent capsaicin was investigated in normal subjects  
class8	2831	seven subjects inhaled three breaths of four doses of capsaicin  0 3  0 6  1 2  and 2 4 nmol  before and immediately after inhaling pgf2 alpha  0 1 mumol  or placebo  0 15m nacl  on separate days  
class8	2831	the numbers of capsaicin induced coughs were greater after pgf2 alpha  mean 42 3 coughs  than after 0 15m sodium chloride  30 1   
class8	2831	visual analogue scores  0 10 on a 10 cm continuous scale  showed that capsaicin was more irritant after pgf2 alpha than after saline  
class8	2831	total respiratory resistance  rrs   measured by the forced oscillation technique  was unaltered throughout the study  
class8	2831	a double blind  placebo controlled study of the effects of inhaled salbutamol  200 micrograms  0 6 mumol  and ipratropium bromide  40 micrograms  0 1 mumol  on cough induced by capsaicin  2 4 nmol  and by pgf2 alpha  0 1 mumol  and on pgf2 alpha augmented  capsaicin induced coughing was performed in seven subjects  
class8	2831	neither drug had any effect on capsaicin induced coughing  
class8	2831	salbutamol reduced coughing due to pgf2 alpha  mean 7 7 coughs after salbutamol  9 3 after placebo  but ipratropium bromide did not  mean 6 9 coughs after ipratropium bromide  6 6 after placebo   
class8	2831	salbutamol also inhibited the augmentation of the capsaicin induced cough that followed inhalation of pgf2 alpha  mean augmentation 1 9 coughs after salbutamol  4 1 after placebo   whereas ipratropium bromide did not  augmentation 1 7 coughs after ipratropium bromide  2 7 after placebo   
class8	2831	no changes in rrs were seen after pgf2 alpha or either drug  
class8	2831	thus salbutamol reduces pgf2 alpha induced cough and the augmentation of capsaicin induced cough that follows pgf2 alpha  
class8	2832	the hyperimmunoglobulinaemia e and recurrent infections syndrome in an adult  published erratum appears in thorax 1990 dec 45 12  984  
class8	2832	a 27 year old white woman with a history of chronic eczema and episodes of serious infection of the chest  skin  and bone presented with acute respiratory failure  
class8	2832	she was found to have a spontaneous right pneumothorax and a pneumatocele in the left upper lobe  
class8	2832	despite a left upper lobectomy she was left with chronic respiratory failure  bullous lung disease  and bilateral bronchiectasis  
class8	2832	the hyperimmunoglobulinaemia e and recurrent infections syndrome was diagnosed only in adult life  
class8	2833	pulmonary disease following intravesical bcg treatment  
class8	2833	bacillus calmette guerin  bcg  is an attenuated strain of mycobacterium bovis that has been used in the treatment of malignant disease for over 20 years and for the treatment of bladder cancer since 1976  
class8	2833	major complications of this treatment are infrequent  
class8	2833	we report two cases of systemic illness with pulmonary manifestations after treatment with intravesical bcg  
class8	2834	use of a fenestrated silicone drain to stent a malignant tracheobronchial stenosis  
class8	2834	an innovative use of a fenestrated silicone drainage tube as an endobronchial stent is reported  
class8	2834	the patient had respiratory obstruction due to a carinal tumour and laser photoresection had failed to restore airway patency  
class8	2835	bronchoalveolar lavage findings in a patient with the organic dust toxic syndrome  
class8	2835	a previously healthy student developed the organic dust toxic syndrome after unloading a grain silo for one day  
class8	2835	bronchoalveolar lavage seven days later showed a total cell count six times normal with 70  lymphocytes  
class8	2835	this suggests that the previously described acute neutrophil influx into the alveolar spaces in this syndrome is rapidly replaced by a lymphocyte dominated infiltration  
class8	2836	pleuropulmonary manifestations of hepatic amebiasis 
class8	2836	pleuropulmonary manifestations of hepatic amebiasis occurred in 30 patients  18  60   presented with at least 1 pulmonary complaint and 10  33   had multiple pulmonary symptoms  
class8	2836	in 14 patients  47    abnormalities were found on examination of the chest  
class8	2836	in 16 chest roentgenograms  53    there was at least 1 abnormality  right sided pleural effusion  9 patients  and elevated right hemidiaphragm  8 patients  were the most common  
class8	2836	all patients were treated with metronidazole  flagyl  and had resolution of the amebic liver abscess and pulmonary disease  
class8	2836	pleuropulmonary disease is a common complication of amebic liver abscess  
class8	2836	the clinical presentation and chest roentgenograms are virtually diagnostic and obviate the need for invasive procedures to confirm the diagnosis  
class8	2836	pleuropulmonary disease resolves with amebicidal treatment of the hepatic abscess  
class8	2837	inhaler and spacer use in obstructive airway diseases  
class8	2837	the role of inhaled aerosols in the treatment of obstructive airway diseases is increasing for both immediate bronchodilation and prophylactic anti inflammatory effects  
class8	2837	inhaled aerosol agents are available in metered dose inhaler and nebulizer forms  
class8	2837	maximum therapeutic benefit from metered dose inhalers is assured when the correct inhaler technique is used  
class8	2837	spacer devices may be helpful in some patients  
class8	2838	characterization of the morphonuclear features and dna ploidy of typical and atypical carcinoids and small cell carcinomas of the lung  
class8	2838	the authors analyzed several cytomorphonuclear parameters related to chromatin distribution and dna ploidy in typical and atypical carcinoids and in small cell lung cancers  
class8	2838	nuclear measurements and analysis were performed with a samba 200  titn  grenoble  france  cell image processor with software allowing the discrimination of parameters computed on cytospin preparations of feulgen stained nuclei extracted from deparaffinized tumor tissues  
class8	2838	the authors  results indicate a significant increase in dna content  assessed by integrated optical density  iod   from typical carcinoids to small cell lung carcinomas  with atypical carcinoids showing an intermediate value  
class8	2838	parameters related to hyperchromatism  short and long run length and variance of optical density  also characterize the atypical carcinoids as being intermediate between typical carcinoids and small cell lung cancers  
class8	2838	the systematic measurement of these cytomorphonuclear parameters seems to define an objective  reproducible  scale  of differentiation that helps to define the atypical carcinoid and may be of value in establishing cytologic criteria for differential diagnosis  
class8	2839	isolation of measles virus in primary rhesus monkey cells from a child with acute interstitial pneumonia who cytologically had giant cell pneumonia without a rash  
class8	2839	the isolation of measles virus in primary rhesus monkey kidney cells  prmk  in patients with documented giant cell pneumonia who have presented without a rash is limited  
class8	2839	the diagnosis usually is made by cytologic examination of nasal or bronchial secretions in which characteristic multinucleated giant cells with intranuclear and intracytoplasmic inclusion bodies are observed  
class8	2839	the diagnosis of giant cell pneumonia has been associated with measles virus but not exclusively  
class8	2839	canine distemper  herpes group viruses  and parainfluenza infections have been associated with these cells  
class8	2839	in addition  vitamin a deficiency also has been cytologically associated with multinucleated giant cells  
class8	2839	the authors describe the isolation of measles virus from bronchial washing and sputum in prmk cells at 4 days from an 11 year old child with acute interstitial pneumonia who was in remission for acute lymphocytic leukemia  
class8	2839	classic cytopathologic effect  cpe  consisting of syncytial and hole formation on the prmk monolayer was apparent  
class8	2839	in addition  a foamy appearance of the monolayer was noted in an otherwise clean lot of monkey cells  
class8	2839	confirmatory testing with measles antibody of the infected areas of the monolayer by indirect immunofluorescence  ifa  was positive for measles antigen and negative for mumps  parainfluenza  types i  ii  and iii  and influenza a and b virus  
class8	2839	serologic studies for measles antibody revealed an ifa igg titer of greater than 1 10 240  and an igm titer of 1 128  
class8	2839	cytologic examination of the same bronchial fluid revealed the typical giant cells with characteristic inclusions associated with measles virus  
class8	2839	because this disease usually is severe  and often fatal  prompt recognition of this virus is essential  not only to the patient  who can be treated with immunoglobulin and or antiviral therapy  but also to prevent the spread of the virus to other patients and medical personnel  
class8	2839	these findings also support direct evidence for the etiologic role of measles virus in giant cell pneumonia that has been detected either histologically or cytologically and in tissue culture at autopsy  
class8	2840	brake mechanics  asbestos  and disease risk  
class8	2840	health risks posed by inhalable asbestos fibers are known to exist in a variety of industrial and nonindustrial settings  
class8	2840	although early studies described an increased risk of asbestosis  lung cancer  and mesothelioma in asbestos industry workers  subsequent research revealed the existence of a potential asbestos related health hazard in nonasbestos industries such as the textile and railroad industries  
class8	2840	brake mechanics and garage workers constitute a large work force with potential exposures to levels of asbestos capable of producing disease  
class8	2840	unfortunately  the health risk faced by these workers has received little attention  
class8	2840	this article briefly discusses currently available information on the asbestos health risks of workers in this setting  and highlights the need for further investigations of this occupational group  
class8	2841	arterial oxygen desaturation during gastrointestinal endoscopy 
class8	2841	this prospective study evaluated the incidence and severity of arterial oxygen desaturation during gastrointestinal endoscopy  
class8	2841	following pulmonary function testing  115 male patients underwent esophagogastroduodenoscopy  egd   colonoscopy  or colonoscopy followed by egd  with continuous recording of arterial oxygen saturation  sao2   
class8	2841	most patients  80 115  70   showed arterial oxygen desaturation  greater than 4  decrease from baseline sao2   severe arterial oxygen desaturation  sao2 less than or equal to 85   reflecting hypoxemia  pao2 less than or equal to 50 mm hg  was noted in one third of patients overall  37 115  32    
class8	2841	severe arterial oxygen desaturation occurred in 9 62 egd patients  15    23 46 colonoscopy patients  50    and 4 7 patients having colonoscopy followed by egd  57    
class8	2841	arterial oxygen desaturation occurs frequently during gastrointestinal endoscopy and is often severe  
class8	2841	these data support the concept that continuous monitoring of sao2 should be standard procedure during all gastrointestinal endoscopic procedures  
class8	2842	treatment of wegener s granulomatosis with intermittent high dose intravenous cyclophosphamide 
class8	2842	purpose  concerns regarding the long term toxicity of daily cyclophosphamide  cp  therapy for the systemic vasculitides have led us to evaluate alternative approaches to treatment in an attempt to achieve comparable efficacy with less toxicity  
class8	2842	this study sought to determine the efficacy  toxicity  and immunologic effects of glucocorticoids  gc  and intermittent high dose intravenous cp   pulse  cp  in the treatment of 14 patients with wegener s granulomatosis  wg   
class8	2842	patients and methods  the diagnosis of active wg was supported by a typical clinical presentation and histopathologic findings of vasculitis  granulomatous inflammation  and tissue necrosis  
class8	2842	gc treatment was initially provided on a daily basis and later tapered to an alternate day schedule if vasculitis remained inactive  
class8	2842	pulse cp treatment was initially administered once a month for 6 months  
class8	2842	if after 6 months remission had been attained and gc therapy had been discontinued  then pulse cp treatment was given at less frequent intervals thereafter  
class8	2842	treatment and evaluation were provided for participants as inpatients in a clinical research center  national institutes of health   
class8	2842	results  thirteen of 14 patients  93   initially experienced unequivocal improvement with pulse cp therapy  and seven of 14  50   achieved remission within 4 months  
class8	2842	however  treatment was associated with significant toxicity in two patients and later relapses in nine patients  so that a total of 79  either failed to achieve sustained remission or were unable to continue therapy  
class8	2842	three of 14  21   patients have achieved sustained remissions with the pulse cp protocol and one additional patient  who had a limited exacerbation of wg  continues to receive that therapy after 14 to 22 months  mean 17 months   
class8	2842	conclusions  the use of pulse cp and gc therapy in 14 patients with wg was associated with a high initial response rate  
class8	2842	however  failure to respond initially to treatment  to sustain improvement  or to tolerate continued treatment was noted in 79  of patients within a period of 1 to 22 months  
class8	2842	these observations indicate that this particular pulse cp protocol does not achieve a high degree of lasting efficacy  
class8	2843	pleuritis as a manifestation of reactivation tuberculosis  
class8	2843	purpose  the purpose of this study was to determine the frequency with which tuberculous pleuritis is a manifestation of reactivation tuberculosis and to compare the clinical manifestations of reactivation tuberculous pleuritis with  classic  tuberculous pleuritis  in which chest roentgenograms reveal no parenchymal infiltrates  
class8	2843	patients and methods  we evaluated the medical records of 59 patients in whom tuberculous pleuritis was confirmed by histologic findings or mycobacterial culture  
class8	2843	twenty seven patients  46   had typical chest roentgenographic findings of reactivation tuberculosis  whereas 32  54   had classic tuberculous pleuritis  
class8	2843	the clinical and laboratory features of these two groups were compared  
class8	2843	results  symptoms were more prolonged and pleural fluid glucose and lactate dehydrogenase concentrations were more markedly abnormal in patients with reactivation pleuritis than in those with classic pleuritis  suggesting a more chronic inflammatory process in the former group  
class8	2843	compared with patients with classic tuberculous pleuritis  those with reactivation pleuritis had a lower frequency of reactive tuberculin skin tests  61  versus 88   and granulomatous pleural inflammation  25  versus 72    but a higher bacillary burden  manifest by a higher frequency of positive sputum smears for acid fast bacilli  50  versus 0   and positive mycobacterial cultures from sputum  60  versus 23   and pleural fluid  91  versus 66    
class8	2843	conclusions  in contrast to previous reports  tuberculous pleuritis was a manifestation of reactivation tuberculosis in 46   27 of 59  of patients  
class8	2843	tuberculous pleuritis is a more chronic process in patients with reactivation disease than in those with classic pleuritis  
class8	2843	the lower frequency of reactive tuberculin skin tests and granuloma formation  combined with the higher bacillary burden in patients with reactivation pleuritis  suggest that these patients mount a less effective immune response to mycobacterium tuberculosis infection than do patients with the classic form of tuberculous pleuritis  
class8	2844	cardiorespiratory effects of endoscopic esophageal variceal sclerotherapy  
class8	2844	endoscopic variceal sclerotherapy  evs  is an effective means of controlling variceal hemorrhage  which develops as a consequence of portal hypertension  
class8	2844	while esophageal perforation  ulceration  strictures  and mediastinitis are potential complications associated with this procedure  it is not clear whether isolated pleuropulmonary events such as pleuritis  pneumonitis  and adult respiratory distress syndrome are causally related to the evs  
class8	2844	endoscopy and sedation with the attendant risk of aspiration  particularly in the background of hepatic encephalopathy  may account for some of these events  
class8	2844	recent controlled studies of respiratory function demonstrate that evs as such results in minor changes in gas exchange  lung volumes  and pulmonary and systemic hemodynamics  
class8	2844	most pulmonary complications have been reported with the use of sodium morrhuate sclerosant  
class8	2844	comparative studies among different sclerosants are necessary to evaluate relative safety  
class8	2844	finally  there have been rare reports of myocardial ischemia and pericarditis reported in association with evs  but these are of a transient nature  
class8	2844	chest symptoms  roentgenographic pleuropulmonary changes  pulmonary hemodynamics  and cardiac perturbations are transient and should not preclude offering evs to patients with variceal hemorrhage  
class8	2845	viral bronchiolitis during early life induces increased numbers of bronchiolar mast cells and airway hyperresponsiveness  
class8	2845	the objectives of this study were to determine the kinetics of sendai virus induced increases in bronchiolar mast cells and to determine whether virus induced increases in bronchiolar mast cells were associated with increased airway responsiveness to methacholine and with altered allergic inflammatory responses to antigen stimulation  
class8	2845	mast cell density in intrapulmonary airways was measured in outbred cd  crl cdbr  rats by use of morphometric techniques at 7  15  30  60  and 90 days after viral or sham inoculation  
class8	2845	density of bronchiolar mast cells was higher in virus inoculated rats than in control rats at 30  60  and 90 days after inoculation  p less than 0 01   but not at 7 or 15 days after inoculation  
class8	2845	total pulmonary mast cell numbers were increased in virus inoculated rats at 30 days after inoculation  
class8	2845	rats at 42 days after viral inoculation had over a threefold increase in sensitivity to the concentration of nebulized metbacholine that would stimulate a 50  increase in respiratory resistance  
class8	2845	virus inoculated rats sensitized to ovalbumin had over a 10 fold increase  p less than 0 02  in pulmonary neutrophils that were recovered by bronchoalveolar lavage at 4 hours after ovalbumin aerosol challenge  
class8	2845	virus inoculated rats at this time also had higher densities of neutrophils in bronchiolar walls than allergen exposed control rats  
class8	2845	the results indicate that sendai virus induces increases in numbers of bronchiolar mast cells at times from 30 to 90 days after inoculation  and that mast cell increases are associated with airway hyperresponsiveness to methacholine and heightened allergic airway inflammatory reactions  
class8	2846	intraluminal fibrosis induced unilaterally by lobar instillation of cdcl2 into the rat lung  
class8	2846	lung injury induced by intratracheal instillation of cadmium chloride  cdcl2  into the rat lung may serve as a model of human interstitial lung disease  
class8	2846	in this study  cdcl2 solutions were instilled through a lobar bronchus into the left lung of the rat  
class8	2846	two doses  400 micrograms or 50 micrograms of cdcl2  each in 400 microliters of neutral saline  were used and the morphologic changes occurring during the first 7 days after a single exposure were documented by light and electron microscopy  
class8	2846	with the higher dose  inflammatory cells appeared in the alveolar interstitium 1 day after cdcl2 administration  
class8	2846	edema and thickening of the alveolar walls were evident  as were damaged type i epithelial cells and denuded basement membranes  
class8	2846	fibrin was found in the air spaces  
class8	2846	within 2 days  inflammatory cells were seen in large numbers and fibroblasts were observed passing through gaps in the alveolar basement membranes into the air spaces  
class8	2846	by 4 and 7 days after cdcl2  various forms of intraluminal fibrosis  including intrabronchiolar budding  mural incorporation  and obliterative changes  were observed  
class8	2846	the contralateral lungs had normal appearing architecture for all the time points investigated  
class8	2846	in the lower dose exposure  gradients of alveolar damage were observed in which normal lung  interstitial fibrosis  and or intraluminal fibrosis were seen within treated lungs  
class8	2846	in the mildly damaged regions  interstitial fibrosis predominated  while in the more severely damaged regions  mural incorporation of the convoluted basement membranes was observed  
class8	2846	the pulmonary fibrosis that developed appeared to be similar to some human interstitial lung diseases and may offer a system in which to study the regulation of collagen deposition and fibrosis development in these pathologic conditions  
class8	2847	neuromuscular effects of respiratory and metabolic acid base changes in vitro with and without nondepolarizing muscle relaxants  
class8	2847	the effects of metabolic  bicarbonate   hco3   and respiratory  carbon dioxide  pco2  acid base changes on indirectly elicited twitch tension with and without nondepolarizing neuromuscular blocking agents were compared in a rat phrenic nerve hemidiaphragm preparation  
class8	2847	ionized calcium  ca2   and magnesium  mg2   concentrations in the modified krebs  solution were measured and kept constant  
class8	2847	likewise  twitch was altered when ph changes were produced by altering either pco2 or  hco3   
class8	2847	decreasing ph either by increasing pco2 or by decreasing  hco3  significantly decreased  p less than 0 01  twitch  by 9 5     0 6  sem  n   8  and 10 6     1 5   respectively  
class8	2847	increasing ph by decreasing pco2 or by increasing  hco3  significantly increased  p less than 0 01  twitch  by 5 6     0 9 and 7 9     0 6   respectively  
class8	2847	after a partial depression of twitch by nondepolarizing neuromuscular blocking agents  the effects of pco2 and  hco3  changes were again assessed  
class8	2847	decreasing ph by increasing pco2 or by decreasing  hco3  intensified d tubocurarine  dtc   28 2     1 6 and 32 0     2 9   respectively  and vecuronium  23 0     1 4 and 36 8     3 2   respectively  block  whereas it reversed metocurine  1 2     2 2  ns and 2 9     1 3   respectively  and pancuronium  8 3     1 5 and 11 5     3 0   respectively  block  
class8	2847	conversely  increasing ph by decreasing pco2 or by increasing  hco3  antagonised dtc  12 8     2 2 and 13 6     1 8   respectively  and vecuronium  25 3     1 7 and 25 0     3 0   respectively  block  whereas it potentiated metocurine  4 2     0 6 and 8 0     1 1   respectively  and pancuronium  11 0     1 2 and 17 5     2 0   respectively  block  
class8	2847	except where indicated  all changes in block described above were statistically significant  
class8	2848	additive effect of albuterol and ipratropium bromide in the treatment of bronchospasm in children  
class8	2848	inhaled albuterol  a   salbutamol  alone and albuterol plus ipratropium bromide  ib  were administered to 12 asthmatic children  
class8	2848	following administration of a alone or in combination with ib  there was a significant increase in fev1 and fef  
class8	2848	significant statistical difference in favor of the association a plus ib was observed at 120 and 240 minutes for fev1 and in the period 120  180  and 240 minutes for fef  
class8	2848	the additive effect was present both in the large and small airways  
class8	2848	the short lived additive effect of a plus ib suggests the opportunity to increase the frequency of drug administration in patients with severe bronchial obstruction  
class8	2849	effects of albuterol and procaterol on exercise induced asthma  
class8	2849	procaterol and albuterol  beta agonists  were studied using a placebo controlled  repeated exercise challenge design in order to assess their duration of effectiveness in both bronchodilation and in modifying exercise induced asthma  eia   
class8	2849	fifty three subjects aged 12 to 50 years who had at least a 20  drop in fev1 during a screening exercise tolerance test were entered  
class8	2849	subjects took two inhalations of procaterol  10 micrograms inhalation   albuterol  90 micrograms inhalation   or placebo  
class8	2849	thirty minutes later they exercised on a treadmill at a workload sufficient to induce greater than or equal to 80  aerobic o2 consumption for six minutes  
class8	2849	pulmonary function was measured before and serially for 30 minutes after exercise  
class8	2849	the same exercise challenge was repeated three  six  and nine hours after drug administration  
class8	2849	both procaterol and albuterol bronchodilated and modified eia at 30 minutes and three hours  mean drops in fev1 being 8 2 and 9 7  respectively at 30 minutes and 16 8 and 16 3  at three hours  
class8	2849	this was compared with placebo falls of 30  and 26   
class8	2849	at six hours the subjects  response was similar after both procaterol and albuterol  and fewer subjects had a 20  fall in fev1 than with placebo  although protection afforded by both beta agonists was substantially less than at three hours  
class8	2849	both drugs were tolerated well  
class8	2850	exercise induced biphasic responses and methacholine reactivity in asthma  
class8	2850	biphasic  early and late  asthmatic responses to exercise occurred in seven of 43 children with reproducible exercise induced asthma  
class8	2850	as biphasic allergen induced asthma is associated with a prolonged increase in nonspecific bronchial hyperreactivity  this effect was not sought in the 43 asthmatic children  
class8	2850	there was no significant change in methacholine pd20 fev1 before and after exercise challenge  either in children who had early  or early and late  exercise responses  
class8	2850	late reactions after allergen exposure are likely to be of considerable clinical significance in relation to the enhancement of bronchial responsiveness  
class8	2850	it is reassuring that this is not the case for exercise challenge  as it would have major implications in relation to the recommendations that asthmatics should participate in normal activities and even in training programs  
class8	2850	furthermore  it suggests that there are differences between the pathophysiology of asthma induced by exercise and that produced by allergens  
class8	2851	oral gold therapy in steroid dependent asthma  nasal polyposis  and aspirin hypersensitivity  
class8	2851	eight patients are described who fulfill the criteria for the triad of asthma  nasal polyposis  and aspirin hypersensitivity who have been treated with oral chrysotherapy from 7 to 17 months  
class8	2851	patient diary and symptom scores reflect an overall improvement in global symptoms  
class8	2851	monthly pulmonary assessment  spirometry  does not indicate a significant change  improvement or deterioration  but average daily oral prednisone requirements have decreased  
class8	2851	one of eight patients experienced a minor side effect of treatment but did not require discontinuation of therapy  
class8	2851	oral gold therapy may prove to be an alternative therapy in a select population of patients and permit a reduction or discontinuation of oral corticosteroid therapy  
class8	2852	functional character and augmentation of lymphocytes in regional lymph nodes of patients with lung cancer  
class8	2852	it appears that lymph node metastases are more frequent in lung cancer than in other cancers because of impaired defensive mechanisms in the regional lymph nodes  
class8	2852	however  little is known about the immunologic function of regional lymph node lymphocytes  rlnl  in patients with lung cancer  
class8	2852	we have studied the immunologic properties of rlnl in comparison with peripheral blood lymphocytes  pbl   
class8	2852	we measured the natural killer  nk  cell activity of rlnl and pbl in patients with lung cancer and found that the nk activity was significantly more depressed in the rlnl than in the pbl  
class8	2852	in contrast  interleukin 2  il 2  production was markedly higher in the rlnl than in the pbl  
class8	2852	the cytotoxic effect of rlnl in nonmetastatic lymph nodes on target cells  such as k562 cells  or pc 3 and pc 10 cells  nk resistant  human lung cancer of adenocarcinoma and epidermoid carcinoma  respectively  was significantly enhanced by in vitro incubation with recombinant il 2  ril 2   
class8	2852	furthermore  we clarified that both ril 2 and ok 432  which is a biologic response modifier and il 2 inducer as well  augmented the cytotoxicity of rlnl and that these effector cells were lymphokine activated killer  lak  cells  
class8	2852	the depletion of lymphocyte subsets by pretreatment with specific monoclonal antibody showed that the lak activity in rlnl was mediated by cd3  and cd8  cells  whereas the lymphocyte subsets contributing the lak activity in pbl were cd3  and cd16  cells  
class8	2852	it was concluded that a majority of the effector cells in rlnl were lak cells of the cytotoxic t cell population  
class8	2853	doppler assessment of pulmonary hypertension induced by hypoxic breathing in subjects susceptible to high altitude pulmonary edema  
class8	2853	to verify the abnormal pulmonary vascular response implicated in the pathogenesis of high altitude pulmonary edema  hape   we examined the hemodynamic responses to hypoxia in hape susceptible subjects  hape s  by means of both right heart catheterization and pulsed doppler echocardiography  
class8	2853	the hape s were seven men and one woman with a history of hape  
class8	2853	six healthy volunteers who had repeated experiences of mountain climbing without any history of altitude related problems served as control subjects  
class8	2853	the hape s showed much greater increase in pulmonary vascular resistance  pvr  than did the control subjects  resulting in a much higher level of pulmonary arterial pressure  ppa  under acute hypoxia both of 15  o2 and 10  o2  
class8	2853	we then evaluated the usefulness of pulsed doppler echocardiography in the prediction of pulmonary hypertension  
class8	2853	acceleration time  act  and right ventricular ejection time  rvet  were measured from the flow velocity pattern in the right ventricular outflow tract  
class8	2853	the ratio of act to rvet was correlated to invasively determined mean ppa  ppa  and pvr  
class8	2853	the results were as follows   1  act rvet   0 52 to 0 0047  ppa   r    0 93  see   0 017  p less than 0 001  hape s    2  act rvet   0 55 to 0 0055  ppa   r    0 70  see   0 030  p less than 0 001  hape s    4  act rvet   0 52 to 0 00077  pvr   r    0 91  see   0 016  p less than 0 001  control subjects   
class8	2853	we conclude that hape s have a constitutional abnormality in the pulmonary vascular response to hypoxia  which is a possible causative factor of hape  and that pulsed doppler echocardiography may be supportive to assess the pulmonary vascular pressor response in the hape s  
class8	2854	endogenous opioids modulate the increase in ventilatory output and dyspnea during severe acute bronchoconstriction  
class8	2854	the aim of this study was to evaluate whether endogenous opioids are involved in the regulation of breathing pattern and respiratory drive during bronchoconstriction induced by methacholine  mch   
class8	2854	we studied six male asymptomatic asthmatics 18 to 35 yr of age  
class8	2854	in a preliminary study we determined the concentration of mch causing a 60  fall in fev1  pc60 fev1   
class8	2854	on two subsequent days  we measured breathing pattern  dyspnea sensation  borg scale   mouth occlusion pressure  p0 1   and fev1 before and 10 min after an intravenous injection of either naloxone  0 1 mg kg  or saline according to a randomized double blind crossover design  
class8	2854	a mch concentration equal to the pc60 fev1 was then inhaled  and measurements were repeated 5 min later  
class8	2854	neither placebo nor naloxone affected baseline breathing pattern  p0 1  and fev1  
class8	2854	naloxone pretreatment did not influence airway response to mch  the mean percent fall in fev1 was 65 9     1 3 and 64 7     1 2   mean     1 se  on the placebo day and the naloxone day  respectively  
class8	2854	after mch inhalation no significant changes in ve  vt  and breathing frequency occurred when patients received placebo  
class8	2854	however  p0 1 increased from 1 48     0 17 to 3 43     0 70 cm h2o  p less than 0 05   and vt ti fell from 0 66     0 08 to 0 52     0 04 l s  p less than 0 05   
class8	2854	naloxone pretreatment resulted in an increase in breathing frequency  from 18 2     1 7 to 22 8     2 6 breaths min  p less than 0 05  and vt ti  from 0 58     0 06 to 0 74     0 05 l s  p less than 0 05  after mch  
class8	2855	the relationship between respiratory impairment and asbestos related pleural abnormality in an active work force 
class8	2855	with the general improvement in environmental controls in workplaces where asbestos is used  an increasing number of workers are seen who exhibit isolated pleural plaques  
class8	2855	the question as to whether these are associated with respiratory impairment independently of parenchymal disease remains unresolved  
class8	2855	the question was reinvestigated using quantitative gallium 67 lung scanning to take into account early parenchymal change not evident on the chest radiograph  
class8	2855	we carried out a cross sectional study of 110 construction insulators all currently at work  
class8	2855	overall  58 2  had pleural abnormality  52 5  pleural plaques only  and 5 5  diffuse pleural thickening as assessed from the pa chest radiograph  
class8	2855	compared with those without  those with any pleural abnormality had a decrease in fev1 and fvc on average of 222 and 402 ml  p less than 0 05   and those with isolated pleural plaques  a decrease on average of 200 and 350 ml  p less than 0 05   after taking into account age  height  smoking status  and the presence of parenchymal abnormality as assessed by chest radiography and gallium uptake  
class8	2855	the complaint of dyspnea with strenuous activities was also significantly related to the width and extent of chest wall pleural thickening  p less than 0 05   independently of parenchymal disease  
class8	2855	this study suggests that the most common radiographic findings in asbestos exposed  isolated pleural plaques are associated with a significant reduction in fev1 and fvc  which cannot be attributed to the presence of radiographic and subradiographic pulmonary fibrosis  
class8	2856	selective igg subclass deficiencies and antibody responses to pneumococcal capsular polysaccharide antigen in adult community acquired pneumonia  
class8	2856	we measured the serum concentrations of igg subclasses in healthy subjects  n   26  and in patients with community acquired pneumonia  cap  on admission  n   38   at recovery  n   21   and 9 months after admission  n   19   
class8	2856	then  in 8 of the control subjects and 15 of the patients  we measured igg subclasses and mean serum antibody concentrations of pneumococcal capsular polysaccharides before and 3 wk after immunization with a pneumococcal vaccine  
class8	2856	compared to the control subjects  the serum concentration of the igg2 subclass was lower at admission in patients with cap of bacterial or unknown cause  p less than 0 005   
class8	2856	concentrations of igg subclasses in patients did not differ between admission and recovery  or between admission and 9 months later  
class8	2856	after vaccination  in both control subjects and patients  there was an increase in the concentrations of igg2 subclasses  p   0 01  and antipneumococcal antibodies  p less than 10  4    
class8	2856	we show that serum igg2 concentration in patients with cap of bacterial or unknown cause is lower than in healthy subjects and remains lower for several months  
class8	2856	after immunization with a pneumococcal vaccine  the increase in serum concentrations of igg subclasses and antipneumococcal antibodies in patients does not differ from those in control subjects  
class8	2857	timing of corticosteroid treatment  effect of lung lymph dynamics in air injury in awake sheep  
class8	2857	in paired experiments  we studied the effects of high dose methylprednisolone on the acute pulmonary injury caused by 4 h of venous air embolization in 19 chronically instrumented  unanesthetized sheep with lung lymph fistulas  
class8	2857	we compared the effect of methylprednisolone  30 mg kg intravenous bolus  given before embolization  early  1 h  in the course of embolization  late  3 h  in the course of embolization  or after embolization  at the beginning of the recovery period   
class8	2857	we measured pulmonary hemodynamics and lymph dynamics  
class8	2857	in six sheep we also fixed lung tissue for semiquantitative histology  and in some we measured leukocyte concentrations in blood and in pulmonary lymph  
class8	2857	methylprednisolone did not significantly affect pulmonary hemodynamics but it largely prevented lung injury when it was given before embolization  
class8	2857	it also lessened the degree of lung injury when it was given during embolization  although this effect became less marked as treatment was delayed  
class8	2857	methylprednisolone had no effect on lung injury when given after embolization was completed  4 h   
class8	2857	we found fewer leukocytes attached to air emboli and fewer endothelial cell gaps in the lungs of sheep given methylprednisolone as prophylaxis  
class8	2857	leukocyte counts were lower in lung lymph and higher in the circulating blood of methylprednisolone treated sheep  
class8	2857	we conclude that methylprednisolone has a preventive effect on air embolism lung injury  such that its effect is greater when given earlier during the development of injury  
class8	2858	central airway obstruction due to cytomegalovirus induced necrotizing tracheitis in a patient with aids  
class8	2858	cytomegalovirus  cmv  infection in patients with the acquired immunodeficiency syndrome  aids  can present as either disseminated disease  pneumonitis  retinitis  gastroenteritis  neuropathy  or a subclinical infection  
class8	2858	we report a patient whose initial manifestation of cmv infection was severe central airways obstruction due to necrotizing tracheitis  
class8	2858	at bronchoscopy  the lesion appeared deeply ulcerated  distinctly different from previously described airway lesions in patients with aids  
class8	2858	mucosal biopsies showed characteristic intranuclear and intracytoplasmic inclusions and cultures yielded only cmv  
class8	2858	the patient responded partially to ganciclovir  steroids  and antibiotics against suspected anaerobic superinfection but died as a result of central nervous system disease believed due to toxoplasmosis or lymphoma  
class8	2858	cmv infection of the upper airway should be considered in the patient with aids presenting with atypical cough or stridor and ulcerated endobronchial lesions  
class8	2859	sarcoidosis complicated by hiv infection  three case reports and a review of the literature  
class8	2859	we report three cases of sarcoidosis complicated by human immunodeficiency virus  hiv  infection and review four other isolated case reports in the literature  
class8	2859	there is clinical overlap of both diseases  including symptoms  pulmonary function abnormalities  and lymphocyte function  
class8	2859	bronchoalveolar lavage  bal  in these patients showed a lymphocytic alveolitis without pathogens  
class8	2859	bal lymphocyte subset analysis showed markedly depressed cd4  cd8  ratios in three patients  
class8	2859	these data were clinically useful for distinguishing the cd8  alveolitis associated with hiv infection from the cd4  alveolitis associated with sarcoidosis  
class8	2859	three patients improved with corticosteroid therapy  
class8	2859	two patients with bal documented cd8  alveolitis tolerated discontinuation of steroids  
class8	2859	one patient s sarcoidosis improved without therapy concurrent with the diagnosis of kaposi s sarcoma  
class8	2859	another patient developed sarcoidosis 1 yr after manifesting hiv positive serology  
class8	2859	bal can be used to distinguish the lymphocytic alveolitis of sarcoidosis from that associated with hiv infection  
class8	2859	patients with active sarcoidosis complicated by hiv infection can be effectively treated with corticosteroid therapy  
class8	2860	ciliary motility in two patients with yellow nail syndrome and recurrent sinopulmonary infections  
class8	2860	the yellow nail syndrome  yns  is described as a combination of yellow nails  chronic lymphedema  pleural effusions  and recurrent sinopulmonary infections  but all these features need not be present for the diagnosis  
class8	2860	the mechanism that renders patients with this syndrome susceptible to respiratory infections is not known  
class8	2860	to determine whether abnormal ciliary motility is a predisposing factor  in vitro ciliary beat frequency  cbf  was measured in two patients with yns and recurrent respiratory infections  
class8	2860	in each case  the cbf was within normal limits  12 hz   
class8	2860	these data suggest that abnormal ciliary motility is not a pathophysiologic mechanism of recurrent sinopulmonary infections in yns  
class8	2861	manual ventilation bags as a source for bacterial colonization of intubated patients  
class8	2861	a group of 14 intensive care unit  icu  patients were studied to determine if manual ventilation bags  mvb  could serve as a source of bacterial or fungal pathogens that could colonize the respiratory tract of intubated patients  
class8	2861	a total of 51 cultures were simultaneously obtained of patient s sputum  the exterior mvb surface  mvb port  and mvb interior  postexhalation valve   
class8	2861	pathogens colonizing or infecting the respiratory tract of intubated icu patients were frequently simultaneously present on the exterior surface of the mvb and inside the mvb port used to connect the mvb with the endotracheal tube  
class8	2861	in addition  coagulase negative staphylococci and yeast were frequently present on the exterior surface of the mvb  
class8	2861	the interior of the mvb was usually sterile  
class8	2861	in three instances pathogens were isolated from the mvb before isolation from the patient s sputum  
class8	2861	mvb may serve as a source for colonizing the respiratory tract of intubated icu patients and or the hands of medical personnel  
class8	2861	the exterior surface and port of mvb should be cleaned of visible debris and disinfected at least once a day  
class8	2862	differential roles of opioid receptors in respiration  respiratory disease  and opiate induced respiratory depression  
class8	2862	in summary  these findings indicate the importance of designing future experiments that delineate between opioid and nonopioid forms of respiratory disease and dysfunction  and the need to identify means of diagnosing them in order to achieve successful recovery  
class8	2862	apparently there is great diversity between animal species in terms of contributions of endogenous opioids to tonic control of ventilation  and future work should strive to identify which species is most appropriate as a model of human ventilatory control and disease  
class8	2862	certain opioid receptor types appear to be linked to independent respiratory functions  
class8	2862	for instance  mu receptors in the brain stem produce strong inhibitory actions on respiratory parameters  including rr  vt  ve  and co2 sensitivity  
class8	2862	these effects have been observed in vivo and by electrophysiologic recordings in vitro  
class8	2862	delta receptors may also exert some inhibitory effect on respiration  especially in the nts  
class8	2862	in the cns  the ventral surfaces of the medulla and pons  especially the nts and na  seem to be important sites for opioid induced inhibition of respiration  whereas the spinal cord probably is not involved in opioid mediated ventilatory depression  
class8	2862	kappa receptors appear to be devoid of respiratory depressant activity  whereas sigma receptors may stimulate some ventilatory parameters  
class8	2862	morphine and similar pure mu agonists  such as fentanyl and oxymorphine  probably produce their analgesic and respiratory depressant effects through stimulation of mu receptors  
class8	2862	mixed agonists antagonists that have mu antagonist  or partial agonist  activity plus kappa agonist and or sigma agonist activity show a ceiling effect for respiratory depression  
class8	2862	future tests need to determine which opioid receptor may be responsible for the ceiling effect  
class8	2862	in addition  the effects of mu  delta  kappa  and sigma selective agonists on hypoxic drive should also be determined  as a drug that stimulates hypoxic sensitivity in the face of hypercapnic depression may produce less overall respiratory depression due to counteractive effects  
class8	2862	in the future  clinically optimal opiates should have more specificity of action than those available now  
class8	2862	this may be achieved by creating drugs selective for single receptors or by creating drugs with desirable combinations of receptor selectivities  
class8	2862	the combinations of mixed agonists antagonists with pure mu agonists currently in use today are promising  as they provide analgesia with reduced respiratory depression  
class8	2862	in the early days of opiate research and development  combination drug regimens were thoroughly tested to determine the  ideal ratios  that would retain analgesic properties but not the other undesirable effects such as respiratory depression  196   abstract truncated at 400 words   
class8	2863	lung lobe torsion following lobectomy  
class8	2863	three cases of postoperative pulmonary lobe torsion were reported  
class8	2863	two of three showed hemorrhagic infarctions  and as a result underwent rethoracotomies and removal of the affected lobes  
class8	2863	from these experiences  we consider that computed tomography  ct  and bronchofiberscopic examinations are useful for the diagnosis of advanced torsion  
class8	2864	clinical prediction rule for pulmonary infiltrates 
class8	2864	objective  to derive and validate a clinical rule for predicting pneumonic infiltrates in adult patients with acute respiratory illness  
class8	2864	design  prevalence studies in three settings  
class8	2864	setting  emergency departments of the university of illinois hospital at chicago  the university of nebraska medical center at omaha  and the medical college of virginia at richmond  
class8	2864	patients  symptoms  signs  comorbidity data  and chest roentgenogram results were recorded for 1134 patients from illinois  the derivation set   150 patients from nebraska  and 152 patients from virginia  the validation sets   
class8	2864	all patients presented to the emergency department and had a chest roentgenogram to evaluate fever or respiratory complaints  
class8	2864	measurements and main results  within the training set  temperature greater than 37 8 degrees c  pulse greater than 100 beats min  rales  decreased breath sounds  and the absence of asthma were identified as significant predictors of radiographically proved pneumonia in a stepwise logistic regression model  p   0 001   
class8	2864	the logistic rule discriminated patients with and without pneumonia in the training set with a receiver operating characteristic  roc  area of 0 82  
class8	2864	in the validation sets  the rule discriminated pneumonia and nonpneumonia with roc areas of 0 82 and 0 76 after adjusting for differences in disease prevalence  p greater than 0 2 compared with the training set   
class8	2864	the predicted probability of having pneumonia for patients with different clinical findings corresponded closely with the incidence of pneumonia among patients with such findings in the three settings  
class8	2864	conclusions  among adults presenting with acute respiratory illness  a prediction rule based on clinical findings accurately discriminated patients with and without radiographic pneumonia  and was used in two other samples of patients without significant decrement in discriminatory ability  
class8	2864	this rule can be used by physicians to develop more effective strategies for detecting pneumonia and for helping to determine the need for radiologic study among patients with acute respiratory disease  
class8	2865	a clinical triad to diagnose paraneoplastic retinopathy  
class8	2865	two elderly men developed photosensitivity and light induced glare  transient visual symptoms  and progressive visual loss several months before small cell carcinoma of the lung was discovered  
class8	2865	both patients had impaired visual acuity and color vision  ring scotomas  and attenuated retinal arteriole caliber  
class8	2865	electroretinography demonstrated abnormal cone and rod mediated responses  
class8	2865	antiretinal antibodies were identified in their serum  
class8	2865	their visual sensory function improved following therapy with immunosuppressive agents  
class8	2865	the triad of photosensitivity  ring scotomatous visual field loss  and attenuated retinal arteriole caliber should alert one to a paraneoplastic disorder affecting the retina  
class8	2866	latent sensitisation to respiratory syncytial virus during acute bronchiolitis and lung function after recovery  
class8	2866	to determine whether latent sensitivity to respiratory syncytial virus antigen s  occurs after infection  27 infants with acute bronchiolitis were studied and compared with 15 hospital controls  
class8	2866	blood was collected for whole blood challenge  and histamine release was measured by a high performance liquid chromatography technique with fluorometric detection  
class8	2866	there was a significantly greater histamine release to respiratory syncytial virus antigen s  in those with bronchiolitis than in controls  expressed either in amount  median 154 nmol l compared with 104 nmol l  or percentage release  median 20  compared with 3    
class8	2866	there was a significant difference between index and control groups in terms of individual histamine responses  
class8	2866	these findings strongly suggest that infants develop latent sensitivity to respiratory syncytial virus antigen s  during the course of acute bronchiolitis  
class8	2866	serial lung function tests were performed in 15 infants  
class8	2866	all infants had abnormalities of lung function at some stage  but the small numbers of subjects precluded comparison between  sensitised  and  non sensitised  infants  
class8	2866	further study is indicated to define the relation of latent sensitisation and subsequent bronchial hyper responsiveness after respiratory syncytial virus infection in infants  
class8	2867	how curable is relapsed wilms  tumour  the united kingdom children s cancer study group  
class8	2867	three hundred and eighty one children with wilms  tumour were treated on the united kingdom children s cancer study group wt1 study  1980 6   
class8	2867	seventy one patients relapsed during or after treatment  which included surgery and chemotherapy  with irradiation depending on stage and histology  
class8	2867	despite treatment with various combinations of chemotherapy  surgery  and radiotherapy there were only 17 survivors  
class8	2867	for unfavourable histology  any stage  only two of 20 survive  
class8	2867	we conclude that  after relapse  even for patients who have had localised disease and favourable histology  the  salvage  rate is little more than 50  and for all others the likelihood of cure is very small  
class8	2867	three of 41 children who relapsed less than 12 months from diagnosis survive  compared with 14 of 30 who relapsed later  
class8	2867	it is essential that even with this  good prognosis  tumour initial treatment is optimal and given by centres experienced in management of children s cancer  
class8	2867	furthermore  there is a clear need for additional effective chemotherapeutic agents for relapsed patients  
class8	2868	an unusual cause of thoracic mass  
class8	2868	a previously well 10 year old boy presented with scoliosis  a mass in the chest wall  and a pleural effusion  
class8	2868	chest radiography showed the triad of chronic consolidation  pleural effusion  and rib periostitis  
class8	2868	investigations confirmed thoracic actinomycosis  
class8	2868	tissue spread was evaluated by computed tomography  
class8	2868	it was successfully treated with benzylpenicillin  which was later replaced by clindamycin  
class8	2869	tumor necrosis factor alpha mediates acid aspiration induced systemic organ injury  
class8	2869	acid aspiration induced systemic organ injury is mediated by the sequestration of activated neutrophils  pmn   
class8	2869	in other settings cytokines have been shown to increase neutrophil endothelial adhesion  a requisite for injury  
class8	2869	this study tests whether the systemic leukosequestration and permeability following localized aspiration is mediated by tumor necrosis factor  tnf  alpha induced synthesis of an adhesion protein  
class8	2869	anesthetized rats underwent tracheostomy and insertion of a fine bore cannula into the anterior segment of the left lung  
class8	2869	this was followed by the instillation of either 0 1 ml 0 1 n hci  n   18  or 0 1 ml saline in control rats  n   18   
class8	2869	localized aspiration induced generalized pulmonary leukosequestration with 95 pmn 10 high power fields  hpf  in the aspirated lung and 46 pmn 10 hpf in the nonaspirated lung  higher than control values of 7 pmn 10 hpf and 5 pmn 10 hpf in saline  and nonsaline aspirated sides  respectively  p less than 0 05   
class8	2869	the leukosequestration was associated with permeability edema shown by increased protein concentrations in bronchoalveolar lavage  bal  of 3900 micrograms ml in the aspirated and 2680 micrograms ml in the nonaspirated side  higher than saline with 482 micrograms ml and 411 micrograms ml  respectively  p less than 0 05   
class8	2869	there was generalized pulmonary edema following aspiration measured by increase in wet to dry weight ratios  w d  of 6 6 in the aspirated and 5 1 in the nonaspirated lung  higher than control values of 3 5 and 3 4  respectively  p less than 0 05   
class8	2869	localized aspiration led to systemic leukosequestration documented by increases in myeloperoxidase activity  units g tissue  of 2 2 and 1 7 in heart and kidney  higher than control values of 0 3 and 0 4  respectively  p less than 0 05   
class8	2869	this event was associated with edema of these organs with w d ratios of 4 6 and 4 3  relative to control values of 3 0 and 3 4  p less than 0 05   
class8	2869	treatment of animals  n   18  20 minutes after aspiration with anti tnf alpha antiserum  rabbit anti murine  but not normal rabbit serum  n   18  reduced lung leukosequestration in the aspirated and nonaspirated segments  61 and 32 pmn 10hpf   bal protein concentration  1490 and 840 micrograms ml   and w d ratio  4 3 and 3 7   all p less than 0 05   
class8	2869	in the heart and kidney there were reductions in myeloperoxidase activity  0 7 and 0 6  and w d ratio  3 5 and 3 6   both p less than 0 05   
class8	2869	treatment of rabbits  n   18  with the protein synthesis inhibitor cycloheximide  0 2 mg kg hr was as effective as tnf alpha antiserum in modifying aspiration injury  abstract truncated at 400 words   
class8	2870	relief of tracheal compression by aortopexy  
class8	2870	we have performed aortopexy in 12 children with tracheal compression  
class8	2870	six infants had compression secondary to a vascular anomaly  group 1   and the other 6 had previous repair of esophageal atresia  group 2   
class8	2870	eleven of the 12 children are alive after a mean follow up of 36 months  
class8	2870	in group 1  1 patient died and 3 patients  50   experienced recurrent respiratory distress  
class8	2870	five infants sustained a major postoperative complication  and the average postoperative hospital stay was 25 days  
class8	2870	in group 2  however  aortopexy was uniformly successful  
class8	2870	there were no deaths  no postoperative complications  and no cases of postoperative respiratory distress  and the mean postoperative hospital stay was only 10 days  
class8	2870	for children with reflex apnea after repair of esophageal atresia  aortopexy is lifesaving and can be performed with minimal morbidity and mortality  
class8	2870	great caution is indicated in children with tracheal compression from other causes  
class8	2871	cor triatriatum  clinical presentation and surgical results in 12 patients  
class8	2871	twelve patients with cor triatriatum have been seen at our institution since 1979  
class8	2871	the clinical presentation  diagnostic evaluation  and surgical results are outlined in this retrospective review  
class8	2871	operation is the treatment of choice for this rare congenital cardiac defect  
class8	2871	one patient died 1 day before scheduled operation  and 2 patients died postoperatively  yielding a surgical mortality rate of 17  and an overall mortality rate of 25   
class8	2871	resection of the obstructing atrial membrane was performed using hypothermic cardiopulmonary bypass in all cases  
class8	2871	left atriotomy was performed in 6 patients  and right atriotomy was performed in 7  
class8	2871	the two postoperative deaths occurred in patients who had serious associated cardiac defects  
class8	2871	associated anomalies include atrial septal defect  persistent left superior vena cava  and partial anomalous pulmonary venous return  
class8	2871	the postoperative course has been excellent in all 9 surviving patients  all remain asymptomatic  
class8	2871	cor triatriatum is amenable to surgical repair with excellent results when diagnosed early and when not complicated by other severe cardiac anomalies  
class8	2872	tracheal and main bronchial disruptions after blunt chest trauma  presentation and management 
class8	2872	tracheobronchial disruption is one of the less common injuries associated with blunt thoracic trauma  
class8	2872	this injury can be life threatening  however  and failure to diagnose it early can lead to disastrous acute or delayed complications  
class8	2872	nine cases of tracheobronchial disruption in the setting of nonpenetrating thoracic trauma were seen at four los angeles trauma centers between 1980 and 1987  
class8	2872	mechanism of injury  presentation  diagnosis  and management of these patients were reviewed  
class8	2872	disruptions involved the trachea in 3 patients  the right bronchus in 5 patients  and the left bronchus in 2 patients  
class8	2872	tracheobronchial disruptions occurred in settings of high energy impact type injuries and were more likely to have associated injuries than they were to occur alone  
class8	2872	common presenting signs included subcutaneous emphysema  dyspnea  sternal tenderness  and hemoptysis  
class8	2872	radiographic findings were most commonly pneumothorax  pneumomediastinum  and clavicle or rib fractures  
class8	2872	rigid bronchoscopy and fiberoptic bronchoscopy were both highly accurate methods for diagnosis but only in the hands of trained cardiothoracic surgeons  
class8	2872	delay in diagnosis increased the likelihood of postoperative complications  
class8	2873	complications after cardiac operations in patients with severe pulmonary impairment  
class8	2873	the postoperative courses of 39 patients with severe lung disease  31 with obstructive disease and 8 restrictive  who underwent a cardiac operation were retrospectively reviewed  
class8	2873	the stay in the intensive care unit of the study group was 7 9     10 3 days  mean     standard deviation  compared with 2 4     3 9 days for the control group  100 patients with less impaired pulmonary function   p less than 0 001   
class8	2873	the study group also had a greater number of valve replacements than did the control group  p less than 0 01   
class8	2873	patients with obstructive disease had more respiratory complications than did patients with restrictive disease  p less than 0 05   
class8	2873	there were 21 cases of atelectasis  
class8	2873	effusions were noted in 11 patients  
class8	2873	ten patients had bronchospasm  
class8	2873	bronchial secretions were a major problem in 6 patients  
class8	2873	pneumonia developed in 4 patients  and pneumothorax occurred in 3 others  
class8	2873	the two in hospital deaths were not directly related to pulmonary complications  
class8	2873	our findings indicate that  1  patients with severe lung impairment generally do well after a cardiac operation but have more postoperative pulmonary complications than patients with less impairment   2  patients with restrictive pulmonary disease appear to fare better than those with obstructive disease   3  pulmonary function tests can alert the clinician to the possible risk of postoperative complications  but they cannot  by themselves  be used to exclude patients from operation  and  4  patients with severe pulmonary impairment facing valve replacement are at greater risk of pulmonary complications than patients having other types of cardiac surgical intervention  
class8	2874	results in 104 patients undergoing bronchoplastic procedures for bronchial lesions  
class8	2874	bronchoplastic procedures were used in 104 patients with various bronchial disorders  
class8	2874	ten had benign lesions and 94  malignant tumors  
class8	2874	the principal operative procedures were sleeve lobectomy and sleeve pneumonectomy for bronchogenic carcinoma  but 11 limited bronchial resections were performed in patients with benign lesions  minute bronchogenic carcinomas  and low grade malignant tumors  
class8	2874	of the 94 patients with malignant tumors  79 underwent a bronchoplastic procedure without carinal resection  sleeve lobectomy in 75 and limited bronchial resection in 4   and there was one operative death  1 3    
class8	2874	the overall 5 year survival rate for the patients with bronchogenic carcinoma in this group was 45  and that for patients undergoing curative resection  57   survival of patients in stages i  ii  and iiia was 79   55   and 30   respectively   
class8	2874	a bronchoplastic procedure with carinal resection was performed in 15 patients  
class8	2874	twelve in this group underwent sleeve pneumonectomy  
class8	2874	there were two operative deaths  and 1 patient has survived for longer than 4 years  
class8	2874	two patients with low grade malignant tumors underwent carinal resection without lung resection and are still alive  
class8	2874	we believe that bronchoplasty is a safe and valuable procedure and that limited bronchial resection appears to be the procedure of choice for localized bronchial lesions  
class8	2875	intraoperative bronchial aspiration of ruptured pulmonary hydatid cysts  
class8	2875	ruptured pulmonary hydatid cysts are seen clinically and radiologically as persistent cavitary lesions of the lung  
class8	2875	bronchi opening into the pericyst cavity allow for discharge of fluid matter but not the escape of solid remnants of the collapsed parasite  
class8	2875	operative manipulation of the involved lung in the course of surgical management of chronic ruptured pulmonary hydatids can force fragments of the laminated membrane or small daughter cysts into the bronchial tree  
class8	2875	such extruded solid fragments lodge in bronchi of the same or opposite lung with resulting acute obstruction of airways  
class8	2875	intraoperative bronchial aspiration of hydatid material was seen in 7 patients with ruptured hydatid cysts of the lung  either primary or secondary to transdiaphragmatic extension of liver hydatids  
class8	2875	the first clinical sign can be unexplained difficulty in ventilation  
class8	2875	effective management consists of prompt exposure of the stem bronchus on the operative side  with bronchotomy for suction retrieval of escaped solid fragments of the parasite  
class8	2876	swan ganz catheter induced massive hemoptysis and pulmonary artery false aneurysm  
class8	2876	swan ganz catheter induced massive hemoptysis and later pulmonary artery false aneurysm occurred in a patient with prosthetic mitral regurgitation  
class8	2876	this patient was successfully managed by double lumen endotracheal intubation  control of pulmonary hypertension  reversal of anticoagulation  mitral valve re replacement  and transcatheter embolization  
class8	2876	the pertinent literature is reviewed  
class8	2877	resection of the superior vena cava for primary lung cancer  5 years  survival  
class8	2877	we describe a patient with squamous cell carcinoma of the right lung that required a resection of the superior vena cava combined with a tracheal sleeve pneumonectomy  
class8	2877	the superior vena cava was totally replaced with a polytetrafluoroethylene graft with 115 minutes cross clamping of the superior vena cava  
class8	2877	the patient remains healthy and the polytetrafluoroethylene graft remains patent 5 years 4 months after operation  
class8	2878	spontaneous pneumothorax in patients with acquired immunodeficiency syndrome treated with prophylactic aerosolized pentamidine  
class8	2878	spontaneous pneumothorax is a known complication of pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome  
class8	2878	to evaluate the possible pathogenesis and natural history of pneumothorax in patients receiving aerosolized pentamidine prophylaxis  we retrospectively reviewed 327 outpatients positive for human immunodeficiency virus receiving aerosolized pentamidine  
class8	2878	there were 12 spontaneous pneumothoraces in this group of patients  
class8	2878	seventy five percent of patients with pneumothorax had roentgenographic evidence of fibrocystic lung parenchyma and clinical evidence of active pneumocystis pneumonia  
class8	2878	the majority  83   required chest tube evacuation  
class8	2878	there was a 50  mortality rate associated with this complication  
class8	2878	these findings suggest that spontaneous pneumothorax in patients treated with aerosolized pentamidine most commonly represents a prophylaxis failure associated with a high mortality rate  
class8	2879	acute renal failure due to ciprofloxacin  
class8	2879	acute renal failure developed in three patients within a few days of starting ciprofloxacin hydrochloride therapy  
class8	2879	an allergic interstitial nephritis was suggested by fever and eosinophiluria in one patient and by erythema multiforme in another  
class8	2879	a kidney biopsy specimen confirmed this diagnosis in one patient  
class8	2879	renal function improved shortly after withdrawal of the drug in all three patients  
class8	2879	literature survey revealed an additional three patients with a similar complication  
class8	2879	allergic manifestations  such as fever or rash  were a feature in most reported cases  
class8	2879	in view of this potential complication  renal function should be closely monitored in patients receiving ciprofloxacin therapy  especially if other potentially nephrotoxic drugs are prescribed concomitantly  
class8	2880	mucinous cystadenoma of the lung  a report of two cases with immunohistochemical and ultrastructural analysis  
class8	2880	we describe two patients who presented with solitary pulmonary masses that consisted of unilocular cysts lined by columnar mucinous epithelium  
class8	2880	the cysts contained copious mucus  
class8	2880	the epithelial lining of the cysts showed foci of stratification and papillary infolding  
class8	2880	histologically identical lesions have previously been termed unusual mucous cysts or mucinous cystadenomas  
class8	2880	we believe that these tumors are true neoplasms differentiating toward the respiratory epithelial mucous cell  
class8	2880	they should be distinguished from a variety of pulmonary neoplasms including bronchoalveolar carcinoma  bronchial mucous gland adenoma  mucoepidermoid carcinoma  and metastatic adenocarcinoma  
class8	2881	pulmonary arteriolar muscularization in coal workers  pneumoconiosis and its correlation with right ventricular hypertrophy  
class8	2881	the relationship between the thickness of the walls of small pulmonary arteries  the medial wall thickness as a percentage of external diameter  percentage of medial thickness  in coal miners and control subjects were studied using morphometric techniques and correlated with the degree of right ventricular hypertrophy  severity of coal workers  pneumoconiosis  emphysema  and other chronic lung diseases  
class8	2881	pulmonary arteries less than 100 microns in external diameter were identified and the external diameter  medial thickness  and intimal thickness were quantitatively measured in the lung tissues of 57 coal miners and 15 control subjects with and without other chronic lung diseases  
class8	2881	coal workers  pneumoconiosis  emphysema  and right ventricular hypertrophy were assessed uniformly in all cases  
class8	2881	the arterial wall thickness correlated with right ventricular hypertrophy  progressive massive fibrosis  and other chronic lung diseases  
class8	2881	severity of emphysema also showed a weak correlation  
class8	2881	although the functional significance of these findings is not known  we conclude that the muscularization of pulmonary arterioles provides a structural basis for the development of right ventricular hypertrophy in coal miners  
class8	2882	pulmonary blastoma with malignant melanoma component  
class8	2882	pulmonary blastomas are rare primary tumors that consist of tubular or glandular structures embedded in an undifferentiated mesenchymal stroma  
class8	2882	focal cartilage  bone  and skeletal muscle as well as squamous differentiation have been described in these tumors  
class8	2882	we report a unique case of a pulmonary blastoma showing a malignant melanoma component  
class8	2882	immunohistochemical stains for s100 protein and hmb 45 were positive in the areas of melanocytic differentiation  
class8	2883	strapless oral nasal interface for positive pressure ventilation  
class8	2883	a custom fabricated strapless oral nasal interface  soni  is described  
class8	2883	it was used in the long term administration of intermittent positive pressure ventilation  ippv  by 18 patients with paralytic or restrictive pulmonary insufficiency  
class8	2883	this interface is an acrylic shell which is firmly fixed to an orthodontic bite plate  it is designed to form a seal over the nose and mouth for the entry of ippv  
class8	2883	eight patients were ventilator dependent 24 hours a day  
class8	2883	the ten patients who required only nocturnal aid had improvement in daytime arterial blood gases  
class8	2883	although nine of these patients could manage less than 15 minutes of unassisted breathing  free time  supine  all slept supine on soni ippv  
class8	2883	the 13 patients who underwent sleep monitoring maintained a mean oxygen saturation of 95 3      1 7  and acceptable end tidal pco2  30 to 45 mmhg   
class8	2883	these 13 patients have used soni ippv for an average of 22 months  range   3 to 63 months   
class8	2883	impediments to successful long term use of a soni include the presence of a hyperactive gag reflex or stimulation of excessive oral secretions  
class8	2883	when combined with mouth ippv  glossopharyngeal breathing  the intermittent abdominal pressure ventilator  or the cuirass ventilator for daytime use  soni ippv is an option for the patient who prefers total ventilatory support by noninvasive means  
class8	2884	selection factors resulting in improved survival after surgical resection of tumors metastatic to the lungs  
class8	2884	from 1973 through 1987  a total of 140 patients underwent 184 operations for removal of metastatic tumors to the lungs  
class8	2884	the number of lesions removed ranged form one to 30  
class8	2884	of the patients  44  had solitary lesions  
class8	2884	overall 3 year survival was 62 6   and 5 year survival was 48 2   
class8	2884	in all primary tumors except melanoma and breast cancer  3 year survival was greater than 50  and 5 year survival was greater than 40   
class8	2884	with rare exceptions  the operation of choice for unilateral lesions was ipsilateral thoracotomy  and for bilateral lesions it was median sternotomy  
class8	2884	adequate conservative resection was the rule  
class8	2884	there were three pneumonectomies  25 lobectomies  71 single wedge resections  38 multiple unilateral wedge resections  and 47 bilateral wedge resections  
class8	2884	there were no postoperative hospital deaths  
class8	2884	cox covariate analysis demonstrated improved survival in patients whose largest lesion was less than 1 5 cm in diameter and with disease free interval longer than 1 year  but survival was not related to number of lesions or age of patient  
class8	2884	an aggressive surgical approach is justified in patients with most primary tumors and a limited number of lung metastases less than 1 5 cm in diameter  
class8	2884	resection of metastases from melanoma and breast cancer should be accomplished after other sites of metastatic disease have been ruled out by the most stringent criteria  
class8	2885	metastatic carcinoma to the retina  clinicopathologic findings in two cases  
class8	2885	two cases of metastatic carcinoma to the neuroretina are reported  
class8	2885	one patient had an oat cell carcinoma of the lung that was metastatic to the brain and retina  this was confirmed postmortem  
class8	2885	the other patient had metastatic breast carcinoma with seeding of tumor cells into the vitreous from a focus of retinal embolism  
class8	2885	the diagnosis was confirmed from a vitrectomy specimen  
class8	2886	critical volume for pulmonary acid aspiration  reappraisal in a primate model  
class8	2886	we have studied  in the monkey  the critical volume for the production of severe pneumonitis following pulmonary aspiration of gastric contents  
class8	2886	aspiration of 0 4 ml kg 1 and 0 6 ml kg 1 at ph1 produced mild to moderate clinical and radiological changes  but no deaths  
class8	2886	aspiration of 0 8 ml kg 1 and 1 0 ml kg 1 at ph1 was associated with an increasingly severe pneumonitis  
class8	2886	at 1 0 ml kg 1  50  of the animals died  a mortality rate considerably less than that reported previously in animal studies  
class8	2886	if these results were to be extrapolated to humans  the critical volume for severe aspiration could be increased from 25 ml to 50 ml  0 8 ml kg 1   considerably reducing the percentage of patients perceived to be  at risk   
class8	2887	effect of different rates of infusion of propofol for induction of anaesthesia in elderly patients  
class8	2887	the effect of changing the rate of infusion of propofol for induction of anaesthesia was studied in 60 elderly patients  
class8	2887	propofol was administered at 300  600 or 1200 ml h 1 until loss of consciousness  as judged by loss of verbal contact with the patient  had been achieved  
class8	2887	the duration of induction was significantly longer  p less than 0 001  with the slower infusion rates  104  68 and 51 s   but the total dose used was significantly less  p less than 0 001  in these patients  1 2  1 6 and 2 5 mg kg 1  respectively   
class8	2887	the decrease in systolic and diastolic arterial pressure was significantly less in the 300 ml h 1 group at the end of induction and immediately after induction  p less than 0 01   
class8	2887	the incidence of apnoea was also significantly less in the slower infusion group  
class8	2888	foam cuffed tracheal tubes  clinical and laboratory assessment  
class8	2888	the efficiency of a foam cuffed tracheal tube has been studied in protecting the pulmonary tree from aspiration of oropharyngeal and gastric contents  
class8	2888	following instillation of methylene blue dye above the cuff  subsequent fibreoptic bronchoscopy revealed no instance of dye staining of the tracheal mucosa  
class8	2888	a  bench  study was undertaken subsequently to estimate the likely pressure that the cuff would exert on the tracheal mucosa as a result of elastic recoil properties of the foam  
class8	2888	the results suggested that  under normal clinical conditions  the pressure is not likely to exceed a value at which impairment of the mucosal blood supply would occur  
class8	2889	wegener s granulomatosis presenting during first trimester of pregnancy  
class8	2889	we describe a case of wegener s granulomatosis in a lady who presented acutely with pulmonary haemorrhage  fever and breathlessness during her early pregnancy  
class8	2889	she responded well to aggressive medical treatment  
class8	2890	variations in urethral and bladder pressure during stress episodes in healthy women  
class8	2890	pressure variations in the urethra and bladder during stress episodes and their time separations were investigated in 30 healthy female volunteers  
class8	2890	the pressure was measured by means of a double microtip transducer catheter with the distal sensor in the bladder and the proximal sensor at the bladder neck  the mid urethra and the distal urethra  
class8	2890	in advance of the pressure spike during cough a pressure rise was demonstrated in the bladder and at all 3 sites of measurement in the urethra  
class8	2890	the urethral pressure increments preceding and following the pressure spike were statistically significantly higher in the mid urethra than the corresponding bladder pressures  
class8	2890	this active urethral pressure generation in the mid urethra and distal urethra was initiated 200 ms before the bladder pressure began to rise  
class8	2890	the pressure in the urethral high pressure zone was higher than the bladder pressure in all cases  
class8	2890	passive pressure transmission to the urethral high pressure zone can take place only insignificantly due to a continuous higher pressure inside the urethra than in the bladder and due to the location of the high pressure zone in the demarcation of the abdominal cavity  
class8	2890	it was concluded that the urethral pressure rise in the high pressure zone during stress episodes is mainly generated actively by intra  and or peri urethral structures  
class8	2891	surgery in patients on long term steroid therapy  a tentative model for risk assessment  
class8	2891	increased morbidity after operation has been associated with long term steroid therapy  
class8	2891	to determine the correlation between steroid therapy and such morbidity  the perioperative course of 55 steroid treated patients was reviewed  27 had bronchopulmonary disorders  group p  and 28 had non pulmonary diseases  group np   
class8	2891	there were six  11 per cent  deaths  of which three were steroid related  
class8	2891	among the 13 non lethal postoperative complications  eight were considered to be steroid related in group p and one in group np  
class8	2891	the duration of steroid therapy was for a median of 24 months  range 1 408 months  in group p and for a median of 6 months  range 1 240 months  in group np  p less than 0 01   
class8	2891	in contrast  the daily dose of hydrocortisone or equivalent before operation was significantly lower in group p  with a median of 0 51 mg kg 1 day 1  range 0 20 2 56 mg kg 1 day 1  than in group np  with a median of 1 20 mg kg 1 day 1  range 0 23 7 38 mg kg 1 day 1   p less than 0 01   
class8	2891	in conclusion  bronchopulmonary disorders requiring a long duration of steroid therapy are associated with a higher risk of steroid related complications after surgery  
class8	2891	a convenient mathematical model is proposed which may allow a preoperative assessment of surgical risk  using steroid dose and duration of treatment  
class8	2892	heterogenous amplification of myc family oncogenes in small cell lung carcinoma  
class8	2892	one hundred forty two foci of small cell lung carcinoma  sclc  from 47 patients were examined for amplification of myc family oncogenes  c myc  n myc  and l myc   by dot blot hybridization using formalin fixed and paraffin embedded materials which were resected surgically or obtained at autopsy  
class8	2892	some selected patients were also examined by in situ hybridization  
class8	2892	amplification of myc family genes was detected in 11 patients  23 4    c myc in one  n myc in five  and l myc in five   
class8	2892	two of the 11 patients  one with n myc and one with l myc  had heterogenously amplified clones  
class8	2892	in the patient with n myc amplification  amplification was detected in metastatic tumors in the pancreas  lung  and pleura  but not in the liver and lymph node metastases  
class8	2892	in the primary tumor  areas with and without n myc amplification were seen  
class8	2892	in the patient with l myc amplification  although amplification was not detected in the surgically resected primary lesion  mediastinal lymph node metastatic lesions obtained at autopsy showed l myc gene amplification  
class8	2892	these two cases  together with previously reported evidence  suggest that myc gene amplification plays an important role in malignant progression  rather than development  of sclc  
class8	2892	in stage iii and iv groups  patients with over ten fold myc gene amplification were suggested to survive for a shorter time than patients without such amplification  p   0 06   
class8	2893	identification of somatostatin receptors in human small cell lung carcinoma  
class8	2893	biopsy specimens obtained from eight patients with lung cancer were tested for content of somatostatin receptors by autoradiography  
class8	2893	somatostatin receptors were detected in two of three patients with small cell lung cancer  sclc  but in none of five patients with non small cell lung cancer  nsclc  including adenocarcinoma  two   squamous cell carcinoma  two   and bronchoalveolar carcinoma  one   
class8	2893	in those with sclc  specific somatostatin receptor binding was evidenced only in tumor foci and not in surrounding stroma or normal lung parenchyma  
class8	2893	further tissue characterization by immunoperoxidase staining with the pancytokeratin monoclonal antibody  mab lu 5  revealed labeling to all of the nsclc but to none of the sclc specimen  
class8	2893	selective immunoreactivity was detected in both the sclc and the nsclc specimen to chromogranin and neuron specific enolase  nse  whereas none of the specimen had detectable immunostaining to somatostatin  bombesin  serotonin  adrenocorticotropic hormone  neurofilament  calcitonin  and synaptophysin  
class8	2893	the identification of somatostatin receptors in primary human lung cancer may have a bearing on the biology of this disease and perhaps on the clinical application of somatostatin analogues in patients with sclc  
class8	2894	nasal lymphoma  a retrospective analysis of 60 cases  
class8	2894	sixty cases of nasal lymphomas were reviewed  
class8	2894	there were 42 men and 18 women  
class8	2894	the median age was 49 years  
class8	2894	the histologic types were low grade in four cases  intermediate grade in 33  high grade in seven  and unclassifiable in 16  
class8	2894	thirteen cases had features of polymorphic reticulosis  
class8	2894	the immunophenotype was available in 18 cases and a majority of 67  of them were t cell  
class8	2894	forty one of them  68   had clinically localized  stage i and ii  disease which often spread locally to neighboring tissues and they presented predominantly with nasal symptoms  
class8	2894	nasal lymphoma appeared to carry a poor prognosis  
class8	2894	although our patients with clinically localized disease had significantly better prognosis than those with advanced disease  the 5 year survival of stage i and ii patients was only 55   
class8	2894	chemotherapy did not appear to be more effective than radiotherapy alone in preventing relapses but the patient number was too small to allow a firm conclusion to be made  
class8	2894	patients with advanced disease had even poorer prognosis with a 5 year survival of only 17   
class8	2894	innovative therapy has to be developed for these patients  
class8	2895	chemotherapy related hemolytic uremic syndrome after the treatment of head and neck cancer  a case report  
class8	2895	a 62 year old woman who was being treated for squamous cell carcinoma of the head and neck developed a chemotherapy related hemolytic uremic syndrome during the second cycle of neoadjuvant chemotherapy consisting of cisplatin  bleomycin  and methotrexate  
class8	2895	though the syndrome was suspected early  attempts at reversing the hematologic and renal abnormalities were unsuccessful  
class8	2895	at postmortem examination  the characteristic microvascular lesions of the hemolytic uremic syndrome were found in the kidneys  
class8	2896	primary carcinoma of the upper urinary tract  effect of primary and secondary therapy on survival  
class8	2896	the pathologic material and medical records of 76 patients with primary upper urinary tract carcinomas were reviewed to identify the role of grade and stage in predicting survival  to determine any differences in survival between ureteral and renal pelvic carcinoma  to understand the role of local therapy in low grade  low stage tumors  and to establish the usefulness of adjuvant therapies in metastatic disease  
class8	2896	kaplan meier survival curves with cox mantel analysis for statistical significance revealed both grade and stage to be excellent predictors of survival  
class8	2896	no differences in survival were noted between renal pelvic and ureteral carcinomas for equivalent stage tumors  
class8	2896	for low grade  low stage tumors  although there was an increased risk of local recurrence with local therapy  there were no differences in survival between patients treated with local therapy or radical surgery  
class8	2896	finally  cisplatin based chemotherapy seemed to improve survival in patients with metastatic disease  
class8	2897	thromboembolism  a complication of weekly chemotherapy in the treatment of non hodgkin s lymphoma  
class8	2897	in a retrospective survey of 85 patients who received chemotherapy as treatment for non hodgkin s lymphomas  the authors found that clinically apparent thromboembolic disorders occurred in four of 11 patients receiving weekly chemotherapy  and in none of 74 patients who were treated on less intensive schedules  suggesting that intensive weekly chemotherapy is thrombogenic  
class8	2897	the possible mechanisms of this effect are discussed  
class8	2898	unusual case of pacemaker lead migration  
class8	2898	pulmonary artery migration of pacemaker lead is rare and may result in pulmonary emboli originating from the thrombus around the infected catheter and causing multiple pulmonary infarcts  
class8	2898	we report an unusual case of pacemaker lead migration to the right pulmonary artery with septic pulmonary embolism  
class8	2898	while being treated with intravenous cefuroxamine  the patient had spontaneous migration of the lead to the left pulmonary artery with subsequent left pulmonary embolism  
class8	2899	left ventricular ejection fraction may not be useful as an end point of thrombolytic therapy comparative trials  
class8	2899	in the era of comparative and adjunctive trials in reperfusion therapy  the need to develop alternative end points for mortality reduction is clear  
class8	2899	left ventricular ejection fraction  which has been commonly used as a surrogate  is problematic due to missing values  technically inadequate studies  and lack of correlation with mortality results in controlled reperfusion trials performed to date  
class8	2899	in this paper  we present a composite clinical end point that includes  in order  severity of adverse outcome death  hemorrhagic stroke  nonhemorrhagic stroke  poor ejection fraction  less than 30    reinfarction  heart failure  and pulmonary edema  
class8	2899	such a composite index may be useful to detect true therapeutic benefit in reperfusion trials without necessitating greater than 20 30 000 patient enrollment  
class8	2900	peak flow nasal patency indices and self assessment in septoplasty  
class8	2900	the present study evaluates the results of septoplasty monitored by the objective peak flow nasal patency indices and the subjective patient self assessment scores of nasal obstruction  
class8	2900	mini wright peak flow meters were used  
class8	2900	the peak flow nasal patency index was defined as the ratio between nasal and oral peak flow rates  
class8	2900	uni and bi lateral  as well as ex and in spiratory  indices were calculated  
class8	2900	both peak ex and in spiratory flow nasal patency indices were significantly increased 1 and 6 months post operatively  indicating improved nasal patency  
class8	2900	the most marked post operative increase of the nasal patency indices was seen for the preoperatively worst airway and the total airway  
class8	2900	a weak significant positive correlation was found between the peak flow nasal patency indices and the patient mean self assessment scores of the uni and bi lateral nasal obstruction  
class8	2900	the change of the peak flow nasal patency indices measured 6 months post operatively correlated well with the patient overall assessment of the operative changes of the total nasal patency  
class8	2900	the method was found quick and easy to handle in monitoring the effect of functional septoplasty and is recommended as an alternative to rhinomanometry  
class8	2901	trimming of the inferior turbinates  a prospective long term study  
class8	2901	the aim of this study was to determine whether the initial benefits of radical trimming and anterior trimming of the inferior turbinates on nasal airflow persisted in the long term  
class8	2901	radical trimming significantly reduced nasal resistance at 2 months following operation  n   12   p less than 0 005   
class8	2901	there was no significant change in nasal resistance over the next 20 months  
class8	2901	symptom scores for nasal obstruction also showed a significant reduction  n   16   p less than 0 005   at 2 months  and did not change significantly over the next 20 months  
class8	2901	radical trimming of the inferior turbinates is a highly effective operation in patients with hypertrophy of the inferior turbinates with few initial complications  
class8	2901	however  further analysis of the data revealed that up to 20  of patients lose the initial subjective benefit of relief of nasal obstruction within 2 years of follow up  
class8	2901	late onset crusting occurs in some patients though this is not directly attributable to an increase in nasal airflow  
class8	2901	this study also concludes that anterior trimming of the inferior turbinates cannot be recommended as a form of treatment  
class8	2902	chest infection following head and neck surgery  a pilot study  
class8	2902	this paper reports the results of a pilot study which examined factors associated with chest infection following head and neck surgery  
class8	2902	the overall rate of chest infection was 11   but was 20  in those patients having a tracheotomy  
class8	2902	no infection developed in patients with an intact airway  
class8	2902	other factors which emerged as possibly important were the duration of surgery and heavy regular alcohol intake  
class8	2902	we recommend that prophylactic antibiotics be continued for at least 48 h in patients requiring a tracheotomy as part of their head and neck surgery  
class8	2902	this is against the trend of shorter antibiotic regimens recommended for prevention of wound infections  
class8	2903	acute respiratory failure  
class8	2903	pregnancy entails many unique physiologic changes that make the management of ards both challenging and unique  
class8	2903	most of these women are young and in excellent health before their acute injury  and their survival should exceed that of the general population who develop ards  
class8	2903	we advocate aggressive management of the suspected lung injury including early intubation and the institution of invasive hemodynamic monitoring  
class8	2903	this approach ensures the most thorough assessment of the extent of the initial injury and allows rapid assessment of therapeutic maneuvers and their subsequent adjustment  
class8	2903	our goal is to reverse the initial insult early while avoiding further iatrogenic injury  
class8	2903	optimal management of the maternal fetal pair requires the cooperation of an obstetrician well versed in cardiopulmonary physiology and physicians skilled in intensive care medicine  
class8	2904	mechanical measures in the prophylaxis of postoperative thromboembolism in total knee arthroplasty  
class8	2904	total knee arthroplasty patients are at high risk for deep venous thrombosis and pulmonary embolism  
class8	2904	prophylaxis against deep venous thrombosis and pulmonary embolism in these patients seems mandatory  
class8	2904	pharmacologic agents such as dextran 40  aspirin  and warfarin are effective but may be associated with significant complications such as drug reaction  bleeding  hematoma  and hemarthrosis  
class8	2904	heparin was not effective and was associated with significant bleeding complications  
class8	2904	mechanical methods such as continuous passive motion and sequential pneumatic compression stockings were without complications and seemed equal to or more effective than pharmacologic agents  
class8	2904	adding warfarin to mechanical methods did not seem to augment the antithromboembolic effect of the mechanical methods  
class8	2905	does alternate day cloprednol therapy prevent bone loss  a longitudinal double blind  controlled clinical study  
class8	2905	osteoporosis is a serious side effect of systemic treatment with steroids  
class8	2905	cloprednol  a synthetic glucocorticoid with an anti inflammatory potency twice that of prednisone  causes less calcium and nitrogen excretion than does prednisone in equipotent doses  
class8	2905	therefore a double blind study was undertaken comparing the effects of alternate day cloprednol and prednisone therapy on bone mineral density in 39 patients  cloprendol  13 men and 8 women aged 48 5     2 8 years  prednisone  9 men and 9 women aged 49 7     1 7 years  with lung diseases  
class8	2905	ten patients with asthma  9 men and 1 woman aged 37 8     3 7 years  inhaling daily beclomethasone served as control subjects  
class8	2905	trabecular and total bone density of the distal tibia and radius was determined quarterly during 1 year with a special purpose computed tomographic system  
class8	2905	initial mean trabecular bone density of the patients receiving cloprednol and prednisone was 17  below normal  
class8	2905	after a treatment period of 1 year  we found a loss of radial trabecular bone density  mean     sem  of 1 33      0 49  in the cloprednol group and 2 38      0 69  in the prednisone group  
class8	2905	in postmenopausal women  prednisone but not cloprednol therapy caused significant  p less than 0 01  trabecular bone loss  5 29      0 99  versus 0 70      0 65    
class8	2905	the control group lost 0 91      0 79   
class8	2905	loss of cortical bone was insignificant in all three groups  
class8	2905	in post menopausal women  1 year of alternate day cloprednol therapy was associated with significantly less bone loss than was prednisone therapy in equipotent dosages  
class8	2906	community acquired pneumonia  evidence of functional inactivation of alpha 1 proteinase inhibitor  
class8	2906	quantitative and qualitative elastase inhibitory capacity  eic  alpha 1 proteinase inhibitor  alpha 1 pi  was measured in pulmonary arterial and systemic arterial blood of patients with community acquired pneumonia  cap   
class8	2906	eleven patients with uncomplicated cap were compared with 16 patients with fulminating pneumonia requiring intensive care management  
class8	2906	an appropriate increase in quantitative alpha 1 pi was demonstrated in all patients  
class8	2906	a significant functional inactivation of alpha 1 pi was demonstrated in the icu treated patients that was not apparent in the uncomplicated cap patients  p less than  01   
class8	2906	this low eic returned to normal 4 wk after hospital discharge in all survivors  
class8	2906	a significant  p less than  02  difference in eic between the pulmonary arterial and systemic arterial blood was found in the nonsurvivors on admission  which suggests that alpha 1 pi is inactivated in the lungs of patients with fulminating cap  
class8	2906	the present data demonstrate that alpha 1 pi is functionally inactivated in patients with fulminating cap  
class8	2906	this low serum functional alpha 1 pi may result in proteolytic lung damage and an unfavorable outcome  
class8	2907	tracheostomy in children with guillain barre syndrome 
class8	2907	during the 10 yr period beginning january 1979  59 infants and children with guillain barre syndrome  gbs  were admitted to our hospital  
class8	2907	tracheostomies were performed in 15 patients and their records were reviewed  
class8	2907	fourteen patients were recalled for assessment of pulmonary function and respiratory muscle strength  rms   
class8	2907	the median duration of assisted ventilation  including endotracheal  et  intubation  was 21 days and the median duration of tracheostomy was 39 days  
class8	2907	only two patients were discharged with the tracheostomy in situ  
class8	2907	all patients were successfully decannulated at the first attempt  
class8	2907	no tracheostomy related complications or symptoms were reported apart from croup in two patients  
class8	2907	on review  lung volumes and maximal inspiratory and expiratory flows were normal  
class8	2907	there was no evidence of tracheal stenosis or significant tracheomalacia  
class8	2907	rms tests were normal  
class8	2907	in this hospital  tracheostomy is a safe  well tolerated procedure in the management of infants and children with gbs who need long term ventilation  
class8	2907	there were no deaths and all patients returned to their normal school or were gainfully employed after their illness  although 12 patients had mild persistent weakness of at least foot dorsiflexion  
class8	2908	prevention of nosocomial lung infection in ventilated patients  use of an antimicrobial pharyngeal nonabsorbable paste  
class8	2908	a comparative  prospective study was made of the incidence of infection in the lower airway  purulent tracheobronchitis and pneumonia  in long term patients who were mechanically ventilated due to respiratory failure of noninfectious origin  
class8	2908	twenty eight patients were randomly allocated into a study group  a  n   13  in which a nonabsorbable paste containing 2  tobramycin  2  amphotericin b  and 2  polymyxin e was administered locally to decontaminate the oropharynx  and a control group  b  n   15  in which a paste without antibiotics was also applied to the oropharynx  
class8	2908	we studied the effectiveness of the prophylactic technique in decontaminating the oropharynx and trachea of organisms potentially pathogenic for the respiratory system  
class8	2908	decontamination was successful in ten of 13 patients in group a vs  
class8	2908	one of 15 patients in group b  p less than  001   
class8	2908	the results demonstrated a lower rate of infection in the lower respiratory tract in the study group  three patients with tracheobronchitis and no pneumonias  than in the control group  three patients with tracheobronchitis and 11 with pneumonia   the difference between both being highly significant  p less than  001   
class8	2908	two  15   patients in group b developed sepsis of pulmonary origin  
class8	2908	none of the patients on prophylactic treatment developed this complication  
class8	2908	although the overall mortality was similar in both groups  group a  30  vs  
class8	2908	group b  33    we believe that infection contributed to a great extent to the death of two of five patients in group b  
class8	2908	we conclude that nosocomial pneumonia  which is a frequent complication in critically ill patients on mechanical ventilation  could be prevented by local application of nonabsorbable antibiotics to the oropharynx  
class8	2909	iatrogenic illness in pediatric critical care  
class8	2909	iatrogenic illness may be an important determinant of the need for pediatric intensive care  
class8	2909	we prospectively evaluated consecutive admissions to a pediatric icu  picu  over two time periods totaling 6 months  
class8	2909	twenty five  4 6   admissions were necessitated by iatrogenic illnesses  
class8	2909	drug induced conditions accounted for eight  32   of the iatrogenic patients  and complications of medical surgical acts accounted for 17  68    
class8	2909	diagnoses included six respiratory failures due to seizure medications  six chronic upper airway complications of neonatal intensive care  four posttonsillectomy and postadenoidectomy complications  two chronic postcardiac surgery complications  two cardiac catheterization complications  and five miscellaneous conditions  
class8	2909	one  3 7   patient with iatrogenic illness died  
class8	2909	as a group  patients with iatrogenic illness were at a risk of dying similar to other patients  
class8	2909	we conclude that iatrogenic illness is a significant cause of picu admission  
class8	2910	high frequency oscillation during simulated altitude exposure  
class8	2910	ventilatory requirements using high frequency oscillation  hfo  during simulated altitude exposure were investigated in control dogs and animals with oleic acid induced lung injury  
class8	2910	fio2 values of 0 21 and 1 0 were supplied by bias flow to the normal and injured dogs  respectively  
class8	2910	after a control period  animals were exposed to a simulated altitude of 8 000 ft  barometric pressure 564 torr   followed by a second control period at ground level  
class8	2910	both experimental groups had similar values of paco2 at ground level and during exposure to reduced barometric pressure  
class8	2910	the tidal volume necessary to maintain eucapnia was higher in oleic acid injured animals compared with the control group  cardiac output and functional residual capacity were lower  
class8	2910	the alveolar arterial oxygen difference was substantially larger in the oleic acid group  
class8	2910	adequate gas exchange can be maintained with hfo during exposure to altitude provided that ventilation and inspired po2 are not reduced below normobaric levels  
class8	2911	undiagnosed tuberculosis in patients with human immunodeficiency virus infection 
class8	2911	we describe the clinical features of 11 patients with human immunodeficiency virus infection in whom tuberculosis was undiagnosed and untreated prior to death  
class8	2911	most patients  9 of 11  had pulmonary complaints and 8 of 11 had roentgenographic findings suggestive of tuberculosis  hilar or mediastinal adenopathy  pleural effusion  apical infiltrate or miliary pattern   
class8	2911	despite these findings  tuberculin skin tests were not performed in any of the patients  
class8	2911	acid fast smears of sputum were obtained in three cases and bronchoscopy performed in only four  reflecting the low index of suspicion for tuberculosis  
class8	2911	pneumocystis carinii pneumonia was the presumptive diagnosis in nine cases but was confirmed in only one case  
class8	2911	autopsy revealed tuberculosis as the cause of death in four patients  
class8	2911	of the seven patients who did not undergo autopsy  disseminated tuberculosis  manifest by mycobacteremia  was the only life threatening illness identified and probably contributed to death  
class8	2911	increased awareness of the clinical and roentgenographic features of tuberculosis in hiv infected patients  combined with more intensive use of acid fast smears and tuberculin skin testing  are necessary in order to decrease mortality from this treatable complication of hiv infection  
class8	2912	pulmonary manifestations of disseminated cryptococcosis in patients with aids  
class8	2912	forty eight patients with disseminated cryptococcosis and aids were retrospectively studied to define the pulmonary manifestations  
class8	2912	cryptococcus neoformans  cn  was first isolated from a pulmonary site in 12 patients  
class8	2912	disseminated disease was subsequently documented in all these patients  
class8	2912	symptoms and roentgenographic manifestations  normal  nodular circumscribed infiltrates  pleural effusions  lobar consolidation  were diverse  
class8	2912	interstitial infiltrates predicted the presence of another opportunistic lung infection besides cryptococcosis in five patients  three untreated and two treated patients   
class8	2912	infectious causes other than cryptococcosis were established by culture and clinical course in five of the ten patients who developed chest roentgenographic abnormalities during amphotericin b therapy  
class8	2912	endobronchial abnormalities were identified in four patients at bronchoscopy  
class8	2912	bronchoalveolar lavage  9 9  and pleural fluid  3 3  cultures were sensitive tests for detection of pulmonary involvement with cn  
class8	2913	mortality from pulmonary embolism in the united states  1962 to 1984  
class8	2913	to examine the effect of advances in the prevention of and therapy for pe  we reviewed mortality for pe in the united states from 1962 to 1984  
class8	2913	age adjusted pe mortality increased by 67 to 100 percent between 1962 and 1974 for white and non white men and women  
class8	2913	from 1975 to 1984  these rates declined by 20 to 28 percent  
class8	2913	non white pe mortality was greater than white pe mortality  men had a greater risk of pe death than women  
class8	2913	age specific patterns  more than 40 years of age  of pe mortality followed those of the age adjusted death rates  with increases noted in all groups between 1962 and 1974 and declines during the 1975 1984 period  
class8	2913	these patterns might reflect improved ascertainment of cases and better prevention of disease  
class8	2913	the magnitude of the rates suggests that the list of indications for prophylactic anticoagulation should be re examined for possible expansion  
class8	2914	exercise performance of polycythemic chronic obstructive pulmonary disease patients  effect of phlebotomies  
class8	2914	the purpose of this study was to determine the effects of phlebotomy on the exercise tolerance and right and left ventricular ejection fraction of polycythemic patients with chronic obstructive pulmonary disease  
class8	2914	ten patients with copd  mean fev1   1 32     0 55 l  and polycythemia  mean hct   62     3 percent  were studied before and after their hematocrits had been reduced to approximately 50 percent  
class8	2914	post phlebotomy the maximal oxygen consumption increased from 1 09     0 34 l min to 1 26     0 43 l min  p less than 0 05  and the maximum workload increased from 56 5     32 6 watts to 74 5     23 4 watts  p less than 0 05   
class8	2914	the increase in the exercise tolerance appeared to be primarily due to an increased cardiac output at emax  
class8	2914	there was no relationship between the increases in the upright exercise capacity and changes in the supine ejection fractions of the right or left ventricular either at rest or during exercise  
class8	2915	quality of well being before and after antibiotic treatment of pulmonary exacerbation in patients with cystic fibrosis  
class8	2915	general quality of life has only recently been measured with an objective tool in patients with cystic fibrosis  cf   and there have been no reported attempts to document changes in patients  overall well being over time  as patients deteriorate or respond to intervention  
class8	2915	we applied the quality of well being scale  qwb  in 28 patients with cf before and after a two week course of oral ciprofloxacin used to treat pulmonary exacerbations  
class8	2915	there were significant correlations between changes in qwb and various pulmonary function test results  qwb vs fev1  r   0 4  p less than 0 03  qwb vs fvc  r   0 5  p less than 0 01  and qwb vs sao2  r   0 4  p less than 0 05  
class8	2915	thus  the qwb can track changes in general well being in cf patients over a brief time and detect changes associated with pulmonary exacerbation and its treatment  
class8	2916	subpleural mononuclear cell infiltration  significance in the differential diagnosis of pleuritis showing nonspecific histologic findings  
class8	2916	to determine if patients who had lymphocyte rich pleural effusion and a pleural biopsy without any specific findings could be histopathologically differentiated between those with tuberculous and nontuberculous pleuritis  we histologically re evaluated the pleural biopsies of all patients whose pleural effusion was predominant with lymphocytes and contained no malignant cells  
class8	2916	a total of 40 patients with a nonspecific histologic findings of pleural biopsy specimen were categorized based on their ultimate diagnosis as having tuberculous  n   15   carcinomatous  n   10  or nontuberculous  benign pleuritis  n   15   
class8	2916	the pleural biopsy specimen of patients with nontuberculous  benign pleuritis frequently showed a band like infiltration of mononuclear cells in the subpleural adipose tissue with minimal pleural inflammatory infiltrate  10 out of 15 patients   while the same finding was infrequent in those with tuberculous pleuritis  0 out of 15  p   0 0001  and pleuritis associated with carcinoma  three out of 10  p   0 082   
class8	2916	based on these results  the presence of band like infiltration of mononuclear cells in the subpleural adipose tissue with minimal pleural inflammatory infiltrate in pleural biopsy specimens of patients with lymphocyte rich pleural effusion suggests that the pleuritis is nontuberculous in its nature  
class8	2917	bronchial cartilage alterations in lung transplantation  
class8	2917	changes in the hyaline cartilage of the proximal bronchial tree were investigated in a group of combined heart lung and double lung recipients with and without ob  
class8	2917	ossification  calcification and fibrovascular ingrowth into the normally avascular hyaline bronchial cartilage were observed in almost all patients and were independent of small or large airway inflammation  
class8	2917	alterations in the integrity of hyaline cartilage have been produced by others in animals by ligation of the blood supply  
class8	2917	finding similar changes in airway cartilage of all transplanted lungs argues that there is relatively poor perfusion to the proximal air conducting passage  
class8	2917	such a mechanism may contribute to the development of ob  bronchiectasis and a predilection for infections following pulmonary transplantation  
class8	2918	hypothyroidism and pleural effusions  
class8	2918	serous effusions have been thought to be an unusual complication of hypothyroidism and most commonly have been associated with ascites  pericardial fluid and heart failure  
class8	2918	pleural fluid as an isolated finding in hypothyroidism is apparently rare and complete analysis of these hypothyroid associated pleural effusions has not been described  
class8	2918	to determine the frequency  chemical characteristics and clinical associations of hypothyroidism and pleural effusions  the medical records of 128 patients with hypothyroidism  defined by an increased serum tsh concentration  were reviewed  
class8	2918	the majority of effusions in patients with hypothyroidism were due to other diseases  
class8	2918	effusions solely due to hypothyroidism appeared to be a real entity  
class8	2918	these effusions were borderline between exudates and transudates and showed little evidence of inflammation  
class8	2919	hyperresponsiveness of the extrathoracic airway in patients with captopril induced cough 
class8	2919	it has been suggested that cough from captopril may originate from an increased sensitivity of receptors in the extrathoracic airway  ea   
class8	2919	to explore this hypothesis  we assessed the responsiveness of ea and bronchi and the cough sensitivity to inhaled histamine in nine hypertensive patients with captopril induced cough  group 1  during treatment and one month after withdrawal of the drug treatment  
class8	2919	nine patients who were asymptomatic while receiving captopril  group 2  and nine patients receiving no current treatment  group 3  served as controls  
class8	2919	the ea responsiveness was assessed by using the maximal midinspiratory flow  mif50  as an arbitrary index of ea constriction and was expressed as the histamine concentration causing a 25 percent decrease in mif50  pc25mif50   
class8	2919	pc15fev1 was the index of bronchial responsiveness and pccough  dose causing five or more coughs  was that of cough sensitivity  
class8	2919	airway hyperresponsiveness  ea hr or bhr  was diagnosed when pc25mif50 or pc15fev1 were 8 mg ml or lower  
class8	2919	patients with captopril cough  as compared with controls  had significantly lower values of pc25mif50  pc15fev1  and pccough  ea hr and bhr were found  respectively  in seven and three of these patients and in none of the control subjects  
class8	2919	in all the patients of group 1  cough and ea hr resolved after withdrawal of captopril treatment  while bhr persisted in one  
class8	2919	pc25mif50  pc15fev1  and pccough were all significantly improved  
class8	2919	our findings suggest that cough during captopril therapy may originate from receptors in the ea  
class8	2920	the entrainment of low frequency breathing periodicity  
class8	2920	it has been predicted by mathematical models of the respiratory control system that the delay between the lung and the respiratory controller may determine the cycle time found in periodic breathing  
class8	2920	we examined cycle time of periodic breathing and circulation time in 11 patients known to have circulation delay due to heart failure  
class8	2920	we did not find a significant relationship between the amount of periodic breathing and circulation delay  but found a very high correlation between circulation delay and the cycle time of periodic breathing  r2   0 825  p   0 0001   
class8	2921	bronchoalveolar lavage in liquid paraffin pneumonitis  
class8	2921	we evaluated cells and lipids recovered in the bronchoalveolar lavage fluid from seven patients with liquid paraffin pneumonitis  
class8	2921	for each patient  the balf was whitish with oil droplets on the surface  
class8	2921	alveolar macrophages contained numerous  large vacuoles that did not react with may grunwald giemsa  papanicolaou  or periodic acid schiff but were stained in black with sudan b  orange with sudan iii and red with oil red o  
class8	2921	liquid paraffin was identified on thin layer chromatography of balf extracted lipids as a very hydrophobic compound migrating on the solvent front as control liquid paraffin  
class8	2921	this abnormal spot was definitely identified as liquid paraffin by infrared spectroscopy and gas liquid chromatography for the first patient  
class8	2921	the number and percentage of ams were largely decreased in the balf of each patient  whereas the number of neutrophils  eosinophils and lymphocytes was increased  
class8	2921	these findings suggest that this cell mediated inflammatory response plays a role in the development of interstitial fibrosis at late stages of liquid paraffin pneumonitis  
class8	2922	feasibility of intraoperative cytodiagnosis of lung cancer  
class8	2922	of 354 thoracotomies  114 cases involved intraoperative cytopathologic evaluation  
class8	2922	the study included 86 men and 28 women  and 184 specimens were examined  
class8	2922	smears were taken from the lung lesion or lymph node and the chest wall or bronchial stump by imprint or needle aspiration  
class8	2922	intraoperative evaluations were compared with histologic findings  
class8	2922	in 85 cases not diagnosed as malignant preoperatively  malignancy was confirmed in 97 6 percent of cases and histologic type in 71 8 percent  
class8	2922	in the 28 cases diagnosed as malignant preoperatively  there was only one false negative  
class8	2922	the most important finding during thoracotomy is whether a lesion is malignant or not  
class8	2922	the time required to obtain a pathologic diagnosis also is important  
class8	2922	we are able to obtain the results of a cytologic diagnosis within 10 min  
class8	2922	cytologic diagnosis of malignancy during thoractomy may be a feasible and convenient method of diagnosis  especially where malignancy is suspected  
class8	2923	concentration of tumor associated trypsin inhibitor  tati  in pleural effusions  
class8	2923	we measured the concentration of tumor associated trypsin inhibitor  tati  in plasma and pleural fluid of 84 patients with pleural effusions of various causes  
class8	2923	we observed elevated  greater than 30 micrograms l  tati levels in pleural fluid in 45 percent of patients with pleural effusion associated with malignant disease and in 15 percent of patients with benign disease  
class8	2923	similar results were obtained for tati in plasma  
class8	2923	the concentration of tati in pleural fluid closely parallelled that in plasma  
class8	2923	in patients with renal insufficiency and in patients with biliary obstruction  the tati levels were elevated both in plasma and pleural fluid  
class8	2923	a positive correlation was seen between the concentration of tati and the activity of alkaline phosphatase in plasma  
class8	2923	the results show that simultaneous determination of tati in plasma and pleural fluid improves the diagnosis of cancer only marginally  
class8	2923	our results also support the hypothesis that elevated tati levels may reflect an acute phase reaction caused by inflammatory disease or tissue destruction associated with cancer not only in inflammatory conditions  but also in malignant disease where the tumor itself is not producing tati  
class8	2924	neural respiratory drive and neuromuscular coupling in patients with chronic obstructive pulmonary disease  copd   
class8	2924	in 15 spontaneously breathing patients with chronic obstructive pulmonary disease  copd  divided into two groups  one with normocapnia  a  and one with chronic hypercapnia  b   we evaluated the maximal voluntary inspiratory muscle strength  mip   the pattern of breathing  the mouth occlusion pressure  po 1   the neural respiratory drive  nrd   assessed by surface electromyographic  emg  activity of the diaphragm  emgd  and emg activity of intercostal muscles  emgint   and the chest wall neuromuscular coupling  assessed in terms of po 1 emgd ratio  
class8	2924	compared with an age matched normal control group  both a and b groups exhibited lower mip  significantly greater emgd and emgint  and lower po 1 emgd ratio  
class8	2924	however  a similar pattern  along with a rapid and shallow breathing  differentiated group b from group a  
class8	2924	in group b we found a significant direct relationship between po 1 emgd ratio and mip  and an inverse relationship between paco2 and po 1 emgd ratio  
class8	2924	these data seem to indicate the following   1  emg is a more precise method than po 1 in assessing the magnitude of the nrd   2  nrd is increased in these patients  and  3  clinical manifestations probably associated with inspiratory muscle fatigue  marked decrease in muscle strength  rapid and shallow breathing  and alveolar hypoventilation  may be accompanied by a greater nrd and a more marked derangement in chest wall neuromuscular coupling in copd  
class8	2925	determinants of cell type in patients with cancer of the lungs  
class8	2925	in order to evaluate the determinants of cell type in patients with primary lung cancer  we compared smoking characteristics in 1 939 patients  1 474 men and 465 women   
class8	2925	patients with squamous cell carcinomas  adenocarcinomas  or small cell carcinomas were eligible  
class8	2925	this study did not consider smoking as a risk factor for lung cancer  as all subjects had a confirmed diagnosis  
class8	2925	we were interested in smoking history and the pattern of smoking among those whose risk was 100 percent  
class8	2925	among these patients  we confirmed that a larger subset of nonsmoking individuals developed adenocarcinomas than squamous cell or small cell carcinomas  however  the duration and intensity of cigarette smoking  as measured by pack years  were not determinants of tumor cell type in male patients  
class8	2925	small cell carcinomas in women were more strongly associated with cigarette smoking than either squamous cell carcinomas or adenocarcinomas  
class8	2925	more than 3 500 different substances have been measured in tobacco smoke  including tumor initiators  promoters  and those involved in tumor progression  
class8	2925	these data confirm the hypothesis that factors other than cigarette smoking are more likely to be involved in the initiation of adenocarcinomas than other cell types  
class8	2925	endogenous and exogenous factors related to gender may be more important than the duration or intensity of cigarette smoking  
class8	2926	real and pseudo late asthmatic reactions after submaximal exercise challenge in patients with bronchial asthma  a new definition for late asthmatic responses after exercise challenge  
class8	2926	the late asthmatic reaction after exercise challenge remains a controversial issue  
class8	2926	in this study  21 patients recorded peak expiratory flow rate  pefr  on two control days without performing exercise  
class8	2926	there was no difference between both control days when pefr at 1 h was compared with baseline pefr and when pefr at 4 to 13 hours was compared with baseline pefr  
class8	2926	after analyzing variation coefficients of baseline pefr on a control day and exercise day  pefr was not allowed to differ more than 15 3 percent in the same patient when comparing exercise day and control day for the late fall in pefr in the study  
class8	2926	in 17 of 81 patients  a late asthmatic reaction after exercise challenge was present when pefr fall was greater than or equal to 20 percent compared with baseline pefr value  
class8	2926	in eight of the 17 patients  a real late asthmatic reaction to exercise challenge was present with a pefr fall greater than or equal to 20 percent on at least three successive time points and who had a pefr fall greater than or equal to 20 percent compared with corresponding clocktime on a control day  
class8	2926	the late asthmatic reaction to exercise challenge is characterized not as a nonspecific epiphenomenon  but as a fall in pefr of greater than or equal to 20 percent compared with baseline pefr value and with corresponding clocktime on a control day on at least three successive time points  
class8	2926	graphic illustration of airway responses following exercises may facilitate the detection of a late asthmatic response  
class8	2927	permeability pulmonary edema following lung resection  
class8	2927	the etiology of edema associated with pulmonary resection was investigated in five patients during the immediate postoperative period  
class8	2927	three patients received pneumonectomy while two patients had one lobe resected  
class8	2927	all patients suffered from severe respiratory distress and had x ray evidence of diffuse interstitial pulmonary edema within 12 hours of surgery  
class8	2927	hemodynamic data were obtained with radial and pulmonary artery catheters  
class8	2927	edema fluid was obtained along with blood samples for simultaneous determination of protein and albumin content  
class8	2927	all patients studied had normal or high cardiac output  normal cardiac filling pressures  and edema fluid protein to serum protein ratio of 0 6 or greater suggestive of permeability changes contributing to edema fluid accumulation  
class8	2927	calculated shunt fraction exceeded 25 percent in all patients  
class8	2927	pulmonary edema has been noted in patients following pulmonary resection in the early postoperative period  
class8	2927	in patients reviewed here  two factors appeared to be significant  
class8	2927	first is an increase in pulmonary capillary pressure associated with passage of a normal to high cardiac output in a reduced volume pulmonary vascular bed  
class8	2927	the second factor  as demonstrated by protein content in the edema fluid  is injury to the alveolar capillary membrane  
class8	2928	hemoptysis in a 49 year old man  an unusual presentation of a sporadic disease  
class8	2928	although amebiasis is prevalent in tropical and subtropical areas  it occurs sporadically in the united states  
class8	2928	pleuropulmonary involvement is seen in about 20 percent of the patients with amebic liver abscesses  
class8	2928	we describe a patient with pleuropulmonary amebiasis who complained of hemoptysis but had no gastrointestinal symptoms  
class8	2928	this rather unusual presentation caused a considerable delay in securing the diagnosis  
class8	2929	rounded atelectasis complicated by obstructive pneumonia and pulmonary arterial thrombosis  published erratum appears in chest 1991 jun 99 6  1556  
class8	2929	a patient with a history of asbestos exposure developed rounded atelectasis  
class8	2929	the mass was associated with local bronchial obstruction  obstructive pneumonia and arterial thrombosis  
class8	2929	autopsy demonstrated marked pleural thickening and radiographically inapparent asbestosis  
class8	2929	this is the first reported case in which seemingly benign rounded atelectasis not only increased morbidity  but also contributed to mortality through airway obstruction and local arterial thrombosis  
class8	2930	dialysis induced respiratory acidosis  
class8	2930	the inability to increase alveolar ventilation can lead to co2 retention and acute respiratory acidosis in patients with ventilatory limitation  
class8	2930	in this case  a young woman receiving maximum ventilatory support was unable to excrete excess co2  associated with increasing dianeal concentrations of peritoneal dialysis  
class8	2930	since the patient s lung disease had necessitated a large amount of ventilatory support  the patient was unable to increase ve appropriately to handle excess co2  
class8	2930	peritoneal dialysate was an additional source of carbohydrates  
class8	2930	peritoneal dialysate is an additional carbohydrate source that may result in hypercapnia and respiratory acidosis in patients with respiratory compromise  
class8	2930	to our knowledge  this is the first case report in an adult which demonstrates that peritoneal dialysis with high glucose loads produced an acute respiratory acidosis that was reversed by decreasing the glucose concentrations in the dialysate  
class8	2930	excess co2 production should be considered with respiratory disorders associated with dialysis  
class8	2931	occult fatal pulmonary embolism with disseminated intravascular coagulation  an unusual case masquerading as miliary tuberculosis  
class8	2931	we report a fatal case of occult pulmonary embolism complicating bronchogenic carcinoma which presented with rapidly progressive pulmonary miliary shadows and respiratory failure  
class8	2931	a clotting profile abnormality compatible with disseminated intravascular coagulation was noted  
class8	2931	postmortem examination showed extensive clots occluding the major pulmonary vessels and areas of pulmonary infarcts  
class8	2931	histologic examination revealed fibrin deposition in the microvasculature compatible with dic  
class8	2931	cases of pulmonary embolism with dic have previously been reported  but this is the first case with pathologic confirmation  
class8	2931	thus  unusual presentation with diffuse lung shadow and dic should not deter the clinician from correct diagnosis so that appropriate treatment can be promptly started  
class8	2932	pulmonary malignant angioendotheliomatosis  presentation with fever and syndrome of inappropriate antidiuretic hormone  
class8	2932	a 64 year old man presented with protracted fever  hyponatremia  and mononeuritis multiplex  
class8	2932	inappropriate antidiuretic hormone secretion was established  
class8	2932	the absence of pulmonary infiltrates precluded any lung biopsy  
class8	2932	autopsy revealed malignant angioendotheliomatosis involving multiple organs including the alveolar septa and pulmonary vasculature  
class8	2932	an early diagnosis of mae in the setting of fever and siadh may be possible via transbronchial biopsy  
class8	2933	utility of angiograms in patients with catamenial hemoptysis  
class8	2933	pulmonary endometriosis is the likely cause in patients with hemoptysis during menses  
class8	2933	while we describe two cases of catamenial hemoptysis  which were localized with chest ct scanning  angiograms revealed normal appearance  
class8	2933	we suggest that angiograms may have little value in the evaluation of patients with pulmonary endometriosis  
class8	2934	kyphoscoliosis and respiratory failure  a patient treated with assisted ventilation for 27 years  
class8	2934	a 62 year old woman had had kyphoscoliosis since age 12 years  
class8	2934	respiratory failure developed at age 35 years following a respiratory infection  
class8	2934	a tracheostomy was done and she required assisted ventilation using a respiratory  bird   
class8	2934	many attempts at weaning her from the ventilator were unsuccessful  
class8	2934	she has remained dependent on assisted ventilation for more than 27 years but has had a relatively comfortable and meaningful life  
class8	2934	in 1983  a left pleuroscopy was done related to recurrent pneumothorax and numerous small bullae were seen on the lung surface  
class8	2934	recent investigation using computed tomographic scanning has shown patchy areas of emphysema in both lungs  
class8	2934	emphysema is not a feature of kyphoscoliosis and it is suggested that intermittent positive pressure applied to the lung over long duration may cause the lung destruction of emphysema  
class8	2935	use of nd yag laser in endobronchial kaposi s sarcoma  
class8	2935	an unusual case of endobronchial kaposi s sarcoma causing right middle and lower lobe atelectasis is reported  
class8	2935	the lesion was successfully removed with nd yag laser photoresection  
class8	2936	the malignancy sarcoidosis syndrome  
class8	2936	in a retrospective review of six patients with malignancy preceding sarcoidosis  we found four cases of malignant lymphoproliferative disease  ld  and one case each of ovarian cancer and breast cancer  
class8	2936	the median interval from onset or relapse of malignancy to sarcoidosis was nine months  
class8	2936	of the four patients with ld  sarcoidosis appeared within six months of termination of chemotherapy for three of the patients and 15 months after allogeneic bone marrow transplantation for the fourth patient  
class8	2936	at the time of diagnosis of sarcoidosis  there was no clinical or pathologic evidence of malignancy in the chest  
class8	2936	we conclude that in contradistinction to the previously described syndrome of sarcoidosis preceding ld  there exists a syndrome of sarcoidosis following malignancy with or without chemotherapy  
class8	2937	septic pulmonary emboli  a rare cause of bilateral pneumothorax in drug abusers  
class8	2937	an intravenous drug abuser presented with bilateral pneumothorax  
class8	2937	this is a previously unreported  to our knowledge  complication of septic pulmonary emboli secondary to right sided endocarditis  
class8	2937	this possibility must be considered in the differential diagnosis of pneumothorax in drug addicts  
class8	2938	retroperitoneal air after routine hemorrhoidectomy  report of a case  
class8	2938	retroperitoneal air as a complication after routine hemorrhoidectomy has not been reported in the literature  
class8	2938	this occurred recently after hemorrhoidectomy in a 34 year old patient receiving glucocorticoid therapy for rheumatoid arthritis  
class8	2938	adverse steroidal effects of wound healing have been well documented  
class8	2938	it is believed that steroid induced tissue changes contributed to the development of this unique complication  
class8	2939	a randomized controlled evaluation of a psychosocial intervention in adults with chronic lung disease  
class8	2939	the effect of a stress management program on morbidity and psychosocial and physical function in patients with chronic lung disease was assessed  
class8	2939	adults attending either a va pulmonary clinic or university hospital pulmonary rehabilitation clinic who met criteria for obstructive or restrictive pulmonary disease were randomly assigned to receive the intervention or to a control group  
class8	2939	the intervention was provided by a nurse and included one to three teaching sessions  reading material  audiotapes  and telephone follow up  
class8	2939	the program focused on stress management techniques such as cognitive restructuring  progressive relaxation  breathing exercises  and visual imagery  
class8	2939	the 45 experimental subjects were similar to the 49 controls with respect to baseline characteristics  
class8	2939	experimental and control subjects had similar rates of mortality  hospital days  bed disability days  restricted activity days  and physician visits during the 12 month follow up  
class8	2939	there were no differences between the two groups in physical or psychosocial function at six months or in levels of stressful life changes  social supports  and self esteem at six and 12 months  
class8	2939	intervention recipients had better function at 12 months  suggesting a possible benefit of the intervention  
class8	2940	effects of supplemental oxygen administration in an infant with pulmonary artery hypertension  
class8	2940	in patients with pulmonary disease  pulmonary artery hypertension often occurs as a result of pulmonary artery vasoconstriction  primarily from hypoxia and alveolar hypotension  
class8	2940	in this report we describe the hemodynamic effects of breathing supplemental oxygen in a child with bronchopulmonary dysplasia and pulmonary artery hypertension  
class8	2940	these hemodynamic effects include an improvement in oxygenation  an increase in systemic vascular resistance  and a decrease in the pulmonary vascular resistance  
class8	2940	as a direct result of these changes in vascular resistances  alterations of heart rate  cardiac index  stroke volume  aortic pressure  oxygen consumption  and pulmonary artery pressure have been shown to occur  
class8	2940	oxygen is widely used to treat many physiologic conditions  
class8	2940	however  during the administration of supplemental oxygen  rarely do we recognize the hemodynamic changes associated with its use  
class8	2940	these hemodynamic effects must be clearly understood and appreciated before oxygen administration in any clinical situation  
class8	2941	trapped lung syndrome after cardiac surgery  a potentially preventable complication of pleural injury  
class8	2941	a case of trapped lung syndrome after coronary artery bypass grafting  cabg  is presented  
class8	2941	a significant pleural injury occurred during the bypass operation resulting in intrapleural hemorrhage  pleural fibrosis  and trapped lung syndrome  
class8	2941	the physicians caring for the patient when she was first seen with the trapped lung syndrome were unaware of the potential relationship between the two prior bypass surgeries to this pulmonary complication  
class8	2941	recognition of the potential for pleural injury to occur after cardiac operations is important and may allow for earlier diagnosis and institution of appropriate therapeutic interventions  
class8	2941	early recognition and treatment with pleural fluid drainage and reexpansion of the collapsed lung may help prevent this potentially serious pleuropulmonary complication from occurring  
class8	2941	in addition  the presentation of this pleuropulmonary complication may be delayed after the cardiac surgery  making early diagnosis more problematic  
class8	2942	hydraulic conductivity of canine parietal pleura in vivo  
class8	2942	the hydraulic conductivity  lp  of the parietal pleura was measured in vivo in spontaneously breathing anesthetized dogs in either the supine  n   8  or the prone  n   7  position and in an excised portion of the chest wall in which the pleura and its adjacent tissue were intact  n   3   
class8	2942	a capsule was glued to the exposed parietal pleura after the intercostal muscles were removed  
class8	2942	the capsule was filled with either autologous plasma or isotonic saline  
class8	2942	transpleural fluid flow  v  was measured at several transpleural hydrostatic pressures  delta p  from the rate of meniscus movement within a graduated pipette connected to the capsule  
class8	2942	delta p was defined as the measured difference between capsule and pleural liquid pressures  
class8	2942	the lp of the parietal pleura was calculated from the slope of the line relating v to delta p by use of linear regression analysis  
class8	2942	lp in vivo averaged 1 36 x 10  3      0 45 x 10  3   sd  ml h 1 cmh2o 1 cm 2  regardless of whether the capsule was filled with plasma or saline and irrespective of body position  
class8	2942	this value was not significantly different from that measured in the excised chest wall preparation  1 43 x 10  3      1 1 x 10  3  ml h 1 cmh2o 1 cm 2   
class8	2942	the parietal pleura offers little resistance to transpleural protein movement  because there was no observed difference between plasma and saline  
class8	2942	we conclude that because the lp for intact parietal pleura and extrapleural interstitium is approximately 100 times smaller than that previously measured in isolated stripped pleural preparations  removal of parietal pleural results in a damaged preparation  
class8	2943	lung overexpansion increases pulmonary microvascular protein permeability in young lambs  
class8	2943	to study the effects of inflation pressure and tidal volume  vt  on protein permeability in the neonatal pulmonary microcirculation  we measured lung vascular pressures  blood flow  lymph flow  ql   and concentrations of protein in lymph  l  and plasma  p  of 22 chronically catheterized lambs that received mechanical ventilation at various peak inflation pressures  pip  and vt  
class8	2943	nine lambs were ventilated initially with a pip of 19     1 cmh2o and a vt of 10     1 ml kg for 2 4 h  base line   after which we overexpanded their lungs with a pip of 58     3 cmh2o and a vt of 48     4 ml kg for 4 8 h  
class8	2943	ql increased from 2 1     0 4 to 13 9     5 0 ml h  
class8	2943	l p did not change  but the ratio of albumin to globulin in lymph relative to the same ratio in plasma decreased  indicating altered protein sieving in the pulmonary microcirculation  
class8	2943	seven other lambs were mechanically ventilated for 2 4 h at a pip of 34     1 cmh2o and a vt of 23     2 ml kg  base line   after which their chest and abdomen were bound so that pip increased to 54     1 cmh2o for 4 6 h without a change in vt  
class8	2943	ql decreased on average from 2 8     0 6 to 1 9     0 3 ml h  p   0 08   and l p was unchanged  
class8	2944	late phase bronchial vascular responses in allergic sheep  
class8	2944	sheep were classified on the basis of their airway response to ascaris suum antigen aerosols as allergic or nonsensitive  
class8	2944	allergic sheep were classed as acute or dual responders  
class8	2944	acute responders had only an immediate increase in mean airflow resistance after antigen  whereas dual responders had an immediate and late phase  6 8 h after antigen challenge  increase in mean airflow resistance  nonsensitive sheep had minimal airway responses to antigen  less than 30  increase from base line   
class8	2944	the sheep were anesthetized 2 wk later and  after a left thoracotomy  were challenged with antigen to determine bronchial vascular responses  bronchial artery blood flow was measured with an electromagnetic flow probe  
class8	2944	airway responses to antigen aerosol challenge were similar in the anesthetized and conscious animals  
class8	2944	the mean fall in bronchial vascular resistance  bvr  immediately after antigen challenge was similar in acute and dual responders  41     7 and 47     9  of base line  respectively   
class8	2944	in dual responders  late phase airway responses were preceded by a significant increase from base line in qbr and a fall in bronchovascular resistance  bvr   
class8	2944	the mean fall in bvr 6 8 h after antigen challenge in documented dual responders was significantly different from bronchial vascular responses in acute responders  59     3 vs  
class8	2944	89     10   respectively   
class8	2944	sheep without airway responses to a  
class8	2944	suum had no significant changes in bronchial hemodynamics or airways mechanics  
class8	2944	late phase associated changes in bvr are a specific response to antigen challenge and may be a sensitive index of mediators being released  
class8	2945	urinary n tau methylimidazole acetic acid excretion in respiratory disease  
class8	2945	n tau methylimidazole acetic acid  n tau miaa  is the principal urinary metabolite of histamine  
class8	2945	the basal urinary excretion rate of n tau miaa was determined as 0 117     0 008  se  mg h  with a renal clearance for n tau miaa of 273     27 ml min implying active secretion  
class8	2945	after subpharmacological infusion of histamine  50 ng kg 1 min 1 over 2 h  in five volunteers that increased plasma histamine from 0 28     0 04 to 0 71     0 15 ng ml  urinary excretion of n tau miaa over 8 h was increased by less than 17  compared with a control saline infusion  
class8	2945	urinary n tau miaa excretion in normal controls  273     14 micrograms mmol creatinine  was similar to that observed in patients with severe acute asthma  253     22 micrograms mmol   antigen induced bronchoconstriction  269     21 micrograms mmol   seasonal allergic rhinitis  304     31 micrograms mmol   and clinically stable bronchiectasis  270     22 micrograms mmol   
class8	2945	in contrast  large increases in metabolite excretion  greater than 7 000 micrograms mmol creatinine  were observed in a patient with systemic mastocytosis where very high plasma histamine levels were recorded  greater than 500 ng ml  and marked systemic hemodynamic effects occurred  
class8	2945	we conclude that urinary n tau miaa will only be increased in pathologies where sustained hyperhistaminemia occurs and that increased local histamine production in the lung or the upper airway does not cause a measurable change in the basal urinary excretion of this metabolite  
class8	2946	an unusual late complication following surgical repair of tetralogy of fallot  
class8	2946	a case is presented of extrusion of right ventricular outflow tract patch material through a mediastino cutaneous fistula occurring five years after repair of tetralogy of fallot  
class8	2946	the focus of the mediastinal infection was an infected epicardial pacemaker electrode placed at the time of initial surgery  
class8	2946	subsequent echocardiographic studies showed minimal right ventricular outflow tract or pulmonary arterial dilatation  and  with no further surgery  the child is well after two and a half years follow up  
class8	2947	parathyroid hormone like peptide in normal and neoplastic human endocrine tissues  
class8	2947	pth like peptide  plp  is produced by tumors commonly associated with hypercalcemia as well as nonneoplastic tissues and several endocrine glands and tumors  
class8	2947	to characterize the distribution of plp in human endocrine tissues and tumors  we localized plp in formalin fixed paraffin embedded material using the avidin biotin peroxidase technique with polyclonal antisera  
class8	2947	among peptide hormone producing tissues  plp was identified in nontumorous adenohypophysis and pituitary adenomas  medullary thyroid carcinomas  normal  hyperplastic  and adenomatous parathyroids  adrenal medulla and pheochromocytomas  normal pancreatic islets  and endocrine tumors of pancreas  gut  and lung  including small cell carcinomas  
class8	2947	in other endocrine tissues plp was identified in nontumorous thyroid follicular epithelium  colloid nodules  and follicular neoplasms  normal adrenal cortex  adrenocortical adenomas  and carcinomas  nontumorous testicular leydig cells  normal ovarian granulosa and thecal cells  an ovarian thecoma and a granulosa cell tumor  placental trophoblast  and decidua  
class8	2947	these results demonstrate that plp is localized in many normal and neoplastic endocrine cells  including those not known to influence extracellular calcium homeostasis  
class8	2947	the presence of plp in a variety of endocrine tissues suggests that it may play a local physiological role in the growth or function of endocrine cells  
class8	2948	thyroiditis as the presenting manifestation of disseminated extrapulmonary pneumocystis carinii infection  
class8	2948	a 38 yr old male with acquired immunodeficiency syndrome developed neck pain in association with mild hyperthyroidism and a diffusely enlarged thyroid gland  
class8	2948	radioactive iodine scanning was consistent with thyroiditis  and biopsy of the thyroid demonstrated the presence of pneumocystis carinii in thyroid tissue  
class8	2948	treatment with pentamidine followed by trimethoprim sulfamethoxazole led to rapid normalization of thyroid size in association with the development of hypothyroidism  
class8	2948	this case illustrates the natural history of pneumocystis carinii thyroiditis and suggests that thyroid disease be added to the spectrum of human immunodeficiency virus associated endocrine dysfunction  
class8	2949	importance of sampling method in dna analysis of lung cancer  
class8	2949	lung carcinomas are characterised by considerable histological variation within the tumour  
class8	2949	the possible effects of this morphological heterogeneity on the estimation of tumour ploidy were investigated  
class8	2949	multiple tissue blocks were systematically taken from 20 lung tumours and analysed by flow cytometry  
class8	2949	the routine  archival paraffin wax embedded diagnostic blocks from these cases were also analysed  
class8	2949	nineteen  95   of the tumours were shown to contain aneuploid stemlines by systematic sampling  but if only one of these systematic tissue blocks had been taken from each case the incidence of dna aneuploidy could have been as low as 45   
class8	2949	only 15  75   tumours were aneuploid when all the routine archival blocks were analysed  but by specifically selecting tumour areas from the archival material the accuracy of this method was increased to 90   
class8	2949	it is concluded that tumour sampling methods are of primary importance in assessing the dna content of lung tumours  
class8	2949	routine paraffin wax embedded archival tissue provides a suitable source of material for this purpose  provided that  turnover  selection is carried out  
class8	2950	life threatening hemorrhage after placement of an endosseous implant  report of case 
class8	2950	this article reports an unusual but dangerous complication of implant surgery  
class8	2950	minimal perforations of the lingual plate and inferior border of the mandible had been considered previously to be benign occurrences  
class8	2950	this report demonstrates the importance of managing acute airway problems resulting from perforations  
class8	2951	role of nasal allergy in chronic maxillary sinusitis  diagnostic value of nasal challenge with allergen  
class8	2951	the role of nasal allergy in chronic maxillary sinusitis without an air fluid level was studied in 37 patients  
class8	2951	seventy three nasal provocation tests with various inhalant allergens were performed in 37 patients by means of rhinomanometry  and maxillary sinus radiographs were performed before and repeatedly after the allergen challenge  
class8	2951	forty one positive nasal responses  nrs  occurred in 29 patients  13 were immediate only  18 were late only  and 10 nrs were dual responses  
class8	2951	of these responses  32 demonstrated radiographic changes  primarily an increase in mucosal edema and or opacification  
class8	2951	these responses were accompanied by increased pressure in the maxillary sinuses  acute headache  and sometimes otalgia  
class8	2951	eight patients did not develop any nrs  however  increased thickening of the mucosal membrane of the maxillary sinuses  accompanied by subjective symptoms  was recorded in three of these nonresponders  
class8	2951	these results demonstrate the role of nasal allergy in some patients with chronic maxillary sinusitis  which may affect the diagnostic and therapeutic approaches to this disorder  
class8	2952	a placebo controlled trial of immunotherapy with two extracts of dermatophagoides pteronyssinus in allergic rhinitis  comparing clinical outcome with changes in antigen specific ige  igg  and igg subclasses  
class8	2952	a double blind  placebo controlled trial of immunotherapy was conducted in patients with dermatophagoides pteronyssinus rhinitis  
class8	2952	thirty patients received an extract with a high content of der p i  pharmalgen   20 received a conventional mite extract  allpyral   and 30 patients received histamine chloride  placebo   
class8	2952	specific igg and subclasses were measured before and after 3 and 12 months of treatment by ria and or elisa  and specific ige by rast  
class8	2952	clinical outcome was assessed by skin prick tests  nasal challenge  visual analogue  and diary card symptom and drug scores  from these findings  a clinical index was derived  
class8	2952	an igg response occurred only in the pharmalgen treated group  d  
class8	2952	pter igg and igg1 increased by 3 months  p less than 0 05  and then plateaued to 12 months  p less than 0 05   
class8	2952	igg4 levels increased throughout treatment  p less than 0 05 and p less than 0 01   as did the igg ige ratio  
class8	2952	a subclass switch from igg1 to igg4 occurred  
class8	2952	d  
class8	2952	pter ige rose at 3 months  p less than 0 05   
class8	2952	clinical improvement occurred at 3 and 12 months in the pharmalgen treated group only  
class8	2952	pretreatment levels of ige  igg1  or igg4 did not predict clinical outcome  
class8	2952	our findings are compatible with the hypothesis that igg subclasses may modulate antigen ige interactions  although the antibody response to this potent extract need not be causally related to improvement  
class8	2953	different prevalence and degree of nonspecific bronchial hyperreactivity between seasonal and perennial rhinitis  
class8	2953	from the patients observed at our respiratory allergology service  we selected patients with rhinitis only  without any past or present respiratory symptoms  for our study  
class8	2953	all these patients had normal pulmonary function  were administered carbachol or methacholine bronchial challenges  and had one or more skin reactions to perennial or seasonal allergens  
class8	2953	patients were allocated to three groups  group a  patients with seasonal rhinitis who were administered nonspecific challenges out of season  group b  patients with seasonal rhinitis tested during the season  and group c  patients with perennial rhinitis  
class8	2953	the three groups were divided into subgroups according to the duration in years of rhinitis and to the degree of nonspecific bronchial responsiveness  
class8	2953	the distribution into four groups of reactivity  arbitrarily defined as normal and mildly  moderately  and severely increased reactivity  was as follows  group a  124  21  30  22  group b  75  15  7  and 21  and group c  69  17  39  and 72  respectively  
class8	2953	the patients of group c  perennial rhinitis  demonstrated a distribution significantly  p less than 0 001  different from subjects with seasonal rhinitis  both group a and group b  
class8	2953	our results are consistent with the hypothesis that perennial rhinitis is much more important than seasonal rhinitis as a risk factor for developing nonspecific bronchial hyperresponsiveness  
class8	2954	neuropeptides and nasal secretion  
class8	2954	recent research has disclosed that neurotransmitters and neuropeptides released within the autonomic nervous system exert homeostatic control of nasal secretion  
class8	2954	although cholinergic and adrenergic influences have long been thought to be the predominant mechanisms  the nonadrenergic  noncholinergic responses may have more suitable  longer lasting effects  
class8	2954	peptides from sensory nerves  such as calcitonin gene related peptide  substance p  and neurokinin a  may participate in axon response mediated vasodilation and plasma extravasation  
class8	2954	substance p and gastrin releasing peptide may induce glandular secretion  
class8	2954	defensive responses to local mucosal injury may be amplified by axon response  which initiates these vascular and glandular reactions  
class8	2954	cholinergic effects are primarily responsible for mediating parasympathetic reflexes  but vasoactive intestinal peptide may regulate acetylcholine release  augment glandular secretory responses  and have a vasodilatory effect  
class8	2954	in the sympathetic nervous system  neuropeptide y probably functions as a long acting vasoconstrictor  
class8	2954	integration of sympathetic and parasympathetic influence may regulate the normal nasal cycle  and sensory and parasympathetic defensive reflexes may respond to epithelial and mast cell stimulation  
class8	2954	it is possible  then  that the pathophysiology of vasomotor rhinitis involves an exaggeration of these neural influences  
class8	2955	the role of histamine in allergic rhinitis  
class8	2955	studies using nasal provocation followed by nasal lavage have demonstrated that histamine plays an important role in the mediation of allergic rhinitis but not of rhinovirus infection  
class8	2955	the response to antigen challenge is often biphasic  
class8	2955	during the early response  increases in histamine levels appear to be associated with activation of mast cells  
class8	2955	in a subset of persons who exhibit an additional late response  however  the rise in histamine is concomitant with an increase in the number of basophils  
class8	2955	further evidence of the role of histamine in allergic rhinitis has emerged from nasal provocation experiments involving pretreatment with a variety of drugs known to antagonize or affect release of histamine  
class8	2955	nasal provocation with histamine causes sneezing  itching  rhinorrhea  and nasal congestion  
class8	2955	most h1 antihistamines have been found to inhibit sneezing and to lessen the increase in vascular permeability  but they do not affect histamine release  
class8	2955	the h1 antihistamine terfenadine  however  inhibits histamine release during the early response  effects on late response remain unknown  
class8	2955	prednisone decreases histamine levels during the late  but not the early  response  
class8	2955	one week pretreatment with topical steroids  on the other hand  affects both the early and the late response  
class8	2956	platelet activating factor  and leukotriene b4 induced release of lactoferrin from blood neutrophils of atopic and nonatopic individuals  
class8	2956	we found increased accumulation of neutrophils and their components  lactoferrin  lf  and elastase  as well as platelet activating factor  paf  and leukotriene b4  ltb4  at sites of ongoing human allergic reactions  
class8	2956	to determine whether paf or ltb4  could be the stimulus for in vivo lf release  blood neutrophils of 17 subjects were incubated with paf  ltb4  or the phorbol ester  phorbol myristate acetate  pma   and the released lf  elisa assay  was compared with spontaneous release  
class8	2956	significantly increased lf release was induced by paf  10  5  to 10  8  mol l  p less than 0 002   ltb4  10  7  to 10  8  mol l  p less than 0 004   and pma  0 05 micrograms ml  in a dose dependent reaction  
class8	2956	cytochalasin was not required for lf secretion but did enhance such responses  
class8	2956	paf induced lf secretion was inhibited by the specific paf antagonist  bn 52063  
class8	2956	more lf was released from neutrophils of atopic than from nonatopic subjects in response to paf  10  6  mol l  4 2 micrograms ml     0 2 versus 2 6 micrograms ml     0 2  p less than 0 001  but not to ltb4  pma  or buffer  p  not significant   
class8	2956	we conclude that  1  paf and ltb4 released in vivo could stimulate local neutrophils to release lf with possible pathogenic effects and  2  neutrophils of atopic subjects are more responsive to paf than neutrophils of nonatopic subjects in this regard  
class8	2957	immediate skin test reactivity to food and drug administration approved standardized extracts  
class8	2957	in an effort to determine whether recently introduced food and drug administration approved standardized extracts produce clinically appropriate responses in a population  200 subjects were skin prick tested  spt   
class8	2957	thirteen extracts  10 pollens  two house dust  hd  mites and cat  were tested in three groups of subjects  50 with a history of asthma or allergic rhinitis  al   50 without asthma or perennial or seasonal allergic rhinitis but with a positive immediate family history for these conditions  fal   and 100 subjects without a personal or family history for these conditions  nal   
class8	2957	an spt mean wheal diameter greater than or equal to 3 mm was considered positive  
class8	2957	ninety percent  95  confidence interval  ci   82  to 98   of al subjects had at least one positive spt  
class8	2957	forty six percent of fal subjects  95  ci  30  to 58   and 29  of nal subjects  95  ci  20  to 38   had at least one positive spt  
class8	2957	more fal than nal subjects had at least one spt  p less than 0 05   and fal subjects had more positive spts than nal subjects  p less than 0 05   further supporting the genetic regulation of allergen specific ige production  
class8	2957	of the five al subjects with no spt wheal greater than or equal to 3 mm  three subjects were available for intradermal tests  
class8	2957	thirteen nonstandardized allergens similar to allergens used for spt were applied intradermally in each of these three subjects and were all negative  
class8	2957	compared with history  an spt wheal greater than or equal to 3 mm to cat produced a sensitivity of 0 90  a specificity of 0 90  and diagnostic accuracy of 0 90  
class8	2957	tenfold dilutions of pollens and cat reduced sensitivity without significantly improving specificity  
class8	2958	increased bronchial hyperresponsiveness after inhaling salbutamol during 1 year is not caused by subsensitization to salbutamol  
class8	2958	recently  it was suggested that long term administration of an inhaled beta 2 agonist might increase bronchial hyperresponsiveness  bhr  to histamine  possibly as a consequence of subsensitization to the inhaled beta 2 agonist  
class8	2958	to test this hypothesis  we studied two groups of patients with asthma or with chronic obstructive pulmonary disease  
class8	2958	an experimental group of 15 patients  inhaling 400 micrograms of salbutamol four times daily during 1 year and subsequently 40 micrograms of ipratropium bromide four times daily for 6 months  and a control group  consisting of 22 patients with the opposite treatment regimen  
class8	2958	the bhr  the response in fev1 to cumulative doses of salbutamol  and the number of beta 2 adrenoceptors and antagonist affinity of these receptors on circulating lymphocytes were assessed at the start of the study and at 6 month intervals for 1 1 2 years  
class8	2958	the bhr increased significantly  p   0 001  during the year salbutamol was inhaled and returned to about the value at the start of the study after inhaling ipratropium bromide for 6 months  
class8	2958	no change occurred in the bronchodilating responses to cumulative doses of salbutamol  nor was any change observed in the number and the affinity of beta 2 adrenoceptors on lymphocytes  
class8	2958	it was concluded that long term use of salbutamol caused a small but significant increase in bhr  
class8	2958	the increase in bhr was not caused by subsensitization of beta 2 adrenoceptors to salbutamol  
class8	2959	measurement of histamine in nasal lavage fluid  comparison of a glass fiber based fluorometric method with two radioimmunoassays  
class8	2959	the determination of histamine in nasal secretions and nasal lavage fluid may be of importance to monitor activation of histamine containing cells in the nasal cavity  
class8	2959	however  such studies have been besieged by controversy  specifically to findings of changes in histamine levels in relation to allergenic stimulation  
class8	2959	this controversy may be due to the specificity and accuracy of the various methods used to determine histamine in the nasal fluid  
class8	2959	we have therefore applied and compared three new methods to determine histamine in nasal lavage fluids obtained before and after allergen challenge in normal subjects and patients with allergic rhinitis  
class8	2959	we used a fluorometric glass fiber based histamine method  fhr  and two rias  i and ii  
class8	2959	the fhr  detection limit  7 0 nmol  and the ria ii  detection limit  0 2 nmol  are specific for histamine itself  whereas the ria i  detection limit  18 0 nmol  measures mainly methylhistamine and cross reacts to some extent with histamine  
class8	2959	the histamine levels in the nasal lavage fluids from the nasal challenges demonstrated histamine values between 100 and 2000 nmol l of histamine with significantly higher levels in the postallergen challenges for the allergic subjects as compared to the normal control subjects  
class8	2959	the fhr correlated well with the ria i and ria ii methods with correlation coefficients of 0 77 to 0 88  p less than 0 001   respectively  
class8	2959	however  the ria i  methylhistamine antibody  always demonstrated absolute histamine values 5  to 20  of values measured by the ria ii  at the level of cross reactivity to histamine   
class8	2960	down regulation in hypersensitivity pneumonitis  
class8	2960	levels of soluble interleukin 2 receptor  sol il 2r  in the bronchoalveolar lavage fluid  balf  of pigeon breeders with hypersensitivity pneumonitis were compared with balf levels in asymptomatic pigeon breeders who had been exposed to pigeon allergens for an equivalent length of time  
class8	2960	no mean difference in sol il 2r levels was detected when these levels were expressed per milliliter balf  epithelial lining fluid  or per t lymphocyte  
class8	2960	in sarcoidosis  the availability of sol il 2r per t cell was significantly higher for the group with inactive sarcoidosis compared with the group with active sarcoidosis  
class8	2960	the results do not support the hypothesis that down regulation  in subjects exposed to allergens causing hypersensitivity pneumonitis  is a function of cell free sol il 2r levels in balf  
class8	2960	in the dynamic situation  however  the hypothesis appears tenable  
class8	2961	developmental expression of plasminogen activator inhibitor type 1 by human alveolar macrophages  possible role in lung injury  
class8	2961	urokinase activity is regulated by the specific endogenous plasminogen activator inhibitors type 1  pai 1  and type 2  pai 2   
class8	2961	one of these inhibitors  pai 1  has been directly implicated in connective tissue metabolism by virtue of its ability to bind extracellular matrix proteins  
class8	2961	because the normal lung is relatively rich in urokinase and abnormalities in urokinase activity have been associated with fibrotic lung diseases  we have explored the possibility of local production of pai 1 and pai 2 in human lung  
class8	2961	reverse transcription and subsequent amplification by the polymerase chain reaction of total lung rna revealed pai 1 mrna in each of three normal samples and in two specimens from patients with the adult respiratory distress syndrome  ards   
class8	2961	in situ hybridizations of lung biopsy specimens from a patient with ards with crna probes to pai 1 and pai 2 indicated that alveolar macrophages express pai 1 mrna during the acute injury phase  
class8	2961	subsequent reverse transcription and pcr amplification of normal human monocyte and alveolar macrophage mrna revealed that neither cell type expressed mrna for urokinase inhibitors  
class8	2961	however  after 24 h stimulation with endotoxin in vitro  monocytes were strongly positive for pai 2 but negative for pai 1 mrna whereas  under the same conditions  alveolar macrophages exhibited mrna for both pai 1 and pai 2  
class8	2961	metabolic labeling of endotoxin stimulated alveolar macrophages with 35s methionine followed by immunoprecipitation with pai 1 and pai 2 antibodies revealed that macrophages synthesized both pai 1 and pai 2  
class8	2961	as judged by immunoprecipitation and functional studies  pai 2 was found to be the major intracellular pa inhibitor whereas pai 1 was found to predominate outside the cell  
class8	2961	thus  mononuclear phagocytes exhibit a developmental potential for pai 1 expression  
class8	2961	the release of pai 1 by stimulated macrophages  as observed in the setting of ards  may be one mechanism by which these cells promote connective tissue accumulation  
class8	2962	a randomized controlled trial of glucocorticoid prophylaxis against experimental rhinovirus infection  
class8	2962	the effects of combined intranasal and systemic glucocorticoid steroids on the local inflammatory response  and symptoms due to experimental rhinovirus infection were studied in 45 adults randomized to prophylaxis with either placebo or steroids  
class8	2962	intranasal beclomethasone  168 micrograms twice a day  was begun 4 days before viral challenge and continued 5 days after challenge  
class8	2962	oral prednisone  30 mg twice daily  was given for 3 days beginning 1 day before challenge  
class8	2962	during the first 48 h after viral inoculation  nasal obstruction  nasal mucus weights  and kinin concentrations in nasal lavages were lower in steroid recipients  but subsequent increases in these variables in the steroid group resulted in no significant cumulative differences between treatment groups  
class8	2962	these data suggest that steroid prophylaxis may suppress nasal inflammation and cold symptoms during the first 2 days in experimental rhinovirus colds  
class8	2963	pneumococcal anticapsular antibodies in patients with chronic cardiovascular and obstructive lung disease in the netherlands  
class8	2963	differences in pneumococcal anticapsular antibody concentrations were assessed among patients with various chronic disorders and among young  25 35 years of age  and older adults  55 65 years   
class8	2963	antibody concentrations were determined by elisa  using the whole 23 valent pneumococcal polysaccharide vaccine as antigen  
class8	2963	no differences in mean or distribution of serum antibody concentrations were found among young adults  either healthy or asthmatic  or among older adults  healthy or with chronic obstructive pulmonary or chronic cardiovascular disease   
class8	2963	each group included individuals with low antibody levels  
class8	2963	therefore  the enhanced susceptibility to pneumococcal infections reported for some groups at risk  that is  elderly individuals and patients with chronic obstructive pulmonary or chronic cardiovascular disease  cannot be attributed solely to low anticapsular antibody concentrations  
class8	2964	adverse effects of aspirin  acetaminophen  and ibuprofen on immune function  viral shedding  and clinical status in rhinovirus infected volunteers  
class8	2964	a double blind  placebo controlled trial was conducted to study the effects of over the counter analgesic antipyretic medications on virus shedding  immune response  and clinical status in the common cold  
class8	2964	sixty healthy volunteers were challenged intranasally with rhinovirus type 2 and randomized to one of four treatment arms  aspirin  acetaminophen  ibuprofen  or placebo  
class8	2964	fifty six volunteers were successfully infected and shed virus on at least 4 days after challenge  
class8	2964	virus shedding  antibody levels  clinical symptoms and signs  and blood leukocyte levels were carefully monitored  
class8	2964	use of aspirin and acetaminophen was associated with suppression of serum neutralizing antibody response  p less than  05 vs  
class8	2964	placebo  and increased nasal symptoms and signs  p less than  05 vs  
class8	2964	placebo   
class8	2964	a concomitant rise in circulating monocytes suggested that the suppression of antibody response may be mediated through drug effects on monocytes and or mononuclear phagocytes  
class8	2964	there were no significant differences in viral shedding among the four groups  but a trend toward longer duration of virus shedding was observed in the aspirin and acetaminophen groups  
class8	2965	transmission of chlamydia pneumoniae in young children in a japanese family  
class8	2965	chlamydia pneumoniae strain twar was isolated from the respiratory tract of a 5 year old girl suffering from pneumonia  
class8	2965	the igm and igg antibody titers to twar were 1 32 and 1 128  respectively  
class8	2965	cultures and serology for other common bacterial and viral respiratory pathogens were negative  
class8	2965	although she was treated with 35 mg kg day rokitamycin  twar was repeatedly isolated after treatment  
class8	2965	her 3 year old sister developed acute bronchitis  and twar was isolated from her nasopharynx  
class8	2965	she was treated with 43 mg kg day erythromycin with prompt improvement  and twar was not isolated after treatment  
class8	2965	although her mother  grandmother  and 8 month old sister suffered from respiratory illness during these periods  twar was not isolated from them  
class8	2965	the repeated isolations from the index patient suggest that infection was transmitted from sister to sister  
class8	2965	this case represents the first reported isolation of twar from young children in the same household and the first from japan  
class8	2966	pilot trial of selective decontamination for prevention of bacterial infection in an intensive care unit  
class8	2966	selective decontamination of the oropharynx and gastrointestinal tract with nonabsorbable antimicrobials and sucralfate  a stress ulcer prophylactic that maintains the normal gastric acid bacterial barrier  were compared for prevention of pneumonia in a cardiac surgery intensive care unit  
class8	2966	over 8 months  51 patients received selective decontamination and 56 received sucralfate  
class8	2966	the selective decontamination regimen included polymyxin  gentamicin  and nystatin given as an oral paste and as a solution  patients also received standard antacid or histamine2 blocker stress ulcer prophylaxis  
class8	2966	patients in the selective decontamination group had significantly less colonization of the oropharynx and stomach by gram negative bacilli  12  vs  
class8	2966	55   p less than  001   significantly fewer infections due to gram negative bacilli  6  vs  
class8	2966	20   p    02   and fewer infections overall  12  vs  
class8	2966	27   p    04   
class8	2966	there was one episode of pneumonia in the selective decontamination group and five in the sucralfate group  
class8	2966	mortality and length of stay did not differ between the groups  but those receiving selective decontamination had less than one third as many days of systemic antibiotic therapy with no increase in colonization or infection with resistant gram negative bacilli  
class8	2966	thus  selective decontamination appeared to reduce both extrapulmonary and pulmonary infections  
class8	2967	lipid peroxidation and expression of copper zinc and manganese superoxide dismutase in lungs of premature infants with hyaline membrane disease and bronchopulmonary dysplasia  
class8	2967	the putative involvement of reactive oxygen species in the etiology of lung damage in infants receiving mechanical ventilation has been examined by comparing the levels of peroxidation and expression of the antioxidant enzymes  cuzn and mn superoxide dismutase  in lungs from control and affected infants as well as from fetuses and infants who died postnatally after term delivery  
class8	2967	mean levels      sd  of lung peroxidation  determined with a thiobarbituric acid method  were similar in affected and control premature neonates and in fetal subjects  1 87     1 26  1 92     2 07  and 1 19     1 36 nmol mg protein  respectively   
class8	2967	expression of cuzn and mn superoxide dismutases was also similar in these subjects and in the patients who died postnatally  
class8	2967	thus activity measurements and immunoblotting studies showed continuous expression of these enzymes throughout development with no apparent change in protein levels or size  
class8	2967	immunohistochemical examination of lung tissue showed expression of cuzn and mn superoxide dismutases in epithelial  smooth muscle  endothelial  and some mesenchyme components  
class8	2967	in patients with bronchopulmonary dysplasia  alveolar walls were thickened by an excess of fibrous tissue and terminal air spaces were lined mainly by type ii pneumatocytes  
class8	2967	all structures  including abnormal fibrous components  were positive for both cuzn and mn superoxide dismutase  
class8	2967	our data show that  unlike some experimental animals  expression of at least these antioxidant enzymes in human infants born prematurely is similar to that in adults  and indicate that such infants are better adapted for life in an oxygen containing environment than previously suspected  
class8	2968	effect of fasting on the lung glutathione redox cycle in air  and oxygen exposed mice  beneficial effects of sugar  
class8	2968	fasting increases susceptibility to hyperoxic lung damage in mice  at least in part  by decreasing lung glutathione level  
class8	2968	to determine whether fasting alters other components of the glutathione redox cycle  and whether a diet of sugar alone reverses fasting s effects  normally fed  sugar fed  and fasted mice were exposed to room air or 100  oxygen for up to 4 days  
class8	2968	in air exposed mice  fasting decreased glutathione peroxidase  gp  and glutathione reductase  gr  activities 15  to 20  on days 3 and 4  p less than 0 01  and glutathione level 25  to 30  on days 2 to 4  p less than 0 05   
class8	2968	when corrected for protein concentration  gp and gr values were similar to those in the fed mice  but glutathione levels remained lower on days 2 and 3  p less than 0 05   
class8	2968	oxidized glutathione  gssg  was unchanged  but the ratio of gssg to total glutathione  reduced glutathione plus gssg  increased on day 2  p less than 0 05   
class8	2968	in oxygen exposed fed mice  gp increased 62  and gr increased 39  on day 4  p less than 0 05   the time when the lung injury was most severe  glutathione increased 30  on days 3 and 4  p less than 0 05   and gssg increased threefold and eightfold on days 3 and 4  p less than 0 01   
class8	2968	oxygen exposed fasted mice were all dead by day 3  versus no deaths in the fed mice   failed to increase gr and total glutathione in response to the oxidant stress  and increased gp and gssg on day 3 to the same extent as the fed mice did on day 4  
class8	2969	role of endoscopy in diagnosing scleroma in its uncommon sites  
class8	2969	eighty cases suffering from rhinoscleroma were studied  
class8	2969	suspected cases were examined by sinoscopy  nasopharyngoscopy and bronchoscopy for detection of secondary involvement in these sites  
class8	2969	antroscleroma  salpingoscleroma and tracheo bronchoscleroma have been found in a relatively high percentage of cases  
class8	2969	the role of endoscopy in early diagnosis  initial symptomatic treatment and follow up cases is discussed  
class8	2970	smoking cessation in chronic reinke s oedema  
class8	2970	in evaluating the long term results of surgical treatment of reinke s oedema  there has been found to be a high incidence of recurrence  
class8	2970	the recurrence rate is significantly lower amongst those patients who gave up smoking after treatment  
class8	2970	a group of patients with chronic reinke s oedema were followed for six months  
class8	2970	maximum efforts were made to help the patients to stop smoking  
class8	2970	twenty nine patients entered the study  but only eight of them  28 per cent  refrained from smoking  all were women  39 70 years  and all experienced reduced discomfort  although none of the voices were restored to normal  
class8	2970	diffuse laryngitis disappeared completely  but the oedema did not disappear entirely in any patient  
class8	2970	before treatment of chronic reinke s oedema patients must be well advised and informed  and if surgery is decided upon  they must be urged most strongly to stop smoking  if they wish to enhance the possibility of satisfactory long term results  
class8	2971	epistaxis as an unusual presentation of an antrochoanal polyp  
class8	2971	antrochoanal polyps rarely present with severe epistaxis  
class8	2971	we present the case of a young male patient who presented in such a manner  thus leading to the suspicion of an angiofibroma as the underlying pathology  
class8	2971	the radiological investigations  treatment and pathological features are discussed  
class8	2972	a  silent  intracranial complication of frontal sinusitis  
class8	2972	intracranial complications of frontal sinusitis  although rare today  do still develop despite widespread use of antibiotics  
class8	2972	we report a case which demonstrates how silently a frontal lobe abscess may present with subtle changes in mood and behaviour  with no focal neurological signs  
class8	2972	diagnosis and management are discussed and a brief review of the incidence of intracranial complications of frontal sinusitis  mode of spread  clinical presentation  investigations  treatment and bacteriology is presented  
class8	2973	infectious mononucleosis complicated by lingual tonsillitis  
class8	2973	although upper airway obstruction and superimposed infection are well known complications of infectious mononucleosis  lingual tonsillitis in this context has not been mentioned in the literature  
class8	2973	we describe a case of acute bacterial lingual tonsillitis with airway obstruction complicating infectious mononucleosis  
class8	2973	the role of the base of tongue region in the pathophysiology of infectious mononucleosis is discussed  
class8	2974	acute upper airway obstruction following teflon injection of a vocal cord  the value of nebulized adrenaline and a helium oxygen mixture in its management 
class8	2974	a 67 year old man presented with a 45 year history of a week voice  
class8	2974	this was result of polio which had left him with a right vocal cord palsy  
class8	2974	the patient underwent a teflon injection of the right vocal cord under general anaesthesia to improve the quality of his voice  
class8	2974	in the immediate post operative period  he suffered acute upper airway obstruction  
class8	2974	the problem of acute upper airway obstruction following teflon injection is considered and its management with nebulized adrenaline and a helium oxygen mixture is discussed  
class8	2975	multiple primary malignancies in patients with malignant tumours of the nasal cavities and paranasal sinuses  
class8	2975	the incidence of multiple primary malignancies  mpm  was analysed in 1297 patients with malignant tumours of the nasal cavities and paranasal sinuses  
class8	2975	the patients were followed for a minimum of six years or until death  
class8	2975	the incidence of mpm was 3 4 per cent  44 1297  which is lower in patients with malignant tumours of other regions in the upper aerodigestive tract  
class8	2975	five of the 44 patients had second malignancies within previously irradiated areas  
class8	2975	there was a difference between the proportion of histologies occurring in irradiated tissues compared with the overall 1297 patients  
class8	2975	this finding suggests that radiotherapy may induce a second cancer  
class8	2976	inter arytenoid glottic bar following intubation  
class8	2976	inter arytenoid glottic bar is a rare complication of prolonged endotracheal intubation  
class8	2976	we present two such cases and their treatment  
class8	2976	the aetiology of this complication is multifactorial and involves local factors  local trauma  movement of the endotracheal tube within the larynx  infection  and anatomical influences  together with systemic factors such as in our two cases  
class8	2976	the relative importance of these factors is discussed  
class8	2976	a comment is also made on the use of a pre operative topogram and the importance of an ent assessment in patients with airway problems following prolonged intubation  
class8	2977	lambert eaton syndrome  autonomic neuropathy and inappropriate antidiuretic hormone secretion in a patient with small cell carcinoma of the lung  
class8	2977	a patient with small cell carcinoma of the lung developed asymptomatic autonomic neuropathy  inappropriate antidiuretic hormone  adh  secretion and lambert eaton myasthenic syndrome  
class8	2977	the autonomic neuropathy and inappropriate adh secretion were present at the time of diagnosis of the tumour  
class8	2977	following chemotherapy these resolved  but 5 months later the patient developed lambert eaton syndrome which responded to 3 4 diaminopyridine  
class8	2977	this sequence of changes appears to be unique  
class8	2978	treatment of small cell lung cancer with an alternating chemotherapy regimen given at weekly intervals  a southwest oncology group pilot study  
class8	2978	we designed an intensive  weekly treatment regimen for patients with small cell lung cancer  sclc  using six of the most active chemotherapeutic agents for this disease  doxorubicin  dox   cyclophosphamide  ctx   vincristine  vcr   etoposide  vp 16   cisplatin  cddp   and methotrexate  mtx    
class8	2978	the goal of this program was to gain rapid  repetitive exposure to multiple  active drugs  
class8	2978	treatment was administered weekly for a total of 16 weeks  
class8	2978	seventy six sclc patients  limited disease  34  extensive disease  42  were treated  
class8	2978	the overall complete plus partial response rate was 82   
class8	2978	complete response rates of 47  and 38  were observed in patients with limited  ld  and extensive disease  ed   respectively  
class8	2978	the median survivals for patients with ld and ed were 16 6 and 11 4 months  respectively  
class8	2978	toxicities were tolerable and were primarily hematologic  
class8	2978	twenty six patients had one or more transient life threatening toxicities  but only one patient developed a fatal toxicity  
class8	2978	eighty four percent of the patients received 80  or greater of the intended protocol dosages over the entire 16 week treatment period  
class8	2978	we conclude that this intensive  short duration treatment regimen is at least as good as other  standard  regimens  and we are encouraged aged by the complete response rate and median survival in patients with ed sclc  
class8	2979	the relative value of conventional staging procedures for developing prognostic models in extensive stage small cell lung cancer  
class8	2979	published prognostic models for small cell lung cancer  sclc  have either combined limited  and extensive stage patients or have not included standard anatomic staging information to assess the relative value of the knowledge of specific sites and number of sites of metastases in predicting survival in extensive stage disease  
class8	2979	we studied 136 extensive stage patients in whom traditional staging procedures were performed and in whom other previously demonstrated significant pretreatment variables were determined  
class8	2979	using the cox proportional hazards model  when all data were included  three variables were significant  performance status  ps   p    0001   number of sites of metastases  p    0010   and age  p    0029   
class8	2979	a prognostic algorithm was developed using these variables  which divided the patients into three distinct groups  
class8	2979	when the anatomic staging data were omitted  the serum albumin  p    0313  was the only variable in addition to ps  p    0001  and age  p    0064  that was significant  
class8	2979	an alternative algorithm using these three variables was nearly as predictive as the original  
class8	2979	therefore  in extensive stage patients  reasonable pretreatment prognostic information can be obtained without using the number or specific sites of metastases as variables once the presence of distant metastases has been demonstrated  
class8	2980	cerebral venous oxygen content as a measure of brain energy metabolism with increased intracranial pressure and hyperventilation  
class8	2980	in order to test the hypothesis that the cerebral arteriovenous oxygen difference  avdo2  and venous oxygen content  vo2  could be used to monitor brain energy metabolism in the setting of increased intracranial pressure  icp   
class8	2980	12 cats were studied with 31p magnetic resonance spectroscopy  
class8	2980	six cats were subjected to intracranial hypertension by cisternal infusion of saline  
class8	2980	energy failure occurred at an average avdo2 of 8 4     3 2 vol       standard deviation   range 4 7 to 14 7 vol    
class8	2980	the vo2 at the point of metabolic failure averaged 1 45     0 6 vol  and extended over a narrower range  1 0 to 2 9 vol    
class8	2980	in an additional six cats  icp was raised to the threshold of metabolic failure and hyperventilation was then instituted  pco2 10 to 18 torr   
class8	2980	five of the six cats experienced a drop in vo2 with hyperventilation  
class8	2980	in two of these animals  hyperventilation resulted in a vo2 of 1 1 vol  or less and in metabolic failure as evidenced by a fall in phosphocreatine  
class8	2980	it is concluded that a vo2 of less than 2 vol  is correlated with brain ischemia and that the safety of hyperventilation in the setting of increased icp can be monitored by the use of vo2  
class8	2981	administered dose and tumor dose of bleomycin labeled with cobalt 57 in mice and men  
class8	2981	tumor concentrations of the chemotherapeutic drug  bleomycin  labeled with cobalt 57  co bleo  were compared in mouse tumor models and in human lung tumors using quantitative single photon emission computed tomography  
class8	2981	drug concentrations in histologically similar human tumors showed marked variability for the same injected dose  id   
class8	2981	small cell carcinomas showed concentrations between 1 09 and 8 85  id cc x 10  3  while non small cell lung tumors showed a concentration variation between 0 36 and 6 75  id cc x 10  3   
class8	2981	in contrast to the situation in human tumors  uptake in mouse tumors showed only slight variability in animals with the same tumor model  
class8	2981	emt 6 tumors in mice showed at 6 hr significantly higher uptake of co bleo  p less than 0 001  and significantly higher tumor to lung ratio  p less than 0 001  when compared to murine fibrosarcomas  
class8	2981	the emt 6 tumors in contrast to the fibrosarcomas responded to bleomycin treatment in a dose dependent manner  
class8	2981	the results indicate that while in mice the tumor dose closely follows the administered dose  in humans  the tumor dose and the tumor to lung ratio in the individual patient cannot be predicted from the administered dose  
class8	2982	imaging of tumor in patients with indium 111 labeled biotin and streptavidin conjugated antibodies  preliminary communication 
class8	2982	tumor localization in patients has been achieved through the in vivo use of streptavidin and biotin  
class8	2982	in these preliminary studies  the monoclonal antibody hmfg1 was conjugated with streptavidin and 1 mg was administered intravenously to each of 10 patients with documented squamous cell carcinoma of the lung  
class8	2982	two to 3 days later  111in labeled biotin was also administered intravenously  
class8	2982	no evidence of toxicity was observed  
class8	2982	background radioactivity levels were reduced in liver  1  id at 24 hr  and kidneys  2   and in all other normal tissues and blood  
class8	2982	images of lung tumor were obtained in as little as 2 hr following administration of labeled biotin  
class8	2982	in eight patients  tumor was detected with labeled biotin alone without the previous administration of streptavidin conjugated antibody but in three of these patients  the images were improved with the prior administration of conjugated antibody  
class8	2982	these results suggest that this approach may improve the tumor to normal tissue radioactivity ratios in radioimmunotargeting  
class8	2983	pedunculated soft tissue mass on the alveolar gingiva  clinical conference  
class8	2983	a case of peripheral ameloblastoma  a rare intraoral neoplasm  has been presented  
class8	2983	the lesion appears most commonly as a mass on the mandibular lingual gingiva of patients in their fifth and sixth decades of life  
class8	2983	the peripheral ameloblastoma does not share the aggressive nature of the intraosseous variant  
class8	2983	the lesion has been overtreated in the past and warrants only a local supraperiosteal excision  
class8	2984	early ribavirin treatment of respiratory syncytial viral infection in high risk children  
class8	2984	a 3 year prospective  blinded  multicenter study was done to assess the efficacy of early ribavirin intervention in mild respiratory syncytial virus illness in children with bronchopulmonary dysplasia or with congenital heart disease  
class8	2984	a cohort of 178 children younger than 36 months of age with bronchopulmonary dysplasia or congenital heart disease were followed  
class8	2984	forty seven infants whose respiratory syncytial virus infection resulted in mild symptoms of less than or equal to 72 hours  duration received ribavirin  n   20  or water placebo aerosol  n   27  either in a hospital or at home  
class8	2984	outcome measures included respiratory and analog score  room air oxygen  saturation  and oxygen flow needed to maintain saturation at greater than or equal to 91   
class8	2984	no difference in age  gender  family size  passive smoking  baseline oxygen saturations in room air  or duration of symptoms before treatment was found between groups  
class8	2984	after 3 days of therapy  ribavirin produced a greater rate of improvement of analog scores  p   less than or equal to 0 001   lower oxygen requirements  p   0 01   and higher oxygen saturation  p   0 01   
class8	2984	respiratory scores and total hospital days did not differ significantly between the groups  
class8	2984	treatment failure occurred in 2 of 20 children  10   in the ribavirin group versus 5 of 27 children  18   in the placebo group  a nonsignificant difference  
class8	2984	no child required assisted ventilation or had an adverse reaction  
class8	2984	we conclude that early ribavirin therapy may help to reduce morbidity from respiratory syncytial virus infection in high risk young children  
class8	2985	prediction of postoperative clinical course by autologous tumor killing activity in lung cancer patients  
class8	2985	fifty patients with primary localized lung cancer were tested at the time of surgery for the ability of their lymphocytes to kill autologous  freshly isolated tumor cells  and the assay was evaluated for prognostic significance  
class8	2985	peripheral blood lymphocytes of 27 patients  54   demonstrated significant autologous tumor killing activity in 6 hour 51cr release assays  
class8	2985	twenty three of the 27 patients with autologous tumor killing activity remained tumor free and survived more than 5 years after curative surgery  while all 23 who were negative for autologous tumor killing activity relapsed by 18 months after surgery and died within 42 months after surgery  
class8	2985	the differences in survival curves for the two groups were highly significant  p less than  00003   
class8	2985	autologous tumor killing activity was not correlated with natural killer  nk  cell activity against k562 human myeloid leukemia cells or proliferation of lymphocytes stimulated with autologous  freshly isolated tumor cells in mixed culture  
class8	2985	there were no differences in total survival between patients with positive results and those with negative results in tests of nk cell activity and autologous mixed lymphocyte tumor culture reaction  
class8	2985	these results indicate that autologous tumor killing activity is a meaningful prognostic indicator and provide evidence for immunological control of tumor growth and metastasis  
class8	2985	according to our preliminary data  it is unlikely that lung cancer patients who remain tumor free after 60 months of follow up will develop recurrence or die from the disease  
class8	2985	we are conducting a study to determine whether induction of autologous tumor killing activity before surgery  by treatment with biological response modifiers can improve the clinical outcome in patients who do not naturally have this potential  
class8	2986	auto peep in the multisystem injured patient  an elusive complication  
class8	2986	auto peep  a peep   unrecognized alveolar positive and expiratory pressure during mechanical ventilation  is an acknowledged hazard in patients with chronic obstructive lung disease  
class8	2986	we evaluated 50 consecutive trauma patients for the presence of a peep and its effect on hemodynamic stability  
class8	2986	injury severity scores  iss  were 8 to 41  21     1   revised trauma scores  rts  ranged from 2 0 to 7 8  6 2     0 2   
class8	2986	mode of ventilation was assist control  inspiratory flow rates were 40 to 120 l m  78     2   
class8	2986	a peep  determined in the non assisting patient by occluding the expiratory port at end exhalation  was present in 28 patients  56   and ranged from 1 to 12 cm h2o  5 3     0 4 cm h2o   
class8	2986	data segregated by a peep versus no a peep were as follows  mean     sem    table  see text   p less than 0 05  ve   minute ventilation  paw   mean airway pressure  
class8	2986	upon reversal of a peep in the eight patients with levels greater than 5 cm h2o  mean blood pressure rose from 90     17 to 102     22 mm hg and central venous pressure fell from 13     5 to 7     5 mm hg  
class8	2986	a peep was successfully treated in these eight patients by increasing peak flows  minimizing ve requirements and selective use of bronchodilators  
class8	2986	in sum  the hypermetabolic ventilated trauma patient should be monitored routinely for this common phenomenon which may have profound cardiopulmonary effects in the setting of acute resuscitation  
class8	2987	effect of endotoxin and a burn injury on lung and liver lipid peroxidation and catalase activity  
class8	2987	both endotoxin and a burn alone produce oxidant induced tissue lipid peroxidation  
class8	2987	the endotoxin response is due in large part to hydrogen peroxide  
class8	2987	the combination of endotoxin after a burn results in an increased liver  but not lung  oxidant injury  
class8	2987	our purpose was to determine whether the burn oxidant injury inactivated endogenous liver tissue catalase  thereby amplifying a subsequent h2o2 insult  
class8	2987	twenty six adult sheep were studied  
class8	2987	twelve sheep had a 15  tbs burn  
class8	2987	tissue catalase activity  measured in lung and liver 3 days postburn  was significantly decreased from a control of 3 58     1 8 and 193     63  respectively  to 1 72     0 63 and 148     33 k sec 1  0 5 gram tissue  
class8	2987	the addition of endotoxin 3 days postburn resulted in an increase in liver malondialdehyde  mda  a measure of lipid peroxidation  from a control of 110     80 to 450     54 nmol gram tissue  
class8	2987	this value was significantly greater than the 210     80 nmol gram tissue seen after endotoxin alone  
class8	2987	lung tissue mda with burn and endotoxin was 65     8 compared to 42     7 for control and 80     6 nmol gram for endotoxin alone  
class8	2987	we conclude that a decrease in liver catalase activity occurs after a burn  
class8	2987	the decrease corresponds to an accentuated oxidant induced lipid peroxidation after an added endotoxin insult where h2o2 is known to be an etiologic agent  
class8	2987	the catalase activity also decreases in postburn lung  but accentuated lung damage was not seen  indicating a variable tissue response from the burn induced decrease in antioxidant activity  
class8	2988	effect of chronic respiratory acidosis on urinary calcium excretion in the dog  
class8	2988	it is currently believed that the two chronic acidemic disorders exert disparate effects on urinary calcium excretion  chronic metabolic acidosis induces consistent hypercalciuria  but no appreciable change or even a decrease in calcium excretion is reported to attend chronic respiratory acidosis  
class8	2988	whereas the effect of metabolic acidosis is well documented  little work has been carried out in chronic hypercapnia  
class8	2988	in fact  most of the studies on chronic respiratory acidosis were short in duration  had employed only mild hypercapnia  or had failed to control carefully the prevailing metabolic conditions  
class8	2988	we have carried out balance observations in nine dogs exposed to a 10  co2 atmosphere in an environmental chamber for a period of two weeks  
class8	2988	chronic respiratory acidosis led to a significant increase in urinary calcium excretion from a mean control value of 0 4     0 1 mmol day to 0 6     0 1 mmol day during both week 1 and 2 of hypercapnia  p less than 0 05   
class8	2988	hypercalciuria occurred even though filtered load of calcium fell  
class8	2988	mean fractional excretion of calcium increased significantly during each week of hypercapnia averaging 0 60     0 12  during control  1 05     0 13  during week 1  and 1 26     0 17  during week 2 of hypercapnic exposure  p less than 0 05   
class8	2988	there were no changes in plasma levels of immunoreactive parathyroid hormone or 1 25 dihydroxyvitamin d3  
class8	2988	these findings suggest that chronic respiratory acidosis  just like chronic metabolic acidosis  augments urinary calcium excretion by a direct depressive effect on the tubular reabsorption of calcium  
class8	2989	diagnosis of malignant cardiac disease by endomyocardial biopsy 
class8	2989	among oncology patients  endomyocardial biopsy has been used primarily for the evaluation of anthracycline cardiotoxicity  
class8	2989	in addition  however  endomyocardial biopsy may be useful for the detection of malignant cardiac neoplasms  
class8	2989	between 1982 and 1989  metastatic involvement of the heart was diagnosed by endomyocardial biopsy in seven patients at our institution  
class8	2989	all except one of these patients were older than 50 years of age and had dyspnea as an initial symptom  and all had a known malignant lesion  
class8	2989	results of endomyocardial biopsy confirmed cardiac involvement by a hematologic malignant lesion in four patients and metastatic melanoma in two patients  
class8	2989	in one patient  who had a history of breast cancer and lymphoma  a metastatic neoplasm of uncertain differentiation was observed  
class8	2989	myocyte damage was evident in endomyocardial biopsy specimens from two of the four patients with hematologic malignant disease  
class8	2989	endomyocardial biopsy was performed to confirm the possibility of metastatic involvement in five patients  in the other two  endomyocardial biopsy was performed to determine whether anthracycline cardiotoxicity was present  and metastatic involvement was unanticipated  
class8	2990	value of antigen detection in predicting invasive pulmonary aspergillosis 
class8	2990	two elisas were used to detect serum and urinary aspergillus antigen in 121 patients who were profoundly neutropenic after leukaemia therapy or bone marrow transplantation  
class8	2990	the presence of antigen correctly predicted development of invasive pulmonary aspergillosis  ipa  in 16 patients  
class8	2990	in 2 other cases antigen appeared after the clinical diagnosis had been made  while in only 1 case was antigen not detected  
class8	2990	in 11 of 13 episodes of clinically suspected fungal infection antigen was detected before clinical diagnosis was made  
class8	2990	by contrast  antigen was detected in only 1 of 90 patients who had no evidence of ipa  
class8	2990	both elisas gave positive and negative predictive values for ipa of greater than 95   demonstrating the value of antigen detection in early diagnosis of aspergillus infection and the assay s ability to predict subsequent development of ipa  
class8	2990	we conclude that neutropenic patients should be screened for aspergillus antigen  and propose that initial detection of fungal antigen justifies commencement of empirical antifungal therapy  
class8	2990	such an approach should improve the survival of patients who are at risk of developing this usually fatal infection  
class8	2991	angioedema from angiotensin converting enzyme inhibitors  a cause of upper airway obstruction  
class8	2991	angiotensin converting enzyme  ace  inhibitors have several side effects of concern to the otolaryngologist  
class8	2991	angioedema is a rare  but potentially lethal adverse effect when associated with upper airway obstruction  
class8	2991	four cases of ace inhibitor induced angioedema  three with significant upper airway obstruction  are reported  
class8	2991	angioedema secondary to ace inhibition appears to be mechanism based  
class8	2991	the probable link is the potentiation of bradykinin  which results in vasodilation  increased vascular permeability  and angioedema  
class8	2991	since angioedema can progress to upper airway obstruction  otolaryngologists must be aware of this association  
class8	2991	the differential diagnosis and treatment of this adverse effect is discussed  as well as a review of ace inhibitors and other causes of angioedema  
class8	2992	computed tomography staging of the paranasal sinuses in chronic hyperplastic rhinosinusitis  
class8	2992	in this study  the computed tomography scans of 100 patients with chronic hyperplastic rhinosinusitis were reviewed to establish a clinical staging system  
class8	2992	fourteen percent of the patients were classified as stage i  single focus disease   36  as stage ii  multifocal disease responsive to conservative therapy   32  as stage iii  diffuse disease partially responsive to medication   and 16  as stage iv  diffuse disease associated with bony changes and poorly responsive to conservative treatment   
class8	2992	the incidence of recurrent or persistent disease ranged from 13  for stage ii to 30  for stage iv  
class8	2992	stage i and iii patients had 13  and 18  recurrence rates  respectively  
class8	2992	computed tomography staging is shown to be useful in outlining operative strategies and is a reliable prognosticator of the disease process  
class8	2993	esthesioneuroblastoma  surgical treatment without radiation  
class8	2993	this study compares the treatment of two groups of patients diagnosed with esthesioneuroblastoma limited to the nasal cavity without evidence of cribriform plate erosion  
class8	2993	five patients were treated with radiation and extracranial excision  and eight patients were treated by craniofacial resection only  
class8	2993	the incidences of local recurrence were 60  and 12   respectively  
class8	2993	the paper also presents a new staging classification for these tumors  
class8	2994	flexible nd yag laser palliation of obstructive tracheal metastatic malignancies  
class8	2994	flexible nd yag endoscopic laser surgery may become an effective new modality for palliation in patients with obstructive endotracheal metastatic malignancies  
class8	2994	we report the results of the treatment of two patients with severely obstructing intraluminal tracheal metastatic melanoma and medullary thyroid carcinoma  using the neodymium yag laser via the flexible fiberoptic bronchoscope  
class8	2994	both patients complained of significant dyspnea  orthopnea  cough  and hemoptysis and were not candidates for rigid bronchoscopy because of underlying medical contraindications and anatomical problems  
class8	2994	multiple treatment sessions were used with treatment intervals of 1 to 2 weeks  
class8	2994	all treatments were performed in the operating room under sedation  without intubation  with topical lidocaine and standard superior laryngeal nerve block  
class8	2994	successful relief of airway obstruction with complete regression of the endotracheal masses was achieved and no recurrences were seen after 9 months  follow up  
class8	2994	flexible nd yag laser bronchoscopy offered an alternative for the relief of obstructing endotracheal or bronchial malignancies in patients in whom the rigid bronchoscope could not be passed  
class8	2994	it seemed to prolong survival in selected cases  and provided definite improvement in quality of life  
class8	2995	an in vivo canine model for testing treatment effects in laryngeal hyperadduction disorders  
class8	2995	adductor spastic dysphonia is a voice disorder characterized by a strained  squeezed  effortful voice produced by true and false cord hyperadduction  
class8	2995	an in vivo canine model has been developed to simulate hyperadduction of the true cords  
class8	2995	using this model  the thyroarytenoid muscle was found to have a greater effect on intraglottic and subglottic pressure than cricothyroid muscle contraction  
class8	2995	the intraglottic and subglottic pressure was reduced after simulated recurrent laryngeal paralysis  
class8	2995	this model can be used in future studies to compare laryngeal treatment modalities for disorders that have a component of vocal cord hyperadduction  such as spastic dysphonia  
class8	2996	pancreaticopleural fistula  report of 7 patients and review of the literature  
class8	2996	pancreaticopleural fistula is an uncommon clinical condition  
class8	2996	its presentation is often confusing because of the paucity of clues suggestive of pancreatic disease and the preponderance of pulmonary symptoms and signs  
class8	2996	most patients are alcoholics but only one half will have a clinical history of previous pancreatitis  
class8	2996	pleural effusions are large  recurrent  and highly exudative in nature  
class8	2996	many patients go through extensive pulmonary evaluation before the pancreas is identified as the site of primary pathology  
class8	2996	an elevated serum amylase may be the first clue to the diagnosis  
class8	2996	however  the key to the diagnosis is a dramatically elevated pleural fluid amylase  
class8	2996	effusions in association with acute pancreatitis  esophageal perforation  and thoracic malignancy are important to consider in the differential diagnosis of an elevated pleural fluid amylase but are usually easy to exclude  
class8	2996	computed tomography is excellent in defining pancreatic abnormalities and should be the first abdominal imaging study in suspected cases  
class8	2996	endoscopic retrograde cholangiopancreatography  ercp  is used as a diagnostic tool only in confusing cases  
class8	2996	although no systematic study evaluates medical versus surgical therapy  we recommend an initial 2 to 4 week trial of medical therapy  including allowance of no oral intake  total parenteral nutrition  chest tube thoracostomy  and possibly a regimen of somatostatin or its analogs  
class8	2996	the major complication in these patients is superinfection  which results in significant morbidity and mortality  
class8	2996	failure of medical therapy should be considered failure of pleural effusion s  to clear  recurrence after reinstatement of oral intake  or superinfection  
class8	2996	for those patients who fail to benefit from medical therapy  surgery is indicated  
class8	2997	disseminated histoplasmosis in the acquired immune deficiency syndrome  clinical findings  diagnosis and treatment  and review of the literature  
class8	2997	histoplasmosis is a serious opportunistic infection in patients with aids  often representing the first manifestation of the syndrome  
class8	2997	most infections occurring within the endemic region are caused by exogenous exposure  while those occurring in nonendemic areas may represent endogenous reactivation of latent foci of infection or exogenous exposure to microfoci located within those nonendemic regions  
class8	2997	however  prospective investigations are needed to prove the mode of acquisition  
class8	2997	the infection usually begins in the lungs even though the chest roentgenogram may be normal  
class8	2997	clinical findings are nonspecific  most patients present with symptoms of fever and weight loss of at least 1 month s duration  
class8	2997	when untreated  many cases eventually develop severe clinical manifestations resembling septicemia  
class8	2997	chest roentgenograms  when abnormal  show interstitial or reticulonodular infiltrates  
class8	2997	many cases have been initially misdiagnosed as disseminated mycobacterial infection or pneumocystis carinii pneumonia  
class8	2997	patients are often concurrently infected with other opportunistic pathogens  supporting the need for a careful search for co infections  
class8	2997	useful diagnostic tests include serologic tests for anti h  
class8	2997	capsulatum antibodies and hpa  silver stains of tissue sections or body fluids  and cultures using fungal media from blood  bone marrow  bronchoalveolar lavage fluid  and other tissues or body fluids suspected to be infected on clinical grounds  
class8	2997	treatment with amphotericin b is highly effective  reversing the clinical manifestations of infection in at least 80  of cases  
class8	2997	however  nearly all patients relapse within 1 year after completing courses of amphotericin b of 35 mg kg or more  supporting the use of maintenance treatment to prevent recurrence  
class8	2997	relapse rates are lower  9 to 19   in patients receiving maintenance therapy with amphotericin b given at doses of about 50 mg weekly or biweekly than with ketoconazole  50 60    but controlled trials comparing different maintenance regimens have not been conducted  
class8	2997	until results of such trials become available  our current approach is to administer an induction phase of 15 mg kg of amphotericin b given over 4 to 6 weeks  followed by maintenance therapy with 50 to 100 mg of amphotericin b given once or twice weekly  or biweekly  
class8	2997	if results of a prospective national institutes of allergy and infectious disease study of itraconazole maintenance therapy document its effectiveness  alternatives to amphotericin b may be reasonable  
class8	2998	coccidioidomycosis during human immunodeficiency virus infection  a review of 77 patients  
class8	2998	through a retrospective review  we identified 77 previously unreported cases of coccidioidomycosis during hiv infection  
class8	2998	patients were classified into 1 of 6 categories based on their primary clinical presentation  20 had focal pulmonary disease  group 1   31 had diffuse pulmonary disease  group 2   4 had cutaneous coccidioidomycosis  group 3   9 had meningitis  group 4   7 had extrathoracic lymph node or liver involvement  group 5   and 6 has positive coccidioidal serology without a clinical focus of infection  group 6   
class8	2998	coccidioidal serologies were positive on initial testing in 83  of the patients in whom such serologic testing was performed  
class8	2998	sera from 39  of patients were positive for tp antibodies while 74  had cf antibodies  
class8	2998	eleven of 12 seronegative patients had pulmonary disease  group 1 or 2   
class8	2998	serologic results of other patients sent to a single reference laboratory were similar  with 26  positive for immunodiffusion tp antibodies and 79  positive for immunodiffusion cf antibodies  
class8	2998	for the 77 patients in this study  the cd4 lymphocyte count was below 0 250 x 10 9  cells l in 46 of the 55 patients who had this test performed  and a low cd4 count was significantly associated with mortality  p less than 0 01   
class8	2998	at the time of follow up  32 of the 77 patients  42   had died  
class8	2998	there were significantly more deaths in those with diffuse pulmonary disease  group 2  than in other groups  p less than 0 001   
class8	2998	amphotericin b  ketoconazole  fluconazole  and itraconazole were all used as antifungal therapies  
class8	2998	outcome could not be related to the therapy used  
class8	2998	of note  3 patients developed coccidioidomycosis while receiving ketoconazole for other conditions  
class8	2999	corticosteroids as adjunctive therapy for severe pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome  a double blind  placebo controlled trial  
class8	2999	background  
class8	2999	preliminary reports suggest that patients with the acquired immunodeficiency syndrome  aids  and pneumocystis carinii pneumonia may benefit from the addition of corticosteroid treatment to antibiotic therapy  
class8	2999	methods  
class8	2999	we conducted a double blind  placebo controlled trial to assess the efficacy of adjunctive corticosteroids in patients with aids and severe p  
class8	2999	carinii pneumonia  
class8	2999	patients with marked abnormalities in gas exchange who had been treated with antibiotics for less than 72 hours were randomly assigned to receive either methylprednisolone  40 mg  or placebo every 6 hours for 7 days  in addition to treatment for 21 days with trimethoprim sulfamethoxazole  
class8	2999	the primary outcome measures were survival until hospital discharge and the development of respiratory failure  
class8	2999	results  
class8	2999	twenty three patients were enrolled in the study  there were no significant differences in base line clinical or laboratory measures between the two treatment groups  
class8	2999	of 12 patients treated with corticosteroids  9  75 percent  survived until hospital discharge  as compared with only 2 of 11 placebo recipients  18 percent   p less than 0 008   
class8	2999	respiratory failure developed in nine placebo recipients  as compared with only three patients treated with corticosteroids  p less than 0 008   
class8	2999	no patient required the interruption or discontinuation of corticosteroid or antibiotic treatment because of toxicity or a complicating event  
class8	2999	because of the marked difference in survival  it was deemed unethical to continue the trial  and the study was terminated  
class8	2999	conclusions  
class8	2999	early adjunctive corticosteroid therapy can improve survival and decrease the occurrence of respiratory failure in patients with aids and severe p  
class8	2999	carinii pneumonia  
class8	3000	a controlled trial of early adjunctive treatment with corticosteroids for pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome  california collaborative treatment group  
class8	3000	background  
class8	3000	pneumocystis carinii pneumonia remains a common cause of serious morbidity and mortality in patients with the acquired immunodeficiency syndrome  aids   
class8	3000	the extensive lung injury that accompanies pneumocystis associated respiratory failure and the reports of clinical benefit from the use of adjunctive corticosteroids provided the rationale for this prospective multicenter trial  
class8	3000	methods  
class8	3000	a total of 333 patients with aids and pneumocystis pneumonia received standard treatment and were randomly assigned to receive either corticosteroids  beginning with the equivalent of 40 mg of prednisone twice daily  or no additional therapy  
class8	3000	the primary end points in this unblinded trial were the occurrence of respiratory failure  hypoxemia ratio  partial pressure of arterial oxygen divided by fraction of inspired oxygen  less than 75  intubation  or death   death  and dose limiting toxicity of the initial standard therapy  
class8	3000	results  
class8	3000	of the patients with confirmed or presumed pneumocystis pneumonia  n   225 and n   26  respectively   those assigned to treatment with corticosteroids had a lower cumulative risk at 31 days of respiratory failure  0 14 vs  
class8	3000	0 30  p   0 004  and of death  0 11 vs  
class8	3000	0 23  p   0 009   as well as a lower risk of death within 84 days  0 16 vs  
class8	3000	0 26  p   0 026   
class8	3000	the frequency of dose limiting toxicity of the standard therapy was similar in the two treatment groups  
class8	3000	intention to treat analyses of the entire cohort confirmed these findings  
class8	3000	clinical benefit could not be demonstrated  however  for patients with mild disease  hypoxemia ratio  greater than 350   equivalent to a partial pressure of oxygen greater than 75 torr on room air  
class8	3000	the patients assigned to corticosteroid treatment had an excess of localized herpetic lesions  26 percent vs  
class8	3000	15 percent  p   0 04  but not of other infections or of neoplasms  
class8	3000	conclusions  
class8	3000	early adjunctive treatment with corticosteroids reduces the risks of respiratory failure and death in patients with aids and moderate to severe pneumocystis pneumonia  
class8	3000	because the adverse effects are few  corticosteroids should be included as part of the initial treatment for persons with aids who have moderate to severe pneumocystis pneumonia  
class8	3001	identification of the primary gene defect at the cytochrome p450 cyp2d locus  
class8	3001	the mammalian cytochrome p450 dependent monooxygenase system is involved in the metabolism of drugs and chemical carcinogens  
class8	3001	the role of these enzymes in toxicological response is exemplified by an autosomal recessive polymorphism at the cytochrome p450 cyp2d6 debrisoquine hydroxylase locus which results in the severely compromised metabolism of at least 25 drugs  and which in some cases can lead to life threatening side effects  
class8	3001	in addition  this polymorphism  which affects 8 10  of the caucasian population  has been associated with altered susceptibility to lung and bladder cancer  
class8	3001	here we report the identification of the primary mutation responsible for this metabolic defect and the development of a simple dna based genetic assay to allow both the identification of most individuals at risk of drug side effects and clarification of the conflicting reports on the association of this polymorphism with cancer susceptibility  
class8	3002	subdural hematoma associated with metastatic neoplasms  
class8	3002	two cases of subdural hematoma  one acute and the other chronic  associated with cancer metastatic to the dura are reported  
class8	3002	various mechanisms of the association of hematomas with cancer are reviewed  
class8	3003	aspiration in bilateral stroke patients  
class8	3003	seventy patients with bilateral strokes underwent neurologic and videofluoroscopic barium swallowing examinations  34  48 6   aspirated  
class8	3003	patients with aspiration were more likely to have posterior circulation strokes  abnormal cough  abnormal gag  and dysphonia  
class8	3003	however  patients likely to aspirate can be identified best by the presence of an abnormal voluntary cough  an abnormal gag reflex  or both  
class8	3003	the prediction of patients at risk for aspiration was not improved by additional clinical information  ie  presence of dysphonia or bilateral neurologic signs   
class8	3004	central neurogenic hyperventilation  pharmacologic intervention with morphine sulfate and correlative analysis of respiratory  sleep  and ocular motor dysfunction  
class8	3004	central neurogenic hyperventilation  cnh   for which there is no effective therapy  can eventually result in respiratory fatigue and death  
class8	3004	this report describes a patient with cnh due to a brainstem anaplastic astrocytoma who also exhibited disturbances of sleep and ocular motor function  
class8	3004	the cnh responded clinically to morphine sulfate and methadone  
class8	3004	analysis of ventilatory response to co2 before and after morphine demonstrated a depression of ventilatory response  49 to 53  of baseline  and occlusion pressure response  35 to 50  of baseline  to co2  with a requirement for high doses of naloxone  10 mg iv  to reverse the effect  
class8	3004	polysomnography revealed sustained hyperventilation  elevated o2 saturation  and low end tidal co2 throughout all stages of non rapid eye movement  nrem  sleep  and absence of rapid eye movement  rem  sleep  
class8	3004	ocular motor evaluation disclosed absence of horizontal and reflexive saccades with compensatory head thrusts  
class8	3004	correlation of the clinical and physiologic data with the mri abnormalities suggested that the lesion responsible for cnh in this patient might reside in the medial tegmental parapontine reticular formation  
class8	3004	since recurrent episodes of hyperventilation responded in a sustained fashion to iv and oral opiates  this treatment may warrant consideration in other patients with cnh  
class8	3005	serologic evidence of subclinical pertussis in immunized children  
class8	3005	incidental to a vaccine study involving 783 immunized children conducted at two study sites  inner city children had significantly higher geometric mean pertussis agglutinin titers compared with suburban children just before the fourth dose of diphtheria tetanus whole cell pertussis vaccine  47 vs  
class8	3005	25  p less than 0 001   
class8	3005	higher titers in the inner city were correlated with residence in census tracts where cases of pertussis were reported  
class8	3005	three hundred thirty two children in a placebo arm of the study who were clinically observed and had paired serum samples taken during a 2  to 4 month period were analyzed for evidence of natural bordetella infection  
class8	3005	twelve  11   inner city children and three  1 3   suburban children had spontaneous 4 fold or greater rises in at least two different pertussis antibodies measured  agglutinin  antitoxin or enzyme linked immunosorbent assay for igg to pertussis toxin  igg and iga to filamentous hemagglutinin   
class8	3005	eighty percent of these children had iga to filamentous hemagglutinin  
class8	3005	nine of 12 inner city children with serologic evidence of pertussis lived within 6 blocks of a case of pertussis reported within 1 month of the observed antibody rise in study subjects  none had a household member with pertussis and none had symptomatic disease  
class8	3006	current epidemiology of pertussis in japan  
class8	3006	since the introduction of whole cell pertussis vaccine into general use as part of the routine immunization in 1947 under the preventive immunization law  a steady decrease in reported cases of pertussis was noted until 1974  
class8	3006	at that time the number of reported cases reached an all time low and no deaths caused by pertussis were reported  
class8	3006	the vaccine  diphtheria tetanus whole cell pertussis vaccine  had been given to infants 12 weeks old or older in a 0 5 ml dose by deep subcutaneous injection  three doses were given at intervals of 3 to 8 weeks and the fourth dose  booster  was given 12 to 18 months after the third dose  
class8	3006	the immunization was completed with those four doses  
class8	3006	because whole cell vaccine appeared to be associated with severe neurologic illnesses  it was temporarily suspended in 1975  
class8	3006	the vaccine was resumed soon thereafter but the age of administration was raised to 24 to 48 months  
class8	3006	under these circumstances acceptance rates of pertussis occurred  reaching a peak in 1979  
class8	3006	although whole cell vaccine was used even after temporary suspension  it was considered to be unacceptable by the public  
class8	3006	as a result the acellular pertussis vaccine was developed and has totally replaced whole cell vaccine since 1981  
class8	3006	a steady decrease in reported cases of pertussis as well as the number of deaths has been noted since 1979 in accordance with increase in vaccine acceptance rates  
class8	3006	the national surveillance system begun in 1981 demonstrated also a steady decrease in the incidence of pertussis during the past 9 years  
class8	3007	thrombocytosis after pneumonia with empyema and other bacterial infections in children  
class8	3007	thrombocytosis is seen in association with many conditions  including infectious diseases  
class8	3007	we studied thrombocytosis after severe bacterial infections  particularly pneumonia with empyema in children  
class8	3007	a systematic survey of the phenomenon was conducted  
class8	3007	twenty seven children admitted for pneumonia with empyema were studied  
class8	3007	thrombocytosis  platelet counts greater than 500 x 10 3  microliters  was present in 92 5   
class8	3007	platelet counts reached their maximum at 15 1     3 7 days  range  7 to 25  and declined to normal after 3 weeks of illness  
class8	3007	compared with a healthy control group  significant thrombocytosis  but of lower incidence  was also noted in children with lobar pneumonia without pleural effusion  bacterial meningitis and osteomyelitis  
class8	3007	platelet functions were examined in seven of the children but no abnormalities were observed  
class8	3007	bone marrow aspiration of three children with pneumonia and empyema showed megakaryocytic hyperplasia  
class8	3007	we found no correlation between thrombocytosis  neutrophilia  fever  the clinical course  complications  prognosis or treatment  
class8	3007	neither thromboembolic nor hemorrhagic phenomena were observed  
class8	3008	immunoglobulin g subclass deficiency and predisposition to infection in down s syndrome  
class8	3008	serum immunoglobulins and igg subclasses were measured in 26 children with down s syndrome using an enzyme linked immunosorbent assay and monoclonal antibodies  
class8	3008	eighteen  69   of the children had increased susceptibility to infection  
class8	3008	none of the children had deficiencies of total igg and igm  and only one had an iga deficiency  
class8	3008	igg4 deficiency was diagnosed in 14  54   children  
class8	3008	one child had a deficiency of igg2  
class8	3008	there were no children with deficiencies of either igg1 or igg3  
class8	3008	there was a significant correlation between igg subclass deficiency and predisposition to infection  p less than 0 05   
class8	3008	ninety percent of the patients with severe infections had low igg4 whereas only 25  of those with no infections had low concentrations of igg4  
class8	3008	these results suggest that it is important to screen patients with down s syndrome who have frequent systemic or respiratory infections for igg subclass deficiencies because this may not be apparent from the assay of total igg  
class8	3009	study design considerations for ribavirin  efficacy studies  
class8	3009	five placebo controlled double blind studies  each including approximately 30 subjects  have addressed the question of the effect of aerosolized ribavirin on the course of rsv lower respiratory infection in infancy  
class8	3009	the fact that each was able to establish a beneficial effect despite the small number of subjects studied is convincing evidence that such an effect exists  
class8	3009	the studies from rochester using oximetry and an analog illness severity scale indicate that this effect is both statistically significant and clinically relevant  
class8	3009	these tools are reliable and easily applicable measures for multicenter studies when illness severity is selected as an outcome measure  
class8	3009	characteristics that should be taken into consideration when assigning experimental groups include age  sex  a history of prematurity or underlying conditions and arterial oxygen saturation  
class8	3009	future studies will address additional questions about the efficacy of ribavirin  such as its role in critically ill children  the economic benefits of its use in terms of duration of hospitalization  the usefulness of early treatment of rsv disease in high risk infants  and the impact of treatment on long term consequences of rsv infection  
class8	3009	these studies may require outcome variables and subject selection strategies different from those used in earlier studies  
class8	3010	transbronchial biopsies in children after heart lung transplantation  
class8	3010	sixty transbronchial biopsies have been performed in eight children after heart lung transplantation  
class8	3010	the selection of fiber optic bronchoscope or a small  4 mm  30 cm  rigid bronchoscope was made according to the size of endotracheal tube required at surgery  
class8	3010	if the endotracheal tube was size 7 5 or greater  a fiber optic bronchoscope was used  whereas if the endotracheal tube size was below 7  a rigid bronchoscope was used  
class8	3010	for the diagnosis of lung rejection  the histology of biopsies revealed a sensitivity of 91  and specificity of 69   similar to the result in adults   
class8	3010	the histology also distinguished lung infection from rejection  
class8	3010	complications included three pneumothoraces and two clinically significant episodes of hemorrhage  one of which led to a cardiorespiratory arrest  which may have been caused by hypoxia  
class8	3010	as a result  arterial oxygen saturation is now monitored during the procedure using a pulse oximeter  
class8	3011	dexamethasone effects on the hospital course of infants with bronchopulmonary dysplasia who are dependent on artificial ventilation  
class8	3011	a randomized double blind placebo controlled trial was conducted to evaluate the effects of enterally administered dexamethasone on the hospital course of infants with bronchopulmonary dysplasia  
class8	3011	a total of 23 infants with a birth weight less than 1500 g who were dependent on artificial ventilation 3 to 4 weeks of age received dexamethasone  n   12  or saline placebo  n   11   
class8	3011	dexamethasone  0 5 mg kg per day  was given in tapering doses for 7 days followed by hydrocortisone  8 mg kg per day  which was progressively reduced for a total of 17 days of therapy  
class8	3011	infants who received dexamethasone required less oxygen on days 8 and 17  p less than  05  and were more likely to extubate 8 days after therapy than infants in the control group  respectively 8 12 vs 3 11 infants  p less than  05  p    12 after yates correction   
class8	3011	the use of dexamethasone significantly shortened median duration of mechanical ventilation  4 vs 22 days  p less than  05  but had no effect on length of oxygen therapy  hospitalization  home oxygen therapy  occurrence and severity of retinopathy of prematurity  rate of growth  and mortality  
class8	3011	no significant complications resulted from dexamethasone therapy  
class8	3011	measurements of plasma dexamethasone levels confirmed the absorption of drug from the gastrointestinal tract  23 7 ng ml in dexamethasone vs 4 6 ng ml in the control group  p less than  05   
class8	3011	dexamethasone administration resulted in short term improvements in pulmonary function but did not ameliorate the hospital course of infants with bronchopulmonary dysplasia  
class8	3012	predicting risk for bronchopulmonary dysplasia  selection criteria for clinical trials 
class8	3012	early identification of neonates in whom bronchopulmonary dysplasia is most likely to develop permits appropriate enrollment into clinical trials testing early intervention therapies for the prevention or treatment of bronchopulmonary dysplasia  
class8	3012	analysis of 160 neonatal intensive care unit survivors to 28 days revealed that supplemental oxygen requirement at 28 days could be predicted by a logistic regression including  1  birth weight  gestational age  5 minute apgar score  and peak inspiratory pressure at 12 hours for 12 hour old neonates and  2  birth weight  gestational age  peak inspiratory pressure at 12 hours  and mean airway pressure at 10 days for 10 day old neonates  
class8	3012	these two regression analyses were applied prospectively to three new data sets totaling 238 neonates to test their predictive ability  
class8	3012	neonates were classified into low   moderate   or high risk groups on the basis of their predicted probability of requiring oxygen supplementation at 28 days  low   probability of less than 25   moderate   probability of 25  to 75   and high   probability greater than 75   
class8	3012	although these populations were demographically distinct from the original group  the regression analyses performed well  
class8	3012	the regression analysis for 12 hours of age classified 125 neonates at low risk of whom 9  required supplemental oxygen at 28 days  and the regression analysis for 10 days classified 141 neonates at low risk of whom 7  required supplemental oxygen  
class8	3012	the 12 hour regression analysis classified 80 neonates at moderate risk of whom 33  required supplemental oxygen at 28 days and the 10 day regression analysis classified 49 neonates at moderate risk of whom 24  required supplemental oxygen  
class8	3013	surfactant replacement therapy with a single postventilatory dose of a reconstituted bovine surfactant in preterm neonates with respiratory distress syndrome  final analysis of a multicenter  double blind  randomized trial and comparison with similar trials  the surfactant ta study group  
class8	3013	the effects of a single dose of surfactant ta were assessed in premature neonates  birth weight 750 to 1749 g  with respiratory distress syndrome  rds  in a multicenter  double blind  randomized clinical trial  
class8	3013	only neonates with surfactant deficiency and without ultrasonographic evidence of intracranial hemorrhage greater than or equal to grade ii were enrolled  
class8	3013	fifty four patients received surfactant  100 mg of phospholipid per kilogram of body weight  and 46 patients received an air placebo within 8 hours of life  
class8	3013	treatment with this surfactant resulted in a significant reduction in the severity of rds with a concomitant increase in the proportion of neonates with mild disease  
class8	3013	the frequency of pulmonary interstitial emphysema and of pneumothorax was significantly lower in treated neonates compared with control neonates  2  vs 26   p    0008  and 7  vs 39   p    0004  respectively   
class8	3013	the frequency of intracranial hemorrhage was significantly lower in the surfactant group compared with the control group  20  vs 54   p    0008  and was also reduced for the smallest neonates in the surfactant group  13  vs 73   p    00008   
class8	3013	when categorized according to severity of intracranial hemorrhage and severity of bronchopulmonary dysplasia  the surfactant group was at a significant advantage  adjusted cochran mantel haenszel x2   10 72  p less than  001 and x2   4 43  p    036  respectively   
class8	3013	the proportion of neonates surviving without intracranial hemorrhage and or bronchopulmonary dysplasia was 63  in the surfactant group vs 26  in the control group  p    0004   as for the smallest neonates  it was 58  in the surfactant group vs 4  in the control group  p    0002   
class8	3013	there were no differences between the groups with respect to the frequency of patent ductus arteriosus  46  vs 37    pulmonary hemorrhage  6  vs 7    necrotizing enterocolitis  0  vs 2    sepsis  4  vs 2    retinopathy of prematurity  13  vs 22    or death  15  vs 22    
class8	3013	it is concluded that treatment with the single dose surfactant regimen used in this study reduces the severity of respiratory distress during the 48 hours after treatment and decreases the major pulmonary morbidity and intracranial hemorrhage in premature neonates with rds  
class8	3013	further studies are needed to determine whether  1  treatment at birth or as soon as after rds is diagnosed and  2  the use of multiple dose of this surfactant would result in any additional benefits  
class8	3014	pulmonary and acid base assessment  
class8	3014	with increased technology  increased patient longevity  and burgeoning health care knowledge  pulmonary assessment of clients has become more complex  and nurses are now challenged to develop more comprehensive skills  
class8	3014	these include a more focused patient history on selected clients as well as careful inspection  palpation  percussion  and auscultation  
class8	3014	additional techniques such as voice sounds provide the nurse with even more assessment data  
class8	3014	an understanding of common pathologic pulmonary problems and their corresponding assessment findings as well as knowledge about acid base imbalances will result in more effective professional nursing care  
class8	3015	dyspnea  
class8	3015	a multidimensional model of dyspnea that includes sensation  perception  distress  response  and reporting components is presented  
class8	3015	assessment tools currently available are evaluated as are recent research findings for pharmacologic  oxygen  physical  and psychologic treatments  
class8	3015	this article concludes by suggesting a role for the nurse in dyspnea amelioration  
class8	3016	let s stop the comeback of tuberculosis  best drug regimens for prevention and treatment  
class8	3016	tuberculosis has been on the increase in recent years  so physicians need to be aware of it once again  
class8	3016	very effective drugs are available to treat the disease  
class8	3016	pharmacokinetics  dosing schedule  and adverse reactions of each anti tuberculous agent need to be considered  
class8	3016	a short  6 month  course of therapy is now recommended  isoniazid  rifampin  rifadin  rimactane   and pyrazinamide are given for the initial 2 months  followed by isoniazid and rifampin for 4 months  
class8	3016	if drug resistance is a factor  a fourth drug is added to the initial regimen  and therapy may have to be extended  
class8	3016	chemoprophylaxis with isoniazid is very important to reduce the incidence of tuberculosis  
class8	3016	it should be given to all high risk persons  
class8	3017	viral pneumonias  a diagnostic and therapeutic challenge  
class8	3017	viral pneumonias are both a diagnostic and a therapeutic challenge for primary care physicians  
class8	3017	the illness should be suspected when an upper respiratory tract infection progresses to include dyspnea and cyanosis  
class8	3017	rapid diagnostic tests are now available to detect most of the viruses that cause pneumonias  
class8	3017	fortunately  viral pneumonias usually resolve without specific antiviral therapy  however  ribavirin is indicated for respiratory syncytial virus pneumonia in children and ganciclovir sodium  cytovene  for cytomegalovirus pneumonia in immunocompromised patients  
class8	3017	acyclovir  zovirax  is indicated for pneumonias due to herpes simplex virus and varicella zoster virus infections  
class8	3017	a high index of suspicion for bacterial superinfections is essential to reduce the risk of death from this complication  
class8	3018	breathing exercises for the medical patient  the art and the science  
class8	3018	the art of breathing exercises can be traced to the late 1800s  
class8	3018	in the past 10 years  the increased demand for treatment for respiratory muscle failure of dysfunction has resulted in numerous studies evaluating methods of treatment or training  
class8	3018	this article provides an overview of research and practice  focused on treating the medical patient experiencing dyspnea or loss of respiratory muscle strength and endurance  
class8	3019	chronic obstructive pulmonary disease  
class8	3019	chronic obstructive pulmonary disease is indeed a multifaceted illness  
class8	3019	the obstructive picture is the result of multiple pathologic processes  
class8	3019	the most common cause is cigarette smoking  
class8	3019	the key to decreasing the incidence of this disease is education to prevent people from starting to smoke and to educate those who do smoke to stop  
class8	3019	the therapeutic management involves numerous medications  oxygen  and physiotherapy  
class8	3019	unfortunately  the pharmacologic management remains largely empiric with sympathomimetics  anticholinergics  methylxanthines  and corticosteroids  
class8	3019	these agents  especially methylxanthines and corticosteroids  are not without considerable toxicity  
class8	3019	therefore  embarking on a pharmacologic plan requires weighing the risk to benefit ratio carefully and having a comprehensive plan to assess subjectively and objectively the efficacy and toxicity of the chosen therapy  
class8	3020	pharmacotherapy of asthma and allergic rhinitis  
class8	3020	it has become easier to treat and control the symptoms of asthma  while the treatment of allergies remains directed toward the prevention and blockade of histamine induced symptoms  
class8	3020	this article details treatment options  including beta 2 selective sympathomimetic agonists  methods of delivery  theophylline  cromolyn  corticosteroids  antihistamines  decongestants  and intranasal steroids  
class8	3021	bacterial tracheitis  report of eight new cases and review  
class8	3021	bacterial tracheitis  previously referred to as nondiphtheritic laryngitis with marked exudate  was commonly discussed in pediatric textbooks before 1940  
class8	3021	it seemed to disappear as a clinical entity after that time  but it has been recorded with increasing frequency in the pediatric literature since 1979  
class8	3021	we describe eight new cases and review 110 previously described cases  
class8	3021	the clinical course consists of a prodromal upper respiratory illness with stridor  fever  and a variable degree of respiratory distress  
class8	3021	unlike patients with croup  patients with bacterial tracheitis do not respond to aerosolized racemic epinephrine  
class8	3021	most patients require endotracheal intubation  some require tracheostomy  
class8	3021	reported complications include pneumonia  pneumothorax  formation of pseudomembranes  toxic shock syndrome  and cardiopulmonary arrest  
class8	3021	bacterial tracheitis is a secondary bacterial infection following a primary viral respiratory infection  
class8	3021	the most common preceding viral infection is parainfluenza  
class8	3021	staphylococcus aureus and haemophilus influenzae are the predominant causes of bacterial tracheitis  
class8	3021	secondary bacterial infection may occur as a result of tracheal mucosal injury or impairment of normal phagocytic function due to viral infection  
class8	3022	acute respiratory disease in spain  seven years of experience 
class8	3022	the clinical and epidemiologic features of viral and nonviral pathogens involved in acute respiratory diseases are described in the context of cases of infection  especially atypical pneumonia and bronchiolitis  studied at the centro nacional de microbiologia  virologia e immunologia sanitarias in madrid during a 7 year period  1979 1986   
class8	3022	these etiologies were demonstrated in 1 637  36 2   of 4 521 cases  
class8	3022	among viruses  respiratory syncytial virus most frequently infected children  influenza virus showed the same pattern of circulation as in other european countries  
class8	3022	of nonviral agents  mycoplasma pneumoniae and c  
class8	3022	burnetii were most often involved in lower respiratory tract infections  with a variable predominance in patients of different ages  
class8	3022	a high proportion of cases of m  
class8	3022	pneumoniae infection occurred in infants and children aged less than 1 year  and most of these cases occurred during spring and summer  
class8	3022	the majority of q fever cases  including those observed in two outbreaks  occurred in the northern region  
class8	3023	resolution of lung abscess due to pseudomonas aeruginosa with oral ciprofloxacin  case report  
class8	3023	a case of lung abscess due to pseudomonas aeruginosa is presented that did not resolve with the use of conventional antipseudomonal antibiotics  including tobramycin with ticarcillin clavulanate and ceftazidime with gentamicin and ticarcillin clavulanate  
class8	3023	oral ciprofloxacin was administered for 12 weeks  and the infection was resolved  
class8	3023	no resistance occurred  and there was no recurrence of abscess within 18 months following therapy  
class8	3024	pulmonary and disseminated infection due to mycobacterium kansasii  a decade of experience  
class8	3024	fifty five patients with mycobacterium kansasii isolates  47 pulmonary and eight disseminated  were identified at a large texas hospital from 1975 to 1985  
class8	3024	the mean age of patients was 60 years  and there was a slight male predominance  
class8	3024	isolation of m  
class8	3024	kansasii usually represented disease  
class8	3024	the great majority of patients with pulmonary infection due to m  
class8	3024	kansasii had underlying pulmonary diseases  and 70  had nonpulmonary predisposing factors  
class8	3024	m  
class8	3024	kansasii pulmonary disease clinically and radiographically resembled pulmonary tuberculosis  
class8	3024	disseminated m  
class8	3024	kansasii infection occurred in severely immunocompromised patients  who frequently had pulmonary predispositions as well  
class8	3024	disseminated infection most of ten involved the lung  reticuloendothelial system  bone  joint  and skin and presented with signs and symptoms related to these organs  
class8	3024	despite only moderate in vitro susceptibility of m  
class8	3024	kansasii to routine antituberculous drugs  most patients responded to rifampin containing regimens  
class8	3024	the prognosis of patients with m  
class8	3024	kansasii disease was determined primarily by their underlying diseases  
class8	3025	early treatment with acyclovir for varicella pneumonia in otherwise healthy adults  retrospective controlled study and review  
class8	3025	the effect of early acyclovir therapy on the course of varicella pneumonia in previously healthy adults was assessed  
class8	3025	medical records from five university affiliated medical centers were retrospectively reviewed  included were all immunocompetent adults with a clinical diagnosis of primary varicella  a chest radiograph consistent with varicella pneumonia  and an arterial blood gas measurement indicating significant hypoxia  
class8	3025	of the 38 patients who met the study criteria  11 had had a course of intravenous acyclovir initiated within the first 36 hours of hospitalization  the mean time from admission to initiation of therapy in this early treatment group was 9 6 hours  
class8	3025	the group that received early acyclovir treatment had a lower mean temperature beginning on the fifth day of hospitalization  37 0 degrees c vs  
class8	3025	37 7 degrees c  p    011  and a lower mean respiratory rate beginning on the sixth day of hospitalization  21 vs  
class8	3025	28 respirations per minute  p    004   
class8	3025	early acyclovir therapy also resulted in a significant improvement in oxygenation beginning on the sixth day of hospitalization in patients with follow up arterial blood gas measurements  p    035   
class8	3025	thus  early institution of acyclovir therapy is associated with reduction in fever and tachypnea and improvement in oxygenation in otherwise healthy adults with varicella pneumonia  
class8	3026	pneumonia due to legionella micdadei in bone marrow transplant recipients  
class8	3026	legionella micdadei has previously been described as a cause of nosocomial pneumonia  particularly in kidney transplant recipients  
class8	3026	cell mediated immunity is the principal host defense against this pathogen  
class8	3026	a common clinical scenario in the immunocompromised host is that of septic pulmonary embolus  but asymptomatic infections have also been reported  
class8	3026	the organism is weakly acid fast in clinical specimens but loses this property when grown on solid media  
class8	3026	we report two cases of l  
class8	3026	micdadei pneumonia  differing markedly in clinical severity and outcome  in bone marrow transplant recipients  
class8	3026	additionally  we note the growth of the organism in liquid culture media with preservation of its acid fast property  
class8	3027	virologic and pathogenetic aspects of cytomegalovirus infection  
class8	3027	cytomegalovirus  cmv  is a ubiquitous agent that rarely causes disease in immunocompetent humans but is an important cause of morbidity and mortality in the immunocompromised  
class8	3027	a number of host and viral factors are associated with pathology following cmv infection  
class8	3027	cmv can be found at many sites in the body but only causes disease at some of these and then only in certain patient populations  
class8	3027	in some situations the mechanism underlying disease is direct viral replication  but in others  particularly cmv pneumonitis in allogeneic transplant recipients  an immunopathologic basis is strongly implicated  
class8	3027	an important factor in the pathogenesis of infection and the expression of symptomatic disease is the source of cmv infection whether it arises from an exogenous source or is due to reactivation of latent endogenous virus  
class8	3027	exogenous infection can occur in previously seronegative individuals or in those with prior exposure to the virus  
class8	3027	in renal transplant recipients both types of exogenous infection have been associated with disease  
class8	3027	another factor that affects the interaction between cmv and its host is the modulating effect of the virus on the host immune response  the mechanism of which remains unknown  
class8	3028	cytomegalovirus infections after allogeneic bone marrow transplantation  
class8	3028	cytomegalovirus  cmv  infection occurs in approximately 50  of all recipients of allogeneic bone marrow transplants and is seen more frequently in cmv seropositive patients than in cmv seronegative patients  
class8	3028	sources of infection include reactivation of latent endogenous virus  blood products from cmv seropositive blood donors  and the use of marrow from a cmv seropositive donor for a cmv seronegative recipient  
class8	3028	the most common and severe clinical syndrome associated with cmv infection in allogeneic transplant recipients is interstitial pneumonia  which occurs in approximately 15  of patients  
class8	3028	risk factors for cmv pneumonia include old age  conditioning with total body irradiation  and severe graft vs  host disease  
class8	3028	the rapid diagnosis of cmv pneumonia has been facilitated by immunochemical staining of bronchoalveolar lavage fluid or by centrifugation of cell cultures with cmv monoclonal antibodies  
class8	3028	the treatment of cmv pneumonia remains problematic  but therapy with a combination of intravenous immune globulin  ivig  plus ganciclovir has resulted in survival rates substantially better than those achieved in previous trials of antiviral therapy  
class8	3028	in cmv seronegative patients  cmv infection and pneumonia can be prevented or modified by the use of cmv seronegative blood products and ivig  
class8	3028	ivig may also have the additional benefits of preventing other infectious complications and graft vs  host disease in patients receiving cmv seronegative blood products  
class8	3028	for cmv seropositive patients  effective prophylaxis for cmv reactivation and pneumonia has not yet been established  but a clinical trial of prophylactic ganciclovir is now under way  
class8	3029	cytomegalovirus infections in bone marrow transplant recipients given intensive cytoreductive therapy  
class8	3029	cytomegalovirus  cmv  infections were studied in 785 bone marrow transplant recipients given intensive cytoreductive therapy  
class8	3029	cmv excretion occurred in 24   viremia in 9   seroconversion in 40   and overall active infection in 47   
class8	3029	cmv disease was much less common  
class8	3029	retinitis  enteritis  and pneumonitis occurred in only one  five  less than 1    and 55  7   of the patients  respectively  
class8	3029	allograft recipients were more likely to develop cmv disease than were autograft patients  p    0001  despite comparable rates of active cmv infection  
class8	3029	cmv disease was rare after primary infection in both autograft and allograft recipients  0 and 1   respectively   
class8	3029	in contrast  cmv disease occurred in 16  of seropositive allograft recipients  
class8	3029	among allograft recipients  risk factors for cmv pneumonitis were seropositivity  age greater than 10 years  and acute graft vs  host disease  while the use of cyclosporine as prophylaxis against graft vs  host disease was protective  
class8	3029	although active infection rates did not decrease  the rates of cmv pneumonitis in allograft recipients during successive years declined significantly  p less than  001   
class8	3030	successful strategy for prevention of cytomegalovirus interstitial pneumonia after human leukocyte antigen identical bone marrow transplantation  
class8	3030	cytomegalovirus  cmv  interstitial pneumonia is a frequent and often fatal complication of allogeneic bone marrow transplantation  
class8	3030	because therapy for cmv pneumonia was  until recently  largely ineffective  prophylactic methods were explored  
class8	3030	this study shows that the strategy of using cmv seronegative blood products for seronegative patients with seronegative donors or weekly administration of intravenous immunoglobulin for all other patients reduced the attack rate of cmv pneumonia  
class8	3030	the results of this study are put into the perspective of previously published data  
class8	3031	complications of extracorporeal membrane oxygenation in neonates  
class8	3031	in cases of severe respiratory failure  cardiopulmonary bypass has been used as support until cardiac and pulmonary recovery occurs  
class8	3031	we report the wilford hall usaf medical center experience with extracorporeal membrane oxygenation  ecmo  and its associated complications  
class8	3031	from july 1985 to march 1989  57 neonates were placed on membrane oxygenators  
class8	3031	the overall survival was 79   
class8	3031	technical complications encountered included catheter related problems  mechanical complications of the pump apparatus  and hemorrhage  
class8	3031	hemorrhagic complications were the most frequent and devastating complications encountered  
class8	3031	intracranial hemorrhage accounted for six deaths associated with bypass  
class8	3031	extracorporeal membrane oxygenation is successful in significantly improving survival of neonates whose predicted mortality approaches 100  with conventional treatment  
class8	3031	the rate of infant mortality using the membrane oxygenator is not affected by technical complications related to catheter position  mechanical problems with the circuit  or hemorrhage  excluding intracranial hemorrhage  
class8	3031	the major cause of death of infants receiving extracorporeal membrane oxygenation is the underlying disease process leading to cardiopulmonary failure  
class8	3032	analysis of the two team approach to anterior spinal fusion  
class8	3032	an anterior approach to the spine via a thoracoabdominal incision offers the surgeon many advantages  
class8	3032	the major vascular structures are visualized  stabilization of a long segment of the spine is strong  and recovery is speedy  
class8	3032	nevertheless  this is a major operation and one with potential morbidity and mortality  
class8	3032	at children s hospital of new orleans  the pediatric surgery and pediatric orthopedic surgery services work together to reduce these risks and in so doing maintain an acceptable morbidity  
class8	3032	with this two team approach  we operated on the spines of 39 patients between 1978 and 1988  
class8	3032	the most common indications for operation included idiopathic scoliosis  neuromuscular disease  and congenital abnormalities  
class8	3032	a thoracoabdominal approach was used in 32 patients  a thoracic approach in four patients  and an abdominal approach in three patients  
class8	3032	twenty nine patients experienced 65 complications  45 of these complications were respiratory in nature  
class8	3032	there were no postoperative deaths  
class8	3032	factors unrelated to the incidence of postoperative complications included age  volume of crystalloid infused during operation  volume of blood replacement  and length of anesthesia  
class8	3033	pneumocystis carinii pneumonia manifested as a hilar mass and cavitary lesion  an atypical presentation in a patient receiving aerosolized pentamidine prophylaxis  
class8	3033	a case of pneumocystis carinii pneumonia  pcp  in a patient with aids was manifested radiographically as a hilar mass and cavitary lesion  
class8	3033	the patient had been receiving aerosolized pentamidine as prophylaxis against pcp  
class8	3033	nonuniform deposition of aerosolized pentamidine was probably responsible for this atypical radiographic appearance of pcp  
class8	3034	pleuropulmonary tularemia  successful treatment with erythromycin  
class8	3034	a 64 year old man had community acquired pneumonia that was retrospectively diagnosed as pleuropulmonary tularemia  
class8	3034	he was successfully treated with erythromycin  
class8	3034	we review the case and briefly discuss the literature on this point  
class8	3035	the contributions of john b  murphy to thoracic surgery  
class8	3035	john b  
class8	3035	murphy was a prominent surgeon who lived in chicago from the 1880s until his death in 1916  
class8	3035	during his career  he was associated with both rush presbyterian and northwestern medical schools  
class8	3035	he was responsible for popularizing the use of an artificial pneumothorax as an effective adjunct in the treatment of pulmonary tuberculosis  
class8	3035	this modality was not  however  his original concept  
class8	3035	in addition to all of the fields of general surgery  murphy undertook the management of empyema and lesions of the chest wall and also performed thoracoplasty procedures  
class8	3035	although he had done several thoracotomy procedures in his laboratory  he rarely undertook this operation in a clinical setting  
class8	3035	drop ether anesthesia was used for all surgical procedures  
class8	3035	murphy did not use closed water seal drainage of the chest  
class8	3035	his oration on thoracic surgery  given at the annual meeting of the ama  in 1898  was an excellent monograph on the subject and undoubtedly contributed to the increased interest and progress in this field of surgery  
class8	3035	murphy was a wise surgeon  an able technician and a scholarly teacher  
class8	3035	the high regard in which he was held by his contemporaries is best expressed by the remark of william mayo      he was the surgical genius of our generation   
class8	3036	radiologic staging of chest in testicular seminoma  
class8	3036	we investigated the usefulness of chest x ray  cxr   conventional planar tomography  tom   and computerized axial tomography  cat  in evaluating patients with stages i and ii testicular seminoma  
class8	3036	all patients had a cxr  and 22 patients had either tom or cat as part of initial staging  
class8	3036	no occult pulmonary or mediastinal nodal disease was found during initial staging  and none of the patients manifested recurrence of tumor in these sites as a first event  
class8	3036	review of the literature corroborates our finding of a very small thoracic failure rate in early stage seminoma  
class8	3036	routine use of cat or tom is not indicated in staging these patients  
class8	3037	nasolaryngoscopy for family physicians  
class8	3037	nasolaryngoscopy is easy to learn and safe and convenient to perform  
class8	3037	it is readily accepted by patients and is a rich source of clinical information  
class8	3037	the flexible nasolaryngoscope allows the physician to directly observe the anatomy of the nasal passages  pharynx and larynx  
class8	3037	the procedure is helpful for identifying the etiology of chronic nasal complaints and hoarseness  
class8	3037	other possible indications for nasolaryngoscopy include suspected nasal foreign body  recurrent nasal or pharyngeal bleeding  and epiglottitis  
class8	3037	with the use of this instrument  treatment of otolaryngologic conditions may be more specific  thereby reducing unnecessary referral or delay in treatment  
class8	3038	hiv disease  a review for the family physician  part ii  secondary infections  malignancy and experimental therapy  
class8	3038	the first part of this two part article included recommendations for the initial evaluation of patients suspected of having hiv infection  the centers for disease control s classification scheme for hiv disease and current recommendations for the use of zidovudine  
class8	3038	in this second part  secondary infections and malignancy are reviewed  and various experimental therapies are briefly discussed  
class8	3039	effects of common illnesses on infants  energy intakes from breast milk and other foods during longitudinal community based studies in huascar  lima   peru  
class8	3039	to assess the effects of common infections on dietary intake  131 peruvian infants were observed longitudinally  
class8	3039	home surveillance for illness symptoms was completed thrice weekly  and food and breast milk consumption was measured during 1615 full day observations  
class8	3039	mean      sd  energy intakes on symptom free days were 557     128 kcal d  92 4     26 5 kcal kg 1 d 1  for infants aged less than 181 d and 638     193 kcal d  77 7     25 7 kcal kg 1 d 1  for infants aged greater than 180 d  
class8	3039	statistical models controlling for infant age  season of the year  and individual showed significant 5 6  decreases in total energy intake during diarrhea or fever  
class8	3039	there were no changes with illness in the frequency of breast feeding  total suckling time  or amount of breast milk energy consumed  
class8	3039	by contrast  energy intake from non breast milk sources decreased by 20 30  during diarrhea and fever  and the small decrements in total energy consumption during illness were explained entirely by reduced consumption of non breast milk foods  
class8	3040	inflammatory myofibroblastic tumor  plasma cell granuloma   clinicopathologic study of 20 cases with immunohistochemical and ultrastructural observations  
class8	3040	twenty cases of inflammatory myofibroblastic tumor  imt  were studied  19 involved the lung and 1 the esophagus only  
class8	3040	the patients  ages ranged from 3 to 72 years  
class8	3040	there were 9 males and 11 females  
class8	3040	involvement of a bronchus was seen in one case and of mediastinal structures in four  
class8	3040	chest pain and dyspnea were common symptoms  eight patients were asymptomatic  
class8	3040	seven patients underwent lobectomy  12 local excision  and 1 biopsy alone  
class8	3040	the lesions were nonencapsulated and ranged from 1 2 to 15 cm  
class8	3040	various proportions of plasma cells  histiocytes  and spindle cells were observed  the latter corresponded ultrastructurally to fibroblasts and myofibroblasts  were immunoreactive for vimentin and actin and focally for desmin  and were negative for epithelial markers  
class8	3040	plasma cells were polyclonal for light chains  
class8	3040	one patient had two recurrences  and in one case a large pleural imt was found eight years after the excision of a similar lesion in the lung  
class8	3040	all patients with follow up  ten  were well as long as ten years after the diagnosis  average  3 7 years   
class8	3041	survey of histologic specimens of human cancer for human papillomavirus types 6 11 16 18 by filter in situ hybridization  
class8	3041	histologic specimens  317  of genital and nongenital cancers and normal tissue were analyzed for the presence of the dna of human papillomavirus  hpv  6  11  16  and 18 by filter in situ hybridization performed on paraffin embedded  formalin fixed tissue  histofish   
class8	3041	hpv dna was found in 73 of 172  42   anogenital lesions and 17 of 116  15   nonanogenital carcinomas  
class8	3041	no hpv dna was found in normal mouse skin  five samples   human autopsy liver  two samples   or kidney  eight samples   or in carcinomas of the breast  three samples   bladder  five samples   or colon  nine samples   
class8	3041	of the nongenital tumors  hpv dna was found in the carcinomas of the lung  2 of 5   anus  7 of 18   esophagus  9 of 39   buccal cavity  1 of 5   and larynx  5 of 50   
class8	3041	hpv dna was also detected in 2 of 11 histologically normal specimens of the cervix and 1 of 3 human skin lesions  
class8	3041	the detection of hpv dna in carcinomas of the lung  larynx  and esophagus as well as in the anogenital region confirms recent suggestions that hpv types 6  11  16  and 18 have a wider association with different types of cancer than previously believed  
class8	3041	the study also shows that histofish is a useful method for detecting hpv dna in histologic specimens  
class8	3042	childhood deaths from toy balloons  
class8	3042	we describe four children who died of suffocation by rubber balloons in canada between 1983 and 1988  
class8	3042	in the united states  at least 121 children have died in a similar manner in the 15 years between 1973 and 1988 according to a report by the us consumer product safety commission  
class8	3042	although the highest mortality occurred among infants  30  25   of the 121 deaths occurred in children 6 years of age or older  
class8	3042	balloons account for 43  of the approximately 15 childhood deaths related to children s products that are documented each year by the consumer product safety commission  
class8	3042	toy rubber balloons are thus the leading cause of pediatric choking deaths from children s products  
class8	3042	preventive efforts should be directed toward a ban on this type of balloon and the development of safer alternatives  
class8	3042	meanwhile  public information campaigns should alert parents  physicians  and policymakers to the dangers of toy rubber balloons  
class8	3043	use of intrapleural streptokinase in the treatment of thoracic empyema  
class8	3043	the incidence of pleural effusions in bacterial pneumonia may exceed 40   a factor that may be related to increased morbidity and mortality  
class8	3043	options in the treatment of complicated pleural effusions or empyema  when unresponsive to closed tube drainage  include repositioning of the indwelling tube thoracostomy or insertion of additional chest tubes  instillation of intrapleural streptokinase  and surgical intervention  
class8	3043	the authors describe the course of three patients wherein the use of intrapleural streptokinase was efficacious in effecting prompt drainage of previously inadequately evacuated empyema  thus eliminating the necessity for further invasive intervention  
class8	3044	pulmonary disease in aids patients  
class8	3044	pulmonary disease remains a major complication of the human immunodeficiency virus  hiv   
class8	3044	over the past decade several changes in the pattern of disease have occurred  
class8	3044	pneumocystis carinii pneumonia  pcp  remains the most common opportunistic pathogen in aids patients  though its incidence on bronchoscopy has declined and empiric therapy often occurs without a specific diagnosis  
class8	3044	changes in the management of patients with pcp have included different dosages and routes of administration for chemotherapy  improved overall survival  and a recent increase in the number of patients surviving episodes of respiratory failure  
class8	3044	in addition  infection with mycobacteria tuberculosis  m tb   has emerged as a major public health problem  
class8	3044	the pattern of m tb  
class8	3044	is distinct from non immunocompromised patients though response to therapy usually occurs  
class8	3045	ultrastructural localization of proteinase 3  the target antigen of anti cytoplasmic antibodies circulating in wegener s granulomatosis  
class8	3045	to investigate the distribution of proteinase 3  the target antigen of anti cytoplasmic antibodies  acpa or c anca   within the organelles of resting normal human polymorphonuclear leukocytes and monocytes  the authors used immunocytochemical techniques on thin frozen sections  
class8	3045	to obtain valuable tools for immunolabeling  two murine monoclonal antibodies  mabs  directed against the acpa antigen were produced  
class8	3045	in neutrophils  the authors observed immunogold label for the acpa antigen  predominantly in myeloperoxidase positive azurophil granules  and in smaller amounts on the plasma membrane  
class8	3045	in monocytes  the acpa antigen could be detected in small granules  which occasionally also contained myeloperoxidase  and rare labeling was found on the monocyte membrane  
class8	3045	the finding that the acpa antigen is expressed on the plasma membrane of neutrophils and monocytes  thereby becoming accessible to circulating autoantibodies  supports the supposition that acpa are not only markers of disease activity  but also are involved in the pathogenesis of wegener s granulomatosis  
class8	3046	inhibition of angiogenesis and tumor growth in the brain  suppression of endothelial cell turnover by penicillamine and the depletion of copper  an angiogenic cofactor  
class8	3046	microvascular proliferation  a hallmark of malignant brain tumors  represents an attractive target of anticancer research  especially because of the quiescent nonproliferative endothelium of the normal brain  
class8	3046	cerebral neoplasms sequester copper  a trace metal that modulates angiogenesis  
class8	3046	using a rabbit brain tumor model  normocupremic animals developed large vascularized vx2 carcinomas  
class8	3046	by contrast  small  circumscribed  relatively avascular tumors were found in the brains of rabbits copper depleted by diet and penicillamine treatment  cdpt   
class8	3046	the cdpt rabbits showed a significant decrease in serum copper  copper staining of tumor cell nuclei  microvascular density  the tumor volume  endothelial cell turnover  and an increase in the vascular permeability  breakdown of the blood brain barrier   as well as peritumoral brain edema  
class8	3046	in non tumor bearing animals  cdpt did not alter the vascular permeability or the brain water content  
class8	3046	cdpt also inhibited the intracerebral growth of the 9l gliosarcoma in f 344 rats  with a similar increase of the peritumoral vascular permeability and the brain water content  
class8	3046	cdpt failed to inhibit tumor growth and the vascularization of the vx2 carcinoma in the thigh muscle or the metastases to the lung  findings that may reflect regional differences in the responsiveness of the endothelium  the distribution of copper  or the activity of cuproenzymes  
class8	3046	metabolic and pharmacologic withdrawal of copper suppresses intracerebral tumor angiogenesis  angiosuppression is a novel biologic response modifier for the in situ control of tumor growth in the brain  
class8	3047	prevalence of chronic bronchitis among us hispanics from the hispanic health and nutrition examination survey  1982 84  
class8	3047	in the hispanic health and nutrition examination survey  hhanes   puerto ricans had a higher age adjusted prevalence of self reported chronic bronchitis  2 9 percent  95  ci   2 2  3 6  than mexican americans  1 7 percent  95  ci   1 3  2 1  or cubans  1 7 percent  95  ci   0 9  2 5   
class8	3047	the prevalence of chronic bronchitis was at least 2 times higher in smokers as compared to nonsmokers among puerto ricans and cubans  but not for mexican americans  
class8	3048	admissions to the intensive care unit after complications of anaesthetic techniques over 10 years  2  the second 5 years 
class8	3048	compared with the first 5 years there was a 19  increase in general anaesthetics  a 171  increase in local and  or  sedation techniques and a 9  increase in obstetric epidurals with no increase in anaesthetic staffing  
class8	3048	in this second 5 year period  46 patients were admitted to the intensive care unit as a result of a complication of an anaesthetic technique  
class8	3048	these patients represented 1 in 2371 anaesthetic techniques carried out in the district compared with the previous 5 years where the incidence was 1 in 1543  
class8	3048	seven patients died  15 2    
class8	3048	the complication was considered to be wholly or partially avoidable in 14 instances  30 4    
class8	3048	four of these subjects died  
class8	3049	treatment of atelectasis of upper lung lobes  selective bronchial suctioning with j shaped catheter tip and guide mark  
class8	3049	we developed a technique for blind bronchial suction using a curved tip catheter with a guide mark  for the treatment of atelectasis of the lower and middle lobes of the lung  
class8	3049	suction of the upper lobe bronchi could not be performed because of the combination of the peculiar anatomy of the upper lobe bronchi with catheter design  
class8	3049	we treated successfully two cases of atelectasis of the right upper lobes using a rusch metras bronchography catheter with a guide mark which is not readily available  
class8	3049	therefore we devised a j shape tipped catheter with a guide mark  
class8	3049	we have successfully treated 13 episodes of atelectasis of the right upper lobe in 10 patients and one episode in the left upper lobe in one patient with this new catheter  
class8	3050	laryngeal oedema from a neck haematoma  a complication of internal jugular vein cannulation  
class8	3050	laryngeal oedema occurred after formation of a neck haematoma after attempted internal jugular vein cannulation  
class8	3050	this resulted in complete respiratory obstruction and respiratory arrest and it was impossible to ventilate her lungs manually or intubate her trachea  
class8	3050	oxygenation of the patient was only possible using transtracheal ventilation  
class8	3051	effects of famotidine and cimetidine on plasma levels of epidurally administered lignocaine  
class8	3051	the effects of two h2 receptor antagonists  famotidine and cimetidine  on the plasma levels of epidurally administered lignocaine were studied  
class8	3051	group a  n   20  received famotidine 20 mg orally the night before surgery and 20 mg intramuscularly 60 minutes before induction of anaesthesia  
class8	3051	group b  n   15  received cimetidine 200 mg orally the night before the surgery and 400 mg orally 60 minutes before the anaesthetic induction  
class8	3051	group c  n   20  received neither famotidine nor cimetidine and served as controls  
class8	3051	twelve millilitres of 2 0  lignocaine with adrenaline 1 200 000 was injected into the epidural space in all patients  after the establishment of general anaesthesia with nitrous oxide  oxygen  and enflurane  0 3 0 5    
class8	3051	the patients who received cimetidine showed significantly higher plasma concentrations of lignocaine compared with either group a or group c at all investigation times  p less than 0 01   
class8	3051	the mean peak plasma concentrations were 2 4  sem 0 1   3 2  sem 0 2  and 2 3  sem 0 1  micrograms ml in group a  b  and c  respectively  
class8	3051	this study suggests that famotidine is preferable to cimetidine for control of gastric acidity before the use of lignocaine as the epidural anaesthetic  
class8	3052	acid aspiration prophylaxis in 288 obstetric anaesthetic departments in the united kingdom  
class8	3052	the choice of drugs for acid aspiration prophylaxis in 288 obstetric anaesthetic departments in the united kingdom was determined by questionnaire  
class8	3052	the results are compared with a similar survey of anaesthetic departments 5 years ago  
class8	3052	the prescription of sodium citrate and the h2 receptor antagonist ranitidine has superseded that of mist  
class8	3052	magnesium trisilicate  
class8	3053	emergency tracheal intubation in the postanesthesia care unit  physician error or patient disease  
class8	3053	inadequate airway maintenance has been a major factor in perioperative morbidity  
class8	3053	to determine the incidence and etiology of emergency tracheal intubations in the postanesthesia care unit  pacu   we retrospectively reviewed 13 593 consecutive admissions to our pacu from october 1986 through october 1988  
class8	3053	twenty six patients  26 13 593   0 19   required the insertion of an endotracheal tube while in the pacu  
class8	3053	seventy seven percent  20 26  of the intubations occurred within 1 h of extubation and or admission to the pacu  
class8	3053	intubation was more common at the extremes of age  54  of those intubated were more than 60 yr old  p   0 003   19  were less than 3 yr old  p less than 0 05   
class8	3053	twenty three percent of the intubated patients had undergone otolaryngologic procedures  p   0 008   
class8	3053	interestingly  73  of the intubations occurred during the months of january through june  p   0 016   
class8	3053	median pacu admission scores were lower for the intubated group  p less than 0 001   
class8	3053	there was no association between intubation and gender  p   0 74   anesthetic technique  p   0 41   or anesthetic agent  p   0 49   
class8	3053	of the 26 intubations  18  69   were considered to be directly related to anesthetic management  
class8	3053	despite the extremely low incidence of emergency tracheal intubation in a heterogeneous group of patients admitted to our pacu  preventable anesthesia related etiologic factors including excessive sedative or anesthetic effect  inappropriate fluid management  persistent muscle relaxant effect  and upper airway obstruction contributed to the majority of these intubations  
class8	3054	local and global function of the right ventricle in a canine model of pulmonary microembolism and oleic acid edema  influence of ventilation with peep  
class8	3054	right ventricular  rv  dysfunction may occur due to increased rv afterload and  hence  might also contribute to the decrease in cardiac output following institution of peep in patients with adult respiratory distress syndrome  ards   
class8	3054	to test this hypothesis  the authors examined the influence of peep on local and global rv function in 12 anesthetized dogs with experimental ards  eards  induced by pulmonary microembolization with glass beads and oleic acid  
class8	3054	local rv function was analyzed in the rv inflow tract  rvit  and rv outflow tract  rvot  by assessing both diastolic segment length  systolic segment shortening  and segment work  sonomicrometry   
class8	3054	global rv contractility was quantified by measuring maximum rate of pressure rise  drvp dtmax  and maximum velocity of contractile element shortening  vmax   
class8	3054	in eards  despite a fivefold increase in pulmonary vascular resistance  there was no change in cardiac index  ci   global rv contractility  rvit and rvot work  and rvit shortening  whereas rvot shortening decreased from 12 4 to 7 4   p less than 0 01   
class8	3054	diastolic segment length increased in rvit  p less than 0 05  but not in rvot  
class8	3054	peep of 10 cmh2o did not alter global rv contractility  rvit and rvot shortening  and rvit work but reduced rvot work   35   p less than 0 01  and ci   11   p less than 0 001   
class8	3054	cardiac index further decreased during peep of 20 cmh2o   38   p less than 0 001   while global rv contractility remained intact despite decreased rvit and rvot shortening   32  and  69   p less than 0 05  and work   26  and  59   p less than 0 01  in the presence of reduced fiber preload in both regions  
class8	3054	from these findings  it was concluded that 1  the decreased ci during mechanical ventilation with peep at constant right ventricular end diastolic pressure  rvedp  is not caused by depressed global rv contractility in dogs with eards and a normal myocardium prior to insult  
class8	3054	decreased diastolic segment length and segment shortening during peep suggest that 2  peep reduces stroke volume by the starling mechanism rather than by ischemia of the rv free wall  
class8	3054	finally  regionally incongruent changes of fiber preload indicate that 3  local differences in rv wall compliance are likely to occur subsequent to eards and peep  
class8	3055	manual translaryngeal jet ventilation and the risk of aspiration in a canine model  
class8	3055	study objectives  manual translaryngeal jet ventilation  tljv  is a safe and effective method of maintaining normal ventilation in apneic subjects  
class8	3055	little data exist on the amount of airway protection afforded with this technique of airway management  
class8	3055	we sought to evaluate the risk of aspiration during manual tljv  
class8	3055	setting  data were collected in a laboratory animal model  
class8	3055	design  a prospective  nonrandomized  controlled trial was performed  
class8	3055	participants  seventeen adult apneic mongrel dogs were enrolled  
class8	3055	interventions  intratracheal gastrograffin was instilled and radiographic changes assessed during ventilation using a 0 to 3 scale  none to severe   
class8	3055	thirty six trials were performed  with equal numbers at both 30 degrees and 45 degrees head elevation  
class8	3055	the three groups studied were animals without airway protection  control   animals with a cuffed endotracheal tube  tube   and animals with a percutaneous tljv cannula and a 50 psi oxygen source ventilated at a rate of 20 breaths per minute  jet   
class8	3055	measurements and main results  significantly less radiographic evidence of aspiration was noted in the jet and tube groups at 30 degrees and 45 degrees compared with control animals  p    002 each   
class8	3055	at 45 degrees head elevation a trend toward increased aspiration scores in the jet group compared with the tube group  p    065  was observed  
class8	3055	conclusion  in our model  manual tljv at 20 breaths per minute and an i e ratio of 1 2 provided protection from aspiration comparable to that observed with a cuffed endotracheal tube at 30 degrees head elevation  
class8	3055	at 45 degrees elevation  this protection was diminished  
class8	3056	prehospital administration of inhaled metaproterenol  
class8	3056	study objectives  we conducted a study of the prehospital use of inhaled metaproterenol  
class8	3056	design  setting  type of participants  and interventions  advanced life support  als  providers were trained with a standardized curriculum to identify patients likely to benefit from prehospital inhaled metaproterenol administration  
class8	3056	unit doses of metaproterenol were used in a small volume nebulizer  
class8	3056	we prospectively included 122 patients in an initial study  71 men  age  63     19 years  to evaluate the safety and effectiveness of metaproterenol in the field  and 150 patients  including the original 122  in an additional study to evaluate patient selection criteria  
class8	3056	measurements and main results  the treatments resulted in an increase in peak flows  a decrease in respiratory rates  and no change in heart rates  
class8	3056	in 62  of patients  the increase in peak flow exceeded 15   
class8	3056	wheezing improved in 59  of the patients  worsened in 4   and did not change in the remainder  
class8	3056	air entry by auscultation improved subjectively in 59  of patients  
class8	3056	mild tremor occurred in 8  of patients  moderate tremor occurred in 1   and no tremor occurred in the remainder  
class8	3056	significant dysrhythmias did not occur  
class8	3056	conclusions  als providers correctly identified patients for this therapy  
class8	3056	no technical problems were encountered in the field with this treatment approach  
class8	3056	we conclude that als providers can be taught to identify patients likely to benefit from inhaled metaproterenol  that inhaled metaproterenol can be administered in the field  and that metaproterenol is both safe and effective when used in the prehospital setting  
class8	3057	atypical presentation of pulmonary embolism  
class8	3057	today we have discussed an interesting patient with an atypical presentation of pulmonary embolism  
class8	3057	we have outlined a suggested algorithm to aid in the diagnosis and management of this disease  
class8	3057	references 8 through 24 in the reference section are suggested readings that offer further insight into the diagnosis and management of this entity  
class8	3058	characterization of distal bronchial microflora during acute exacerbation of chronic bronchitis  use of the protected specimen brush technique in 54 mechanically ventilated patients  
class8	3058	to obtain accurate information on distal bronchial microflora during acute exacerbation in patients with chronic bronchitis  we prospectively studied 54 such patients who had been receiving mechanical ventilation because of hypercapnic respiratory failure  
class8	3058	fiberoptic bronchoscopy using a protected specimen brush  psb  was performed on each patient within the first 24 h after admission  
class8	3058	cultures of protected brush specimens demonstrated no growth in 27 patients  50    
class8	3058	with the exception of fever  38 2     0 8 versus 37 7     0 6 degrees c  p less than 0 05   the initial severity of the episode of exacerbation was similar in patients with and without infection  
class8	3058	a total of 44 organisms were isolated in the 27 patients with positive cultures  the predominant pathogens were hemophilus spp  
class8	3058	and streptococcus spp  
class8	3058	 involved in 74  of cases   but other organisms were isolated in 12 of 27 patients  
class8	3058	mortality rates  duration of mechanical ventilation  and duration of hospitalization were not significantly different between patients with bronchial microflora treated with appropriate antimicrobial therapy  n   27  and patients without bronchial microflora either receiving empirical antibiotic therapy  n   18  or not  n   9   
class8	3058	these data suggest that distal bronchial infection due to the usual pathogens  as far as shown by protected specimen brush cultures  may not be the sole or even the predominant cause of acute exacerbation of chronic bronchitis in patients requiring mechanical ventilation  
class8	3059	distinguishable types of dyspnea in patients with shortness of breath  
class8	3059	dyspnea frequently accompanies a variety of cardiopulmonary abnormalities  
class8	3059	although dyspnea is often considered a single sensation  alternatively it may encompass multiple sensations that are not well explained by a single physiologic mechanism  
class8	3059	to investigate whether breathlessness experienced by patients represents more than one sensation  we studied 53 patients with one of the following seven conditions  pulmonary vascular disease  neuromuscular and chest wall disease  congestive heart failure  pregnancy  interstitial lung disease  asthma  and chronic obstructive pulmonary disease  
class8	3059	patients were asked to choose descriptions of their sensation s  of breathlessness from a dyspnea questionnaire listing 19 descriptors  
class8	3059	cluster analysis was used to identify natural groupings among the chosen descriptors  
class8	3059	we found that patients could distinguish different sensations of breathlessness  
class8	3059	in addition  we found an association between certain groups of descriptors and specific conditions producing dyspnea  
class8	3059	these findings concur with those in an earlier study in normal volunteers in whom dyspnea was induced by various stimuli  
class8	3059	we conclude that different types of dyspnea exist in patients with a variety of cardiopulmonary abnormalities  
class8	3059	furthermore  different mechanisms may mediate these various sensations  
class8	3060	a family study of the variability of pulmonary function in alpha 1 antitrypsin deficiency  quantitative phenotypes  
class8	3060	a group of 52 alpha 1 antitrypsin deficient individuals of phenotype pi z and 117 of their relatives underwent a protocol including pulmonary function testing  completion of a questionnaire  and blood donation  
class8	3060	our population permitted a minimum frequency estimate  7 x 10  4   for pi null alleles  
class8	3060	five quantitative phenotypes were measured  including fev1  fef25 75  total serum alpha 1at  oxidized serum alpha 1at  and total serum ige  
class8	3060	we found that  1  total alpha 1at levels were higher in pi z subjects with lung function impairment  fev1 less than or equal to 65  of predicted  than in pi z subjects who were not impaired   2  pi z subjects with lung function impairment had elevated serum levels of oxidized alpha 1at  and  3  ige levels were relatively elevated in first degree pi mz relatives of impaired pi z subjects  
class8	3060	moreover  fev1 tended to be relatively reduced in heterozygous parents of impaired pi z subjects  suggesting that a subset of pi mz individuals are at risk for development of lung disease because of familial factors  
class8	3060	these results represent an initial step toward the development of intermediate phenotypes that will be predictive of a severe course in alpha 1at deficiency  they suggest that  in addition to cigarette smoking  atopic predisposition and undetermined familial factors may be important codeterminants of lung disease progression  
class8	3061	pulmonary denervation in humans  effects on dyspnea and ventilatory pattern during exercise  
class8	3061	the role of the pulmonary autonomic nerves in the mediation of respiratory sensation is unclear  
class8	3061	pulmonary neurogenic mechanisms may contribute to dyspnea either directly or indirectly via an influence on the pattern of ventilation  
class8	3061	using human heart lung transplantation as a model of pulmonary denervation  we studied the ventilatory response  respiratory drive  p0 1   and sensation of breathlessness  modified borg scale  during maximal incremental bicycle exercise  
class8	3061	the subjects were four female heart lung transplant recipients 3 to 9 months post transplant and 10 age matched control subjects  
class8	3061	the ventilatory response to increasing co2 output  vco2  was higher  p less than 0 001  in transplant recipients than in control subjects  such that ventilation at peak exercise was similar in the two groups despite a lower peak vco2 in transplant recipients  
class8	3061	the ratio of tidal volume to inspiratory capacity increased with increasing ventilation in a similar fashion in both groups  
class8	3061	although the respiratory rate increased more quickly in transplant recipients  it was similar at peak ventilation in the two groups  
class8	3061	ventilatory timing and duty cycle at half peak and peak ventilation were similar in transplant recipients and control subjects  
class8	3061	dyspnea ratings were not different between the two groups at similar levels of ventilation  
class8	3061	dyspnea as a function of p0 1 was also similar in transplant and control groups  
class8	3061	these results indicate that pulmonary neurogenic mechanisms play a role in determining the level  but not the pattern  of ventilation during exercise  
class8	3061	furthermore  these pathways do not appear to contribute significantly to the perception of breathlessness in normal humans  
class8	3062	the role of mucous glycoproteins in the rheologic properties of cystic fibrosis sputum  
class8	3062	cystic fibrosis  cf  is characterized by excessive amounts of thick and tenacious mucous secretions that obstruct organ ducts and passages  
class8	3062	in the respiratory tract this is associated with chronic infection resulting in the hypersecretion of purulent sputum  which the patient finds difficult to clear  
class8	3062	we have studied the rheologic properties of purulent sputum from six patients with cf and five patients with chronic bronchitis to assess whether cf is associated with increased sputum viscoelasticity  
class8	3062	in addition  we have isolated the major rheologic determinants  mucous glycoproteins  from cf and chronic bronchitis sputa and  using a magnetic microrheometer  investigated the possibility that the altered properties of mucus in cf are associated with abnormalities in these glycoproteins  
class8	3062	creep compliance analysis indicated that the cf sputa possessed raised levels of both elasticity  p less than 0 01  and viscosity  p less than 0 01   
class8	3062	these increases in both rheologic parameters were found to be associated with increases in the dna content  p less than 0 01  and dry weight  p less than 0 05   
class8	3062	mucous glycoproteins were isolated from cf and chronic bronchitis sputum samples by gel filtration on sepharose cl4b  followed by concentration to form 8  wt wt gels  
class8	3062	in the absence of other sputum components  no abnormality in the rheologic properties of cf mucin gels could be detected  
class8	3062	however  when dna was added  the cf gels responded with increases in both elasticity and viscosity of as much as 30   p less than 0 05   an effect not observed in the chronic bronchitis gels  
class8	3062	these results suggest that a subtle abnormality may exist in cf mucous glycoproteins and that this could have a role in the altered physical properties of mucous secretions in cf  
class8	3063	frequency and clinical implications of monoclonal antibody detection of tumor associated antigens in serum of patients with lung cancer  
class8	3063	we previously showed that a panel of monoclonal antibodies  mab   5e8  5c7  and 1f10  that detect serum tumor associated antigens  taa  could distinguish patients with lung cancer from those without to a highly significant degree  
class8	3063	however  among patients with lung cancer  the frequency and clinical importance of serum taa expression were not established  
class8	3063	therefore  we analyzed the serum and initial clinical characteristics of 52 philadelphia va patients with newly diagnosed lung cancer seen over a 13 month period  
class8	3063	a modified semiquantitative elisa was employed to determine mab reactivity  
class8	3063	our cohort was characterized by a mean age of 65     9 year  sd  and mean karnovsky score of 74     10  marked weight loss was present in 28 subjects  and 39 presented with either stage iii or iv disease  
class8	3063	the panel detected taas in 38 of 52 cases  sensitivity 73   95  cl  60 83    including 13 of 22 squamous cell  9 of 12 adenocarcinoma  10 of 11 undifferentiated  and 6 of 7 small cell carcinomas  
class8	3063	no significant differences were found between the reactive and nonreactive patients in terms of age  stage at presentation  histologic subtype  performance status  or weight loss  
class8	3063	however  1f10 and 5c7 were each associated with a greater risk of early death by cox proportional hazard analysis  p   0 017 and 0 006  respectively  even when other prognostic variables are accounted for  
class8	3063	we conclude that specific serum taa can be detected in the majority of lung cancer patients with all major histologic subtypes in a cohort with advanced tumors and poor prognostic indices  
class8	3064	determination of serum concentrations of type iii procollagen peptide in mechanically ventilated patients  pronounced augmented concentrations in the adult respiratory distress syndrome  
class8	3064	type iii procollagen peptide  pcp  is a byproduct of type iii collagen synthesis and a potential marker of collagen secretion  
class8	3064	in chronic diffuse interstitial lung diseases  elevated pcp concentrations have been found in serum as well as in bronchoalveolar lavage fluid  
class8	3064	it has been proposed that pcp is a marker of early  active stages of fibrosis  
class8	3064	as severe fibrosis is a frequent complication in adult respiratory distress syndrome  ards   we investigated pcp in patients with ards and compared the results with those from patients requiring mechanical ventilation because of heart failure and after neurosurgical and surgical interventions  and those from spontaneously breathing patients  including healthy volunteers and patients with pneumonia  liver cirrhosis  and renal failure  
class8	3064	pcp concentrations in patients with ards were extremely elevated compared with those in control subjects  p less than 0 001  and correlated positively with fio2  r   0 71  p less than 0 01   
class8	3064	these results support the pathophysiologic concept of early fibrogenesis in ards  
class8	3064	as preventing pulmonary fibrosis in ards is essential in improving survival rate  we believe pcp can be a valuable diagnostic tool in ards  
class8	3065	effect of pentoxifylline on hemodynamics  alveolar fluid reabsorption  and pulmonary edema in a model of acute lung injury  
class8	3065	we investigated the effect of pentoxifylline  ptx  on the development of pulmonary edema in a model of adult respiratory distress syndrome in rabbits  
class8	3065	lung injury was induced by repeated saline lavages in adult rabbits weighing 2 5 to 3 5 kg  
class8	3065	rabbits pretreated with ptx  20 mg kg bolus followed by 20 mg kg h infusion  developed significantly lower amounts of lung edema 4 h after saline lavage  extravascular lung water to dry weight ratio  w d   6 9     0 6 sd versus 8 9     0 5 in control animals   
class8	3065	ptx produced a 25  increase in cardiac output  but there were no differences between treated and untreated groups in calculated pulmonary vascular resistance or microvascular pressure  
class8	3065	to determine whether ptx could have lowered pulmonary venous resistance and thus lowered effective microvascular pressure for fluid filtration  we directly measured pulmonary artery and left atrial pressures  and measured by micropuncture the pressure in 20 to 40 microns subpleural venules in four open chested rabbits 3 to 4 h after lavage  
class8	3065	venous resistance was low  venous pressure drop 0 9     0 1 mm hg  and was unchanged by ptx infusion  
class8	3065	to determine if ptx decreased lung water by accelerating active alveolar fluid reabsorption  a single 60 ml aliquot of saline was instilled into the lungs of normal rabbits treated with saline or ptx  
class8	3065	both groups had a similar decrease in lung water content 1 and 4 h later  
class8	3065	our data indicate that ptx reduces edema formation in rabbits after saline lavage  not by lowering microvascular pressures for fluid filtration or by acceleration alveolar fluid reabsorption  but possibly by its anti inflammatory effect on neutrophil function  
class8	3066	persistent lower respiratory tract inflammation associated with interstitial lung disease in patients with tropical pulmonary eosinophilia following conventional treatment with diethylcarbamazine  
class8	3066	tropical pulmonary eosinophilia  tpe  presents as an acute syndrome with dyspnea  fluffy infiltrates  and rounded opacities on the chest radiograph  reduced lung function  marked eosinophilia in the blood and lower respiratory tract  and high titers of specific ige and igg antifilarial antibodies  
class8	3066	the standard therapy for tpe is a 3 wk course of diethylcarbamazine  dec  following which there is almost always a marked improvement in all parameters  
class8	3066	however  clinical observations suggest that the disease can persist despite dec therapy and lead to chronic dyspnea with restrictive lung impairment  
class8	3066	to evaluate the concept that dec therapy is not completely  curative  for tpe  but rather leaves most individuals with a mild  chronic form of tpe defined by persistent inflammation of the lower respiratory tract  we evaluated 23 individuals an average of 12     2 months following a standard 3 wk course of diethylcarbamazine for acute tpe  
class8	3066	in the majority there were mild  persistent symptoms referrable to the lung  chest x ray abnormalities  blood eosinophilia  and elevated serum ige and filarial specific igg  
class8	3066	on the average  lung function was consistent with the presence of chronic  mild interstitial lung disease  
class8	3066	when the inflammatory cells from the lower respiratory tract were examined  there was a persistent eosinophilic alveolitis  tpe post dec 1769     376 eosinophils microliters epithelial lining fluid  normal subjects 256     38  p less than 0 02   
class8	3066	evaluation of the lower respiratory tract inflammatory cells recovered from the tpe post dec treated individuals demonstrated spontaneous release of exaggerated amounts of o2   
class8	3066	and h2o2 compared to normal subjects  p less than 0 05  both comparisons   
class8	3067	the penetration of aminoglycosides into the alveolar lining fluid of rats  the effect of airway inflammation  
class8	3067	the concentration time profile of gentamicin and tobramycin in the alveolar lining fluid  alf  of rats was determined after intravenous bolus injection using bronchoalveolar lavage  bal   
class8	3067	bal can be used for evaluating the penetration of both aminoglycosides into the alf if highly sensitive detection methods are used  and an endogenous marker  urea  can be applied to avoid the unpredictable dilutional effect of the lavage procedure  
class8	3067	the concentration of gentamicin and tobramycin in alf reached a peak after 5 and 10 min  respectively  and remained high when plasma concentrations were declining  suggesting an accumulation reservoir in the lung acini  
class8	3067	the ratio of the auc of the concentration time profile in alf and plasma was 0 67 and 0 45 for gentamicin and tobramycin  respectively  
class8	3067	the penetration of both aminoglycosides into the alf was significantly higher after induction of airway inflammation by inhalation of endotoxin  
class8	3067	the ratio of the auc in alf and plasma in the endotoxin exposed animals was 0 76 and 0 55 for gentamicin and tobramycin  respectively  
class8	3067	the ratio of the auc of the concentration time profile of gentamicin in alf to that of tobramycin was 1 27 without inflammation and 1 44 after endotoxin exposure  
class8	3067	thus  both with and without inflammation  gentamicin penetrates better into the alf than does tobramycin  
class8	3068	bronchodilator response to ipratropium bromide in infants with bronchopulmonary dysplasia  
class8	3068	although the muscarinic antagonist ipratropium bromide is used clinically as a bronchodilator in infants ventilated because of bronchopulmonary dysplasia  bpd   no studies have compared the response or efficacy of different dosages or its effectiveness in combination with beta adrenergic agonists  
class8	3068	we measured the response of respiratory system mechanics in 10 ventilated infants  25     2 days of age  to 75  125  and 175 micrograms ipratropium bromide  ib   125 micrograms ib plus 0 04 mg salbutamol  sal   175 micrograms ib plus 0 04 mg sal  and saline vehicle  delivered via nebulizer into the ventilator circuit  
class8	3068	respiratory system resistance  rrs  and compliance  crs  were measured by the passive flow volume technique  
class8	3068	rrs and crs were measured before and at 1 to 2 h and at 4 h after delivery of the five drug dosages or saline  
class8	3068	all six studies were completed within a 72 h period  
class8	3068	saline had no significant effect on mechanics  
class8	3068	significant responses to ipratropium alone were seen only after 175 micrograms where rrs decreased 20     3   sem   p less than 0 05  at 1 to 2 h and 16     5   p less than 0 05  at 4 h  
class8	3068	after 125 micrograms ib   sal and 175 micrograms ib   sal  rrs was significantly decreased both at 1 to 2 h and at 4 h  and crs was significantly increased 20     6  and 20     4   respectively  at 1 to 2 h  
class8	3068	the greatest decrease in rrs  26     6   was seen 1 to 2 h after 175 micrograms ib   salbutamol  
class8	3069	formoterol  a new inhaled beta 2 adrenergic agonist  has a longer blocking effect than albuterol on hyperventilation induced bronchoconstriction  
class8	3069	the duration of effect of inhaled formoterol  24 micrograms  was compared with that of a placebo and that of inhaled albuterol  200 micrograms  in 12 adult asthmatic subjects who underwent hyperventilation tests with cold dry air   20 degrees c  on 4 study days  
class8	3069	on the control day  they were subjected to four hyperventilation tests to ensure functional stability  
class8	3069	on the 3 remaining days  after a first hyperventilation test  they inhaled placebo  albuterol  or formoterol in randomized  double blind fashion  
class8	3069	the hyperventilation test was repeated 1  4  and 8 h and  if the blocking effect was still present  12 and 24 h after the drug had been administered  
class8	3069	the dose of hyperventilation of cold air causing a 20  fall in fev1  pd20  was interpolated on the dose response curve  
class8	3069	the magnitude of the blocking effect at each time interval on each study day was assessed by comparing the changes in pd20 from baseline with the within day variability of pd20  standardized change in pd20   
class8	3069	the acute bronchodilator effect was not significantly different as assessed 15 min  21     14  for albuterol and 18     18  for formoterol  and 1 h  20     13  for albuterol and 18     17  for formoterol  after administering the medication  
class8	3069	the duration of the blocking effect  defined as the return to 2 sd from the standardized change in pd20  was significantly more prolonged for formoterol  8 0     3 4 h  than for albuterol  3 0     1 7 h   t   4 2  p less than 0 0001   
class8	3070	respiratory health effects of the indoor environment in a population of dutch children  
class8	3070	the effect of indoor exposure to nitrogen dioxide on respiratory health was studied over a period of 2 yr in a population of nonsmoking dutch children 6 to 12 yr of age  
class8	3070	lung function was measured at the schools  and information on respiratory symptoms was collected from a self administered questionnaire completed by the parents of the children  
class8	3070	nitrogen dioxide was measured in the homes of all children with palmes  diffusion tubes  
class8	3070	in addition  information on smoking and dampness in the home was collected by questionnaire  
class8	3070	there was no relationship between exposure to nitrogen dioxide in the home and respiratory symptoms  
class8	3070	respiratory symptoms were found to be associated with exposure to tobacco smoke and home dampness  
class8	3070	there was a weak  negative association between maximal midexpiratory flow  mmef  and exposure to nitrogen dioxide  
class8	3070	fev1  peak expiratory flow  and mmef were all negatively associated with exposure to tobacco smoke  
class8	3070	home dampness was not associated with pulmonary function  
class8	3070	lung function growth  measured over a period of 2 yr  was not consistently associated with any of the indoor exposure variables  
class8	3070	the development of respiratory symptoms over time was not associated with indoor exposure to nitrogen dioxide  
class8	3070	there was a significant association between exposure to environmental tobacco smoke in the home and the development of wheeze  
class8	3070	there was also a significant association between home dampness and the development of cough  
class8	3071	pulmonary fibrosis in aluminum oxide workers  investigation of nine workers  with pathologic examination and microanalysis in three of them  
class8	3071	epidemiologic surveys have indicated an excess of nonmalignant respiratory disease in workers exposed to aluminum oxide  al2o3  during abrasives production  
class8	3071	however  clinical  roentgenographic  histologic  and microanalytic description of these workers are lacking  
class8	3071	this is a report of nine al2o3 exposed workers with abnormal chest roentgenograms  profusion greater than or equal to 1 0  ilo uc  from a plant engaged in the production of al2o3 abrasives from alundum ore  
class8	3071	mean duration of exposure was 25 yr  and time since first exposure was 28 yr  
class8	3071	in a subgroup of three  the severity of symptoms  reduction in the forced vital capacity  67  predicted  and diffusing capacity  51  predicted   and progressive roentgenographic changes  profusion greater than or equal to 2 2  prompted open lung biopsy  
class8	3071	lung tissue was analyzed by scanning electron microscopy and electron microprobe analysis  
class8	3071	in each of the three biopsies  interstitial fibrosis with honeycombing was seen on routine section  
class8	3071	in one biopsy  silica and asbestos fiber counts were at the low end of the range seen with silicosis and asbestosis  however  the absence of asbestos bodies and silicotic nodules suggested that the fibrosis was due to another cause  
class8	3071	metals occurred in amounts several orders of magnitude above background  and the majority was aluminum as al2o3 and aluminum alloys  
class8	3071	the findings in these nine workers suggests a common exposure as the possible cause  
class8	3071	the nonspecific pathologic findings  absence of asbestos bodies and silicotic nodules  and the striking number of aluminum containing particles suggest that al2o3 is that common exposure  
class8	3071	the possibility of  mixed dust  fibrosis should also be considered  
class8	3072	computerized tomography in the evaluation of allergic bronchopulmonary aspergillosis  
class8	3072	allergic bronchopulmonary aspergillosis  abpa  is a destructive disease of the lung characteristically associated with central bronchiectasis  
class8	3072	this study was designed to determine if high resolution computerized tomography  ct  could be used to define bronchiectasis in patients with suspected disease  
class8	3072	sixteen patients with asthma were studied  
class8	3072	all demonstrated immediate cutaneous reactivity to common aeroallergens including aspergillus fumigatus  
class8	3072	eight patients had clinical and immunologic evidence of abpa  
class8	3072	six to 12 high resolution ct sections  1 5 mm  were obtained at 1  to 2 cm intervals from the aortic knob to the dome of the diaphragm  
class8	3072	all radiographs were evaluated separately by two readers in a blinded fashion and graded as to the presence and type of bronchial dilatation and bronchial wall thickening  
class8	3072	bronchial dilatation was seen in 41  of lung lobes in the abpa group compared to 15  in the non abpa asthmatic control group  
class8	3072	upper lobe involvement and bronchial wall thickening was common to both groups  
class8	3072	the presence of bronchiectasis in the control group may indicate that asthma is a more destructive lung disease than is currently appreciated  
class8	3072	high resolution ct of the chest has been shown in previous studies to have a sensitivity and specificity approaching that of bronchography  and the current findings support its use in the detection of bronchiectasis in patients with asthma suspected of having abpa  
class8	3073	pulmonary histiocytosis x with mediastinal lymph node involvement  
class8	3073	in this report  we describe a patient with the classic histology of pulmonary histiocytosis x  who had bilateral reticulonodular densities and mediastinal lymph node involvement  
class8	3073	the diagnosis was confirmed by the use of electron microscopy and immunohistochemical markers  ps100  hla dr  and cd1   which allowed us to recognize the lymph node infiltration of x histiocytes  
class8	3073	an association of mediastinal lymph node enlargement with pulmonary histiocytosis x has been reported but it has never been histologically documented  
class8	3074	flexible bronchoscopic removal of radioccult polyurethane foam  with pneumonitis in a hyperventilated lobe  
class8	3074	an intellectually delayed adult ingested and aspirated a large quantity of polyurethane foam  developing acute respiratory failure in association with partial airway obstruction  
class8	3074	the foam was identified by flexible bronchoscopy and successfully removed from the bronchus intermedius and left mainstem bronchus with a retrieval basket  
class8	3074	this facilitated normalization of blood gases and eventual recovery  
class8	3074	however  the unobstructed right upper lobe became infiltrated radiographically  presumably resulting from regional hyperinflation and or occult focal aspiration  
class8	3075	colobronchial fistula  a rare complication of crohn s colitis  
class8	3075	a 29 yr old white woman presented with chronic pneumonia in the left lower lobe and with left pleural effusion  
class8	3075	she was known to have inflammatory bowel disease  but she was asymptomatic under maintenance treatment with 5 asa  
class8	3075	she received numerous antibiotic regimens according to susceptibility testing of microorganisms cultured from sputum and bronchial lavage and on an empiric basis was also given antituberculosis treatment  but there was no clinical improvement or change in the chest radiographic findings  
class8	3075	sputum was repeatedly examined and yielded  among other organisms  clostridium inocuum  enterobacter  klebsiella pneumoniae  proteus mirabilis  and staphylococcus aureus  
class8	3075	on one microscopic examination of sputum  the presence of feculent material was suspected  
class8	3075	a subsequent gastrografin enema revealed a cologastric and colobronchial fistula between the splenic flexture of the colon and the greater curve of the stomach and the bronchial system  
class8	3075	segmental resection of the colon and resection of the lower lobe of the left lung were performed  
class8	3075	histologic findings of the resected colon were consistent with crohn s disease  
class8	3075	after a long period of postoperative recovery  the patient returned to good general health and well being  
class8	3075	to our knowledge  a colobronchial fistula caused by crohn s colitis has not been previously reported  
class8	3076	the rise of tuberculosis in america before 1820  
class8	3076	bills of mortality  newspaper and gazette articles  journals  and other records with specific references to  consumption    phthisis   and other terms for tuberculosis were reviewed to determine the occurrence and importance of tuberculosis in the american colonies before 1820  
class8	3076	review of these sources indicates a marked increase in the proportional mortality from tuberculosis in the united states in the 18th century  
class8	3076	 consumption  may have been the leading cause of death in adult american colonists  
class8	3077	six month isoniazid rifampin treatment for pulmonary tuberculosis in children  
class8	3077	one hundred and seventeen children with pulmonary tuberculosis underwent treatment with a 6 month daily regimen of rifampin  15 mg kg day  and isoniazid  10 mg kg day   
class8	3077	the criteria for the diagnosis of pulmonary tuberculosis were  1  clinical symptoms and signs in 93 children  79     2  history of direct contact with an adult with tuberculosis in 106 children  91     3  tuberculin reaction of 5 mm or more  without previous bacillus calmette guerin  bcg   in 45 children  38     4  suggestive radiologic alterations in all patients  and  5  positive bacteriology or histology in four patients  3    
class8	3077	the treatment was completed by 97 children  83    
class8	3077	the mean weight gain during therapy was 2 145 g  
class8	3077	there was an excellent clinicoradiologic response to the treatment  and improvement in chest roentgenograms was observed in all patients at the end of therapy  
class8	3077	no relapses occurred among the patients followed for an average of 21 4 months  
class8	3077	this study indicates that the treatment of primary pulmonary tuberculosis in children with a combination of rifampin and isoniazid daily for 6 months is efficacious and does not result in any relapse  
class8	3078	tumor cell lines established in vitro  an independent prognostic factor for survival in non small cell lung cancer  
class8	3078	objective  to determine the relation between in vitro establishment of tumor cell lines and survival in patients with non small cell lung cancer  
class8	3078	design  cohort study  
class8	3078	setting  single institution tertiary care center  
class8	3078	patients  one hundred twenty three consecutive patients with non small cell lung cancer from whom a viable tumor specimen could be obtained  
class8	3078	intervention  tumor tissue was removed at the time of entry into a therapeutic protocol  
class8	3078	the tumor tissue was processed in the laboratory for attempted cell line establishment  
class8	3078	patients classified as potentially curable  stages i  ii  and iiia  were treated with surgical resection  radiation therapy  or a combination  
class8	3078	patients suitable for palliative therapy only  stages iiib and iv  were treated with radiation therapy with or without chemotherapy  
class8	3078	chemotherapy was based on in vitro drug sensitivity when available  
class8	3078	cell line establishment was correlated to clinical outcome  
class8	3078	measurements and main results  univariate analysis of survival was done using the log rank test  multivariate analysis was done by cox modeling step up and step down techniques  
class8	3078	cell lines were established from the tumor specimens of 25 patients  20    
class8	3078	those patients experienced a median survival of 7 months compared with 18 months in patients from whom cell lines could not be established  p less than 0 001   
class8	3078	in the 61 patients with potentially curable disease  8 patients  13   with cell lines established had a median survival of 8 months compared with 32 months for those without cell lines established  p   0 001   
class8	3078	in the 62 palliative group patients  the median survival of the 17 patients  27   from whom tumor cell lines were established was 5 months compared with 7 months for those without cell lines  p   0 15   
class8	3078	multivariate analysis in both groups showed cell line establishment to be a significant indicator of prognosis  p less than 0 0001 for curable group  p less than 0 01 for palliative group   
class8	3078	conclusion  in vitro tumor growth is related to decreased patient survival  which in turn reflects the biologic aggressiveness of cancers giving rise to these tumor cell lines  
class8	3079	systems architecture for quantification of dynamic myoelectric and kinematic activity of the human vocal tract  
class8	3079	this paper describes a systems architecture useful for scientific investigations that require the acquisition and analysis of multiple  time synchronous signals in large volume  
class8	3079	the architecture has recently been developed by this group to enhance our capability to research and quantify central nervous system function in the production of normal and pathologic speech  
class8	3079	the architecture utilizes modern advances in desktop microcomputers and has been designed so that vocal motor control laboratories  or similar settings  with modest funding can more fully participate in comprehensive investigations of speech production  
class8	3079	research experiments organized with this architecture may involve many more subjects and measures than previously possible without significant increases in time and personnel resources  
class8	3079	this paper will demonstrate the technique and practicality of this architecture as it is being used to successfully guide research to map hierarchic central nervous system regions of involvement in two speech disorders  spasmodic dysphonia and stuttering  
class8	3079	the architecture has broad usefulness to many areas of otolaryngology and health science  
class8	3080	peak inspiratory pressure requirements in infants born weighing less than 750 g  
class8	3080	the possibility that peak inspiratory pressure requirements or the arterial alveolar oxygen ratio can predict the clinical outcome in infants weighing less than 750 g at birth was explored in a consecutive series  
class8	3080	nine of 10 infants  90   with a peak inspiratory pressure requirement of more than 18 cm h2o at 48 hours or more than 16 cm h2o at 72 hours from age subsequently died later of respiratory causes  defined as death after 72 hours of pulmonary interstitial emphysema  bronchopulmonary dysplasia  or cor pulmonale   
class8	3080	twenty of 21 remaining infants  95   survived until discharge  
class8	3080	using these data a 95th centile for peak inspiratory pressure requirement during the first 72 hours of life was constructed  
class8	3080	the potential value of this centile in predicting later death of respiratory causes was examined in a separate series  
class8	3080	twelve of 15 infants  80   whose peak inspiratory pressure requirements remained below the 95th centile  or were not ventilated  n   6   survived  
class8	3080	in contrast  11 of 12  92   infants whose requirements crossed the 95th centile died later of respiratory causes  
class8	3080	the infants who died had more radiological changes and higher mean arterial carbon dioxide pressure than survivors suggesting that the severity of the initial lung disease rather than the way that ventilation was managed determined prognosis  
class8	3080	peak inspiratory pressure requirement was more useful than arterial alveolar oxygen ratio in clearly distinguishing between survivors and infants who died later of respiratory causes  
class8	3081	thoracoplasty  current application to the infected pleural space 
class8	3081	thoracoplasty  once commonly used in the management of cavitary pulmonary disease  continues to find application in the obliteration of infected pleural spaces  
class8	3081	this study reports a series of 13 patients receiving thoracoplasty between 1976 and 1989  
class8	3081	five patients had chronic apical empyema spaces without prior resection of lung tissue  
class8	3081	two of the empyemas were due to tuberculosis  two were due to atypical mycobacteria  and one was due to postpneumonic empyema  
class8	3081	all patients had extensive destruction of upper lobe tissue  
class8	3081	eight patients had undergone prior pulmonary resection  3 had persistent infected spaces in the early postoperative period  3 had development of empyemas and bronchopleural fistulas late  5 to 19 years  after pulmonary resection  and 2 had postpneumonectomy empyema  
class8	3081	all patients had rigid cavity walls preventing space obliteration by rib removal alone and required concomitant resection of the thickened pleura and intercostal muscle tissues  
class8	3081	bronchopleural fistulas were present in 11 patients and were closed with adjacent nonintercostal muscle  
class8	3081	all patients survived and had successful obliteration of the infected spaces with acceptable physiological and cosmetic results  
class8	3081	we conclude that thoracoplasty remains a useful procedure in the management of the infected pleural space in select patients  
class8	3082	strategy for lymphadenectomy in lung cancer three centimeters or less in diameter 
class8	3082	we have surgically treated 221 patients with a primary lung cancer 3 0 cm or less in diameter  
class8	3082	there were 8 patients with a tumor 1 0 cm or less in diameter  group a   84 with a tumor 1 1 to 2 0 cm in diameter  group b   and 129 with a tumor 2 1 to 3 0 cm in diameter  group c   
class8	3082	the incidence of n0  n1  and n2 disease was 100   0   and 0   respectively  for patients in group a  83   5   and 12  in group b  and 62   12   and 25  in group c  n0 versus n2  p less than 0 01   
class8	3082	for the 63 patients with regional lymph node involvement   skipping  metastasis was present in 28 6   
class8	3082	the 5 year survival rate was 80  for group a  74  for group b  and 51  for group c  group b versus group c  p less than 0 01   
class8	3082	of the 121 patients who underwent complete resection and were followed up for 5 years  41  had recurrence  8  with local recurrence and 33  with distant metastasis  
class8	3082	therefore  it is important to do as complete a resection as possible together with mediastinal lymphadenectomy  
class8	3082	efforts to detect systemic spread should be made at the time of preoperative evaluation  even when the lung tumor is small  
class8	3083	prognostic determinants in extracorporeal membrane oxygenation for respiratory failure in newborns  
class8	3083	extracorporeal membrane oxygenation  ecmo  is becoming an accepted therapeutic modality for newborn respiratory failure  but there is little information available regarding the prognostic determinants with this technique  
class8	3083	one hundred thirty five newborns treated with ecmo over a 4 year period were critically analyzed with regard to the influence that birth weight  gestational age  age at initiation of ecmo  best blood gases before ecmo  number of hours on ecmo  renal failure  intracerebral hemorrhage  and long distance air transport had on survival  
class8	3083	infants with meconium aspiration and those undergoing long distance transfer showed significant differences in blood gases before ecmo  with survivors having more normal ph and carbon dioxide tension values  
class8	3083	intracerebral hemorrhage and renal failure that developed during ecmo were grave prognostic signs  with few survivors in either group  
class8	3083	these data show that ability to ventilate patients before ecmo  giving normal carbon dioxide tension and ph values  is an important prognostic sign in infants with meconium aspiration and undergoing long distance transfer for ecmo  whereas renal failure and intracerebral hemorrhage are usually lethal complications of ecmo  
class8	3083	each center performing ecmo should continually reevaluate this invasive technique and its results and complications  
class8	3084	surgical management of pulmonary metastatic leiomyosarcoma with gross endobronchial extension  
class8	3084	metastatic leiomyosarcoma occasionally is seen with gross endobronchial extension without invasion of the bronchial wall  
class8	3084	these patients have major airway obstruction and partial or total atelectasis of the lung  
class8	3084	precise bronchoscopic assessment coupled with intraoperative bronchotomy allows the surgeon to determine the origin of the tumor and to save uninvolved pulmonary parenchyma  
class8	3084	our experience with 4 such patients illustrates the possibility of saving lung tissue despite total bronchial obstruction  
class8	3085	giant chest wall tumor resulting from tissue reaction to foreign bodies  
class8	3085	three patients are reported in whom chest wall tumors developed 19 to 28 years after thoracoplasty and increased in size with time  
class8	3085	the tumors could be removed operatively with good results  
class8	3085	all tumors were composed of hematoma and necrotic material  and in all cases they revealed foreign bodies microscopically  
class8	3085	diagnosis and possible etiological factors are discussed  
class8	3086	thoracoscopic treatment of spontaneous pneumothorax using carbon dioxide laser  
class8	3086	in an effort to improve the success rate of the previously described thoracoscopic electrocautery ablation technique of spontaneous pneumothorax  the carbon dioxide laser was evaluated in 12 patients  
class8	3086	the recurrent  5 patients  or persistent  7 patients  spontaneous pneumothoraces were caused by rupture of  1  blebs in 6 patients   2  intrapulmonary apical type ii bullae in 3 patients  and  3  diffuse bullous emphysema  type iii  in 3  
class8	3086	the air leaks were successfully sealed in all but 1 patient with ruptured type ii bulla  
class8	3086	surgical specimen from this single failure suggested that the entire inner lining of the bullae must be thermocoagulated  
class8	3086	this technical modification led to successful outcome in 2 subsequent cases  
class8	3086	with the use of carbon dioxide laser  it was possible to treat not only small blebs but all types of bullae causing spontaneous pneumothorax  
class8	3086	laser thoracoscopy is effective and safe in treating spontaneous pneumothorax  
class8	3087	pulmonary resection combined with cardiac operations  
class8	3087	surgical management of patients with concomitant critical cardiac disease and resectable lung lesions is controversial  
class8	3087	during a 7 year period  1982 to 1988   21 patients underwent combined cardiac and pulmonary operations  
class8	3087	patients had cardiac symptoms only  the lung lesions were found on preoperative chest roentgenograms  
class8	3087	the pathological diagnosis was established in only 2 of the patients before operation  
class8	3087	all underwent concurrent pulmonary resection during cardiac operations requiring extracorporeal circulation  
class8	3087	the pulmonary operations included 17 wedge resections and four lobectomies  
class8	3087	the final diagnoses in 8 patients with stage i non small cell lung cancer included epidermoid carcinoma  4   adenocarcinoma  3   and bronchoalveolar carcinoma  1   
class8	3087	postoperatively  1 patient required a permanent pacemaker and 1 patient died  
class8	3087	the actuarial survival at 5 years for all patients who underwent combined procedures was 95   
class8	3087	the 5 year survival for the 8 patients with lung cancer was 88  compared with 100  for those with benign pulmonary pathology  p   0 172   
class8	3087	this experience suggests that combining pulmonary resection with cardiac operations is safe and offers a favorable prognosis to a select group of patients  
class8	3088	tracheal reconstruction with polytetrafluoroethylene graft in dogs  
class8	3088	use of prosthetic materials for long segment tracheal reconstruction has been limited owing to infection  graft migration  ingrowth of fibrous tissue  and stenosis  
class8	3088	polytetrafluoroethylene  ptfe  is flexible and porous  and it may resist infection more than previously used materials  
class8	3088	we evaluated ptfe for use in long segment tracheal reconstruction  
class8	3088	a 5 cm segment of trachea was resected in 9 dogs and replaced with a 20 mm reinforced ptfe graft using 4 0 vicryl sutures  
class8	3088	in 2 control dogs  one tracheal arch was resected and a primary anastomosis was performed  
class8	3088	the animals were followed up with weekly bronchoscopy and endoscopic photography  
class8	3088	euthanasia was performed at 16 weeks or when signs of respiratory distress developed  
class8	3088	at postmorten examination  the anastomoses were examined grossly and with light and scanning electron microscopy  
class8	3088	in all 9 dogs that underwent tracheal replacement with ptfe  granulation tissue developed at the anastomoses resulting in airway obstruction after 3 to 8 weeks  
class8	3088	no epithelial growth occurred over the graft between the anastomoses  
class8	3088	the control animals did well  
class8	3088	we conclude that granulation tissue formation at the anastomosis and the lack of respiratory epithelial ingrowth across the graft makes ptfe unsuitable for long segment tracheal reconstruction  
class8	3089	long term results of operation for non small cell lung cancer in the elderly  
class8	3089	we surgically treated 185 patients with non small cell lung cancer who were 70 years old or older  
class8	3089	the operative mortality rate was 3   and the 5 year survival rate was 48   
class8	3089	the mortality and prognosis were similar to those in younger patients  
class8	3089	the number of elderly patients who smoked heavily or who had ventilatory defects was high  but the incidence of pneumonectomy was low  
class8	3089	there were no differences based on age in regard to histological type  tnm classification  and curability  
class8	3089	pulmonary complications occurred in 21  of the elderly patients and were correlated with preoperative pulmonary function and smoking habits  
class8	3089	when the elderly are to undergo elective pulmonary resection for lung cancer  the preoperative evaluation of pulmonary function should be thorough  and both preoperative and postoperative physical therapy should be given  
class8	3089	if postoperative pulmonary function is predicted to be less than 0 8 l m2 of vital capacity and 0 6 l m2 of forced expiratory volume in 1 second  a limited resection or nonsurgical therapy should be considered  
class8	3090	pleuropulmonary morbidity  internal thoracic artery versus saphenous vein graft  
class8	3090	although use of the internal thoracic artery  ita  for coronary artery bypass grafting results in superior graft patency and improved patient survival  our initial clinical observations suggested an increased incidence of pleuropulmonary morbidity with its use  
class8	3090	one hundred consecutive patients with left ita grafts were studied prospectively and compared with a consecutive retrospective group of 100 patients undergoing coronary artery bypass grafting with saphenous vein grafts only  
class8	3090	preoperative  postoperative day  pod  2  pod 6  and postoperative week 8 chest roentgenograms were analyzed for atelectasis and effusion  
class8	3090	postoperative left lower lobe atelectasis was common in both groups on both pod 2  saphenous vein  43   versus ita  53   not significant  and pod 6  saphenous vein  40   versus ita  41   not significant   
class8	3090	there was a significantly higher incidence of pleural effusion on pod 6 in the ita group  84  versus 47   p less than 0 05  but most of these were small  
class8	3090	there was more chest tube drainage  1 413 versus 1 028 ml  p less than 0 01  and a greater need for secondary thoracostomy or thoracentesis  4  versus 0   in the ita group  
class8	3090	the left pleural space was opened in 67 of the 100 ita patients but pleurotomy did not appear to influence postoperative morbidity  
class8	3090	we conclude that use of the internal thoracic artery for coronary artery bypass grafting results in a small but significant increase in pleuropulmonary morbidity  
class8	3091	management of aortobronchial fistula with graft replacement and omentopexy  
class8	3091	massive hemoptysis due to a recurrent aortobronchial fistula after repair of a thoracic aortic aneurysm developed in a 64 year old woman  
class8	3091	the infected aortic tissue was resected and replaced with an in situ dacron graft covered by omentum  
class8	3091	the patient is alive and well 15 months later  
class8	3092	congenital tracheoesophageal fistula associated with carcinoma of the lung in an adult  
class8	3092	a rare case of adult congenital h type tracheoesophageal fistula was diagnosed  
class8	3092	subsequently  at operation  large cell  undifferentiated carcinoma of the right middle lobe with extension to the right lobe and adherence to the diaphragm was documented  
class8	3092	the diagnosis  surgical intervention  and 4 year follow up are presented  
class8	3093	bronchial anomaly of the right upper lobe  
class8	3093	this case report presents a rare anomaly of right upper lobe bronchial anatomy  
class8	3093	during routine right upper lobe resection for carcinoma  a common right upper and middle lobe bronchus was found  
class8	3093	the resection was completed as a right upper and middle bilobectomy  
class8	3093	knowledge of this uncommon variant was beneficial in performing the pulmonary resection  
class8	3093	a review of the literature is presented  
class8	3094	left recurrent laryngeal nerve paralysis  an unusual presentation of histoplasmosis  
class8	3094	a case of histoplasmosis seen as left recurrent laryngeal nerve paralysis in a 49 year old man is described  
class8	3094	the patient had roentgenographic findings of a solitary  noncalcified left upper lobe mass and mediastinal adenopathy  
class8	3094	tissue diagnosis of histoplasmosis was obtained using a thoracotomy  allowing institution of appropriate treatment  
class8	3095	job s syndrome  a rare cause of recurrent lung abscess in childhood  
class8	3095	a clinical syndrome characterized by recurrent staphylococcal infection of the skin and respiratory tract from birth was described in 1966 and referred to as job s syndrome  
class8	3095	marked hyperimmunoglobulinemia e was later found to be associated with this syndrome  
class8	3095	this article describes a case of job s syndrome as a cause of recurrent lung abscess during childhood necessitating lung resection  
class8	3096	lower extremity weakness as the initial manifestation of lung cancer  published erratum appears in arch phys med rehabil 1991 jan 72 1  61  
class8	3096	a 55 year old woman had progressive lower extremity weakness  
class8	3096	she had an 80 pack per year history of cigarette smoking  
class8	3096	electromyographic findings were consistent with the lambert eaton myasthenic syndrome  
class8	3096	despite a normal chest x ray  normal laboratory studies  and negative bronchoscopy  investigation for lung cancer was pursued  
class8	3096	the final thoracotomy and pathology reports indicated a diagnosis of oat cell carcinoma  
class8	3096	after treatment with chemotherapy and radiation therapy  clinical and electrophysiologic findings have resolved  
class8	3096	two years after diagnosis  the patient remains in good health without evidence of recurrence  
class8	3097	diffusing capacity of the lung and nifedipine in systemic sclerosis  
class8	3097	lung involvement in systemic sclerosis may be due in part to a functional abnormality of the pulmonary vasculature  
class8	3097	to investigate the possible role of a pulmonary vasospastic process in this disorder  21 non smoking patients who had no evidence of cardiac disease or pulmonary hypertension were evaluated with pulmonary function tests prior to administration of nifedipine  30 minutes after a single oral dose of nifedipine  20 mg   and after 4 weeks of treatment with nifedipine  10 mg 3 times daily   
class8	3097	treatment with nifedipine did not significantly change any of the pulmonary function values  except for the carbon monoxide diffusing capacity  dlco   
class8	3097	the linear trend between the individual dlco values at baseline and their changes immediately following the initial 20 mg dose of nifedipine  r    0 603  p   0 02  and after 4 weeks of treatment  r    0 636  p   0 01  showed that the lower the dlco value at baseline  the greater the improvement caused by nifedipine  
class8	3097	these findings support the hypothesis of a potentially reversible pulmonary vasospasm in systemic sclerosis and suggest that nifedipine may be useful in the treatment of lung disease in these patients  however  further studies are needed  
class8	3098	leiomyosarcoma of the sinonasal tract  a clinicopathologic study of nine cases  
class8	3098	the clinicopathologic features of nine cases of sinonasal tract leiomyosarcoma  sntl  referred to the armed forces institute of pathology  washington  dc  during the period from 1970 through 1988 are described  
class8	3098	this report represents the largest study to date on sntl  and our results are compared with the 21 previously reported cases of sntl  
class8	3098	of the nine cases described  patients ranged in age from 22 to 86 years  mean  55 years   
class8	3098	the most frequent clinical presentation was nasal obstruction unilaterally  
class8	3098	the neoplasms were limited solely to the nasal cavity in four cases  44   and involved both the nasal cavity and paranasal sinuses in the remaining five cases  
class8	3098	light microscopic  immunocytochemical  and ultrastructural features served to characterize these tumors as malignant neoplasms of smooth muscle origin  
class8	3098	in contrast with previous studies  immunocytochemistry was employed to differentiate sntl from other spindle cell malignancies of the region  using newly available monoclonal antibodies to smooth muscle antigens  
class8	3098	treatment was surgical  
class8	3098	radiotherapy or chemotherapy did not appear to affect the progression of the disease  
class8	3098	furthermore  no relationship was found between the aggressiveness of sntl and morphologic parameters  eg  mitotic count and tumor size   
class8	3098	instead  prognosis was dependent on the distribution of disease at presentation  
class8	3098	of all 30 patients with sntl described to date  10 had the neoplasm confined solely to the nasal cavity  
class8	3098	the 10 neoplasms did not recur  
class8	3098	we conclude that sntl may best be regarded as a locally aggressive neoplasm with only limited metastatic potential and that it could be curable by complete surgical excision  
class8	3099	metastasizing pleomorphic adenoma of the nasal septum  
class8	3099	pleomorphic adenoma is the most common benign tumor of glandular tissue occurring in the head and neck region  
class8	3099	there have been several reports of metastasis of this benign appearing tumor from the salivary glands to distant sites  suggesting hematogenous spread and implantation  
class8	3099	although occurrence of pleomorphic adenoma on the nasal septum has been described  to our knowledge this is the first reported case of recurrent septal pleomorphic adenoma with histologically benign tissue in an enlarged metastatic ipsilateral submandibular lymph node  suggesting lymphatic spread  
class8	3099	the literature concerning the subject is reviewed  
class8	3099	wide septal excision and modified neck dissection is the recommended treatment  
class8	3100	glucocorticoids inhibit neurogenic plasma extravasation and prevent virus potentiated extravasation in the rat trachea  
class8	3100	capsaicin increases the permeability of blood vessels in the rat tracheal mucosa through a mechanism involving the release of tachykinins from sensory nerves  
class8	3100	this capsaicin induced increase in vascular permeability is potentiated by viral infections of the respiratory tract  
class8	3100	the present study was done to determine whether this  neurogenic plasma extravasation  can be inhibited by glucocorticoids  to learn the time course of this inhibition  and to determine whether glucocorticoids can prevent the potentiating effect of viral respiratory infections on neurogenic plasma extravasation  
class8	3100	groups of pathogen free f344 rats were treated with dexamethasone for 2 or 8 h  4 mg kg i p   or 48 or 120 h  0 5 4 mg kg per d i p    
class8	3100	another group of rats was treated with dexamethasone for 120 h following the intranasal inoculation of sendai virus  
class8	3100	the magnitude of plasma extravasation produced by capsaicin or substance p was assessed after this treatment by using monastral blue pigment and evans blue dye as intravascular tracers  
class8	3100	we found that dexamethasone reduced  in a dose dependent fashion  the magnitude of plasma extravasation produced in the rat trachea by capsaicin and substance p  
class8	3100	significant inhibition was produced by a dose of dexamethasone as small as 0 5 mg kg i p  
class8	3100	the effect of dexamethasone had a latency of several hours and reached a maximum after 2 d of treatment  
class8	3100	furthermore  dexamethasone prevented the potentiation of neurogenic plasma extravasation usually present after 5 d of sendai virus respiratory infection  
class8	3101	transforming growth factor beta activity in sheep lung lymph during the development of pulmonary hypertension  
class8	3101	chronic pulmonary hypertension is associated with extensive structural remodeling of the pulmonary arterial bed  
class8	3101	the structural changes in the arterial walls include increased production of extracellular matrix components and smooth muscle cell hypertrophy  changes that have been similarly induced by transforming growth factor beta  tgf beta  in culture  
class8	3101	in the present study  experiments were performed to determine whether tgf beta is present in sheep lung lymph  and whether tgf beta levels were altered in an animal model of chronic pulmonary hypertension induced by continuous air embolization  
class8	3101	several standard biological assays for tgf beta activity were used for these determinations including soft agar assays  inhibition of epithelial cell proliferation  and a tgf beta specific radioreceptor assay  
class8	3101	in each case  control lung lymph contained high concentrations of tgf beta  100 ng ml  which required transient acidification for detection  
class8	3101	samples of lung lymph from hypertensive sheep showed a transient and early two  to threefold increase in concentrations of latent tgf beta  
class8	3101	this activity could be partially blocked by tgf beta antibodies  
class8	3101	these studies indicate that sheep lung lymph contains tgf beta and that the level of tgf beta increases early during the development of pulmonary hypertension  
class8	3101	thus  tgf beta may contribute to the development of the structural changes in the pulmonary arteries that occur during the onset of chronic pulmonary hypertension  
class8	3102	avoiding a wrapped endotracheal tube in laser laryngeal surgery  experiences with apneic anesthesia and metal laser flex endotracheal tubes  
class8	3102	ninety one laser laryngeal procedures using the apneic technique of anesthesia were performed in 28 patients between 2 months and 64 years of age  
class8	3102	seventy two procedures  79   were performed on children and 19 on adults  
class8	3102	there were no complications  
class8	3102	eight laser laryngoscopies were performed using a new metal laser flex endotracheal tube  
class8	3102	obstruction of the endotracheal tube with a mucous plug occurred in one case  
class8	3102	the apneic technique described in this paper provides a laser operative field free of an endotracheal tube  virtually eliminating the danger of a laser fire  
class8	3102	it is a relatively safe and effective means of performing laser laryngeal surgery  
class8	3102	in addition  the laser flex endotracheal tube appears to be an acceptable alternative to a metallic tape wrapped endotracheal tube  
class8	3103	a palmar dermatosis linked to occult carcinoma of the upper thorax  head and neck  bazex s syndrome and tripe palm  
class8	3103	an unusual  persistent  corregated to honeycombed thickening of the palms accompanied by tenderness around the fingernails was found to be a cutaneous marker for internal malignancy  
class8	3103	this combination of signs and symptoms has been reported under two clinical entities  bazex s syndrome and tripe palm  
class8	3103	this paraneoplastic syndrome is of interest to head and neck surgeons due to the location of the primary tumor  the site of metastatic disease  and the ability to cure the cutaneous disease by surgical removal of the primary tumor  
class8	3103	in our patient  a squamous cell carcinoma of the lung not detectable on chest x ray presented as a cervical mass accompanied by cutaneous changes on the palms and fingernails  
class8	3103	recognition of the relationship of the dermatologic changes to malignancy of a specific body region eventually led to the detection of the primary tumor  
class8	3103	the characteristics of these paraneoplastic syndromes were reviewed in this report  
class8	3104	trends in lung cancer incidence and mortality  united states  1980 1987  published erratum appears in mmwr morb mortal wkly rep 1990 dec 14 39 49  906  
class8	3104	lung cancer is the most common fatal malignant neoplasm in the united states  
class8	3104	based on current smoking patterns  the substantial public health burden of smoking related lung cancer will continue during the next several decades  
class8	3104	this report describes trends in lung cancer incidence from 1980 through 1986 and lung cancer mortality from 1980 through 1987  
class8	3105	bronchoscopy in critically ill patients  when is it appropriate  
class8	3105	fiberoptic bronchoscopy is a valuable diagnostic and therapeutic tool for use in carefully selected patients with serious pulmonary disease  
class8	3105	the authors review the benefits and risks of fiberoptic bronchoscopy and discuss the essentials of nursing care before  during  and after the procedure  
class8	3106	emergent signs of cancer  recognizing them early in the office or er  
class8	3106	primary care physicians have a crucial role in recognition of potentially emergent conditions in patients with known or suspected cancer  
class8	3106	this task presents a significant challenge because the initial manifestations of these conditions are usually nonspecific  
class8	3106	in most cases  therapy is far more effective when diagnosis is made at the earliest possible point  
class8	3106	thus  physicians should become familiar with conditions commonly seen in cancer patients  such as superior vena cava syndrome  malignant pericardial effusion  spinal epidural metastasis  and altered mentation from brain metastases  metabolic encephalopathy  or hypoglycemia  
class8	3107	surgical treatment for secondary retracted nose  
class8	3107	this surgical technique is presented to correct nasal tip retraction  which is frequently associated with other surgical sequelae that can be corrected simultaneously  
class8	3107	it is based on the use of a shield  an anchor  or half an anchor of otocartilage  with one or two posterior supports that are sutured together forming a small l and are fixed to the bed to project the nasal tip and  if necessary  to correct the unilateral or bilateral alar collapse  
class8	3108	small cell lung cancer  staging with mr imaging  
class8	3108	small cell lung cancer is an aggressive neoplasm  metastases are detected in two thirds of patients at diagnosis with use of conventional staging  which includes bilateral bone marrow biopsy  bone scintigraphy  and computed tomography  ct  of the head and abdomen  
class8	3108	in 25 patients  small cell lung cancer was staged prospectively with both conventional staging and a magnetic resonance  mr  imaging protocol that included 1 5 t mr imaging of the pelvis  abdomen  spine  and brain  
class8	3108	according to conventional staging  14 patients had extensive disease and 11 patients had limited disease  according to staging with mr  19 patients had extensive disease and six had limited disease  
class8	3108	all metastatic disease sites seen with conventional staging were identified on mr images  
class8	3108	mr images showed additional metastatic involvement in bone  four patients  and liver  three patients  not detected at conventional staging  
class8	3108	a low attenuation hepatic lesion on a ct scan was identified as a hemangioma on mr images  
class8	3108	these preliminary data suggest that small cell lung cancer may be accurately staged with use of a single mr imaging study  
class8	3109	small nodular lesions in the lung periphery  new approach to diagnosis with ct  
class8	3109	to evaluate relationships between lesions in the lung periphery and surrounding structures  particularly vessels and bronchi  axial multiplanar reconstruction  ampr  computed tomography  ct  was used to study 26 patients who underwent surgical resection of pulmonary nodules less than 3 cm in diameter  
class8	3109	findings at ampr ct  conventional ct  and digital radiographic tomography were compared with findings obtained at evaluation of the resected specimen with regard to the ability to display the relationships between vessels  bronchi  and lesions  
class8	3109	ampr ct was significantly superior to conventional ct and digital radiographic tomography in detecting involvement of pulmonary vessels  p less than  001   
class8	3109	involvement of pulmonary veins was seen in all lung cancers  whereas such involvement was seen in only one of eight nonneoplastic lesions  
class8	3109	thus  involvement of pulmonary veins is strongly suggestive of malignancy  
class8	3109	ampr ct permits three dimensional visualization and morphologic assessment of pulmonary nodules  
class8	3110	search and nonsearch protocols for radiographic consultation  
class8	3110	six radiologists  acting as radiograph reviewers  used two different consultation protocols to differentiate among 292 ambiguous chest radiographic findings  120 simulated nodules and 172 normal findings  previous readers  false positive reports of nodules   
class8	3110	the nonsearch protocol identified each finding  by film location   and reviewers rated the likelihood of each finding s being a pulmonary nodule  
class8	3110	the search protocol asked reviewers to report and rate all locations regarded as possible nodules on each radiograph and assigned a default negative rating to any unreported finding  nodule or normal structure   
class8	3110	receiver operating characteristic analyses demonstrated a significantly higher accuracy for each reviewer s search protocol discriminations between these nodules and ambiguous normal findings  
class8	3110	this superiority of search result suggests that radiologists  second opinions about suspected lesions might be more accurate when consultants follow a search protocol  independently reviewing radiographs without prior knowledge of the specific findings that concerned the primary radiograph readers  
class8	3111	potential usefulness of an artificial neural network for differential diagnosis of interstitial lung diseases  pilot study  
class8	3111	an artificial neural network approach was applied to the differential diagnosis of interstitial lung diseases  
class8	3111	the neural network was designed to distinguish between nine types of interstitial lung diseases on the basis of 20 items of clinical and radiographic information  
class8	3111	a data base for training and testing the neural network was created with 10 hypothetical cases for each of the nine diseases  
class8	3111	the performance of the neural network was evaluated by means of receiver operating characteristic analysis  
class8	3111	the decision performance of the neural network was high  it was comparable to that of chest radiologists and superior to that of senior radiology residents  
class8	3111	the preliminary results strongly suggest that the neural network approach has potential utility in the computer aided differential diagnosis of interstitial lung diseases  
class8	3112	pulmonary masses  contrast enhancement  
class8	3112	radiographic studies to discriminate benign from malignant pulmonary masses have previously focused on the morphologic and  more recently  the computed tomographic  ct  attenuation characteristics of the lung mass  
class8	3112	experience with the use of an intravenously administered iodinated contrast medium in examining the enhancement properties of lung masses was reviewed  
class8	3112	distinctive differences in the vascularity  pathophysiologic features  and pharmacodynamics of malignant versus benign pulmonary masses were identified  
class8	3112	forty five patients with peripheral pulmonary masses were examined  
class8	3112	enhancement was evaluated by means of optical density values measured on trispiral tomograms of the lung masses before and after bolus injection of contrast medium  
class8	3112	results suggest that contrast enhancement of pulmonary masses can be measured on sectional images and that this may become a feasible diagnostic method in the detection of lung cancer  
class8	3112	ct offers a simplified technique that is now being explored by the authors  
class8	3113	diagnosis and treatment of pneumonia in the surgical intensive care unit  published erratum appears in surg gynecol obstet 1991 apr 172 4  324  
class8	3113	it is often difficult to detect the onset of parenchymal pulmonary infection  pneumonia  in a surgical intensive care unit  sicu  setting  
class8	3113	clinical and laboratory parameters that usually indicate the presence of pneumonia  such as fever  elevated white blood cell count and abnormal sputum culture  may also be present in patients with nonpneumonic infection  
class8	3113	prompt diagnosis is particularly important for patients in sicu because the mortality rate associated with pneumonia in these patients may be as high as 50 per cent  
class8	3113	in the sicu setting  pneumonia is best diagnosed using well defined roentgenologic criteria  
class8	3113	treatment should consist of a broad spectrum antibiotic regimen to which all sputum pathogens are sensitive  
class8	3113	such a regimen significantly reduces the mortality rate for patients with pneumonia in an sicu setting  
class8	3113	aztreonam has been found to be as effective against susceptible gram negative bacilli as traditional agents  such as the aminoglycosides  and to have a significantly milder side effect profile  
class8	3114	aqueductal  pencil  glioma presenting as neurogenic pulmonary edema  a case report  
class8	3114	a case of neurogenic pulmonary edema due to hydrocephalus  without initial neurological deficit  is described  
class8	3114	computed tomography demonstrated a ring enhancing lesion in the tectum of the mesencephalon obstructing the aqueduct of sylvius  
class8	3114	the lesion  on autopsy  was a rare mesencephalic glioma described in the literature as a  pencil glioma  of the aqueduct  
class8	3115	amiodarone  a postmarketing evaluation of monitoring for drug induced toxicity  
class8	3115	amiodarone  an antiarrhythmic drug with predominantly class iii effects  has demonstrated serious adverse drug reactions and interactions  
class8	3115	the departments of pharmacy and cardiology retrospectively evaluated the monitoring parameters at this institution  
class8	3115	criteria based on current literature were developed  
class8	3115	twenty six patients were administered amiodarone  qualifying for entry into the audit  
class8	3115	of these patients  seven were excluded because their medical records were unavailable or incomplete  
class8	3115	the 19 eligible patients were hospitalized during initiation of therapy and followed in the outpatient cardiology clinic  
class8	3115	the collected data extracted from the medical charts were compared with the following elements of the criteria selected  baseline evaluation prior to the start of therapy  monitoring for signs of pulmonary  hepatic  thyroid  cardiac  ophthalmologic  neurologic  and dermatologic toxicity  and evaluation of potential drug interactions with digoxin and warfarin type anticoagulants  
class8	3115	the percentage of criteria elements appropriately monitored on each patient ranged from 82 to 100 percent  with an average of 91 percent  
class8	3115	the most frequently overlooked parameters were warning the patient of a possible photosensitivity reaction  decreasing the digoxin dose if the patient was concurrently taking amiodarone  and performing a slit lamp examination every six months  
class8	3115	frequent examination of the patient s total organ system and laboratory tests  in addition to patient education  are essential to safe monitoring of amiodarone therapy  
class8	3116	ability of calcium entry blockade by felodipine to disclose different pathogenetic mechanisms behind hyperventilation induced myocardial ischemia in men  
class8	3116	to verify that myocardial ischemia occurring during either the overbreathing or recovery phase of the hyperventilation test is based on different pathogenetic mechanisms  2 consecutive series of patients  selected on the basis of their response to a run in hyperventilation test  were studied  
class8	3116	group i comprised 15 patients who developed st segment depression early during overbreathing  whereas group ii consisted of 12 patients showing st segment depression late during the recovery phase  
class8	3116	a single oral dose of felodipine 10 mg or of placebo was administered on 2 consecutive days according to a randomized  double blind  crossover design  and the hyperventilation test was repeated  on both days of the study  3 to 5 hours after drug intake  
class8	3116	in group i  st segment depression occurred after placebo in all patients during overbreathing  with an increase in rate pressure product  from 112     31 at baseline to 168     55 mm hg x beats min 100 at the onset of st segment depression  p less than 0 01   
class8	3116	after felodipine  13 patients continued to show st segment depression during overbreathing  together with an increase in rate pressure product  from 107     24 at baseline to 158     46 mm hg x beats min 100 at the onset of electrocardiographic changes  p less than 0 01   
class8	3116	in group ii  all 12 patients showed st segment depression during recovery after placebo  with a rate pressure product comparable to baseline conditions  112     35 at baseline vs 102     27 mm hg x beats min 100 at the onset of st segment depression  difference not significant   
class8	3116	after felodipine  no patient developed st segment depression or chest pain  
class8	3117	angiocentric lymphoma with histologic features of neoplastic angioendotheliomatosis presenting with predominant respiratory and hematologic manifestations  report of a case and review of the literature 
class8	3117	neoplastic angioendotheliomatosis  nae  is a rare fatal disease characterized by widespread intravascular proliferations of neoplastic mononuclear cells  
class8	3117	clinically  dermatologic and bizarre neurologic manifestations usually predominate  
class8	3117	the origin of the neoplastic cells remains still undetermined  
class8	3117	the authors report a patient with nae peculiar with respect to the following points   1  the patient predominantly manifested respiratory symptoms and hematologic findings and lacked cutaneous or neurologic manifestations  and  2  immunohistochemical and molecular genetic studies showed the b cell nature of the neoplastic cells  although previous cases with predominant respiratory or hematologic manifestations were reported to be of endothelial origin  
class8	3117	despite the rarity  this type of nae or angiocentric lymphoma should be recognized because it is easily confused with other disorders  particularly vasculitis or thrombotic thrombocytopenic purpura  
class8	3118	midfacial hypoplasia associated with long term intubation for bronchopulmonary dysplasia  
class8	3118	six preterm infants with bronchopulmonary dysplasia were nasotracheally intubated for 68 to 243 days  
class8	3118	gestational age at birth ranged from 24 to 35 weeks  
class8	3118	endotracheal tube size was changed to account for growth and varied from 2 5 to 4 0 mm  
class8	3118	these infants developed features of midfacial hypoplasia  namely  depressed nasal bridge  small tipped nose  long philtrum  underdeveloped malar areas  and carplike mouth  
class8	3118	these features have not been associated with long term intubation in premature infants  
class8	3118	we suggest that features of prolonged nasotracheal intubation  such as direct compression by the tube and the method of tube fixation  decreased air flow through the developing nares and sinuses and reduced faciomuscular activity  resulting in the observed midfacial hypoplasia  
class8	3118	the degree to which growth corrects these deformations is unknown  
class8	3119	cardiogenic hepatorenal syndrome  
class8	3119	a variant of hepatorenal syndrome occurring in patients with chronic congestive heart failure following an episode of cardiogenic pulmonary edema  and in the absence of hypotension  is described  
class8	3119	this was observed in 13 patients during an eleven year period  
class8	3119	the clinical picture is characterized by hepatic injury and functional renal impairment  
class8	3119	increase of serum glutamic oxaloacetic transaminase levels as high as 2100 iu  prolongation of prothrombin time  elevation of serum bilirubin  creatinine  blood urea nitrogen  and potassium levels  decrease in urinary sodium excretion  and a normal urinary sediment are the salient laboratory abnormalities of this entity  
class8	3119	treated with conventional medication  the patients  course was fatal in 4 cases  
class8	3119	when the splanchnic vasodilator dopamine was added to the patients  management  5 of 9 patients recovered  
class8	3119	cardiogenic hepatorenal syndrome is a severe but potentially reversible complication of heart failure  
class8	3119	the apparently beneficial effect of low dose dopamine needs further evaluation  
class8	3120	lymphangiomyomatosis  newer concepts in pathogenesis and management  case reports  
class8	3120	lymphangiomyomatosis was first reported more than forty years ago  
class8	3120	although its incidence is rare  its occurrence is being increasingly recognized and has been the subject of a growing number of cases reports in recent years  
class8	3120	this study adds 2 more cases to the file  
class8	3120	both cases involved young women with the characteristic symptoms of dyspnea  cough  abdominal discomfort and swelling  chest pain  and hemoptysis  with abundant formation of refractory chylous  serous ascites  
class8	3120	although the progression of the disease differed in each case  pulmonary function was affected in a similar way by the presence of obstructive and restrictive defects and a decrease in diffusing capacity  
class8	3120	underlying abnormalities were dilated lymphatics  thickened lymphatic walls  and muscular proliferation of leiomyomatous origin  leading to bronchial restriction  
class8	3120	the authors point to the subtlety required in arriving at a differentiated diagnosis of lymphangiomyomatosis lymphangioleiomyomatosis and the difference between the two conditions  
class8	3120	they also make particular recommendations in respect to the importance of preliminary hormone receptor tests and to the wisdom to be exercised in ligating a main lymphatic duct in the chest to control the formation of ascites  
class8	3120	pneumothorax  a frequent manifestation of lymphangiomyomatosis  is found to be the result of chronic air trapping due to a combination of narrowing of conducting airways and disruption of normal lung parenchyma  
class8	3121	masqueraders in clinical allergy  laryngeal dysfunction causing dyspnea  published erratum appears in ann allergy 1991 jan 66 1  22  
class8	3121	the allergist may be called upon to evaluate patients with dyspnea that is labeled  refractory asthma   in some patients  the site of origin of their dyspnea is the larynx  
class8	3121	the diagnosis of laryngeal disorders requires a thorough understanding of the normal function of the laryngeal anatomy and physiology  
class8	3121	some patients with asthma may have a component of their airway obstruction in the larynx and large airways  
class8	3121	paradoxical vocal cord motion occurs when the true vocal cords approximate during inspiration  and although severe subjective dyspnea may occur  in most cases there is no evidence of hypoxia  hemoglobin desaturation  or an abnormality of the arterial alveolar oxygen gradient  
class8	3121	provocative tests with methacholine are negative in this group of patients  
class8	3121	patients with pvcm are usually female and may have an affiliation with the medical profession  
class8	3121	many have psychologic difficulties  and the foundation of treatment is speech therapy and psychotherapy if indicated  
class8	3121	other disorders that may produce dyspnea from laryngeal dysfunction include meige syndrome  abductor spastic dysphonia  and laryngospasm  
class8	3121	recognition of these disorders will expedite timely  accurate diagnosis and treatment  
class8	3122	mast cell heterogeneity in chronic idiopathic urticaria  
class8	3122	patients with chronic urticaria are more sensitive to codeine skin testing than other allergic individuals  
class8	3122	nonlesional skin in most patients with chronic urticaria was found to contain increased numbers of both total and atypical mast cells  
class8	3122	the presence of increased mast cell density was found to correlate with the degree of clinical  dermatographism  and functional  codeine skin test  skin sensitivity  
class8	3123	the association of selected cancers with service in the us military in vietnam  iii  hodgkin s disease  nasal cancer  nasopharyngeal cancer  and primary liver cancer  the selected cancers cooperative study group 
class8	3123	as part of a series of investigations into the health of vietnam veterans  we conducted case control studies involving 310 men with hodgkin s disease  48 with nasal carcinoma  80 with nasopharyngeal carcinoma  130 with primary liver cancer  and 1776 controls between 1984 and 1988  
class8	3123	all men born between 1929 and 1953 and diagnosed in an area covered by eight cancer registries were considered eligible as cases  controls were recruited by random digit dialing  
class8	3123	whereas the study had excellent power  96   to detect a twofold increase in risk for hodgkin s disease among vietnam veterans  its ability to detect a similarly elevated risk in the other cancers was limited  ranging from 38   nasal carcinoma  to 75   primary liver cancer   
class8	3123	analyses showed that risks among vietnam veterans relative to other men were 1 1  hodgkin s disease   0 7  nasal carcinoma   0 5  nasopharyngeal carcinoma   and 1 2  primary liver cancer   
class8	3123	none of these relative risks was significantly different from 1 0  
class8	3123	similar results were obtained if vietnam veterans were compared with  1  other veterans or  2  men who never served in the military  
class8	3123	an examination of several attributes of military service in vietnam  eg  branch  duration of service  and other characteristics that may have been associated with the use of agent orange  failed to identify any groups of veterans who were at increased risk for hodgkin s disease  
class8	3123	small numbers limited further analyses of nasal  nasopharyngeal  and liver cancer  
class8	3123	these results provide no evidence that  15 to 25 years following service in vietnam  the risk of these malignant neoplasms is higher among veterans  
class8	3124	decision analysis  public health policy  and isoniazid chemoprophylaxis for young adult tuberculin skin reactors  
class8	3124	as part of a plan to eliminate tuberculosis in america  tuberculin skin testing was advised for all us citizens  with isoniazid chemopreventive therapy administered to appropriate positive reactors  
class8	3124	implementation of this plan  however  may be limited by concerns over which skin test reactors should receive isoniazid therapy  
class8	3124	recent decision analyses suggest that  contrary to american thoracic society guidelines  asymptomatic skin test reactors under age 35 years with normal chest roentgenograms and no predisposing conditions to tuberculosis reactivation will not benefit from isoniazid chemopreventive therapy  
class8	3124	repeated analysis of these studies reveals that calculated life expectancy depends on estimates of the probability of certain chance outcomes  
class8	3124	if the isoniazid related hepatitis case fatality rate is below 1   isoniazid chemopreventive therapy appears to be beneficial  
class8	3124	a literature review suggests that this rate is indeed this low  
class8	3124	if the tuberculosis case fatality rate is above 6 7   also supported by the literature  the advantages of isoniazid therapy are further increased  
class8	3124	this repeated analysis should reassure physicians that isoniazid chemoprophylaxis for tuberculin skin test reactors is beneficial to the individual and consonant with public health policies  
class8	3125	clindamycin vs penicillin for anaerobic lung infections  high rate of penicillin failures associated with penicillin resistant bacteroides melaninogenicus  
class8	3125	thirty seven adult patients with anaerobic lung infections  27 lung abscesses and 10 necrotizing pneumonias  were submitted to transthoracic needle aspiration and or bronchoscopic specimen brush cultures before therapy and thereafter in all cases considered to be failures  
class8	3125	patients were randomly assigned to receive either clindamycin  600 mg intravenously every 6 hours  or penicillin g  2 million u every 4 hours for no less than 8 days  until clinical and radiological improvement became apparent  
class8	3125	treatment was continued orally with clindamycin  300 mg every 6 hours  or penicillin v  750 mg every 6 hours  until completing a minimum of 4 weeks  
class8	3125	ten of the 47 anaerobes initially isolated from the lung  nine bacteroides melaninogenicus and one bacteroides capillosus  were resistant to penicillin  but none were resistant to clindamycin  
class8	3125	five of the nine patients harboring these penicillin resistant bacteroides received penicillin  and all failed to respond to therapy  
class8	3125	overall  eight of the 18 patients in the penicillin group and one of 19 in the clindamycin group failed to respond to therapy  
class8	3125	these drugs were equally well tolerated in both groups  
class8	3125	the presence of penicillin resistant bacteroides is a frequent cause of penicillin failure in patients with anaerobic lung infections  
class8	3125	in this setting  clindamycin appears to be the current therapy of choice for initial treatment  
class8	3126	spectrum of invasive haemophilus influenzae type b disease in adults  
class8	3126	a prospective nationwide surveillance of invasive haemophilus influenzae type b disease among adults  greater than or equal to 16 years old  was conducted in finland during 1985 through 1988  
class8	3126	thirty one cases were identified  annual incidence  0 22 100 000   
class8	3126	of these infections  71  occurred in patients with severe underlying conditions  
class8	3126	the overall case fatality rate was 26   
class8	3126	septicemia  13 patients  and pneumonia  seven patients  were the most common clinical manifestations of h influenzae type b infection  the others were epiglottitis  six patients   meningitis  three patients   and arthritis  two patients   
class8	3126	epiglottitis occurred in significantly younger patients  all of whom were women and four of whom were previously healthy  
class8	3126	subtyping of the h influenzae type b isolates according to the major outer membrane protein subtype  biotype  and lipopolysaccharide serotype showed that patterns that were uncommon  14   among children were more common  27   in the adults  
class8	3127	barotrauma associated with high frequency jet ventilation for hypoxic salvage  
class8	3127	most reports describe reduction in proximal airway pressures with high frequency jet ventilation  
class8	3127	this led us to speculate that high frequency jet ventilation might reduce barotrauma by providing alveolar ventilation at lower airway pressures  
class8	3127	we describe a group of patients in whom a high incidence of barotrauma was observed after institution of high frequency jet ventilation despite reduction in measured airway pressures  
class8	3127	fifteen hypoxic patients who could not be treated with conventional ventilation and who had no roentgenographic evidence of barotrauma were entered into the study  
class8	3127	airway pressures were measured during conventional ventilation and at 2 and 24 hours after high frequency jet ventilation  
class8	3127	despite significant reduction in peak inspiratory and mean airway pressures  pneumothorax developed in seven of the 15 patients  an average of 21 hours after initiation of high frequency jet ventilation  
class8	3127	five patients had bilateral pneumothorax and three developed tension pneumothorax  
class8	3127	despite reductions in proximal airway pressures  barotrauma is a significant potential complication of high frequency jet ventilation in patients with noncompliant lungs  
class8	3127	we currently place bilateral prophylactic thoracostomy tubes in patients with adult respiratory distress syndrome prior to initiation of high frequency jet ventilation  
class8	3128	visualization of acute pulmonary emboli by transesophageal echocardiography  
class8	3128	this report describes a patient who became hypoxic and hypotensive while awaiting cardiac surgery  
class8	3128	an urgent transesophageal echocardiogram in the operating room showed a mass at the junction of the main and right pulmonary arteries consistent with thrombus  
class8	3128	the thrombus was removed surgically  and the patient then had a successful aortic valve replacement  
class8	3128	transesophageal echocardiography is therefore useful in the evaluation of the critically ill patient  
class8	3129	combined modality therapy for locally advanced non small cell lung carcinoma  
class8	3129	multi modality treatment consisting of cisplatin  vp 16  and 5 fluorouracil chemotherapy given concomitantly with external beam radiation was used to treat 64 patients with locally advanced stage iii non small cell lung carcinoma  
class8	3129	this regimen was used in a preoperative fashion for four cycles in patients considered surgically resectable and with curative intent for six cycles in the remainder of patients  
class8	3129	the clinical response rate for the entire group was 84  and the overall local control rate was 74   
class8	3129	the median survival was 13 months with a median follow up for live patients of 19 months  
class8	3129	the actuarial 3 year survival and disease free survival rates were 30  and 23   respectively  
class8	3129	histologic complete response was 39  and appeared to predict for survival  
class8	3129	the 3 year actuarial survival and disease free survival rates for 23 resected patients were 69  and 45   respectively  with the complete histologic responders having a disease free survival of 78   
class8	3129	the pattern of first recurrence did not appear to differ by histology or presence of lymph nodes in this subset of patients  
class8	3129	the actuarial 3 year survival and disease free survival rates for inoperable patients receiving six cycles of treatment were 18  and 23   respectively  
class8	3129	the local control was 67  with the majority of these patients having stage iiib disease  
class8	3129	the mountain international staging system appeared to predict for operability  local recurrence  and survival  
class8	3129	this concomitant treatment regimen is feasible  with the major toxicities being leukopenia  nausea  and vomiting  
class8	3130	angiocentric immunoproliferative lesion t cell non hodgkin s lymphoma and the acquired immune deficiency syndrome  a case report and review of the literature  
class8	3130	the lesions known as lymphocytic vasculitis  polymorphic reticulosis  midline malignant reticulosis  lethal midline granuloma   lymphomatoid granulomatosis  and angiocentric lymphoma form what have been collectively termed the angiocentric immunoproliferative lesions  ail   
class8	3130	because of recent reports demonstrating clonal rearrangements of the t cell receptor in these lesions  the ail are now thought to represent a continuous spectrum of post thymic t cell non hodgkin s lymphoma  nhl   
class8	3130	nhl associated with the acquired immune deficiency syndrome  aids  represents intermediate or high grade b cell malignancies in hiv infected patients that may be etiologically related to the epstein barr virus  ebv   
class8	3130	there have been reports of ebv associated t cell nhl  ail  and large granular lymphocyte  lgl  proliferations  as well as hiv associated t cell neoplasia  lgl t cell proliferations  and ail  
class8	3130	we describe a case of polymorphic reticulosis  lethal midline granuloma  arising in an hiv infected individual  who later progressed to aids  and review the literature on hiv associated and ebv associated t cell neoplasia  lgl t cell proliferations  and ail  
class8	3130	the etiology of this ail t cell nhl  especially in relation to ebv and hiv  is discussed  
class8	3131	chylothorax after posterior spinal instrumentation and fusion  
class8	3131	chylothorax occurred in a 16 year old girl after posterior spinal fusion and instrumentation for idiopathic scoliosis  
class8	3131	nonoperative management  including chest tube drainage for 26 days and total parenteral nutrition  successfully treated this unusual complication after a posterior spinal fusion  
class8	3132	swallowing disorders in patients with prolonged orotracheal intubation or tracheostomy tubes  
class8	3132	eleven patients were tested for swallowing dysfunction after prolonged orotracheal intubation  
class8	3132	ten had a tracheostomy tube  
class8	3132	mean duration of orotracheal intubation was 19 9 days  mean age 65 yr  and no patient had a concomitant neurologic deficit  
class8	3132	all patients had a modified barium swallow with videofluoroscopy  
class8	3132	all patients had at least one defect of 11 defects characterized  
class8	3132	there was a mean of six defects patient  
class8	3132	the most common defects were delayed triggering of the swallow response  present in all patients  and pharyngeal pooling of contrast material  n   9   
class8	3132	follow up videofluoroscopy was performed in five patients  all had improved  with mean defects decreasing from 6 1 to 2 8 patient  
class8	3132	with one exception  no patient had any defect that was worse than mild in severity  
class8	3132	we concluded that prolonged orotracheal intubation with or without tracheostomy may cause prolonged and severe swallowing dysfunction  
class8	3132	the deficits improve with time  
class8	3132	the presence of a gag reflex does not confer protection against aspiration of pharyngeal contrast  
class8	3133	does prematurity alter the course of respiratory syncytial virus infection  
class8	3133	we compared previously healthy prematurely born infants with full term infants hospitalized with respiratory syncytial virus  rsv  infection to evaluate the role of prematurity on the clinical course of the illness  
class8	3133	during a 5 yr period  1984 to 1989   484 previously healthy patients were admitted to the hospital with rsv infection  
class8	3133	no differences were found in the presenting symptoms of respiratory distress  cough  fever or shock  although the premature group was more likely to present with apnea  p less than  001   
class8	3133	chest roentgenograms revealed that premature infants had a higher incidence of atelectasis infiltrate and hyperinflation  p less than  05   
class8	3133	premature infants had longer hospital stays as well as a higher physiologic stability index and therapeutic intervention score  p less than  001   
class8	3133	they were also more likely to receive supplemental oxygen  icu admission  mechanical ventilation  and nothing by mouth status  p less than  001   
class8	3133	we conclude that premature birth increases the risk of more severe and prolonged rsv disease  
class8	3134	respiratory response and pharmacokinetics of intravenous salbutamol in infants with bronchopulmonary dysplasia  
class8	3134	the effects of iv salbutamol on respiratory mechanics were studied in six infants with bronchopulmonary dysplasia  
class8	3134	salbutamol was infused at a dose of 30 micrograms kg over 30 min in five infants  a sixth infant received 66 7 micrograms kg over 4 min  
class8	3134	salbutamol caused improvement in total respiratory system compliance and in airflow resistance  
class8	3134	there was no correlation between salbutamol serum concentration and pulmonary function  
class8	3134	elimination half time appears to be dictated in these infants more by the distribution volume  vd  than by clearance  cl   
class8	3134	the area under concentration time curve of salbutamol correlated inversely to the change in heart rate  hr   
class8	3134	there was a significant positive correlation between vd and percent hr change  
class8	3134	these data provide evidence that preterm infants have measurable activity of bronchiolar beta 2 receptor responsive to salbutamol  
class8	3135	incidence of colonization  nosocomial pneumonia  and mortality in critically ill patients using a trach care closed suction system versus an open suction system  prospective  randomized study  
class8	3135	eighty four intubated  mechanically ventilated patients were prospectively evaluated for incidences of colonization and nosocomial pneumonias dependent on whether they received endotracheal suctioning by an  open  suction method vs  
class8	3135	 closed  suction  trach care closed suction system  method  
class8	3135	results show that closed suctioning is associated with a significant  67  vs  
class8	3135	39  p less than  02  increase in colonization compared with open suctioning  
class8	3135	however  difference in the incidence of nosocomial pneumonia was not significantly  26  vs  
class8	3135	29   different between closed and open suctioning  
class8	3135	differences in severity of illness  acute physiology and chronic health evaluation ii and therapeutic intervention scoring system   age  sex  presence of ng tubes  use of h2 antagonists or antacids  use of antibiotics  and history of smoking were all nonsignificant  
class8	3135	survival analysis demonstrated that the probability of survival without developing nosocomial pneumonia was greater among closed suctioning patients vs  
class8	3135	open suctioned patients  p less than  03   
class8	3135	this study shows that suctioning performed via the trach care closed suction system increases the incidence of colonization but not the incidence of nosocomial pneumonia  and may actually decrease mortality when compared with open suction systems  
class8	3136	pentoxifylline attenuates edema formation in proteolytic enzyme induced lung injury  
class8	3136	ex vivo canine lung lobes were exposed to a pancreatic proteolytic enzyme  chymotrypsin  alone or chymotrypsin after pretreatment with a continuous infusion with pentoxifylline  
class8	3136	the lobes exposed to chymotrypsin gained 133 g  while the pentoxifylline treated lobes gained only 65 g  p less than  05  over the 3 h experimental period  
class8	3136	these results suggest that pentoxifylline significantly attenuates the lung weight gain associated with chymotrypsin  
class8	3137	continuous  in vivo pulmonary venous admixture from fiberoptically measured hemoglobin saturations  
class8	3137	in six anesthetized swine  pulmonary venous admixture  qsp qt  was calculated by four methods  a  qsp qt 1  fiberoptically measured arterial and mixed venous hgb saturation  sao2 and svo2   pao2 and pvo2 derived from saturations  b  qsp qt 2  fiberoptically measured sao2 and svo2  pao2 and pvo2 measured by blood gas analysis  c  qsp qt 3  pao2 and pvo2 measured by blood gas analysis  sao2 and svo2 derived from tensions  d  qsp qt 4  sao2 and svo2 measured by bench oximetry  pao2 and pvo2 derived from saturations  
class8	3137	input from the fiberoptic catheters was fed into a computer programmed to calculate qsp qt 1 every 20 sec  
class8	3137	fifty eight of these values were compared with simultaneously calculated qsp qt 2  3  and 4  
class8	3137	there was no difference between fiberoptic and derived sao2 or fiberoptic and cooximetric svo2  
class8	3137	correlations and slopes for qsp qt 1 with qsp qt 2  3  and 4 were significant  p less than  05   
class8	3137	comparing mean differences  qsp qt 1 was significantly different only from qsp qt 3  p less than  01   
class8	3137	we conclude that dual oximetry reliably tracks qsp qt  
class8	3138	prototype volume controlled resuscitator for neonates and infants  
class8	3138	twenty five infants receiving assisted ventilation in an icu were manually ventilated for 5 min periods using either a new prototype volume controlled resuscitator  vcr  or a standard self inflating resuscitator  sir   
class8	3138	variables monitored during these 5 min periods included heart rate  respiratory rate  mean arterial pressure  mean airway pressure  paw   end tidal co2  petco2   pulse oximetry oxygen saturation  pao2  and paco2  
class8	3138	significant differences in posttrial values for the following variables were  a  petco2  31 2     9 1 vs  
class8	3138	25 6     8 2 torr  p less than  001   b  paco2  38 0     4 9 vs  
class8	3138	33 2     6 7 torr  p less than  01   and c  ph  7 4     0 6 vs  
class8	3138	7 5     0 1  p less than  04  at comparable paw  9 5     7 6 vs  
class8	3138	8 0     6 0  ns   
class8	3138	eighty four percent  21 25  of infants in the vcr group had normal paco2 values  35 to 45 torr  while only 44   11 25  in the sir group achieved normocarbia  p less than  001   
class8	3138	measurements of the highest  pmax  and lowest  pmin  inspiratory pressure  cm h2o  in 15 patients demonstrated marked variation in pmax with the sir  
class8	3138	differences in pmax  sir minus vcr  were significant  10 8     3 7  p less than  02  but not in pmin  0 5     3 5  ns   
class8	3138	our study demonstrates that ventilation with the vcr resulted in less hyperventilation with minimal pressure variability as compared with the sir  
class8	3138	further studies in the neonate are warranted  
class8	3139	utility of fiberoptic bronchoscopy in nonresolving pneumonia 
class8	3139	although fiberoptic bronchoscopy  fob  has been traditionally used to evaluate nonresolving pneumonia  its efficacy is unknown  
class8	3139	we  therefore  reviewed fob in 35 consecutive patients who had  1  a roentgenographic infiltrate   2  cough   3  either temperature greater than 38 1 degrees c  leukocytosis  sputum production   4  symptoms present for at least ten days  and antibiotic therapy for at least one week  
class8	3139	known lung cancer and aids were excluded  
class8	3139	fiberoptic bronchoscopy was diagnostic in 86 percent  12 14  in whom a specific cause was found  
class8	3139	no patient had endobronchial cancer  
class8	3139	two patients with nondiagnostic fob and persistent systemic symptoms had open lung biopsy specimens showing wegener s granulomatosis and bronchiolitis obliterans with organizing pneumonia  boop   
class8	3139	twenty one patients with nondiagnostic fob had no final diagnoses other than community acquired pneumonia  
class8	3139	we conclude that fob is extremely useful in finding a specific diagnosis for a nonresolving pneumonia when a specific diagnosis can be made  
class8	3139	fiberoptic bronchoscopy was most likely to yield a specific diagnosis in nonsmoking patients with multilobar infiltrates of long duration and could have been avoided in older  smoking  or otherwise compromised patients with lobar or segmental infiltrates with no decrease in diagnostic yield in our series  
class8	3140	acute lobar atelectasis  a comparison of two chest physiotherapy regimens  
class8	3140	fourteen cases of acute lobar atelectasis were alternately allocated to one of two chest physiotherapy regimens for treatment  
class8	3140	treatment in group 1 comprised positioning  vibrations  hyperinflation  and suction  and in group 2  treatment consisted of hyperinflation and suction alone  
class8	3140	treatment in either group was given hourly for six hours  
class8	3140	patients in group 1 had a significantly higher mean percentage resolution of their atelectasis  mean value  60 1 percent   as seen on chest roentgenogram  after one treatment intervention than patients in group 2  mean value  7 6 percent  p less than  006   
class8	3140	after the intensive six hour treatment period  the difference between the groups was marginally statistically significant  still favoring group 1 over group 2  p less than  055   
class8	3140	follow up roentgenograms at 24 and 48 hours revealed no significant difference between the treatment groups  p greater than  10 and greater than  20  respectively   
class8	3140	these results suggest that  at least initially in the course of acute lobar atelectasis  positioning and vibrations add to the efficacy of a treatment of hyperinflation and suction alone  
class8	3141	diagnostic value of maximal exercise tidal volume  
class8	3141	though breathing pattern is frequently analyzed during clinical exercise testing  there is little information regarding its usefulness in the differential diagnosis of impaired exercise tolerance  
class8	3141	this study tested the hypothesis that differences in peak tidal volume during exercise between patients with different cardiorespiratory diseases are related largely to differences in severity of respiratory mechanical impairment  vital capacity   not to differences in disease state  
class8	3141	patients with chronic obstructive pulmonary disease  restrictive lung disease  bronchial asthma  and heart disease  mitral valve disease or left ventricular dysfunction  were studied  
class8	3141	subjects selected had one and only one of the above diagnoses  
class8	3141	all subjects performed maximal  symptom limited  incremental exercise on a cycle ergometer  
class8	3141	multiple linear regression of all subjects  n   30  in all four groups showed a significant correlation between vtmax and vc  vtmax   0 55  vc  0 09 l  r   0 827  p less than 0 0001   
class8	3141	the vtmax vc  x 100  was  mean     sd  44     15  54     11  56     11  and 54     12 for the copd  rld  ba and hd patients respectively  
class8	3141	there was no significant difference between any of the groups  
class8	3141	we concluded that differences in vtmax between different patients are related largely to differences in vc  ie  differences in severity of respiratory mechanical impairment   not to differences in disease state  
class8	3141	measurement of vtmax or the vtmax vc ratio has little value in the differential diagnosis of exertional dyspnea  
class8	3142	systemic hypertension in sleep apnea syndrome  relationship with sleep architecture and breathing abnormalities  
class8	3142	to examine the possible relationship between systemic ht and sas we compared 21 hypertensive  ht   and 29 normotensive  ht   patients for morphologic characteristics  sleep disturbances and respiratory events monitored during a full night polysomnography  
class8	3142	there was no significant difference between ht  and ht  patients with respect to age  weight  bmi  sleep stage distribution and disorganization  apnea hypopnea index  number of episodes per hour of sleep  and duration  minutes per hour of sleep  nor o2 saturation indices  mean nocturnal and minimum o2 saturation  
class8	3142	we conclude therefore that ht in sas patients is not directly related to morphologic characteristics  sleep disturbances and breathing abnormalities  
class8	3143	atypical presentations of pneumocystis carinii pneumonia in patients receiving inhaled pentamidine prophylaxis  
class8	3143	inhaled pentamidine is used commonly to prevent pneumocystis carinii pneumonia  pcp  in patients with advanced human immunodeficiency virus infection  
class8	3143	case reports indicate that pcp can recur in patients who receive inhaled pentamidine and that clinical features may be atypical  
class8	3143	to determine the magnitude of this problem  we reviewed retrospectively the medical records of patients with proven pcp during a 30 month period at two hospitals  
class8	3143	four  31 percent  of 13 patients with previous pcp who received inhaled pentamidine prophylaxis had recurrent p carinii infection  including one patient with widely metastatic extrapulmonary disease  
class8	3143	chest roentgenographic findings included cavities  pneumothoraces  bilateral and upper lobe interstitial infiltrates  and pleural effusion  
class8	3143	false negative bronchoalveolar lavage and induced sputum examinations were frequent  
class8	3143	we conclude that recurrent pcp in patients maintained on a regimen of inhaled pentamidine prophylaxis occurs frequently  causes chest roentgenographic abnormalities other than interstitial infiltrates  and may be difficult to diagnose  
class8	3143	clinicians who choose to use this effective and convenient mode of prophylaxis should be aware of the problems attendant to its use  
class8	3144	rapid diagnosis of lung cancer from palpable metastases by needle thrust  
class8	3144	this study encourages the use of percutaneous fnb to diagnose and stage advanced lung cancer in patients with palpable metastases in supraclavicular lymph nodes or soft tissues  
class8	3144	percutaneous fnb of metastases is much easier to learn than transthoracic needle aspiration  the superficial target is anchored and sampled with multiple passes using a short needle grasped directly in the fingers  
class8	3144	it is fast  accurate  economical and nearly free of risk and pain  
class8	3144	the technique saves time and money because it is the only procedure needed by many patients with palpable disease in stage iiib and iv  
class8	3144	bronchoscopy  transthoracic needle aspiration and open surgical biopsy thus can be avoided in most patients with palpable metastases  
class8	3144	prompt diagnosis by fnb of metastases speeds palliation for patients with urgent need  
class8	3144	tumor cell type from fnb correlated with cytologic findings from sputum samples  bronchoscopy specimens and autopsy results  
class8	3145	elevated prostaglandin e2 levels in bronchoalveolar lavage fluid of patients with bronchogenic carcinoma  
class8	3145	understanding local pulmonary immunoregulatory mechanism s  in patients with carcinoma of the lung is an important step towards the development of innovative methods of treatment  
class8	3145	prostaglandin e2 plays an integral role in immunoregulation  
class8	3145	therefore  we evaluated pge2 concentrations in balf from 18 patients with bronchogenic carcinoma  compared to that from six patients with pulmonary diseases other than carcinoma and ten normal smokers of similar age  
class8	3145	the level of pge2 in patients with lung carcinoma  158 1     88 7 pg ml  was significantly  p less than 0 001  higher than the other two groups  16 2     6 9 and 4 4     3 4 pg ml   
class8	3145	levels of pge2 also varied among patients with carcinoma of different cell types  
class8	3145	patients with sqca had significantly  p less than 0 001  higher levels of pge2  242 7     29 4 pg ml  than patients with adca or scca  82 3     27 9 and 66 3     15 2 pg ml  respectively   
class8	3145	furthermore  there was a marked difference in pge2 concentration between carcinomatous lung and clinically noninvolved lung in patients with sqca and adca  
class8	3145	further study is warranted to determine the interactions between pge2 and other cytokines  interleukin 1  il 2  and tumor necrosis factor   as well as the activity of cytolytic lymphocytes  lak cells  in the lungs of patients with bronchogenic carcinoma  
class8	3146	pulmonary vascular steal in chronic thromboembolic pulmonary hypertension  
class8	3146	after pulmonary thromboendarterectomy  performed for relief of chronic thromboembolic pulmonary hypertension  perfusion lung scans have frequently disclosed new perfusion defects in segments served by undissected pulmonary arteries  
class8	3146	our hypotheses were that these new postoperative defects occurred with great frequency and did not represent postoperative vessel occlusion  
class8	3146	we retrospectively reviewed the preoperative and postoperative perfusion scans of 33 consecutive patients undergoing pulmonary thromboendarterectomy  
class8	3146	new postoperative perfusion defects were noted in 23 of 33 patients  
class8	3146	the incidence of new defects was increased tenfold in segments that had  1  normal preoperative angiographic findings   2  normal preoperative radionuclide perfusion  and  3  not been entered at the time of surgery  
class8	3146	postoperative angiograms  available in 15 of 33 patients  documented the nonembolic  nonocclusive nature of the new perfusion scan defects  
class8	3146	the most plausible alternate explanation for this previously undescribed finding is a redistribution of pulmonary arterial resistance induced by the thromboendarterectomy  namely  a pulmonary vascular  steal    
class8	3147	pathologic dependence of oxygen consumption on oxygen delivery in acute respiratory failure secondary to aids related pneumocystis carinii pneumonia  
class8	3147	oxygen consumption is pathologically dependent on oxygen delivery in ards and sepsis  
class8	3147	we asked whether oxygen consumption is dependent on oxygen delivery in severe acute respiratory failure secondary to aids related pcp  
class8	3147	in five patients who had aids related pcp  diffuse bilateral pulmonary infiltrates  no evidence of bacterial infection  and acute respiratory failure requiring mechanical ventilation with arterial oxygen tensions less than 75 mm hg while breathing at least 50 percent oxygen  and peep greater than 10 cm h2o  we determined oxygen delivery and consumption by calculation from thermodilution cardiac output and arterial and mixed venous oxygen contents  
class8	3147	oxygen delivery was increased using transfusion of two units of packed red blood cells over one hour  
class8	3147	oxygen delivery increased 22 percent  638     204 to 778     201 ml min m2  p less than or equal to 0 006   
class8	3147	oxygen consumption increased 11 percent  134     34 to 149     29 ml min m2  p less than or equal to 0 02   
class8	3147	the oxygen extraction ratio did not change  
class8	3147	we conclude that similar to ards and sepsis  oxygen consumption may be pathologically dependent on oxygen delivery in patients who have severe acute respiratory failure secondary to aids related pcp  
class8	3148	prostacyclin but not phentolamine increases oxygen consumption and skin microvascular blood flow in patients with sepsis and respiratory failure  
class8	3148	inadequate tissue oxygenation may occur in critically ill patients with sepsis despite an apparently adequate o2 transport  qo2   and this may contribute to the development of an o2 debt and also to multiple organ failure  
class8	3148	it has been shown that increasing qo2 by infusing a vasodilator may reveal this o2 debt in septic patients  
class8	3148	to investigate whether the site of action of vasodilators may be of importance in unmasking such an o2 debt  we administered prostacyclin  a prostaglandin with a preferential effect on the microcirculation  and phentolamine  an arteriolar vasodilator  in 11 patients studied during the first 48 hours after the onset of sepsis  and compared their effect on whole body oxygen consumption  vo2  and skin microvascular blood flow  
class8	3148	the results demonstrated that increasing qo2 by prostacyclin but not by phentolamine significantly increases vo2 in critically ill patients with sepsis  
class8	3148	the site of action of vasodilators may therefore play an important role in their ability to unmask an o2 debt  
class8	3149	selection and evaluation of recipients for heart lung and lung transplantation  
class8	3149	heart lung and lung transplantation is being successfully performed with increasing frequency in patients with end stage cardiopulmonary and pulmonary disease  
class8	3149	transplantation must now be considered as a therapeutic option in selected patients  and physicians are required to understand the principles involved for determining suitable candidates and operative procedures of choice  
class8	3149	indications  contraindications  and choice of operation with respect to underlying disease are discussed herein  as are methods of evaluation and appropriate timing for transplantation  
class8	3149	special considerations regarding specific patient populations are also addressed  
class8	3149	in properly selected patients  heart lung and lung transplantation provide a viable therapeutic option in those with end stage disease who are unresponsive to conventional management  
class8	3150	pneumothorax following cytotoxic chemotherapy in malignant lymphoma  
class8	3150	pneumothorax occurring as a complication of the antitumor effect of cytotoxic chemotherapy has been reported in occasional cases of a variety of tumors  
class8	3150	its occurrence in malignant lymphoma has not been reported heretofore  
class8	3150	in this report  we describe two cases of this complication in patients with malignant lymphoma and discuss the possible pathophysiologic mechanisms involved  
class8	3150	because pulmonary involvement with the tumor was found in both cases  pneumothorax could be attributed to the anti tumor effect of cytotoxic agents on underlying lung involvement in patients with malignant lymphoma  
class8	3151	tracheal stenosis and failure to wean from mechanical ventilation due to herpetic tracheitis  
class8	3151	a 64 year old man with chronic obstructive pulmonary disease presented with pneumococcal pneumonia that progressed to respiratory failure within one week  requiring mechanical ventilation  
class8	3151	despite a low minute ventilation and clear chest roentgenogram  multiple weaning attempts failed  
class8	3151	bronchoscopy revealed significant narrowing of the distal trachea with erythema  edema  and ulceration of the mucosa  
class8	3151	cytology of tracheal washings was consistent with herpes simplex virus  and the patient was successfully extubated following treatment with intravenous acyclovir  
class8	3151	bronchoscopy following acyclovir therapy demonstrated resolution of the inflammation and narrowing  
class8	3151	herpetic tracheitis is a rarely recognized reversible cause of tracheal stenosis  especially in a nonimmunocompromised patient  
class8	3151	it should be suspected in patients without an obvious cause of failure to wean from mechanical ventilation  and can be successfully treated with acyclovir  
class8	3152	septic pulmonary embolism complicating a central venous catheter  
class8	3152	bacteremia is a recognized complication in patients with indwelling central venous catheters  
class8	3152	more recently pulmonary embolism in such patients has also been described  
class8	3152	despite abundant clinical experience with these devices  to our knowledge  septic pulmonary embolism has not been reported in adult patients  
class8	3152	this case illustrates such a complication  
class8	3153	adult respiratory distress syndrome due to blastomycosis during pregnancy  
class8	3153	a 23 year old healthy woman in her third trimester of pregnancy developed adult respiratory distress syndrome secondary to blastomyces dermatitides  
class8	3153	pregnancy related immunosuppression was believed to be responsible for the fungal infection  
class8	3153	following emergency delivery of the infant and a full course of amphotericin b therapy  the patient made an uneventful recovery  
class8	3153	although the fetal and maternal sides of the placenta demonstrated fungal spores  the child remained healthy  
class8	3153	to our knowledge  this is the first report of blastomycosis associated adult respiratory distress syndrome occurring during pregnancy  
class8	3154	phrenomediastinal echinococcosis  
class8	3154	a patient with the rare presentation of posterior mediastinal echinococcosis is reported  
class8	3154	magnetic resonance imaging  mr  demonstrated the extension of a primary retroperitoneal cyst into the posterior mediastinum which was subsequently confirmed surgically to be of echinococcal origin  
class8	3154	such a case of phrenomediastinal echinococcosis has been described only once before in literature  
class8	3155	pneumomediastinum  pneumothorax and subcutaneous emphysema following the measurement of maximal expiratory pressure in a normal subject  
class8	3155	mediastinal and subcutaneous emphysema have been reported as a consequence of deliberate manipulations of the breathing pattern producing a valsalva like maneuver in healthy subjects  
class8	3155	we present a case of pneumomediastinum  pneumothorax and subcutaneous emphysema occurring in a normal volunteer after repeated measurements of the pemax  
class8	3156	ear involvement in the yellow nail syndrome  
class8	3156	recognized features of the yellow nail syndrome include yellow nails  lymphedema  and pleural effusions  
class8	3156	we report a patient with the additional feature of keratosis obturans  which may be a manifestation of this syndrome in the external ear  
class8	3157	bilious pleural effusion following liver biopsy  
class8	3157	pleural effusions in patients with chronic liver disease are common and usually are of little consequence  
class8	3157	bilious pleural effusion can occur following percutaneous biopsy or cholangiography procedures if the pleura is traversed  
class8	3157	this report emphasizes the role of biliary tract obstruction in the development of a bilious effusion and the importance of biliary tract decompression in treatment  
class8	3157	we discuss the laboratory evidence supporting the diagnosis of bilious effusion and review the reported experience with this complication  
class8	3158	acute bronchitis  general practitioners  views regarding diagnosis and treatment  
class8	3158	a survey was conducted among 800 dutch general practitioners to establish their views on the diagnosis and treatment of bronchitis and related disorders with reference to 12 theoretical patients  
class8	3158	the answers of the 467 respondents  response rate 60   showed no clear relationship between signs and symptoms of the patients and the diagnosis made  
class8	3158	in the authors  opinion the diagnosis of pneumonia was made too often  
class8	3158	the decision whether or not to prescribe an antibiotic for a coughing patient was based in part on the diagnosis made  but in part it was also made on the basis of the signs and symptoms  irrespective of the diagnosis  
class8	3158	the authors have the impression that general practitioners tend to prescribe antibiotics too quickly to coughing patients  
class8	3158	there is a need for guidelines for diagnosis and treatment of patients with acute bronchitis and related conditions  
class8	3159	enteric neuronal autoantibodies in pseudoobstruction with small cell lung carcinoma  
class8	3159	severe gastrointestinal dysmotility is a newly recognized paraneoplastic syndrome that occurs with small cell lung carcinoma  
class8	3159	thirty four patients with small cell carcinoma  of whom 5 had chronic intestinal pseudoobstruction and 29 had no digestive symptoms  were studied serologically  
class8	3159	four of the 5 patients with gut dysmotility had immunoglobulin g antibodies reactive with neurons of the myenteric and submucosal plexuses of jejunum and stomach in an indirect immunofluorescence assay  
class8	3159	antibodies of this type were not found in any of the 29 patients who had no gut dysmotility  nor were they found in patients with chronic idiopathic intestinal pseudoobstruction  n   8   ovarian cancer  n   20   or epilepsy  n   4  or in normal subjects  n   9   
class8	3159	in 4 of the patients with paraneoplastic pseudoobstruction  antibodies in highly diluted serum  1 4000 1 8000  bound selectively to nuclei and cytoplasm of neuronal elements in the gut  
class8	3159	this novel autoantibody activity suggests that intestinal pseudoobstruction occurring in patients with small cell carcinoma may have an autoimmune basis  
class8	3159	from a clinical standpoint  serological testing offers a simple means for determining which patients with gut dysmotility syndromes may have associated small cell carcinoma  thereby enabling earlier diagnosis and treatment of the tumor  
class8	3160	segmental vascular resistance in postobstructive pulmonary vasculopathy  
class8	3160	chronic unilateral pulmonary arterial ligation has been touted as a model of arteriopathy resulting in a tremendous increase in anastomotic bronchial flow  qbr  via collaterals  
class8	3160	to investigate its effects on the pulmonary vasculature  we ligated the left main pulmonary artery of seven dogs and 120 days later pump perfused their left lower lobes  lll  via a cannula in the pulmonary artery at pulmonary arterial flow  qpa  of 250 ml min  
class8	3160	we measured qbr  330 ml min  and compared lll with control contralateral right lower lobes  rll  and three lll from normal dogs  
class8	3160	pressure flow  p q  curves were obtained by varying qpa  
class8	3160	with arterial and venous occlusion we measured total  arterial  venous  and middle segment resistances under baseline conditions  after serotonin and histamine  either with or without qpa and with antegrade and retrograde qbr  
class8	3160	light microscopy was done postmortem  
class8	3160	the slope of the p q curve was 33 4 mmhg l 1 min in the ligated lobes compared with 15 9 in the controls  attributable by the occlusion technique mainly to a rise in arterial resistance  22 4 mmhg l 1 min compared with 7 4 in the controls  with a small rise in venous resistance  
class8	3160	this was explained by significant arterial medial muscle thickening and some loss of lll volume  
class8	3160	the arterial segment was markedly hypersensitive to serotonin  and the venous segment was mildly hypersensitive to histamine compared with controls  
class8	3160	the occlusion data also enabled us to model the point of entry of the bronchial circulation into the pulmonary circuit at the precapillary level and to calculate bronchial vascular resistance  
class8	3160	we conclude that postobstructive vasculopathy substantially raises pulmonary vascular resistance  mainly upstream from the site of entry of the bronchial circulation  
class8	3160	the role of the latter may be to keep it from rising excessively in the segments it perfuses  i e   the middle and venous ones  
class8	3161	altered function of pulmonary surfactant in fatty acid lung injury  
class8	3161	to determine whether acute fatty acid lung injury impairs pulmonary surfactant function  we studied anesthetized ventilated rabbits given oleic acid  55 mg kg iv  n   11  or an equivalent volume of saline  n   8   
class8	3161	measurements of pulmonary mechanics indicated a decrease in dynamic compliance within 5 min of injury and a decrease in lung volume that was disproportionately large at low pressures  consistent with diminished surfactant activity in vivo  
class8	3161	bronchoalveolar lavage fluid obtained 1 h after injury had significantly increased erythrocytes and total leukocytes  largely polymorphonuclear cells  
class8	3161	the phospholipid content and composition of the cell free fraction had only minor changes from those of controls  but the protein content was increased 35 fold  
class8	3161	measurements of lavage surface activity in vitro showed an increase in average minimum surface tension from 1 3     0 4  se  dyn cm in controls to 20 2     3 9 dyn cm in injured animals  
class8	3161	the alterations in static pressure volume curves and decrease in lavage surface activity suggest a severe alteration of surfactant function in this form of lung injury that occurs despite the presence of normal amounts of surfactant phospholipids  
class8	3162	pulmonary blood volume and edema in postpneumonectomy lung growth in rats  
class8	3162	after pneumonectomy in young animals  the contralateral lung undergoes compensatory growth and generally attains the same weight and air space volume as both lungs in age matched controls  
class8	3162	in this study  we determined the contribution of lung edema and increased blood volume to the weight gain in rats  
class8	3162	three weeks after pneumonectomy  n   18  or sham pneumonectomy  n   17   the pulmonary blood volume and the extravascular water and albumin were evaluated by use of 51cr labeled erythrocytes and 125i labeled albumin  
class8	3162	the air space volume  blood free lung weights  and dna and protein content were also compared  
class8	3162	the data show that the total pulmonary blood volumes and the blood volume per gram of blood free dry lung were similar in pneumonectomized and age matched sham controls  
class8	3162	the total extravascular albumin and the extravascular albumin per gram of blood free dry lung were also similar as well as the extravascular lung water  wet to dry weight ratios  dna and protein content  and air space volumes  
class8	3162	these data indicate that the increased weight of the postpneumonectomy lung was due to cellular and stromal proliferation  
class8	3162	the blood volume and interstitial fluid increased in proportion to the increase in lung parenchyma  
class8	3162	neither vascular congestion nor increased extravascular protein and water contributed to the observed weight gain  
class8	3163	physiology of aging related to outcome in the adult respiratory distress syndrome  
class8	3163	thirty nine patients with adult respiratory distress syndrome  ards  were enrolled in a study to identify potential age related changes in organ system function that may help explain the apparent association between age and poor outcome in these patients  
class8	3163	criteria for enrollment included an arterial po2 to inspired o2 concentration ratio less than or equal to 200 in a clinical setting consistent with ards  
class8	3163	patients were excluded if they were less than 18 yr old  had clinical manifestations of congestive heart failure  were seropositive for the human immunodeficiency virus  or had stage ii metastatic lung cancer  
class8	3163	patients were divided into two groups  those less than 60 yr old  mean 42     3 yr  n   17  and those greater than or equal to 60 yr old  73     2 yr  n   16   
class8	3163	a group of six patients was analyzed as a separate subset based on a body temperature less than or equal to 97 5 degrees f at enrollment  hypothermic patients  73     4 yr old   
class8	3163	sepsis was present in 67  of the nonhypothermic patients and in all the hypothermic patients  
class8	3163	mortality rates were 12  in the patients less than 60 yr and 69  in the nonhypothermic patients greater than or equal to 60 yr  
class8	3163	all the hypothermic patients died  
class8	3163	sequential data obtained over 6 days were compared within and between groups  
class8	3163	the following results were obtained  
class8	3163	1  the ratio of arterial po2 to inspired o2 fraction was greater and the positive end expiratory pressure used was significantly less in the patients greater than or equal to 60 yr old compared with the younger group  
class8	3164	congenital midline nasal masses  diagnosis and management  
class8	3164	congenital midline nasal masses  cmnms  are rare lesions most commonly caused by dermoids  hemangiomas  nasal gliomas or encephaloceles  
class8	3164	we report a case of nasal glioma and discuss the embryologic development  evaluation  and management of such cmnms  
class8	3165	effects of prostaglandin e1 on platelet attenuation of oxidant induced edema in isolated rabbit lungs  
class8	3165	numerous studies suggest that platelets may contribute to preservation of normal endothelial cell permeability in models of lung injury  
class8	3165	we have previously shown that washed human platelets prevent xanthine oxidase induced edema in the isolated perfused lung and that protective mechanisms depend on the platelet glutathione redox cycle  
class8	3165	it is uncertain  however  whether platelets preserve endothelial function by reducing toxic oxygen metabolites or by aggregating and releasing endothelial cell supportive factors an activity that may require the glutathione redox cycle  
class8	3165	in this study  we present data demonstrating that platelet prevention of oxidant lung injury occurs independent of platelet aggregation and release  
class8	3165	isolated rabbit lungs perfused with a cell free medium were instilled with purine  2 mmol l  and xanthine oxidase  0 003 u ml  to generate oxidant lung edema  
class8	3165	the infusion of washed human platelets  1 x 10 10  cells  prevented lung edema formation as measured by lung weight gain  wet to dry lung weight ratios  and lung histology  
class8	3165	incubation of platelets with prostaglandin e1  pge1   a potent inhibitor of platelet aggregation and release  did not inhibit platelet attenuation of lung edema  
class8	3165	additionally  with the instillation of pge1 into the perfusate to further inhibit platelet aggregation  no prevention of lung protection by pge1 treated platelets was seen when these results were compared with those from studies in which lungs were infused with xanthine oxidase and pge1  
class8	3165	aggregometry studies documented that the inhibitory effect of pge1 on platelet aggregation persisted for up to 60 minutes  which was the duration of the isolated lung protocol  
class8	3165	we conclude that platelet aggregation and release of platelet factors is not required for platelet attenuation of oxidant lung edema  
class8	3166	the effect of rifampicin on rhinoscleroma  an electron microscopic study  
class8	3166	twenty five cases suffering from rhinoscleroma were divided into two groups  
class8	3166	the first group consisted of 15 patients treated with rifampicin systemically  
class8	3166	the other group consisted of 10 patients treated locally with rifampicin in the form of ointment  
class8	3166	electron microscopic study of the pathological changes in the lesions showed that rifampicin is highly effective both systemically and locally in the treatment of rhinoscleroma  
class8	3167	radiological diagnosis of aspirated foreign bodies in children  review of 343 cases  
class8	3167	in our series of 400 chinese children with foreign body aspiration  fba   343 cases were evaluated by fluoroscopy and or plain chest x rays before endoscopic removal of the foreign bodies  
class8	3167	the majority of the foreign bodies  fbs  were organic  378 400  94 5 per cent   
class8	3167	the results showed that mainstem bronchial foreign bodies were diagnosed correctly in 68 per cent of cases compared with 65 per cent correct diagnoses with segmental bronchial foreign bodies  but only 22 per cent correct diagnoses with tracheal  and 0 per cent correct diagnosis in those with laryngeal foreign bodies  
class8	3167	eighty per cent  32 40  of the children with laryngotracheal fbs had normal x ray findings  whereas 67 7 per cent  205 303  of the children with bronchial fbs had abnormal chest x ray findings  
class8	3167	the most common positive radiological signs in the children with tracheobronchial fbs were obstructive emphysema  131 213  62 per cent  and mediastinal shift  117 213  55 per cent   
class8	3167	the incidence of major complications was related not only to the size of the foreign body and its location but also the duration since aspiration  
class8	3167	the most common types of bronchial obstructions by airway fbs are discussed  
class8	3168	chronic sinusitis and the yellow nail syndrome  
class8	3168	diagnosing syndromes that include chronic sinusitis can expedite the management of both conditions  
class8	3168	yellow nail syndrome is usually described as the combination of yellow nails  lymphoedema and often respiratory manifestations such as chronic sinusitis  bronchiectasis and pleural effusions  
class8	3168	the pathology responsible for the syndrome is believed to be lymphatic hypoplasia  
class8	3168	diagnosis of yellow nail syndrome is clinical not requiring any specialized tests  
class8	3168	in the two cases described  the respiratory tract manifestations required the most active investigation and management  
class8	3168	the significance of this syndrome to the otolaryngologist is discussed  
class8	3169	rigid spine syndrome with respiratory failure  
class8	3169	the pathogenesis and therapy of respiratory failure in the rigid spine syndrome are discussed in two cases who improved with respiratory assistance  
class8	3169	in both cases  the partial pressures of oxygen and carbon dioxide were reversed in arterial blood gas analysis and  vc was less than 30   
class8	3169	remission from respiratory failure has been obtained by the use of a ventilator during the night  
class8	3169	the cause of the respiratory failure in both cases was severe restrictive respiratory dysfunction due to extreme flattening of the chest and fixation of the thorax during respiration as a result of contracture of costovertebral joints  
class8	3169	all the previously reported cases of the rigid spine syndrome with respiratory failure died  
class8	3169	appropriate use of the ventilator can improve the prognosis  
class8	3170	high frequency oscillatory ventilation compared with conventional intermittent mechanical ventilation in the treatment of respiratory failure in preterm infants  neurodevelopmental status at 16 to 24 months of postterm age  the hifi study group  
class8	3170	the high frequency intervention trial was a 10 center randomized clinical trial to test the efficacy and safety of high frequency oscillatory ventilation  hfo  in the treatment of neonates weighing 750 to 2000 gm  327 infants were assigned to hfo and 346 to conventional intermittent mechanical ventilation  imv   
class8	3170	survival and lung morbidity rates were the same in the two groups  
class8	3170	bayley psychometric evaluations and cns examination were performed at 16 to 24 months of postterm age in 77  of the survivors  185 hfo and 201 imv   
class8	3170	there was no difference in growth or respiratory status at follow up  
class8	3170	cerebral palsy was diagnosed in 19  10   hfo treated infants and 23  11   imv treated infants  
class8	3170	there was no difference in severity between the two groups  
class8	3170	a significantly higher incidence of hydrocephalus  12  vs 6   was present in the hfo group  p less than 0 05   
class8	3170	bayley index scores greater than 83 were scored in 57  of hfo treated infants compared with 66  of imv treated infants  
class8	3170	the proportion of children at follow up with a normal neuro developmental status  i e   bayley score greater than 83 and no major cns defect  was significantly less in the hfo than in the imv group  54 vs 65   p less than 0 05   
class8	3170	both treatment groups showed a strong association between the presence of grade 3 or 4 intraventricular hemorrhage and the development of major cns or cognitive defects  
class8	3170	no significant long term beneficial or deleterious effects were demonstrated in the use of hfo versus imv for the treatment of respiratory failure in low birth weight premature infants  except that there were slightly more neurologic deficits in the hfo group related to the higher proportion of survivors with major intraventricular hemorrhage  
class8	3171	improved outcome at 28 days of age for very low birth weight infants treated with a single dose of a synthetic surfactant 
class8	3171	two identical double blind  controlled  randomized trials were initiated to determine whether the administration of a single 5 ml kg dose of a synthetic surfactant  exosurf neonatal   soon after the delivery of infants with birth weights 700 to 1350 gm  would improve rates of survival without bronchopulmonary dysplasia  
class8	3171	both trials were terminated before enrolling their planned sample sizes because of the availability of exosurf under the provisions of a treatment investigational new drug program  
class8	3171	we report the combined results of these trials  
class8	3171	study infants were stratified according to birth weight and gender before random assignment to a treatment regimen  
class8	3171	one hundred ninety two infants received exosurf and 193 received an air placebo  
class8	3171	the study groups were similar when a variety of demographic features describing the mothers  their pregnancies  the circumstances of the births  and the infants were compared  
class8	3171	exosurf treated infants required significantly less oxygen and respiratory support during the first 3 days of life in comparison with the air treated infants  
class8	3171	fewer infants in the exosurf group had pulmonary interstitial emphysema  26 vs 13  p   0 028   
class8	3171	in the exosurf group  there was a significant reduction in the combined outcome  neonatal death or survival with bronchopulmonary dysplasia  57 vs 39  p   0 042   and there was a significant increase in rates of survival without this disease  128 vs 137  p   0 042   
class8	3171	there were no differences between treatment groups in the incidences of a variety of complications of prematurity  including apnea  patent ductus arteriosus  intraventricular hemorrhage  and necrotizing enterocolitis  
class8	3171	we conclude that improvements in respiratory physiology after a single prophylactic dose of exosurf result in an increased likelihood of neonatal survival without bronchopulmonary dysplasia  
class8	3172	effect of extracorporeal membrane oxygenation on survival of infants with congenital diaphragmatic hernia  
class8	3172	to determine the effect of extracorporeal membrane oxygenation  ecmo  on the survival of infants with congenital diaphragmatic hernia  we undertook a retrospective review of 31 infants with congenital diaphragmatic hernia treated at children s national medical center  
class8	3172	infants were categorized by means of the bohn quadrant analysis to determine the impact of ecmo on infants with congenital diaphragmatic hernia and a  poor prognosis   all infants assigned to the bohn 100  mortality quadrant required ecmo  
class8	3172	the survival rate in this group was 86   6 7  when assessed preoperatively and 67   6 9  when assessed postoperatively  
class8	3172	comparison of the change occurring in ventilation index and arterial carbon dioxide pressure demonstrated that after repair the clinical condition of 48  of infants deteriorated  40  improved  and 12  remained unchanged  
class8	3172	of the 12 infants whose condition was worse after surgery  11 eventually required ecmo  
class8	3172	our review demonstrates that ecmo improved survival significantly in infants with congenital diaphragmatic hernia who had a  poor prognosis  by the criteria of bohn et al  
class8	3172	we recommend consideration of ecmo for all infants with congenital diaphragmatic hernia for whom maximal medical therapy has failed  
class8	3173	national survey of the pattern of care for carcinoma of the lung  
class8	3173	a national survey of the patterns of care for carcinoma of the lung sponsored by the commission on cancer of the american college of surgeons has documented continuing changes in epidemiology  treatment  and outcome  
class8	3173	the project consisted of a long term study of 15 219 patients whose diagnosis was made in 1981 and a short term study of 19 074 patients whose diagnosis was made in 1986  
class8	3173	the male female incidence ratios have continued to decrease and the decrease has moved into the older age groups  
class8	3173	although the percentage of adenocarcinoma is increasing at the expense of squamous carcinoma  the latter is still the most prevalent histologic type  
class8	3173	the accuracy of percutaneous needle biopsy and transbronchial biopsy of lung nodules reported from this group of 941 hospitals was high and equal to that reported by single institutions  
class8	3173	the percentage of patients having a resection did not increase from 1981 to 1986  but for smaller lesions a move was apparent toward more lung sparing resections  
class8	3173	little change has occurred in the use of adjuvant radiotherapy  particularly in stage iii disease  where approximately 50  of the patients received postoperative irradiation  
class8	3173	an improvement in the overall 5 year survival when compared with surveillance  epidemiology  and end results data was noted  
class8	3173	whether this is a true improvement in survival or is the result of selection because of an unrecognized change in the pattern of care for patients with a carcinoma of the lung is unknown  
class8	3174	carcinosarcoma and spindle cell carcinoma of the lung  clinicopathologic and immunohistochemical studies  
class8	3174	we examined pulmonary carcinomas with prominent sarcoma like lesions both clinicopathologically and immunohistochemically  
class8	3174	grossly  two tumors had predominantly endobronchial growths  four bulky parenchymal growths  and two endobronchial  parenchymally mixed growths  
class8	3174	in these eight patients  six tumors were completely resected  one patient was given irradiation only  and one patient died in the early postoperative period  
class8	3174	on the basis of specific differentiation of the sarcoma like lesions  the tumors were separated into three groups  two with  true  sarcoma differentiated into soft tissues such as striated muscle or osteoid tissue  three with a fibromatous sarcoma resembling atypical pseudosarcomatous stroma  and three with spindle cell carcinoma with evidence of epithelial differentiation  
class8	3174	the prognosis was poor  and tumors with specific differentiation into rhabdomyosarcoma  chondrosarcoma  or spindle cell carcinoma progressed more rapidly than did those with a fibromatous sarcoma  
class8	3174	because the fibromatous sarcoma like lesions were found to relate to a longer survival time for the patients  we wish to emphasize that a distinction of sarcomatous components should be made with regard to assessing the prognosis of pulmonary carcinoma with sarcoma like lesions  
class8	3175	utility of frozen section evaluation of lymph nodes in the staging of bronchogenic carcinoma at mediastinoscopy and thoracotomy  
class8	3175	we conducted a retrospective analysis of the utility of frozen section diagnoses in determining lymph node status at mediastinoscopy in 122 consecutive patients with bronchogenic carcinoma  
class8	3175	thirty five of 122 patients had one or more lymph nodes with frozen section evaluation positive for metastatic carcinoma  
class8	3175	subsequent nodal sections not in the original frozen section study revealed metastatic carcinoma in two additional patients  
class8	3175	the false negative rate was 1 6   
class8	3175	sensitivity was 94 6   
class8	3175	predictive value of negative frozen section evaluation results was 97 7   
class8	3175	because there were no false positive frozen section results  specificity and predictive value for positive results of frozen section evaluation were 100   
class8	3175	the statuses of individual lymph nodes from these 122 patients were also evaluated  
class8	3175	six hundred twenty lymph nodes were sampled from the mediastinum at mediastinoscopy  
class8	3175	frozen sections in 47 lymph nodes were positive  
class8	3175	subsequent nodal sections not in the original frozen sections examination revealed metastatic carcinoma in four additional lymph nodes  
class8	3175	the false negative rate was 0 6   
class8	3175	sensitivity was 92 2   
class8	3175	predictive value of negative results from frozen section evaluation was 99 3   
class8	3175	because there were no false positive frozen section results  specificity and predictive value for positive results of frozen section examination were 100   
class8	3175	we conclude that frozen section evaluation of lymph nodes at mediastinoscopy reliably indicates lymph node status  thus enabling the physician to decide whether to proceed to thoracotomy  
class8	3175	thus staging of the carcinoma and definitive surgery can be accomplished during a single anesthetic procedure  
class8	3175	combining mediastinoscopy and thoracotomy with frozen section diagnostic control also reduces both the length and cost of hospitalization  
class8	3176	primary osteosarcoma of the lung  report of two cases and review of the literature  
class8	3176	two cases of primary osteosarcoma of the lung are presented  
class8	3176	in one case  the radiologic  clinical  and cytologic findings led to a preoperative diagnosis of undifferentiated carcinoma of the lung  
class8	3176	in the second case  a lung nodule was discovered during postchemotherapy follow up in a patient with lymphoma  
class8	3176	fine needle aspiration in the second case showed lymphoma  and further chemotherapy was instituted  however  persistent growth of the nodule prompted a resection  
class8	3176	microscopic examination of the resected tumors in both cases revealed histologic features of high grade osteosarcoma  
class8	3176	flow cytometric analyses of the primary tumors showed abnormal hyperdiploid deoxyribonucleic acid populations in accordance with those seen in high grade malignant neoplasms  
class8	3176	immunohistochemical studies supported a mesenchymal origin for these tumors  
class8	3176	these tumors shared clinical features with other reported cases of primary osteosarcoma of the lung such as large size at diagnosis  occurrence in older individuals  and aggressive behavior  
class8	3177	inhibition of exercise induced bronchoconstriction by mk 571  a potent leukotriene d4 receptor antagonist 
class8	3177	background  
class8	3177	exercise is a common stimulus of bronchoconstriction in subjects with asthma  who also have bronchoconstriction after inhaling the sulfidopeptide leukotriene d4  ltd4   
class8	3177	the purpose of this study was to investigate the importance of ltd4 as a mediator of exercise induced bronchoconstriction  
class8	3177	methods  
class8	3177	in a double blind  randomized  crossover study  12 subjects with stable asthma were treated intravenously with mk 571  160 mg   a selective and potent ltd4 receptor antagonist  or placebo  20 minutes before each of two challenges involving exercise at a level previously demonstrated to cause a fall of at least 20 percent in the forced expiratory volume in one second  fev1   
class8	3177	the two exercise challenges were separated by one week  
class8	3177	the results of the challenges were expressed as both the maximal fall in fev1 after exercise and the time to recovery from bronchoconstriction  
class8	3177	results  
class8	3177	treatment with mk 571 attenuated exercise induced bronchoconstriction in all the subjects  
class8	3177	the mean      sem  maximal percent decrease in fev1 after exercise was 25 2     3 5 percent in the subjects taking placebo and 9 2     2 5 percent in the subjects taking mk 571  p less than 0 001   
class8	3177	the mean percent inhibition for the entire group was 69 5 percent  
class8	3177	the mean time to recovery after exercise was 33 4     4 0 minutes in the placebo group and 8 4     2 5 minutes in the mk 571 group  p less than 0 001   
class8	3177	conclusions  
class8	3177	this study demonstrates that pretreatment with a potent and selective ltd4 antagonist markedly attenuates exercise induced bronchoconstriction  and it suggests that ltd4 is a major mediator of this type of bronchoconstriction  
class8	3178	reduced allergen induced nasal congestion and leukotriene synthesis with an orally active 5 lipoxygenase inhibitor 
class8	3178	background and methods  
class8	3178	the clinical importance of leukotrienes in human allergy has not been defined  in part because there have been no selective 5 lipoxygenase inhibitors that have been effective and safe for use in humans  
class8	3178	to address the hypothesis that stimulated leukotriene synthesis causes symptoms of immediate hypersensitivity reactions in vivo  i investigated the effects of a new 5 lipoxygenase inhibitor  a 64077  on provoked allergic nasal symptoms and mediator release in a double blind  randomized  placebo controlled study  
class8	3178	eight subjects with allergic rhinitis underwent nasal challenge on two occasions after an oral dose of 800 mg of a 64077 or an identical appearing placebo  
class8	3178	results  
class8	3178	allergen induced nasal congestion was significantly attenuated  p less than 0 02  by a 64077  peak levels of leukotriene b4  median  684 pg per milliliter  and 5 hydroxyeicosatetraenoic acid  median  704 pg per milliliter  in nasal rinse fluids were markedly reduced  to 67 and 185 pg per milliliter  respectively  p less than 0 01   whereas levels of prostaglandin d2 were not  
class8	3178	histamine release and sneezing were not reduced significantly by a 64077  but there was a significant correlation  p less than 0 01  between the changes in these variables within subjects  
class8	3178	the mean      sem  stimulated synthesis of leukotriene b4 in whole blood ex vivo was markedly reduced by a 64077  from 153     19 to 20     9 ng per milliliter  p less than 0 01   and the specificity of a 64077 for 5 lipoxygenase inhibition was verified by its lack of effect on the synthesis of serum thromboxane b2 or 12 hydroxyeicosatetraenoic acid  
class8	3178	conclusions  
class8	3178	these results provide direct evidence of an important role for the 5 lipoxygenase products of arachidonic acid in allergic rhinitis and support the notion that further experiments in this area may lead to new therapeutic approaches to allergic disorders  
class8	3179	late pulmonary sequelae of bronchopulmonary dysplasia 
class8	3179	background  
class8	3179	bronchopulmonary dysplasia is a chronic lung disease that often develops after mechanical ventilation in prematurely born infants with respiratory failure  
class8	3179	it has become the most common form of chronic lung disease in infants in the united states  
class8	3179	the long term outcome for infants with bronchopulmonary dysplasia has not been determined  
class8	3179	methods  
class8	3179	we studied the pulmonary function of 26 adolescents and young adults  born between 1964 and 1973  who had bronchopulmonary dysplasia in infancy  
class8	3179	we compared the results with those in two control groups  26 age matched adolescents and young adults of similar birth weight and gestational age who had not undergone mechanical ventilation  and 53 age matched normal subjects  
class8	3179	results  
class8	3179	sixty eight percent of the subjects with bronchopulmonary dysplasia in infancy  17 of the 25 tested  had airway obstruction  including decreases in forced expiratory volume in one second  forced expiratory flow between 25 and 75 percent of vital capacity  and maximal expiratory flow velocity at 50 percent of vital capacity  as compared with both control groups  p less than 0 0001 for all comparisons   
class8	3179	twenty four percent of the subjects with bronchopulmonary dysplasia in infancy had fixed airway obstruction  and 52 percent had reactive airway disease  as indicated by their responses to the administration of methacholine or a bronchodilator  
class8	3179	hyperinflation  an increased ratio of residual volume to total lung capacity  was more frequent in the subjects with a history of bronchopulmonary dysplasia than in either the matched cohort  p less than 0 0006  or the normal controls  p less than 0 0004   
class8	3179	six of the subjects who had bronchopulmonary dysplasia in infancy had severe pulmonary dysfunction or current symptoms of respiratory difficulty  
class8	3179	conclusions  
class8	3179	most adolescents and young adults who had bronchopulmonary dysplasia in infancy have some degree of pulmonary dysfunction  consisting of airway obstruction  airway hyperreactivity  and hyperinflation  
class8	3179	the clinical consequences of this dysfunction are not known  
class8	3180	n ras 61 oncogene mutations in hurthle cell tumors  
class8	3180	mutations of ras oncogenes are believed to play an important role in the initiation or progression of human tumors  
class8	3180	in thyroid tumors the incidence of ras activation by specific point mutations has been reported to range from 33  in follicular adenomas up to 60  in anaplastic carcinomas  
class8	3180	because of our long standing interest in hurthle cell tumors  we began a study of 70 such cases to determine the incidence of ras mutations and their clinical correlates  
class8	3180	analysis of n ras sequences at condon position 61  with the polymerase chain reaction method and oligonucleotide probe hybridization  showed point mutations of the normal codon caa  in eight tumor samples  
class8	3180	one was a mutation from caa to aaa  one from caa to cta   and six from caa to cga  
class8	3180	these mutations would result in amino acid substitutions of lysine  leucine  or arginine for the normal glutamine at position 61 in the n ras protein  
class8	3180	identical ras mutations in two tumors and some of their surrounding thyroid tissue may indicate that activating ras point mutations are an early event in carcinogenesis  
class8	3180	the incidence of mutations was 1 of 24  4   of the histologically benign tumors  5 of 34  15   of the intermediate tumors  with vascular or capsular permeation   and 2 of 12  17   in the malignant group  
class8	3180	four of these eight patients died of metastatic thyroid disease and four are alive without evidence of recurrence  
class8	3181	role of small calibre chest tube drainage for iatrogenic pneumothorax  
class8	3181	a 2 mm teflon catheter was used as a chest tube in 28 patients with iatrogenic pneumothorax  
class8	3181	frequent aspirations through the catheter were performed in 16 of the patients  
class8	3181	in the remaining 12 patients the catheter was connected to a one way flutter valve  
class8	3181	the treatment was successful in 27 of the 28 patients  one patient required a large calibre chest tube  
class8	3181	the mean drainage time was 48 hours  
class8	3181	the small catheter technique is superior to the use of a large intercostal drain as it is much less traumatic and troublesome  
class8	3181	the small calibre chest tube with a one way valve is recommended as a safe and easy technique  
class8	3182	intraluminal irradiation for the palliation of lung cancer with the high dose rate micro selectron  
class8	3182	fifty patients with inoperable  symptomatic endobronchial carcinoma were treated by a single exposure of intraluminal radiotherapy  
class8	3182	a high dose rate afterloading system  the micro selectron hdr  was used to minimise radiation exposure for staff  
class8	3182	haemoptysis was relieved in 24 of 28 patients  breathlessness in 21 of 33 patients  and cough in nine of 18 patients  
class8	3182	radiological collapse resolved in 11 of 24 patients  
class8	3182	treatment was given on an outpatient basis and was well tolerated  
class8	3182	intraluminal radiotherapy appears to offer an effective alternative to conventional fractionated external beam radiotherapy  
class8	3183	granulomatous pneumocystis carinii pneumonia in a patient with the acquired immunodeficiency syndrome  
class8	3183	a patient with an unusual granulomatous response to infection with pneumocystis carinii is described  
class8	3183	the diagnosis was made by open lung biopsy after two negative bronchoalveolar lavages  
class8	3184	bronchoalveolar lavage via a modified stomach tube in intubated patients with the acquired immunodeficiency syndrome and diffuse pneumonia  
class8	3184	a simple non bronchoscopic bronchoalveolar lavage method was used in 30 patients with the acquired immunodeficiency syndrome undergoing assisted ventilation for respiratory failure  
class8	3184	a modified argyle levin stomach tube was passed via the endotracheal tube and lavage performed  
class8	3184	the lavage was well tolerated and performed quickly and easily  required little training  and had a high degree of sensitivity  73   a diagnosis in 22 of the 30 cases   
class8	3185	giant lymph node hyperplasia of the lung  castleman s disease  associated with recurrent pleural effusion  
class8	3185	a case of giant lymph node hyperplasia  castleman s disease  of the lung presented with pleural effusion  which was recurrent   an unusual complication  
class8	3185	the patient was treated with pneumonectomy and has survived for three years without relapse  
class8	3185	this is the first report of the disease from black africa  
class8	3186	asymptomatic rhabdomyolysis of unknown etiology  
class8	3186	a 7 year old boy developed rhabdomyolysis with a peak creatine phosphokinase level of 261 400 iu l after his appendectomy  
class8	3186	these abnormalities occurred following a 2 3 day illness consisting of upper respiratory tract symptoms  fever  and abdominal pain mimicking acute appendicitis  
class8	3186	at the time of operation  a normal appendix was removed  and mesenteric lymphadenitis was noted  
class8	3186	the myoglobinuria and elevation of creatine phosphokinase were transient  and the patient remained asymptomatic  
class8	3186	we review various causes of right lower quadrant pain and rhabdomyolysis and address the roles of malignant hyperthermia and infectious agents  
class8	3186	the possible cause of the phenomena observed in this patient is discussed  
class8	3187	malignant melanoma presenting as nasal obstruction  
class8	3187	mucosal melanomas arising in the nasal cavity are rare tumors comprising less than 1 percent of all melanomas  
class8	3187	often  the common clinical symptom is nasal obstruction  
class8	3187	grossly  they may or may not be pigmented and frequently attain large sizes  
class8	3187	histologic diagnosis of these tumors may be difficult  requiring immunohistochemical or electron microscopic confirmation  
class8	3187	aggressive surgical management is the treatment of choice in clinical stage i disease  
class8	3187	subsequent surveillance for recurrence is mandatory  
class8	3187	markers such as 5 s cysteinyldopa may prove useful in staging  prognosticating  and postoperative surveillance for early recurrence  but their exact role has yet to be delineated  
class8	3187	ultimate prognosis is poor  
class8	3188	hypersensitivity pneumonitis  
class8	3188	the lung is constantly exposed to a wide variety of environmental insults  
class8	3188	in its defense against these environmental challenges  however  the lung responds through a limited number of pathophysiologic mechanisms  
class8	3188	this is well illustrated by a group of diseases which are collectively referred to as hypersensitivity pneumonitis  
class8	3188	this syndrome includes a very large number of different diseases  
class8	3188	however  in the united states  only farmer s lung  bird breeder s lung  and ventilation hypersensitivity pneumonitis occur with any significant frequency  
class8	3188	each of these is characterized by flu like symptoms  in conjunction with a pneumonitis consisting of lymphocytic granulomatous infiltration of the alveoli and terminal bronchioles  
class8	3188	this disease is caused by the inhalation of antigenic material which usually originates from the dusts of organic material  
class8	3188	a host of different dusts and antigens have been described in conjunction with hypersensitivity pneumonitis but each leads to the same characteristic clinical syndrome  
class8	3188	thus  each of the diseases shares similar clinical features but differs primarily with respect to the nature of the exposure and causative antigens  
class8	3188	the clinical features  pathogenesis  course  prognosis  and treatment of these related diseases are reviewed  
class8	3189	capillary haemangioma presenting as a lung pseudocyst  
class8	3189	a girl who developed a lung cyst at 24 hours of age during gentle ventilation for respiratory distress syndrome is reported  
class8	3189	instead of resolving as expected of a pseudocyst it continued to expand  
class8	3189	resection at 1 year of age showed a cyst entirely surrounded by capillary haemangioma  
class8	3189	aspiration of this cyst would have been dangerous  
class8	3190	corticosteroids in primary tuberculosis with bronchial obstruction  
class8	3190	the usefulness of prednisolone in combination with the modern potent antituberculous drugs has been studied in 29 children with primary lung tuberculosis and hilar adenopathy causing bronchial obstruction  
class8	3190	these children were divided at random in two groups of 15 and 14 patients  
class8	3190	both groups were treated similarly except that one group received prednisolone  
class8	3190	both groups were very similar before the onset of treatment for most variables  
class8	3190	tuberculous infection healed in both groups but the group on steroids improved earlier and had significantly fewer complications  both on radiography and bronchoscopy  
class8	3190	only two of the patients on steroids still had progressive lesions  a very young baby probably because he developed two severe viral infections consecutively  and another infant of 7 months whose treatment was unreliable  as the parents were not very compliant  
class8	3190	some patients initially not treated with prednisolone improved only after it was given  
class8	3190	prednisolone treatment is not recommended when the reliability of the treatment cannot be guaranteed  as the hazard of harm would exceed the expected benefit  
class8	3191	ventilator dependency in the united kingdom  
class8	3191	there are 24 children who are currently long term ventilator dependent in the uk  
class8	3191	nine of these are cared for entirely at home  
class8	3191	an additional 11 children have been long term ventilator dependent since march 1983  
class8	3191	the prevalence of these children appears to be increasing  
class8	3191	the financial and manpower resources needed for these children whether at home or in hospital is considerable  
class8	3191	there are reasons to suppose that the apparent increase in prevalence will continue  
class8	3192	air leaks and vasopressin release  
class8	3192	eleven very low birthweight babies being ventilated for respiratory problems during the first week of life developed air leaks on 22 occasions  
class8	3192	on 16 out of 19 occasions the infants showed increases in urinary excretion of vasopressin after these events and on 10 occasions out of 13 there was a rise in the plasma arginine vasopressin concentration  
class8	3192	the peripheral signs of the syndrome of inappropriate antidiuretic hormone release were seen on only one occasion in response to the sometimes high vasopressin concentrations  
class8	3193	crohn s disease of the lung 
class8	3193	two years after developing colonic crohn s disease  a 17 year old boy presented with focal pulmonary consolidation  
class8	3193	a lung biopsy specimen showed areas of non caseating epithelioid granuloma  
class8	3193	although some respiratory abnormalities appear to be associated with inflammatory bowel disease  granulomatous disease affecting the lung has not previously been reported in a child  
class8	3194	nasal valve malfunction resulting from resection of cancer  
class8	3194	following cancer resection of the nasal unit  nasal valve malfunction is manifested by the symptoms of nasal stuffiness or difficulty getting air into the nostril  
class8	3194	these symptoms occur in cases in which the resection is in the alar crease at the junction with the lateral sidewall of the nose  
class8	3194	wound scar contracture elevates the alar margin and causes the alar and lateral cartilages to move inward forming a visible and palpable shelf on the lateral wall of the nasal vestibule  
class8	3194	this displacement of the alar and lateral cartilages and the rigid scar formed between these cartilages render the nasal valve immobile  
class8	3194	since it is easier to prevent nasal valve malfunction than to repair it later  wounds that bridge the alar crease or are located in either the alae or lateral sidewall and come within 1 mm of the alar crease with a total diameter of 1 0 cm should be repaired to prevent nasal valve malfunction  
class8	3194	in the process of repairing deep defects  the overlapping region of the lateral crus of the alar cartilage and the lateral cartilage may be stabilized by a conchal cartilage graft  
class8	3194	this cartilage graft may be used in combination with reconstruction of the nasal skin with a forehead flap and repair of the nasal lining  
class8	3194	in the event that the nasal lining is intact  the cartilage graft may be used with a full thickness skin graft  
class8	3195	complications of nasotracheal intubation in neonates  infants and children  a review of 4 years  experience in a children s hospital  
class8	3195	a computerized database was set up to study the incidence and outcome of complications of nasotracheal intubation in a paediatric hospital  
class8	3195	we studied 2953 intensive care admissions over a 4 yr period  
class8	3195	the overall complication rate was 8   
class8	3195	accidental extubation and tube blockage were the most frequent events  accounting for a mean of 3 5  and 2 6  of the complications per year  respectively  
class8	3195	complications were more common in smaller children and there were differences between fields of intensive care  
class8	3195	none of the complications was fatal or resulted in serious sequelae  
class8	3195	none of the children in the study showed clinical symptoms of acquired subglottic stenosis before discharge from hospital  and none has been readmitted for this condition subsequently  
class8	3196	acute pulmonary oedema following administration of ornithine 8 vasopressin  
class8	3196	we report the case of a patient who developed acute pulmonary oedema following a short and uneventful surgical procedure  
class8	3196	among the differential diagnoses  the role of ornithine 8 vasopressin is emphasized  
class8	3197	effect of oral omeprazole on intragastric ph and volume in women undergoing elective caesarean section 
class8	3197	we have studied in obstetric patients the efficacy of omeprazole in increasing intragastric ph to more than 2 5 and reducing volume to less than 25 ml  
class8	3197	omeprazole 40 mg was given orally the night before and again on the morning of surgery to 30 asian women scheduled to undergo elective caesarean section  
class8	3197	after induction of anaesthesia  a gastric tube was inserted and intragastric contents aspirated  
class8	3197	volume and ph were recorded and measurements were repeated on completion of surgery  
class8	3197	the median  range  volume was 2  1 13  ml before surgery and 4  0 14  ml at the end of surgery  
class8	3197	there was insufficient volume to measure ph in all patients  
class8	3197	the median  range  ph was 6 7  4 6 7 4  before surgery in 20 patients and 6 6  4 6 7 8  at the end of surgery in 28 patients  
class8	3197	no adverse drug reactions were noted in mothers or neonates  
class8	3197	omeprazole 40 mg orally twice before elective caesarean section appeared to be effective in reducing intragastric volume and acidity to acceptable values  
class8	3198	what causes cryptogenic fibrosing alveolitis  a case control study of environmental exposure to dust  
class8	3198	objective  to investigate the role of occupational and domestic exposure to dust in the aetiology of cryptogenic fibrosing alveolitis  
class8	3198	design  matched case control study  
class8	3198	subjects  40 patients with cryptogenic fibrosing alveolitis and 106 community controls matched for age and sex who responded to a questionnaire  
class8	3198	main outcome measure  responses to self administered questionnaire asking about lifetime exposure to dust  animals  and smoke at home and at work  
class8	3198	results  the patients with cryptogenic fibrosing alveolitis were more likely to report occupational exposure to metal dust  matched odds ratio 10 97  95  confidence interval 2 30 to 52 4   p less than 0 001  or wood dust  2 94  0 87 to 9 90   p   0 08   to have worked with cattle  10 89  1 24 to 96 0   p   0 01   and to have lived in a house heated by a wood fire  12 55  1 04 to 114   p   0 009   
class8	3198	a history of smoking and social class based on occupation were not significantly related to disease state  
class8	3198	conclusion  environmental exposure to dust may be an important factor in the aetiology of cryptogenic fibrosing alveolitis  
class8	3199	rising mortality from cryptogenic fibrosing alveolitis  
class8	3199	objective  to determine the pattern of mortality ascribed to cryptogenic fibrosing alveolitis and to identify factors that might be important in the aetiology of the disease  and to assess the validity of death certification of the disease  
class8	3199	design  a retrospective examination of mortality ascribed to cryptogenic fibrosing alveolitis in england and wales between 1979 and 1988 with analysis  by multiple logistic regression  of independent effects of age  sex  region of residence  and social class as indicated by occupation on data for 1979 87  also a retrospective review of hospital records of patients certified as having died of cryptogenic fibrosing alveolitis in nottingham and of the certified cause of death of patients known to have had the disease  
class8	3199	main outcome measures  time trends in mortality nationally  effects on mortality of age  sex  and region of residence  validity of death certification in nottingham  
class8	3199	results  the annual number of deaths ascribed to cryptogenic fibrosing alveolitis doubled from 336 in 1979 to 702 in 1988  the increase occurring mainly at ages over 65  
class8	3199	mortality standardised for age for both sexes likewise increased steadily over the period  
class8	3199	deaths due to cryptogenic fibrosing alveolitis were commoner in men  odds ratio 2 24  95  confidence interval 2 11 to 2 33  and increased substantially with age  being 7 84  7 24 to 8 49  times higher in subjects aged much greater than 75 than those aged 45 64  
class8	3199	odds ratios of death due to cryptogenic fibrosing alveolitis adjusted for age and sex were increased in the traditionally industrialised central areas of england and wales  p less than 0 02  maximum odds ratio between regions 1 25   but no significant increase in odds of death was found for manual occupations  
class8	3199	of 23 people whose deaths were registered in nottingham as having been due to cryptogenic fibrosing alveolitis  19 were ascertained from clinical records to have had the disease  
class8	3199	only 17 of 45 patients known to have had cryptogenic fibrosing alveolitis in life were recorded as having died from the disease  
class8	3199	conclusions  the diagnostic accuracy of death certification of cryptogenic fibrosing alveolitis is high  but the number of deaths recorded as being due to the disease may underestimate the number of patients dying with the disease by up to half  
class8	3199	mortality due to the disease is increasing  and the male predominance and regional differences in mortality suggest that environmental factors are important in its aetiology  
class8	3200	clinical and prognostic assessment of patients with resected small peripheral lung cancer lesions  
class8	3200	one hundred fifteen patients with small  less than or equal to 2 cm in diameter  peripheral lung cancer lesions underwent surgical treatment in the department of surgery  the research institute for chest diseases and cancer  tohoku university  miyagi prefecture  japan  
class8	3200	the authors investigated several prognostic factors of these cases  
class8	3200	the 5 year survival rate of these 115 patients was 70   
class8	3200	various factors such as histologic type  nodal involvement  pleural involvement  pathologic stage  and curativity of the operation were revealed to affect survival significantly  
class8	3200	in patients with and without nodal involvement  there was no significant difference between the survival rate of patients with lung cancer lesions smaller than 2 cm and those with lesions 2 1 to 3 cm  
class8	3200	however  the rate of lymph node metastasis was significantly different in the group with lesions smaller than 2 cm compared with those with lesions 2 1 to 3 cm  21  versus 43   respectively   
class8	3201	pulmonary problems in pregnancy  
class8	3201	pregnant women with asthma and pulmonary infections should be treated essentially the same as nonpregnant women with similar disease severity  
class8	3201	definitive diagnosis and prompt treatment with heparin should be used for patients with pulmonary thromboembolism  
class8	3202	childhood pulmonary function following hyaline membrane disease  
class8	3202	hyaline membrane disease per se is not associated with abnormal lung function or increased nonspecific airway reactivity in childhood or adulthood  
class8	3202	very low birth weight infants who survive almost routinely in neonatal icus are at risk  however  for developing airflow obstruction and having airway hyperreactivity as children  and for having recurrent bouts of wheezing  cough  and respiratory infections  
class8	3202	neonates who develop bpd have the greatest risk of abnormal pulmonary function as children  
class8	3202	continued research into the prevention of premature birth and into the causes of neonatal lung injury  combined with improvements in the neonatal icu and follow up treatment  will undoubtedly contribute to improvement in the clinical course of premature infants  
class8	3203	the adult respiratory distress syndrome  
class8	3203	the adult respiratory distress syndrome remains an enigmatic disorder with a high mortality rate  although it can sometimes be managed effectively  
class8	3203	recognizing the conditions with which it is associated is the first step in preventing its occurrence  
class8	3203	decreasing the risk factors of developing ards remains the fundamental goal of initial management  
class8	3203	once the syndrome has developed in a particular patient  the clinician s goals in management are to stabilize the patient  avoid further insults  maximize the support therapies available  and be cognizant of and avoid the potential adverse effects of these supportive therapies  
class8	3204	approaches to the patient with aspiration and swallowing disabilities  
class8	3204	aspiration  or soiling of the tracheobronchial tree  can produce life threatening pulmonary disease  
class8	3204	intermittent or persistent aspiration may cause symptoms including cough  intermittent fever  recurrent tracheobronchitis  atelectasis  pneumonia  and or empyema  
class8	3204	the pulmonary disease may be associated with weight loss  cachexia  and dehydration  
class8	3204	in many cases the aspiration is caused by laryngeal dysfunction  allowing pulmonary contamination by swallowed material  
class8	3204	in other cases the aspiration is caused by a dysfunction of the oral  pharyngeal  or esophageal phases of swallowing  
class8	3204	in some cases the aspiration is caused by a combination of laryngeal and swallowing dysfunction  
class8	3204	geriatric patients are more likely to experience aspiration  since muscle weakness causing mechanical disability and neurologic impairment are more common in this age group  
class8	3204	therefore  with the ever increasing aging of our population  these disabilities will be on the rise  with an associated increase in pulmonary disease and death  
class8	3204	the approach to evaluation and management of these disorders must be based on an understanding of the underlying functional impairment  
class8	3205	effects of a multidisciplinary management program on neurologically impaired patients with dysphagia  
class8	3205	dysphagia is a major problem in patients with neurologic disorders  
class8	3205	aspiration pneumonia and impaired nutritional status are consequences of dysphagia that result in high morbidity and mortality rates  
class8	3205	assessment and treatment of the dysphagic patient by a multidisciplinary team have been advocated but to date the effects of such an approach have not been demonstrated quantitatively  
class8	3205	this prospective study was conducted to determine if a dysphagia program would improve patients  caloric intake and body weight  decrease the instances of aspiration pneumonia  or improve patients  feeding ability  
class8	3205	patients were referred from a 26 bed neurology neurosurgery unit  
class8	3205	a time series design was utilized  
class8	3205	the control group consisted of 15 patients  mean age   46 1 years   managed according to the existing ward routine  
class8	3205	subsequently  nursing staff attended a dysphagia training program  
class8	3205	following this  the treated group of 16 patients   mean age   49 3 years  was assessed by the dysphagia team  using bedside and videofluoroscopic examinations to determine the specific swallowing disorder  
class8	3205	an individualized treatment program was designed for each patient  
class8	3205	the groups were compared on the basis of deviation from their baseline weight  deviation from ideal energy intake  and the incidence of aspiration pneumonia  
class8	3205	statistical analysis revealed that the groups were comparable in age  number of days on the study  and glasgow coma scale score  and that a significant weight gain and increase in caloric intake occurred in the treated group  
class8	3205	no incidence of aspiration pneumonia was reported in either group  
class8	3205	we speculate that this may have been influenced by the meticulousness of the care delivered in an acute unit as well as greater attention to prevention given in both groups  
class8	3206	bolus versus infusion regimens of etoposide and cisplatin in treatment of non small cell lung cancer  a study of the north central cancer treatment group 
class8	3206	in an effort to test clinically the hypothesis that the duration of cellular exposure to etoposide  vp 16  and cisplatin  cddp  is an important determinant of cytotoxicity  we performed a phase iii randomized trial comparing an outpatient bolus regimen of combined vp 16 and cddp with a sequential infusion over 72 hours of these same two drugs  
class8	3206	all patients had stage iv non small cell lung cancer  and survival was the primary end point  
class8	3206	of 113 patients randomly allocated to the study  108 were assessable for response  survival  and toxicity  
class8	3206	a major response was observed in 20  37   of 54 patients on the bolus regimen and in 16  30   of 54 patients receiving infusion therapy  
class8	3206	the median time to progression was 61 and 88 days for bolus and infusion therapy  respectively  
class8	3206	the median survival time was 148 and 157 days  respectively  p    71   
class8	3206	study results were not consistent with the possibility that infusion therapy could be associated with a 50  improvement in median survival  i e  
class8	3206	from 5 months to 7 1 2 months  
class8	3206	toxicity was primarily myelosuppression and was significantly greater with the infusion regimen  
class8	3206	we conclude that infusion therapy as tested in this protocol with vp 16 and cddp does not offer any advantage in response rate  time to disease progression  or survival as compared with bolus therapy  
class8	3206	in addition  infusion therapy is associated with a greater degree of neutropenia and more treatment related deaths  
class8	3207	immune competent cells of regional lymph nodes in colorectal cancer patients  ii  immunohistochemical analysis of leu 7  cells  
class8	3207	distribution of leu 7  cells in cancer tissues and regional lymph nodes was immunohistochemically examined to estimate the role of nk cells in colorectal cancer patients  
class8	3207	leu 7  cells were rarely observed both in the primary and distant metastatic lesions  but the number of these cells was large in the germinal center of the lymph nodes  
class8	3207	studies of leu 7  cell population in the lymph node indicated that intermediate nodes in n0 and n1 groups showed significantly higher values than those in the control group  
class8	3207	comparative study of the population in identical patients revealed a significantly higher rate in the intermediate nodes than in the paracolic nodes both in n0 and n1 groups  
class8	3207	these data suggest that leu 7  cells might be related to the defense mechanism of regional lymph nodes against tumor  
class8	3208	carcinoid tumors  
class8	3208	the authors carried out a retrospective study of 32 patients  23 m  9 f  with carcinoid tumors who were diagnosed and treated at harlem hospital center  new york  from 1967 to 1988  
class8	3208	all the patients were black and the commonest sites were the ileum  28 1    rectosigmoid and rectum  21 9    and the appendix and lung  15 6  each   
class8	3208	metastasis correlated with site  size  and depth of the primary tumor and occurred in 12 patients  38    most frequently to the regional lymph nodes and liver  
class8	3208	carcinoid syndrome developed in 12 5   3 f  1 m   
class8	3208	surgical resection for cure or palliation was the mainstay of treatment  
class8	3208	overall 5 year survival rate was 66   and for those with metastases was 0   
class8	3208	the poorer survival rates are probably related to the socioeconomic status of our patient population  
class8	3208	the only observed racial difference compared to other series is the preponderance of males  and the disproportionately higher ratio of females with the carcinoid syndrome  
class8	3209	congenital abnormalities of the lymphatic system  a new clinical classification  
class8	3209	the numerous clinical presentations of congenital abnormalities of the lymphatic system in children and the confusing terminology used to describe their pathologic diagnoses impede the physician s understanding of the condition  
class8	3209	the clinical classification based on the actual symptoms of the congenital problems we have presented here should help the physician identify the specific abnormality and a potential treatment  
class8	3209	future research should concentrate on the specific causes and the treatment of these congenital abnormalities  
class8	3210	hospitalization decision in patients with community acquired pneumonia  a prospective cohort study  
class8	3210	purpose  to identify a low risk subset of patients with community acquired pneumonia that could safely be treated in the ambulatory setting  and to assess how clinicians make the hospitalization decision  
class8	3210	patients and methods  we performed a prospective  observational study of 280 ambulatory and hospitalized adults with clinical and radiographic evidence of pneumonia  
class8	3210	patients were followed to assess all potential morbid complications and 6 week mortality  
class8	3210	physicians responsible for managing these patients were surveyed to assess the reasons for treating in a hospital or ambulatory setting and the therapies that dictate hospitalization  
class8	3210	results  sixty one percent  170 of 280  of patients did not have an indication for admission at presentation using modified appropriateness evaluation protocol criteria  a severe vital sign abnormality  alteration in mental status  suppurative complication  arterial hypoxemia  severe laboratory abnormality  or an acute coexistent medical problem requiring admission independent of the pneumonia   
class8	3210	among these 170 patients  38  had a complicated course defined as death within 6 weeks  development of a new suppurative or medical complication due to pneumonia  intensive care unit admission  persistent fever or use of intravenous fluids or oxygen beyond 3 days  hospitalization lasting more than 3 days  or subsequent hospitalization in patients initially treated in the ambulatory setting  
class8	3210	five predisposing factors for a complicated course were identified in logistic regression models  
class8	3210	the odds ratio for age more than 65 years was 2 7  for comorbid illness  3 2  for temperature more than 38 3 degrees c  101 degrees f   4 1  for immunosuppression  12 0  and for a high risk etiology  23 3  
class8	3210	the risk of a complicated course increased linearly with the number of risk factors  from 12  with none to 100  with four or more factors  p less than 0 001   
class8	3210	physicians most often relied on the general clinical appearance of the patient when making the triage decision  and most commonly cited intravenous antibiotics and chest physical therapy as treatments requiring hospitalization  
class8	3210	conclusions  if validated  our findings could improve physicians  assessment of prognosis  and may identify a low risk subset of patients with community acquired pneumonia who could safely be managed in the ambulatory setting  
class8	3211	ofloxacin treatment of chlamydia pneumoniae  strain twar  lower respiratory tract infections  
class8	3211	purpose  limited data suggest that tetracycline or erythromycin is the antibiotic of choice for treating chlamydia pneumoniae infection  but they are not always effective or well tolerated  
class8	3211	because the fluoroquinolone ofloxacin is effective for chlamydia trachomatis infections  we investigated its role in treating c  
class8	3211	pneumoniae infections  
class8	3211	patients and methods  eighty seven patients were enrolled in a randomized trial of antibiotic therapy for acute lower respiratory tract infections  
class8	3211	the patients were randomly assigned to oral treatment with either ofloxacin  400 mg twice a day  or erythromycin  400 mg four times a day  for 10 days  
class8	3211	frozen acute and convalescent serologic specimens were tested for twar antibody by microimmunofluorescence  
class8	3211	susceptibility testing of c  
class8	3211	pneumoniae to ofloxacin was also performed  
class8	3211	results  four patients who received ofloxacin were retrospectively identified as having c  
class8	3211	pneumoniae pneumonia  two  or bronchitis  two   
class8	3211	within 2 weeks of starting ofloxacin therapy  all were cured or markedly improved  
class8	3211	the minimum inhibitory concentrations of ofloxacin for three previously isolated clinical strains of c  
class8	3211	pneumoniae were determined to be 1 0 to 2 0 micrograms ml  well within the achievable serum levels  3 to 5 micrograms ml  with ofloxacin therapy  
class8	3211	conclusion  ofloxacin may be an effective alternative antibiotic treatment for c  
class8	3211	pneumoniae respiratory infections  
class8	3212	failure to limit quantities of benzodiazepine hypnotic drugs for outpatients  placing the elderly at risk  
class8	3212	purpose  the long term use of benzodiazepine hypnotics by the elderly is associated with serious side effects  and prescriptions of large quantities of these agents allow such use  
class8	3212	therefore  we determined the quantities of these agents prescribed to outpatients in our veterans administration teaching hospital  and the relationship of patient age to total number of doses prescribed per prescription  
class8	3212	patients and methods  pharmacy and patient records related to 655 consecutive prescriptions for triazolam  halcion  and flurazepam  dalmane  were reviewed  
class8	3212	only 266  41   of the prescriptions were for 30 or fewer doses  while 178  27   were written for 180 or more doses  
class8	3212	results  thirty six percent of prescriptions for patients aged 65 years or older were for 180 or more doses  compared with 24  for those aged 45 to 64 years old  and 16  of the prescriptions for patients less than 45 years old  p less than 0 0001   
class8	3212	in a multivariate analysis controlling for six other factors related to the total number of doses prescribed  patients aged 65 years or older were still more likely to receive a prescription for 180 or more doses  relative risk 1 9  95  confidence interval 1 3  2 8   
class8	3212	conclusion  we conclude that inappropriately large quantities of benzodiazepine hypnotics were commonly prescribed  and that patients aged 65 years or older were at greatest risk for receiving such prescriptions  
class8	3213	role of systemic therapy in advanced non small cell lung cancer  
class8	3213	increasing evidence supports the investigation of chemotherapy in patients with non small cell lung cancer  nsclc   
class8	3213	randomized studies in patients with stage iv disease have shown increased survival in chemotherapy treated patients compared to best supportive care and indicate the ability of chemotherapy to alter the natural history of this disease  
class8	3213	randomized studies involving adjuvant and neoadjuvant chemotherapy have also shown encouraging results  
class8	3213	these studies and results of recent pilot studies utilizing neoadjuvant chemotherapy and concomitant chemoradiotherapy indicate a potential benefit from the use of chemotherapy in patients with nsclc and call for its continued intensive investigation in clinical trials  
class8	3214	admission and mid stay medisgroups scores as predictors of death within 30 days of hospital admission  
class8	3214	we examined the ability of medisgroups  a severity measure based on clinical data abstracted from the medical record  to predict mortality 30 days following admission  
class8	3214	medisgroups measures severity both on admission and approximately one week into the hospital stay  
class8	3214	the data base was a random sample of 20 985 admissions of medicare beneficiaries with one of six conditions from 833 hospitals in seven states between january 1985 and may 1986  
class8	3214	in all six conditions  higher admission and mid stay severity scores were generally associated with higher risk of death  
class8	3214	across the six conditions  the r squared values for predicting death using admission scores ranged from 0 01 to 0 16  r squared values using mid stay scores ranged from 0 03 to 0 34  and r squared values from combining admission and mid stay scores ranged from 0 05 to 0 41  
class8	3214	admission medisgroups score was thus only modestly predictive of 30 day mortality  
class8	3214	while the mid stay score was more powerful  it may not be an appropriate severity adjuster to screen for quality using hospital mortality rates because it could be influenced by substandard care  
class8	3215	perioperative blood transfusion adversely affects prognosis of patients with stage i non small cell lung cancer  
class8	3215	it has been speculated that blood transfusion might adversely affect prognosis in cancer patients by immunosuppression  
class8	3215	to avoid the confounding affect of advanced disease  we tested this hypothesis in 117 patients with stage i non small cell lung cancer  
class8	3215	mean and median follow up were 49 7 months and 47 months  respectively  
class8	3215	patients who died during the postoperative period were not included  
class8	3215	perioperative transfusion was defined as administration of whole blood or packed cells within 30 days of operation  
class8	3215	the overall cumulative 5 year disease free survival rate was 67   
class8	3215	in patients with transfusion  it was 53  and in patients without transfusion it was 81   p   0 0055   
class8	3215	a multivariate analysis was performed that included patient age  race  sex  cell type  extent of operation  pneumonectomy versus lobectomy segmentectomy   operative blood loss  admission hematocrit  discharge hematocrit  and the presence or absence of perioperative transfusion  
class8	3215	the only variable that significantly correlated with 5 year disease free survival was the presence or absence of perioperative transfusion  p   0 0278   and this effect was not related to the number of transfusions  
class8	3215	retrospective analysis of long term results of patients surviving curative operation for stage i lung cancer shows that any perioperative transfusion significantly worsens the patient s prognosis and suggests very strongly that this association is due to an adverse effect of the transfusion rather than the transfusion serving as a marker for another risk factor  
class8	3216	life threatening complications during anaesthesia in a patient with a ventriculo atrial shunt and pulmonary hypertension  published erratum appears in anaesthesia 1991 mar 46 3  241  
class8	3216	a 6 year old patient with hydrocephalus who underwent revision of a ventriculo atrial shunt is described  
class8	3216	anaesthesia was complicated by the occurrence of systemic hypertension and arterial hypoxaemia  
class8	3216	the patient was subsequently found to have pulmonary hypertension secondary to recurrent pulmonary thromboembolism  
class8	3216	the pathophysiological mechanisms for the patient s deterioration are discussed and the anaesthetic management of children with pulmonary hypertension is outlined  
class8	3216	it is concluded that patients with a ventriculo atrial shunt who present for surgery should be screened carefully for the presence of pulmonary hypertension  
class8	3217	isolated lung transplantation for pulmonary fibrosis  
class8	3217	the peri operative anaesthetic management of 11 patients with pulmonary fibrosis undergoing single lung transplantation is presented  
class8	3217	intra operative problems  the early postoperative phase of recovery and intensive care  and other incidents in which general anaesthesia was required for the management of complications  are featured  
class8	3217	results  both short  and long term  are mentioned  
class8	3217	major intra operative events that cause concern appear to be related to the severity of the presenting illness and the development of respiratory failure  
class8	3217	others have reported the development of intra operative cardiac failure  
class8	3217	all cases were successfully managed operatively using conventional one lung anaesthesia  although resort to partial cardiopulmonary bypass may have been indicated in some  
class8	3217	the indications and attitudes to utilising cardiopulmonary bypass in the evolution of techniques for facilitating single lung transplantation are reviewed  
class8	3218	intact epithelial barrier function is critical for the resolution of alveolar edema in humans 
class8	3218	within 15 min of endotracheal intubation  the resolution of pulmonary edema was studied over the next 12 h in 34 mechanically ventilated patients by  1  serial measurements of the alveolar arterial oxygen difference   2  the extent of edema on the initial and follow up chest radiograph  and  3  by an initial and final measurement of total protein and albumin concentration in sequential samples of pulmonary edema fluid  
class8	3218	based on the oxygenation and chest radiographic data  24 patients clinically improved and 10 patients did not improve  
class8	3218	in the 10 patients who did not clinically improve  3  hydrostatic edema  7  permeability edema   there was no change in the final edema fluid protein concentration  4 1     1 1 g 100 ml  compared with the initial edema fluid protein concentration  4 2     1 0 g 100 ml   p   ns   
class8	3218	however  in the 24 patients who clinically improved  15  hydrostatic edema  9  permeability edema   there was an increase in every patient s final edema protein concentration  5 6     2 3 g 100 ml  compared with their initial edema protein concentration  3 8     1 2 g 100 ml   p less than 0 01   
class8	3218	in 13 of these 24 patients  the final edema fluid concentration  7 3     1 6 g 100 ml  exceeded the final plasma protein concentration  5 6     0 8 g 100 ml  by a mean value of 1 7 g 100 ml protein  
class8	3218	the data provide the first evidence in humans to support the hypothesis that active ion transport across the alveolar epithelial barrier is the primary mechanism for clearance of edema fluid from the air spaces of the lung  
class8	3219	the effect of corticosteroid or methotrexate therapy on lung lymphocytes and macrophages in sarcoidosis  
class8	3219	methotrexate appears to be an effective alternative to corticosteroid therapy for some patients with sarcoidosis  
class8	3219	the mechanism of action of methotrexate as an immunosuppressive is unknown  
class8	3219	patients with symptomatic pulmonary sarcoidosis underwent pulmonary function tests and bronchoscopy with bronchoalveolar lavage  
class8	3219	patients were treated with 10 mg methotrexate or prednisone weekly for at least 6 months and repeat studies were performed  
class8	3219	a comparison was made between those patients receiving methotrexate  12 patients  and those receiving prednisone  12 patients   
class8	3219	for both groups  there was a significant improvement in the vital capacity with therapy  prednisone  pre   2 5     0 14 l  mean     sem   post   3 1     0 18 l  p less than 0 01  methotrexate  pre   2 4     0 14 l  post   2 8     0 18 l  p less than 0 01   
class8	3219	in addition  the percentage of lymphocytes in the lavage fell significantly for both the prednisone  pre  30     3 5   post  16     2 7   p less than 0 001  and methotrexate  pre  37     3 4   post  13     2 9   p less than 0 001  groups  
class8	3219	alveolar macrophages from the symptomatic sarcoid patients were found to be spontaneously releasing hydrogen peroxide and tumor necrosis factor  
class8	3219	after treatment with either prednisone or methotrexate  alveolar macrophages retrieved by lavage spontaneously released less of either macrophage product  
class8	3219	we found that effective doses of methotrexate for sarcoidosis led to significant changes in lymphocyte and macrophages retrieved by lavage  
class8	3220	surfactant replacement improves lung recoil in rabbit lungs after acid aspiration  
class8	3220	we tested the hypothesis that surfactant replacement would be beneficial in the acid aspiration model of acute lung injury  
class8	3220	hcl  0 1 n  2 ml kg  was injected into the trachea of excised rabbit lungs  n   8   
class8	3220	control lungs  n   4  had no intervention  
class8	3220	all were perfused with tyrode s solution mixed 1 1 with autologous whole blood at 40 ml min kg for 30 min  and then degassed  
class8	3220	a modified natural surfactant  survanta  ross laboratories  was then injected into the trachea of four lungs injured with hcl  100 mg kg at 25 mg ml   
class8	3220	two quasi static pressure volume curves were determined  
class8	3220	the mean alveolar pressures at 50  60  70  80  and 90  of tlc were greater in the hcl group than in the control group  p less than 0 05   
class8	3220	however  no difference was observed between the control lungs and those that received hcl   survanta  
class8	3220	in 13 anesthetized  paralyzed  and ventilated rabbits  deflation pressure volume curves were determined from tlc to frc  measured by helium dilution   
class8	3220	then  0 1 n hcl  3 ml kg  was injected into the trachea and  in seven  survanta was instilled 5 min later  
class8	3220	the mean alveolar pressures at 60  70  80  and 90  tlc were higher at 15 and 60 min in the hcl group compared with their pre hcl time point  p less than 0 05   
class8	3220	in the hcl   survanta group  no differences were seen at 15 min  and only slight increased were seen at 60 min  
class8	3220	no effect of surfactant replacement on arterial blood gases was observed  
class8	3220	hcl aspiration increased recoil in both excised and in vivo lungs  and surfactant replacement with survanta returned recoil to normal  
class8	3221	inspiratory flow dynamics during mechanical ventilation in patients with respiratory failure  
class8	3221	we studied the effect of inspiratory flow rate on respiratory resistance during mechanical ventilation in 15 patients with acute respiratory failure  arf   
class8	3221	resistance was measured by both constant flow inflation and occlusion methods as inspiratory flow rates were increased from 0 66 to 2 0 l s  
class8	3221	endotracheal tube resistance was subtracted from total resistance to obtain respiratory resistance  
class8	3221	in contrast to the flow dependent increase in endotracheal tube resistance  respiratory resistance decreased continuously as flow rate and airway pressure increased  except in four of six patients with asthma in whom respiratory resistance increased as flow increased  
class8	3221	mechanical airway dilatation  tissue resistance  stress relaxation  and time constant inequalities may contribute to the decrease in respiratory resistance  
class8	3221	in status asthmaticus  however  the effects of turbulence  noncompliant airways  and or  reflex  bronchoconstriction may be sufficient to cause a flow dependent increase in resistance  
class8	3222	nasal and oral flow volume loops in normal subjects and patients with obstructive sleep apnea  
class8	3222	because flow volume loops  fvls  are clinically useful in evaluating upper airway  ua  obstruction and the fact that patency of the nasopharyngeal ventilatory pathway is important to the prevention of obstructive sleep apnea  osa   the present study examined the role of nasal compared with oral fvls in evaluating patients with osa  
class8	3222	fourteen obese male patients 56     3 yr of age with a mean apnea plus hypopnea index  ahi  of 51     9 h were studied along with 14 nonobese  healthy  age  and sex matched control subjects whose mean ahi was 6     1 h  
class8	3222	nasal and oral fvls obtained in the normal subjects indicated the nose behaved like a variable resistor  with flow limitation during inspiration but not during expiration  
class8	3222	in the patient group  flow limitation was observed during expiration as well as inspiration indicating nondistensibility of the nasopharyngeal ventilatory pathway in the patients compared to the control subjects  
class8	3222	a change in body position from upright to supine in the osa group was associated with small reductions in expiratory but not inspiratory flow rates  
class8	3222	the area under the nasal supine flow volume loop  fvlanasup  was found to be highly correlated with awake resting pao2  r   0 80  and paco2  r    0 83  in the patient group  
class8	3222	in addition  multiple linear regression analysis revealed that pao2 and the area under the nasal fvls independently contributed to the prediction of ahi with a multiple r of 0 89  
class8	3222	these results suggest that limitations to ventilation via the nasopharynx may significantly influence both gas exchange and the frequency of sleep disordered breathing in patients with osa  
class8	3223	decreased ventilation and hypoxic ventilatory responsiveness are not reversed by naloxone in lhasa residents with chronic mountain sickness  
class8	3223	persons with chronic mountain sickness  cms  hypoventilate and are more hypoxemic than normal individuals  but the cause of the hypoventilation is unclear  
class8	3223	studies of 14 patients with cms and 11 healthy age matched control subjects residing in lhasa  tibet  china  3 658 m  were conducted to test the hypothesis that hypoventilation  blunted hypoxic ventilatory responsiveness  hvr   and hypoxic ventilatory depression of cms were due to increased endogenous opioid production  
class8	3223	patients with cms compared with control subjects exhibited hypoventilation  end tidal carbon dioxide pressure  petco2    36 6     1 0 versus 31 5     0 5 mm hg  p less than 0 05   lower tidal volume  vt   0 54     0 02 versus 0 61     0 02 ml btps  p less than 0 05   blunted hvr  shape parameter a   17     8 versus 114     22 mm hg l btps min  p less than 0 05   and a depressant effect of ambient hypoxia on ventilation  delta petco2 with acute hyperoxia    3 5     0 5 versus  1 0     0 6 mm hg  p less than 0 05   
class8	3223	reduced forced expiratory volume in 1 s to vital capacity ratios  fev1 vc  and a higher proportion of cigarette smokers in the group of patients with cms compared with control subjects suggested that at least some patients with cms had mild airway obstructive lung disease  
class8	3223	naloxone infusion  0 14 mg kg  to six patients with cms did not change resting vt  petco2  hvr  or sao2  
class8	3224	radiologic detection of pleural thickening  
class8	3224	the purpose of this study was to investigate four aspects of the radiologic detection of pleural thickening  the specificity of chest x rays read by b readers  the effects of threshold definitions of positivity  the extent of variability among different x ray readers  and the effect of film quality  
class8	3224	a series of 421 chest x rays corresponding to consecutive autopsies was reviewed by six b readers working independently and using modified international labour organization forms  
class8	3224	the prevalence of true pleural thickening was approximately 6   
class8	3224	using a strict definition of positivity  the average specificity was 0 85  
class8	3224	specificity decreased when a more liberal definition was used  
class8	3224	 the average sensitivity was 0 32  which appeared to increase with a more liberal definition of positivity  because of small numbers of true positives  the sensitivity estimates were unstable   kappa statistics for interreader agreement ranged from 0 06 to 0 40  suggesting considerable interreader variability  
class8	3224	decreasing film quality was associated with decreasing sensitivity  but specificity was not affected by film quality  
class8	3224	because the chest x ray has suboptimal test characteristics in the diagnosis of pleural thickening and because there is considerable interreader variability  we conclude that caution is required in interpreting radiologic detection of pleural thickening using ilo procedures  
class8	3225	the south karelia air pollution study  the effects of malodorous sulfur compounds from pulp mills on respiratory and other symptoms  
class8	3225	the paper mills in south karelia  the southeast part of finland  are responsible for releasing a substantial amount of malodorous sulfur compounds such as hydrogen sulfide  h2s   methyl mercaptan  ch3sh   and methyl sulfides   ch3 2s and  ch3 2s2   into ambient air  
class8	3225	in the most polluted residential area the annual mean concentrations of hydrogen sulfide and methyl mercaptan are estimated to be 8 and 2 to 5 micrograms m3 and the highest daily average concentration 100 and 50 micrograms m3  
class8	3225	the annual mean and highest daily concentrations of sulfur dioxide  so2  are very low  
class8	3225	we studied the effects of malodorous sulfur compounds on eye  nasal and respiratory symptoms  and headache in adults  
class8	3225	a cross sectional self administered questionnaire was distributed in february 1987 and responded to by 488 adults living in a severely  n   198   a moderately  n   204   and a nonpolluted community  n   86   
class8	3225	this included questions about occurrence of the symptoms of interest during the previous 4 wk and 12 months and individual  behavioral  and other environmental determinants of the symptoms  
class8	3225	the response rate was 83   
class8	3225	the odds ratios  or  for symptoms experienced often or constantly in severely versus nonpolluted and moderately versus nonpolluted communities were estimated in logistic regression analysis controlling potential confounders  
class8	3225	the odds ratios for eye  moderate exposure or 11 70  cl95  2 33 to 58 65  severe exposure or 11 78  cl95  2 35 to 59 09  and nasal symptoms  or 2 01  cl95  0 97 to 4 15  or 2 19  cl95  1 06 to 4 55  and cough  or 1 89  cl95  0 61 to 5 86  or 3 06  cl95  1 02 to 9 29  during the previous 12 months were increased  with a dose response pattern  
class8	3226	methacholine responsiveness among working populations  relationship to smoking and airway caliber  
class8	3226	it has been suggested that the development of bronchial hyperresponsiveness  bhr  in some smokers may be an intermediate event in the progression to chronic obstructive pulmonary disease in this group  
class8	3226	if this is true  prevalence data on bhr in a general population should show an independent association between bhr and smoking status  
class8	3226	to test this  we analyzed bhr to inhaled methacholine in 654 white men without known asthma  in relation to smoking  skin test reactivity  type of work  office versus industrial   and indicators of baseline airway caliber  fev1   predicted and fev1 fvc   
class8	3226	bhr was measured in the traditional way  pc20  and as the slope of fev1 versus the methacholine concentration  linear scale   
class8	3226	a pc20 of less than 16 mg ml was considered  responsive  for analyses of this outcome  
class8	3226	we found that although a positive skin test  smoking  and being an industrial worker all appeared to be significant predictors of increased bhr  p less than 0 05   once fev1    predicted  and fev1 fvc  were taken into account  none of these variables alone remained significantly associated with bhr  
class8	3226	the strongest predictors of bhr were prechallenge fev1 and fev1 fvc  both p less than 0 01   
class8	3226	the combination of smoking  atopy  and work groups  which identified a small subgroup of atopic smokers who were office workers  also remained significantly associated with increased bhr  
class8	3226	we also used a regression model that allowed for comparison of predictors for bhr between the most responsive subset of the population  n   84  and the remainder of the study population  
class8	3227	cigarette smoke causes physiologic and morphologic changes of emphysema in the guinea pig  
class8	3227	to investigate the long term effect of cigarette smoke on pulmonary structure and function  we exposed groups of guinea pigs to the smoke of 10 cigarettes each day  5 days per week  for 1  3  6  and 12 months  
class8	3227	we found that the guinea pigs developed progressive lung destruction  emphysema  and alterations in their pulmonary function tests similar to that seen in humans with cigarette smoke induced chronic obstructive lung disease  
class8	3227	this method of smoke induced lung destruction should provide a good model for the study of the early changes of emphysema  
class8	3228	a rat model of prolonged pulmonary infection due to nontypable haemophilus influenzae  
class8	3228	pulmonary colonization and infection with nontypable  unencapsulated  haemophilus influenzae  nthi  occurs commonly in the setting of chronic lung diseases  
class8	3228	because the study of nthi pulmonary infection in animal models has been limited by the rapid clearance of organisms  a model of persistent pulmonary infection was developed  
class8	3228	groups of rats were inoculated by transtracheal instillation of viable nthi suspended in broth or semisolid agar  
class8	3228	some rats had received hexamethylphosphoramide  hmp  in drinking water before inoculation to cause respiratory epithelial mucosal damage  
class8	3228	groups of animals were sacrificed serially  
class8	3228	lungs were cultured quantitatively and their gross and microscopic anatomy examined  
class8	3228	nthi was recovered in small quantities from few broth inoculated rats after the first day of infection and in none after day 7  
class8	3228	in contrast  nthi was recovered from the majority of animals and in greater amounts through 2 wk after agar borne inoculation  
class8	3228	hmp pretreatment further enhanced recovery through 4 wk after inoculation with an agar vehicle  
class8	3228	the pulmonary inflammatory reaction was brief in broth inoculated rats  
class8	3228	the longer persistence of gross and histologic changes seen in agar infected lungs paralleled the enhanced recovery of nthi  
class8	3228	abscess formation occurred at 7 to 14 days in some agar inoculated animals  
class8	3228	thus pulmonary inoculation of nthi in a viscous vehicle resulted in perpetuation of infection and inflammatory response  and previous damage to respiratory mucosal epithelium induced by hmp further enhanced such infection  
class8	3229	bilateral intrapulmonary hematomas  
class8	3229	a 67 yr old man  known to have chronic obstructive lung disease  developed bilateral localized pulmonary densities on chest radiographs after cardiopulmonary resuscitation  
class8	3229	an autopsy disclosed bilateral intrapulmonary hematomas without communication with bronchi  pulmonary arteries  or pleural cavities  
class8	3229	we suggest blunt pulmonary injury is the most probable cause of the hematomas and discuss its pathogenic mechanism  
class8	3229	intrapulmonary hematomas should be considered in the differential diagnosis of pulmonary densities developing after a vigorous resuscitation  
class8	3230	bombesin stimulation of mitogenesis  specific receptors  signal transduction  and early events  
class8	3230	quiescent cultures of swiss 3t3 cells can be stimulated to recommence dna synthesis by polypeptide growth factors  neuropeptides  and various pharmacologic agents that act via multiple signal transduction pathways  
class8	3230	neuropeptides of the bombesin family provide potent mitogens to elucidate these pathways  
class8	3230	these peptides bind to specific receptors that have been characterized by radioligand binding and sensitivity to antagonists and identified as glycoproteins with a mr of 75 000 85 000 by chemical cross linking  
class8	3230	after binding  bombesin elicits a cascade of early molecular events including stimulation of phosphorylation of the acidic mr 80 000 cellular protein  which is a major substrate of protein kinase c  ca2  mobilization mediated by ins 1 4 5 p3  na  and k  fluxes  transmodulation of egf receptor  enhancement of camp accumulation  and expression of the proto oncogenes c fos and c myc  
class8	3230	studies using membrane preparations and permeabilized 3t3 cells indicate that g proteins play a role in the transduction of the mitogenic signal triggered by the binding of bombesin to its receptor  
class8	3230	a pertussis toxin insensitive g protein couples the bombesin receptor to the generation of a signal that activates protein kinase c  whereas a pertussis toxin sensitive g protein mediates cross talk between transmembrane signaling pathways  
class8	3230	bombesin mediated mitogenesis can be blocked by different antagonists and by interrupting the signal transduction process at various postreceptor levels  
class8	3230	thus  prolonged treatment with vasopressin causes heterologous desensitization to the mitogenic action of bombesin  
class8	3230	this mitogenic block is mediated by uncoupling the receptor from its signaling system  
class8	3230	loss of responsiveness to bombesin stimulated dna synthesis is also induced by down regulation of protein kinase c  
class8	3231	gene amplification in human lung cancer  the myc family genes and other proto oncogenes and growth factor genes  
class8	3231	the development of human lung cancer may require multiple genetic deletions affecting a number of chromosomes  e g   1  3  11  13  and 17  
class8	3231	these genetic aberrations may induce the activation of proto oncogenes  c jun  ras  c raf1  and the loss of tumor suppressor genes  p53   
class8	3231	some of the activated proto oncogenes and tumor suppressor genes are more selectively expressed or absent in small cell lung cancer  l myc  c myb  c scr  rb gene  or non small cell lung cancer  c erbb 2  c sis  c fes   
class8	3231	these genes may thus be of importance for selection of differentiation pathway  
class8	3231	the c myc oncogene is frequently amplified in small cell lung cancer cell lines in a much higher frequency than in vivo  
class8	3231	this indicates that c myc seems to be related to tumor progression and a relatively late event in the lung cancer development  
class8	3231	the uncontrolled production of multiple growth factors has been identified in human lung cancer cell lines  
class8	3231	these factors can promote and inhibit the proliferation via paracrine and autocrine loops via specific receptors  
class8	3231	the products from some of the activated proto oncogenes  c sis  c erbb 2  are sequences homologous to a certain growth factor  pdgf  and a receptor  egf  identified in lung cancer  
class8	3231	the production and action of these growth factors may be of major importance for further activation of proto oncogenes via intracellular signal transduction and specific oncogenic activation leading to further tumor progression  
class8	3232	the ras oncogenes in human lung cancer  
class8	3232	the three well characterized genes of the ras gene family h ras  k ras  and n ras  code for closely related 21 kd proteins that have a role in the transduction of growth signals  
class8	3232	the ras proteins acquire transforming potential when a point mutation in the gene leads to replacement of an amino acid in one of the critical positions 12  13  or 61  
class8	3232	overexpression of the normal protein  usually associated with gene amplification  can have similar effects  
class8	3232	the detection of mutationally activated ras genes has been facilitated by the development of oligonucleotide hybridization assays that allow the identification of each possible mutation at the critical sites  
class8	3232	employment of the polymerase chain reaction has greatly increased the sensitivity of these assays  
class8	3232	studies of human lung cancer have shown that adenocarcinoma is the only subtype associated with ras mutations  
class8	3232	these occur in about 30  of primary tumors  
class8	3232	in almost all cases  the mutation is present in codon 12 of the k ras gene  
class8	3232	no mutations have been observed to date in tumors of nonsmokers  suggesting that the mutation may result from exposure to carcinogenic ingredients of tobacco smoke  
class8	3232	amplifications of ras genes were shown to be very uncommon in clinically early stages of lung cancer  
class8	3232	analysis of the clinical data of patients who were operated on for adenocarcinoma of the lung shows that k ras mutations are not associated with particular histologic characteristics of the tumors or with specific presenting features  
class8	3232	patients with k ras mutations  however  had significantly worse survival than did those without an activation  
class8	3233	the beta type transforming growth factor  mediators of cell regulation in the lung  
class8	3233	an increased interest in the role of growth factors in the regulation of processes concerning normal and pathologic lung physiology has spurred a flurry of research in this area  
class8	3233	peptide growth factors are known to control not only cell proliferation but other events such as differentiation  chemotaxis  and matrix deposition as well  
class8	3233	the transforming growth factor beta  tgf beta  family of regulatory peptides serves as a prime example to illustrate the multiplicity of effects elicited by peptide growth factors in various lung derived cell types  
class8	3233	at present  the tgf beta family consists of at least 17 proteins and  based on sequence analysis  they can be divided into two groups  a cluster that shows very high sequence similarity to tgf beta 1  the closely related group  and a cluster that shows weaker sequence similarity to tgf beta 1  the distantly related group  
class8	3233	the purpose of this brief review is to summarize the salient features of tgf beta structure and regulatory abilities of the closely related group  
class8	3233	in addition  we will outline the evidence suggesting a role for tgf beta in normal lung development and physiology  
class8	3233	emphasis will be placed on studies with the closely related members tgf beta 1 and tgf beta 2 because  until recently  purified protein was available only for these two proteins  
class8	3234	positive and negative regulation of proliferation and differentiation in tracheobronchial epithelial cells  
class8	3234	the lung  in particular the bronchial epithelium  is a major site for tumor formation in humans  
class8	3234	environmental factors in conjunction with genetic factors are important determinants in this disease  
class8	3234	the acquisition of defects in the control of proliferation and differentiation appears to constitute crucial steps in the transition of a normal to a neoplastic cell  
class8	3234	several factors have been identified that control positively or negatively the proliferation and differentiation of tracheobronchial epithelial cells  
class8	3234	these factors include egf tgf alpha  tgf beta  insulin igfi  kgf  certain cytokines  retinoids  and activators of protein kinase c  
class8	3234	studies with neoplastic cells have identified several protooncogenes and tumor suppressor genes whose gene products are involved in the regulation of cell growth of normal tracheobronchial epithelial cells  and when mutated  lost  or activated  bring about a neoplastic phenotype  
class8	3234	future studies on the precise function of these genes will help to elucidate the mechanisms by which proliferation and differentiation in normal tracheobronchial epithelial cells are regulated and help to understand the molecular changes involved in diseases such as cancer  
class8	3235	genetic strategies of tumor suppression  
class8	3235	the evaluation of the cancer cell is a complex multigene process  
class8	3235	tumor suppressor genes that are lost or inactivated  as well as genes that are overexpressed  play key roles in tumor progression  
class8	3235	the identification of overexpressed genes has been expedited by the presence of transforming genes in some animal retroviruses  
class8	3235	however  tumor suppressor genes have been difficult to identify and isolate because of their loss or inactivation during tumorigenesis  
class8	3235	by a variety of methods  summarized in this review  a few tumor suppressors have been cloned and characterized  and many more have been recognized indirectly  
class8	3235	the general finding at this time is that the same tumor suppressors  and oncogenes  are found associated with many different tumors  that several different altered genes are found typically in the same tumors  and that other oncogenes and tumor suppressor genes seem to be characteristically altered in particular tumor types as well  
class8	3235	functions of tumor suppressor genes include the control of normal cell activities such as proliferation and differentiation as well as senescence  which is a special kind of differentiation in which cells lose their ability to divide  
class8	3235	the genetic basis of senescence and identification of genes involved in overcoming senescence  leading to immortalization  i e   indefinite growth potential   are important areas of current investigation  
class8	3235	our laboratory is engaged in senescence immortalization studies as a result of our discovery that normal human mammary epithelial cells can be immortalized by dna of the human papilloma virus  
class8	3235	these new studies are summarized here  
class8	3236	recessive oncogenes in lung cancer  
class8	3236	the observation that carcinogen exposure is strongly associated with the probability of developing pulmonary neoplasms has suggested for many years that acquired somatic mutations play a key role in the genesis of these environmentally induced cancers  
class8	3236	with the advent of new techniques in cytogenetics and in the molecular analysis of dna extracted from lung tumors  it has now become possible to test this hypothesis and to search for candidate genes that may be targeted by the chronic exposure of these environmental insults  
class8	3236	early work in this field  studying lung tumors of different histologic types  appears to implicate several distinct chromosomal loci  at chromosomes 3p  13q  17p  and others   suggesting that sequential genetic events occur during the initiation and progression pathways to pulmonary tumorigenesis  
class8	3236	identifying the candidate gene products and understanding the chronology and stringency of mutational events at these loci will be an essential goal to understanding the cellular basis of lung tumors and for developing strategies for the next generation of diagnostic and therapeutic studies  
class8	3237	src expression in small cell lung carcinoma and other neuroendocrine malignancies  
class8	3237	the proto oncogene c src codes for two tyrosine kinases  pp60c src and pp60c srcn  
class8	3237	the latter protein appears to be exclusively expressed in neurons and neuronally differentiated tumors  
class8	3237	in cell lines derived from neuroblastoma and small cell lung carcinoma  src expression correlates positively with neuroendocrine differentiation  
class8	3237	however  pp60c srcn is expressed only in highly differentiated neuroblastomas  
class8	3237	although c src expression in neuroendocrine tumors probably reflects and is the result of the differentiation stage at which the tumors have been arrested  high c src expression and kinase activities in non neuroectodermal tumors  e g   colon carcinoma  breast carcinoma  might instead be a part of the malignant phenotype and contribute to the development of these tumors  
class8	3238	aggravation of myasthenia gravis by erythromycin  
class8	3238	erythromycin is not currently recognized as causing clinical aggravation of myasthenia gravis  
class8	3238	we report the case of a patient who experienced exacerbations of myasthenia gravis subsequent to each of several doses of intravenous erythromycin  
class8	3238	we suggest that erythromycin can cause clinical worsening in patients with disease of the neuromuscular junction  
class8	3239	pulmonary capillaritis and glomerulonephritis in an antineutrophil cytoplasmic antibody positive patient with prior granulomatous aortitis  
class8	3239	a 59 year old man showed asynchronous development of noninfectious granulomatous aortitis with aneurysm  followed 9 months later by pulmonary capillaritis and glomerulonephritis in association with elevated serum antineutrophil cytoplasmic antibody levels  
class8	3239	to our knowledge  the combination of large artery vasculitis and small vessel systemic vasculitis  capillaritis  has not been previously reported  
class8	3239	this case may represent a hybrid type of systemic vasculitis combining features of giant cell arteritis and wegener s granulomatosis  
class8	3240	pulmonary malakoplakia in a patient with the acquired immunodeficiency syndrome  differential diagnostic considerations  
class8	3240	malakoplakia is an unusual inflammatory condition characterized histopathologically by accumulations of benign macrophages  or von hansemann s cells  that are associated with diagnostic intracellular and extracellular calcospherites  termed michaelis gutmann bodies  
class8	3240	currently believed to represent an acquired defect of macrophage digestion  malakoplakia most commonly occurs in the urinary tract and is associated with a variety of infectious agents  notably gram negative bacilli  
class8	3240	we describe a patient with the acquired immunodeficiency syndrome who presented with a cavitating lingular mass  
class8	3240	a transbronchial biopsy specimen revealed pulmonary malakoplakia  the seventh reported case of this condition and the second reported occurrence of pulmonary malakoplakia in a patient with acquired immunodeficiency syndrome  
class8	3240	microbiological cultures were positive for rhodococcus equi  
class8	3240	the significance of this finding  and the differential diagnosis of intra alveolar histiocytic proliferations in patients with acquired immunodeficiency syndrome  is discussed  
class8	3241	extramedullary hematopoiesis in a bronchial carcinoid tumor  an unusual complication of agnogenic myeloid metaplasia  
class8	3241	a case of bronchial carcinoid tumor with foci of extramedullary hematopoiesis is presented  
class8	3241	the patient had a 6 year history of agnogenic myeloid metaplasia and hepatosplenomegaly  
class8	3241	all three hematopoietic cell lines were represented in different areas of the bronchial tumor  
class8	3241	to our knowledge  this is the first case of extramedullary hematopoiesis described in a bronchial carcinoid and only the fourth report of hematopoietic cells in a neoplasm of otherwise unrelated origin  
class8	3241	the pathogenesis of this uncommon finding is discussed and the literature is reviewed  
class8	3242	the role of indium labelled leukocyte imaging in pyrexia of unknown origin  
class8	3242	indium 111 labeled white blood cell scanning is often used in the investigation of pyrexia of unknown origin  puo  to locate an otherwise occult source of sepsis  
class8	3242	from a series of 166 white blood cell studies performed for sepsis  28 cases of true puo were identified and reviewed  
class8	3242	the sensitivity was 60  and specificity 70   with a positive predictive value of 38  and negative predictive value of 90   
class8	3242	only 11  of studies revealed a pyogenic cause for puo  
class8	3242	these results are discussed and the potential role of gallium scanning in puo is raised  
class8	3243	nicardipine reduces the cardio respiratory toxicity of intravenously administered bupivacaine in rats  
class8	3243	the purpose of our study was to examine the effect of intravenous  iv  nicardipine pretreatment  30 micrograms kg 1   given three minutes before an iv bolus of bupivacaine to determine its effect on the incidence of fatal bupivacaine cardio respiratory toxicity in adult male sprague dawley rats anaesthetized with intraperitoneal pentobarbital  
class8	3243	fifty rats were divided into four groups  
class8	3243	groups i and ii  n   10 each  received 3 5 mg kg 1 0 5 per cent bupivacaine and groups iii and iv  n   15 each  received 5 0 mg kg 1  0 5 per cent bupivacaine  
class8	3243	groups i and iii received pretreatment with normal saline before bupivacaine  whereas groups ii and iv were given pretreatment with nicardipine  30 mg kg 1  
class8	3243	there was no difference in the incidence of survival between the nicardipine pretreatment group and the saline placebo pretreatment group given 3 5 mg kg 1  0 5 per cent bupivacaine  no fatalities in either group   
class8	3243	however  there was significant protection by nicardipine pretreatment in the group given 5 mg kg 1  0 5 per cent bupivacaine  13 of 15 survived  compared with only 4 of 15 in the saline pretreatment group  p less than 0 001   
class8	3243	in conclusion  our data demonstrate that in rats given 0 5 per cent bupivacaine  5 mg kg 1  nicardipine pretreatment protected against fatal cardio respiratory toxicity  
class8	3244	an adherent subline of a unique small cell lung cancer cell line downregulates antigens of the neural cell adhesion molecule  
class8	3244	small cell lung cancer  sclc  lines are distinguished from non small cell lung cancer  nsclc  lines by their growth in floating aggregates  in contrast to the adherent monolayers formed by nsclc cells in culture  
class8	3244	of 50 well characterized sclc lines recently described by the national cancer institute  nci  navy medical oncology branch  only four variant cell lines  sclc v  grew as adherent monolayers  
class8	3244	one line  nci h446  was unique in growing long term with coexisting floating and surface adherent subpopulations  
class8	3244	we have physically segregated these two populations over many passages in vitro to enrich for relatively pure cultures of floating and adherent cells  
class8	3244	no differences in c myc expression  keratin pattern  or cytogenetic appearance were found between the adherent and floating sublines  
class8	3244	however  expression of the neuroendocrine marker neuron specific enolase in the floating cells was three times that found in the adherent cells  
class8	3244	the floating subline also had much greater surface expression of neuroendocrine tumor antigens detected by monoclonal antibodies uj13a and hnk 1  which have been recently shown to detect the neural cell adhesion molecule  ncam  on sclc cells  
class8	3244	two other adherent sclc v lines were also found to be unreactive with uj13a and hnk 1  generalizing the association between ncam expression and the growth of most sclc cultures as floating aggregates  
class8	3244	in conclusion  we have an interesting model to study expression of ncam as related to the adhesive properties of sclc cells  
class8	3245	causes of death in the elderly and their changing pattern in hisayama  a japanese community  results from a long term and autopsy based study  
class8	3245	the causes of death for the elderly were prospectively studied in hisayama  japan  a rural community  
class8	3245	we compared 1 621 subjects  aged 40 years or over  recruited in 1961  and 2 053 subjects recruited in 1974  
class8	3245	each cohort was studied in a follow up that lasted 10 years  they had autopsy rates of 82 1  and 86 1  during each 10 year period  respectively  
class8	3245	the most common causes of death for those aged 70 years or over were cerebrovascular disease  malignant neoplasms  and pneumonia  
class8	3245	deaths due to cerebrovascular disease tended to decrease in the recent cohort  but the proportion of decline was more prominent in cases aged 40 to 69 years  
class8	3245	there was a sex difference in the changing pattern of mortality from heart diseases including ischemic heart disease  
class8	3245	deaths by both heart diseases and ischemic heart disease increased in the more recent cohort of aged women  whereas they decreased in the aged men  
class8	3245	pneumonia was an important cause of death for the elderly in both cohorts  
class8	3245	deaths due to  senility  were rare  being only 1  of the deceased aged 70 or over  
class8	3245	with prolonged lifespan  especially for women  the impact of atherosclerosis and its related disorders on the recent japanese aged population appears to have increased  
class8	3246	leukocyte larceny  spurious hypoxemia confirmed with pulse oximetry 
class8	3246	leukemic patients with extremely high white blood counts may exhibit the phenomenon of leukocyte larceny  in which white blood cells metabolize plasma oxygen in arterial blood gas samples  abg  producing a spuriously low oxygen tension  
class8	3246	we report the case of a leukemic patient with a white blood count in excess of 500 000 in whom multiple abgs documented hypoxemia out of proportion to his clinical picture  
class8	3246	pulse oximetry was used to confirm higher hemoglobin oxygen saturation to establish the leukocyte larceny  
class8	3247	the electrocardiogram in chronic obstructive pulmonary disease  
class8	3247	the electrocardiogram is often abnormal in patients who have chronic obstructive pulmonary disease  
class8	3247	the most frequent abnormalities are a rightward p wave axis  greater than or equal to 70 degrees  and a rightward qrs axis  greater than or equal to 90 degrees   
class8	3247	in addition  low voltage in the limb leads  an s1s2s3 pattern  poor r wave progression  a posterior superior terminal qrs vector or other changes may be present  
class8	3247	transient atrial and ventricular dysrhythmias are common  
class8	3247	knowledge of the usual electrocardiographic manifestations of chronic obstructive pulmonary disease enables the clinician to recognize uncharacteristic abnormalities  which often represent the effects of superimposed illnesses or drug toxicity  
class8	3248	microscopic wegener s disease  a particular form of wegener s granulomatosis  
class8	3248	we describe a case of wegener s granulomatosis in which the disease was manifested with crescentic glomerulonephritis  upper airway ulcerations  and microangiopathic hemolytic anemia with consumptive coagulopathy  
class8	3248	no granuloma was identified but antibodies to cytoplasmic components of neutrophils were strongly positive with a diffuse pattern  
class8	3248	because microscopic vessels were predominantly involved  capillaritis   and granuloma were absent  were refer to this particular form of the disease as  microscopic wegener s disease    
class8	3249	multiple organ failure  inflammatory priming and activation sequences promote autologous tissue injury  
class8	3249	systemic inflammation promotes multiple organ failure through the induction of diffuse microvascular leak  
class8	3249	inflammatory cells such as neutrophils propagate this process  
class8	3249	tissue injury by neutrophils may be viewed as a normal process  inflammation  that has become uncontrolled and generalized  
class8	3249	multiple inflammatory stimuli synergistically promote neutrophil mediated tissue injury in priming and activation sequences  
class8	3249	in some settings  cellular priming is mediated by platelet activating factor and can be prevented by platelet activating factor antagonists  
class8	3249	inhibiting cellular priming could be efficacious in the therapy of multiple organ failure  
class8	3250	endotoxin requirements for alveolar macrophage stimulation  
class8	3250	acute pulmonary failure or ards in severely injured patients continues to be a significant problem  
class8	3250	the most important clinical risk factor identified is sepsis syndrome  
class8	3250	sepsis syndrome is the clinical correlate of a malignant systemic inflammatory process and is directed in large part by the tissue fixed macrophage  m phi   such as the alveolar m phi  
class8	3250	the m phi is capable of producing most of the central inflammatory mediators responsible for the pathophysiology seen during sepsis and organ injury  
class8	3250	two major mediators are procoagulant activity  pca   leading to diffuse microvascular thrombosis  and tumor necrosis factor  tnf   causing much of the physiologic derangement of sepsis  
class8	3250	endotoxins  lps  derived from gram negative bacterial cell walls are the primary inflammatory stimulus for the tissue fixed m phi production of inflammatory mediators  
class8	3250	it is not completely known how lps interacts with its various cellular targets  but it is hoped that knowledge of the molecular interactions involved in stimulation of the m phi by endotoxin will lead to therapies to modulate the response and prevent deleterious processes such as ards  
class8	3250	in the present studies  lps from e  
class8	3250	coli 0111 b4 was shown in a dose response to stimulate large levels of both pca and tnf in alveolar m phi  
class8	3250	lps from bacteroides fragilis and lipid x  the monosaccharide precursor of endotoxin  were unable to cause stimulation of the m phi in vitro  
class8	3250	however  both moieties  b  
class8	3250	fragilis lps and lipid x  were able to effectively and specifically compete with e  
class8	3250	coli lps and block m phi stimulation  
class8	3251	neutrophil disorders in burn injury  complement  cytokines  and organ injury  
class8	3251	because of the association of burn injury with subsequent bacterial infection  numerous studies have been performed characterizing neutrophil function in burn injury  
class8	3251	these studies provide a picture of intravascular complement activation  neutrophil c5a interactions  and consequent disordered cellular function  
class8	3251	neutrophil dysfunction includes suppressed random and c5a directed migration and hyperresponsiveness to oxidative stimuli  
class8	3251	these observations do not explain the histologic and functional involvement of neutrophils in ards and perhaps other organ failure states  
class8	3251	circumstantial and extrapolated information suggests that macrophage lineage cells function as regulators of neutrophil function within matrix environments in burn injury  
class8	3251	elevated endotoxin levels have been found in burned patients  which would support the notion of endotoxin stimulated monocytes macrophages as inducing neutrophil migration into connective tissue matrices  ltb4 and il 8   inducing prolonged oxidant production  tnf alpha  gm csf   and inducing neutrophil release of regulatory substances from neutrophils  g csf   
class8	3251	this information suggests a variety of experimental approaches to testing this hypothesis  
class8	3252	a lethal complication of papaverine induced priapism  
class8	3252	a large series of patients was treated for impotence with intracorporeal injections of papaverine and phentolamine with no major complications and no deaths reported  
class8	3252	we report on a 45 year old black man with advanced multiple sclerosis who died after such therapy  
class8	3252	when the first self administered injection of phentolamine and papaverine failed to produce an adequate erection the patient injected a second dose that resulted in priapism and death of massive pulmonary embolism  
class9	3253	abnormal differentiation of human papillomavirus induced laryngeal papillomas  
class9	3253	we studied the proliferation and differentiation of human laryngeal papillomas  which are benign tumors induced by human papillomaviruses  
class9	3253	immunofluorescent stains of tissues for a number of differentiation specific proteins showed abnormal differentiation  
class9	3253	papilloma tissue fragments in vitro showed a slightly decreased fraction of proliferating cells that incorporated tritiated thymidine and a markedly reduced incorporation of tritiated uridine when compared with normal tissue  
class9	3253	we propose that papillomavirus infection results in normal basal cell proliferation but abnormal terminal differentiation and that this abnormality significantly contributes to the hyperplasia of the papillomas  
class9	3254	transtympanic endoscopic findings in patients with otitis media with effusion  
class9	3254	using a fine  rigid endoscope  olympus  ses 1711k   we examined the middle ear  including the tympanic orifice of the eustachian tube  of children with otitis media with effusion  ome  in its active stage  26 ears   in the convalescent stage  13 ears   and during treatment with ventilation tubes for 10 days to 6 months  five ears  through myringotomy with the patients under general anesthesia  
class9	3254	several color photographs of representative ears are shown  
class9	3254	in the active stage of ome  edema  73 1   and hyperemia  23 1   were characteristic features of the middle ear mucosa  and normal mucosa was seen in only one ear  3 1    
class9	3254	the tympanic orifice of the eustachian tube  which could be examined in 12 ears  were stenosed with edema in four ears  33 3   or plugged with effusion in three ears  25 0   in this group  
class9	3254	in the convalescent stage of ome  dilated vessels were most often seen  69 2    but the rest of the patients had normal mucosa  30 8   in the middle ear  and none of them had edema nor hyperemia  
class9	3254	the tympanic orifice of the eustachian tube  which could be examined in five ears  was clearly patent in all the patients in this group  
class9	3254	one ear that was treated with a ventilation tube for 1 month showed dilated vessels and less severe inflammation than did ears that were in the active stage of ome  and three ears that were treated for more than 3 months showed almost normal middle ear mucosa  
class9	3255	pseudocyst of the auricle  case report and world literature review 
class9	3255	we treated a patient with pseudocyst of the auricle and reviewed the 113 cases previously published in the world literature  
class9	3255	pseudocyst of the auricle is an asymptomatic  noninflammatory cystic swelling that involves the anthelix of the ear  results from an accumulation of fluid within an unlined intracartilaginous cavity  and occurs predominantly in men  93  of patients   
class9	3255	characteristically  only one ear is involved  87  of patients   and the lesion is usually located within the scaphoid or triangular fossa of the anthelix  
class9	3255	previous trauma to the involved ear is uncommon  
class9	3255	the diagnosis may be suggested by the clinical features  and analysis of the aspirated cystic fluid and or histologic examination of a lesional biopsy specimen will confirm the diagnosis  
class9	3255	therapeutic intervention that maintains the architecture of the patient s external ear should be used in the treatment of this benign condition  
class9	3256	multiple intracranial mucoceles associated with phaeohyphomycosis of the paranasal sinuses  
class9	3256	the purpose of this article is to alert clinicians to a new pathogenic fungus of the paranasal sinuses called exserohilum rostratum  
class9	3256	exserohilum species are one of the etiologic agents of phaeohyphomycosis  a constellation of entities caused by dematiaceous fungi  
class9	3256	this class of fungal sinus infection has emerged only in the past decade  it occurs primarily in immunocompetent individuals and produces a tenacious  progressive pansinusitis  
class9	3256	to our knowledge  this study describes the first case of multiple intracranial mucoceles secondary to e rostratum  
class9	3256	the diagnostic workup includes computed tomography and magnetic resonance imaging followed by direct microscopic examination of tissue biopsy specimens  
class9	3256	a craniotomy followed by a bilateral external ethmoidectomy was necessary for complete extirpation of the infected mucoceles  
class9	3256	aggressive surgical management of this mycotic infection is described  
class9	3257	osteoma of the middle ear  report of a case  
class9	3257	osteomas of the middle ear are rare  
class9	3257	we report a case of a 7 year old boy with osteoma originating from the pyramidal eminence  combined with congenital cholesteatoma  
class9	3257	the osteoma and cholesteatoma were successfully removed by tympanomastoidectomy  
class9	3257	the long process of the incus and the superstructure of the stapes disappeared  
class9	3257	the body of the incus was sculpted and used as a columella  
class9	3257	histopathologically  the osteoma was much the same as an external auditory canal osteoma  
class9	3257	the possibility of a primary congenital origin of this neoplasm is suggested  
class9	3258	topographic classification  clinical characteristics  and diagnostic delay of cancer of the larynx hypopharynx in torino  italy  
class9	3258	the case series of a population based case control study of laryngeal and hypopharyngeal cancers in torino  italy  included 281 men with clinical and anamnestic data  
class9	3258	two hundred fifteen  28  and 38 cancers originated from the endolarynx  epilarynx  and hypopharynx  respectively  
class9	3258	regions invaded by the tumor were divided into 26 subsites  
class9	3258	a classification based on the number of invaded subsites was proposed  which agreed well with the t classification of the tnm system  
class9	3258	cancers originating from the hypopharynx invaded more subsites than cancers from the endolarynx  and among the latter  supraglottic were more invasive than glottic lesions  
class9	3258	the number of invaded subsites was strongly associated with nodal involvement  
class9	3258	among symptoms at onset of disease and at diagnosis  patients with endolaryngeal lesions reported dysphonia and dyspnea more frequently  and patients with lesions from other regions had a higher prevalence of dysphagia  odynophagia  otalgia  and adenopathia  
class9	3258	clinical and epidemiologic results of this study suggest considering the endolarynx  epilarynx  and hypopharynx as separate anatomic entities  
class9	3258	diagnostic delay was not associated with tumor size and showed a negative trend with involvement of cervical lymph nodes  suggesting that stage at diagnosis is due to intrinsic differences in tumor aggressiveness  
class9	3259	human papillomavirus type 16 associated with oral squamous carcinoma in a cardiac transplant recipient  
class9	3259	human papillomavirus type 16  hpv 16  has been associated with a variety of squamous carcinomas  particularly those involving the anogenital tract  
class9	3259	the authors report the development of an oropharyngeal carcinoma in a 43 year old man approximately 20 months after cardiac transplantation while he was on a maintenance regimen of cyclosporine a and prednisone  
class9	3259	the carcinoma was resistant to treatment  and he died of complications related to metastatic disease 3 years posttransplantation  
class9	3259	molecular biologic studies using nonisotopic labeled viral dna probes were done  
class9	3259	in situ hybridization demonstrated the presence of hpv 16 dna in the tumor cells  
class9	3259	dna dot blot analysis confirmed the presence of multiple copies of hpv 16 dna within the tumor cells and their absence from adjacent normal appearing tissue  
class9	3259	southern blot analysis suggested that the hpv 16 dna was integrated into the tumor cell genome  
class9	3259	with increasing recognition of the carcinogenicity of hpv type 16 infection  a role for this virus in the development of squamous cell malignancies in immunosuppressed organ transplant recipients is likely to be noted with increasing frequency  
class9	3260	a clinical and flow cytometric analysis of patients with nasopharyngeal cancer  
class9	3260	abnormal cellular dna content  a hallmark of malignancy  is known to be an important prognostic factor in many human solid tumors  however  no data have been published on whether cellular dna content carries prognostic significance for patients with nasopharyngeal cancer  npc   
class9	3260	archival  formalin fixed  paraffin embedded pathology specimens representing pretreatment tissue biopsies from 55 patients  41 men and 14 women  with npc were analyzed for cellular dna content in a retrospective fashion from 1968 to 1988  
class9	3260	individual tumors were classified as either lymphoepithelioma  squamous cell  or anaplastic carcinoma  and were staged according to international union against cancer  uicc  criteria  
class9	3260	all patients were treated with curative intent using a 4 to 6 mev linear accelerator to total doses ranging from 50 to 60 gy in 4 to 6 weeks  
class9	3260	the overall 5 year actuarial survival for all 55 patients was 44 4   men  41   women  52    
class9	3260	survival by t stage was as follows  t1  65   t2  51   t3  36   and t4  27   
class9	3260	similarly  the 5 year survival rate declined as the bulk of nodal metastases increased  n0  62   n2  50   n3  37   and n1  25   
class9	3260	patients who had anaplastic carcinoma had a 5 year survival of 73   those with lymphoepithelioma had a 60  survival  and those with squamous cell cancer  scc  had a 30  survival  
class9	3260	there was a statistically significant difference in 5 year survival between patients with scc and those with nonkeratinizing histologies  p less than 0 05   
class9	3260	in addition  there was a significant association between patients older than 40 years of age with scc and patients younger than 40 years of age with nonkeratinizing malignancies  p less than 0 01   
class9	3260	of the 55 tumors successfully analyzed  22  40   were diploid and 33  60   were aneuploid  
class9	3260	the mean coefficient of variation  cv  of all 55 samples was 6 17   
class9	3260	there was no significant difference in 5 year survival between patients with diploid and those with aneuploid tumors  48  versus 42    
class9	3260	furthermore  there was no statistically significant survival difference between aneuploid and diploid tumors within any one histologic subgroup  
class9	3260	there was also no significant survival difference related to the dna index  
class9	3260	the results indicate that the extent of local tumor spread is still the most important prognostic factor for patients treated with radiotherapy for npc  
class9	3260	the data support the conclusion that patients with lymphoepithelioma and anaplastic carcinomas have a superior survival to patients with squamous cell carcinoma  abstract truncated at 400 words   
class9	3261	aqueous beclomethasone diproprionate nasal spray  regular versus  as required  use in the treatment of seasonal allergic rhinitis  
class9	3261	objective  to determine the effect of alternative regimens of nasal steroid administration on symptoms and quality of life  
class9	3261	design  randomized  double blind  parallel group comparison  
class9	3261	subjects  sixty ragweed sensitive adults recruited from participants of previous studies and through media advertising  
class9	3261	interventions  200 micrograms of aqueous beclomethasone diproprionate nasal spray  twice daily  from 1 week before until 1 week after the ragweed pollen season  regular  or 100 micrograms of the spray  taken as required  up to 400 micrograms daily  troublesome nasal symptoms were treated  in both groups  by increasing the daily dose to 800 micrograms until symptoms were controlled  
class9	3261	if this treatment was insufficient  120 mg of terfenadine  daily  was added  
class9	3261	results  one subject in the  as required  treated group withdrew with uncontrolled nasal symptoms  
class9	3261	in the remaining subjects  sneezing  stuffy nose  and rhinorrhea  measured by a daily diary  were significantly better controlled in the regular treated group  p less than 0 025   
class9	3261	impairment of quality of life  including sleep disturbance  nonhay fever symptoms  practical problems  and uncomfortable emotions were greater in the as required treated group  p less than 0 001   
class9	3261	subjects in the regular treated group required less additional terfenadine  0 27 tablets per subject versus 1 40  p   0 022   
class9	3261	eye symptoms and eye drop use were similar in the two treated groups  
class9	3261	conclusion  in patients with seasonal allergic rhinitis  regular use of inhaled steroids results in fewer symptoms and better quality of life than when the spray is taken only as required  
class9	3262	comparison of cefuroxime axetil  cefaclor  and amoxicillin clavulanate potassium suspensions in acute otitis media in infants and children  
class9	3262	in this randomized  blinded  multicenter comparison study  377 infants and children with acute otitis media  aom  received a 10 day course of an oral suspension of one of the following  cefuroxime axetil  cae   30 mg kg day  cefaclor  cec   40 mg kg day  or amoxicillin clavulanate potassium  amx cl   40 mg kg day  
class9	3262	clinical efficacy was determined by pneumatic otoscopy and tympanometric testing 3 to 5  11 to 14  and 22 to 26 days after the initiation of therapy  
class9	3262	there was a statistically significant difference among the three treatment groups with respect to clinical outcome  more patients in the cae group  62   than in the cec group  46   or the amx cl group  52   had complete resolution of signs and symptoms of aom  including effusion   
class9	3262	paired comparisons revealed a significant difference in efficacy between cae and cec and a nearly significant difference between amx cl and cec  
class9	3262	taste acceptability was highest for cec and lowest for this formulation of cae  
class9	3262	significantly more patients in the amx cl group than in the cae or cec group had a side effect  primarily diarrhea  vomiting  or diaper rash  
class9	3262	we conclude that cae suspension has greater clinical efficacy than cec and fewer side effects than amx cl  
class9	3263	nonendoscopic percutaneous gastrostomy  
class9	3263	tight peritoneal adherence of the stomach to the abdominal wall as a prerequisite of percutaneous gastrostomy can be achieved by a newly developed cannula  
class9	3263	it serves for puncture and fixation of the gastric wall  
class9	3263	thus  percutaneous gastrostomy can be established safely even in instances of an endoscopically nonaccessible stomach  
class9	3263	further applications of the device for the purpose of intestinopexy and facilitation of endoscopic procedures are being evaluated  
class9	3264	magnetic resonance imaging of radiation optic neuropathy  
class9	3264	three patients with delayed radiation optic neuropathy after radiation therapy for parasellar neoplasms underwent magnetic resonance imaging  
class9	3264	the affected optic nerves and chiasms showed enlargement and focal gadopentetate dimeglumine enhancement  
class9	3264	the magnetic resonance imaging technique effectively detected and defined anterior visual pathway changes of radionecrosis and excluded the clinical possibility of visual loss because of tumor recurrence  
class9	3265	complications of the pectoralis major myocutaneous flap in head and neck reconstruction  
class9	3265	a retrospective review of the complications in 211 patients undergoing pectoralis major myocutaneous flap reconstruction is presented  
class9	3265	the flap was used for mucosal lining of the oral cavity or oropharynx in 109 patients  for pharyngoesophageal reconstruction in 44  for skin coverage in 47  and for other locations in 14 patients  
class9	3265	flap related complications developed in 63  of the patients  
class9	3265	these included flap necrosis  suture line dehiscence  fistula formation  infection  and hematoma  
class9	3265	analysis of risk factors for the development of flap complications showed the following factors to be significant  age over 70  female gender  nomographic overweight  albumin less than 4 g dl  use of the flap in reconstruction of the oral cavity after major glossectomy  and presence of other systemic diseases  
class9	3265	the median length of hospitalization for those developing complications was 33 days compared with 16 days for those who did not develop any complications  
class9	3265	thirty five  26   of the 135 patients developing complications required reoperation and only 2 among these required a second flap  
class9	3265	similarly  only 13 of the 61 patients who developed fistulas required surgical closure  
class9	3266	patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract  
class9	3266	a consecutive series of 1 081 previously untreated patients undergoing 1 119 radical neck dissections  rnds  for squamous carcinoma of the head and neck was reviewed to study the patterns of nodal metastases  
class9	3266	primary tumors were located in the oral cavity in 501 patients  in the oropharynx in 207 patients  in the hypopharynx in 126 patients  and in the larynx in 247 patients  
class9	3266	lymph node metastases were confirmed histologically in 82  of 776 therapeutic neck dissections  and micrometastases were discovered in 33  of 343 elective rnds  
class9	3266	lymph node groups in the neck were described by levels  i to v   
class9	3266	predominance of certain levels was seen for each primary site  
class9	3266	levels i  ii  and iii were at highest risk for metastasis from cancer of the oral cavity  and levels ii  iii  and iv were at highest risk for metastasis from carcinomas of the oropharynx  hypopharynx  and larynx  
class9	3266	supramohyoid neck dissection  clearing levels i  ii  and iii  for no patients with primary squamous cell carcinomas of the oral cavity and anterolateral neck dissection  clearing levels ii  iii  and iv  for no patients with primary squamous cell carcinomas of the oropharynx  hypopharynx  and larynx are recommended  
class9	3267	efficacy of radical neck dissection for the control of cervical metastasis after radiotherapy for nasopharyngeal carcinoma  
class9	3267	fifty one patients who had persistent or recurrent neck disease from nasopharyngeal carcinoma after radiotherapy underwent radical neck dissection  
class9	3267	the follow up period ranged from 0 5 to 9 years  median  2 years   
class9	3267	multiple cervical lymph node involvement was present in 51  of the patients  26 of 51   
class9	3267	malignant cells were detected in 88  of the resected specimens  45 of 51   
class9	3267	the clinical sign of fixation of lymph node is the only factor that affects the successful control of neck disease  p   0 04   
class9	3267	extracapsular extension of the nodal disease was present  and 35  of the lymph nodes were adherent to surrounding structures at operation  18 of 51   
class9	3267	there was one hospital mortality and the overall morbidity was minimal  
class9	3267	the actuarial survival at 5 years was 38   and the probability of control of neck disease was 66   
class9	3267	radical neck dissection is effective in controlling post irradiation cervical metastasis from nasopharyngeal carcinoma  
class9	3268	comparison of propofol and thiopental halothane for short duration ent surgical procedures in children  
class9	3268	experiences with propofol in pediatric anesthesia are limited  
class9	3268	we undertook a study to evaluate the quality of induction and recovery from anesthesia with propofol compared to thiopental halothane  
class9	3268	twenty children received 3 mg kg 1 min 1 of propofol as a loading dose followed by a maintenance dose of 0 1 mg kg 1 min 1      10    
class9	3268	twenty children received 5 7 mg kg of thiopental  and maintenance was provided with halothane  0 5  1 5    
class9	3268	the interval between the end of the administration of propofol or thiopental halothane and extubation  as well to discharge to the ward  was significantly shorter with propofol  4 4 versus 13 5 min and 7 22 versus 30 4 min  respectively   
class9	3268	spontaneous movements and pain on injection were seen significantly more frequently with propofol  whereas laryngospasm and hiccup were only observed with thiopental  
class9	3268	during the first 6 h after the surgical procedure  analgesics were needed significantly more often in the thiopental group  
class9	3268	nausea and vomiting also were observed more frequently in the thiopental group  
class9	3268	in conclusion  propofol used as a single anesthetic is a satisfactory technique for ent surgery of short duration in children  
class9	3269	a controlled  double blind study of the effect of quazolast on nasal challenge with ragweed antigen  
class9	3269	quazolast is a potent mediator release inhibitor as determined by in vitro and in vivo testing  
class9	3269	a placebo controlled  double blind  two way crossover study compared the safety and efficacy of quazolast  400 mg bid orally  with placebo in 23 subjects with ragweed  rw  allergy  out of season  
class9	3269	subjects were assigned to two 7 day treatments in a random sequence with an 8 day washout  
class9	3269	subjects were challenged on days 1 and 7 of each trial with serial dilutions  10  100  1000  1350  and 2700 pnu 0 135 ml  of rw  using metered pump spray bottles   two sprays delivered 0 135 ml   preceded by saline control  
class9	3269	efficacy evaluation consisted of nasal flow rates measured by rhinomanometry  sneeze counts  nasal itchiness scores  and weight of nasal secretions during challenges  
class9	3269	during quazolast treatment  subjects had significantly lower  p less than  05  mean percent decreases in nasal flow rate at 1350 and 2700 pnu  
class9	3269	nasal itchiness scores were significantly lower  p less than  05  during quazolast treatment than at placebo at 1000  1350  and 2700 pnu  
class9	3269	although sneeze counts were lower during treatment with quazolast than with placebo  the results did not reach statistical significance  
class9	3269	no significant improvement was seen in the weight of nasal secretions  
class9	3269	adverse experiences  clinical laboratory results  and physical examinations were unremarkable  posttreatment  
class9	3269	quazolast was superior to placebo in protecting against nasal congestion and nasal itchiness after ragweed nasal challenge  
class9	3270	effect of vitamin c on histamine bronchial responsiveness of patients with allergic rhinitis  
class9	3270	the effect of acute oral administration of 2 g vitamin c on bronchial responsiveness to inhaled histamine in 16 patients with allergic rhinitis was compared with placebo on two consecutive days in a double blind  crossover design  
class9	3270	the pc15fev1 was significantly increased one hour after treatment with vitamin c but not after placebo  
class9	3271	teflon versus thyroplasty versus nerve transfer  a comparison  
class9	3271	surgical rehabilitation of the paralyzed larynx is currently performed by teflon injection  thyroplasty  and reinnervation techniques  
class9	3271	proponents of the two newer techniques maintain that they are preferred to teflon injection because superior phonatory quality is achievable  
class9	3271	this paper was written in an attempt to dissect the issues regarding this question  
class9	3271	teflon remains the quickest and least expensive procedure  but further experience with stroboscopic and other voice analyses reveals that the other procedures demonstrate some superiority in phonatory quality over teflon  
class9	3271	in this author s hands  the nerve transfer offers the best opportunity to achieve a normal phonatory voice  
class9	3271	in addition  it is the only one of the three procedures that leaves the vocal cord entirely undisturbed  important in the event one of the other two procedures becomes necessary  
class9	3272	endoscopic laser arytenoidectomy revisited  
class9	3272	arytenoidectomy is currently the most reliable method of treating patients with bilateral vocal cord paralysis  
class9	3272	although both endoscopic and external approaches have been described  the endoscopic laser technique is more desirable because it requires no incision and allows for the immediate assessment of airway size  
class9	3272	eleven patients with bilateral vocal cord paralysis treated by endoscopic laser arytenoidectomy were presented in 1984  
class9	3272	at that time  10 of the 11 patients had been successfully decannulated  
class9	3272	follow up on that group of patients revealed that 7 of the 10 successfully treated patients remain decannulated with a good airway  although 2 of these patients required a revision procedure to excise a granuloma  
class9	3272	one patient failed at 15 months and has failed two subsequent revision operations  and 2 patients have been lost to follow up  
class9	3272	since 1984  17 additional patients with bilateral vocal cord paralysis have been treated by the authors using the same endoscopic laser arytenoidectomy technique  all have been successfully managed  with a minimum follow up of 3 years  
class9	3272	the technique of this operation will be reviewed  
class9	3272	this study demonstrates the clinical usefulness of endoscopic laser arytenoidectomy in the treatment of bilateral vocal cord paralysis  
class9	3273	combined laryngeal framework medialization and reinnervation for unilateral vocal fold paralysis  
class9	3273	the laryngeal framework silastic implant technique has become an increasingly attractive alternative to teflon injection  particularly when there is fixation of the cricoarytenoid joint or the defect to be corrected is larger than usual  but it does not restore ability to change tension in the vocal fold  
class9	3273	unilateral vocal fold reinnervation can overcome this drawback and  when used in conjunction with surgical medialization  may offer return of function very close to normal  
class9	3273	twenty nine patients with unrecovered unilateral vocal fold paralysis and or fixation of the cricoarytenoid joint have been managed by use of a silastic implant combined with unilateral vocal fold reinnervation with no complications  
class9	3273	voice improvement has been assessed on preoperative and postoperative voice recordings  
class9	3273	the combined surgical techniques for reinnervation and a modification of silastic implantation via the laryngeal framework approach are reported  
class9	3274	immunohistochemical interpretation of early epithelial disorders of pyriform sinus  
class9	3274	expression of cytokeratins  cks  was investigated immunohistochemically by use of monospecific monoclonal anti ck antibodies in normal epithelia of pyriform sinus and epithelial lesions such as simple hyperplasia  different degrees of dysplasia  in situ carcinoma  and invasive carcinoma  
class9	3274	in normal epithelium  strong expression of ck 19 was consistently observed only in the basal layer as basic ck  while expression of ck 13 showed a completely reverse pattern  being expressed only in suprabasal layers as stratification related ck  
class9	3274	characteristic changes in expression pattern of these two cks were observed in accordance with the degree of epithelial disorders and differentiation of carcinoma  
class9	3274	cytokeratin 1  as keratinization associated ck  was observed only in keratinized cells of hyperplastic epithelia and well differentiated carcinomas  
class9	3274	these findings may be useful in evaluating epithelial disorders and classifying carcinomas more objectively  and may assist earlier detection of carcinoma when used with standard histologic techniques  
class9	3275	vestibular recruitment in meniere s disease  
class9	3275	the aim of this study was to search for vestibular recruitment in a sample of patients with meniere s disease  
class9	3275	recruitment was defined as an abnormal growth of response with increasing stimulus intensity  
class9	3275	twenty nine patients were tested with sinusoidal rotation of three different magnitudes at four different frequencies  
class9	3275	we also searched for auditory recruitment in each patient via tests of auditory brain stem responses  acoustic reflexes  and loudness balance and discomfort level  
class9	3275	analysis of vestibular responses indicated  on average  a linear relationship between stimulus magnitude and response magnitude  ie  doubling the stimulus magnitude resulted in twice the response magnitude  
class9	3275	meniere s patients did not yield results significantly different  although they were more variable  from those of the normal subjects  
class9	3275	the vestibular responses of patients with auditory recruitment did not differ systematically from those of patients without auditory recruitment  
class9	3275	we conclude that vestibular recruitment  if it exists in patients with meniere s disease  is not demonstrated by sinusoidal rotational testing  
class9	3276	identification and characterization of middle ear vascular leakage sites in experimental otitis media  
class9	3276	the site of leakage in middle ear vessels was determined and characterized in experimental otitis media in rats  
class9	3276	middle ear effusion was induced by intravenous administration or local application in the tympanic bulla of substance p  sp   acetylcholine  and histamine  
class9	3276	in another experiment  a 14 degrees c airstream was blown into the external auditory canal  
class9	3276	colloidal carbon was used to trace leakage sites at the light and electron microscopic levels  
class9	3276	all mediators tested and the 14 degrees c airstream resulted in an increased number of leaking vessels in the pars flaccida and the middle ear mucosa  
class9	3276	the leakage sites were restricted to capillaries and postcapillary venules  
class9	3276	increased numbers of degranulated pars flaccida mast cells were observed for sp only  
class9	3276	interendothelial gaps formed in leakage vessels after administration of mediators and stimulation of the external auditory canal with a 14 degrees c airstream  
class9	3276	also  cytoplasmic vesicle like structures within the endothelial cells increased in number following sp and histamine treatment  suggesting that an increased permeability in experimental otitis media does not occur exclusively through interendothelial gaps  
class9	3277	histopathologic study of otitis media in individuals with head and neck tumors  
class9	3277	five temporal bones  each including the eustachian tube  were obtained from five adults with advanced malignant tumors of the head and neck  
class9	3277	the specimens were from the side on which the tumor had occurred  
class9	3277	otitis media had been detected clinically in two cases  and was detected histopathologically in the other three  
class9	3277	we discuss the possibility that otitis media might have been caused by tumor invasion of the paratubal area  by postoperative inflammation in the nasopharynx  or by an inflammatory reaction of tubal structures to radiotherapy  or that these conditions may have coexisted  
class9	3278	nasal lymphoma  a retrospective analysis of 60 cases  
class9	3278	sixty cases of nasal lymphomas were reviewed  
class9	3278	there were 42 men and 18 women  
class9	3278	the median age was 49 years  
class9	3278	the histologic types were low grade in four cases  intermediate grade in 33  high grade in seven  and unclassifiable in 16  
class9	3278	thirteen cases had features of polymorphic reticulosis  
class9	3278	the immunophenotype was available in 18 cases and a majority of 67  of them were t cell  
class9	3278	forty one of them  68   had clinically localized  stage i and ii  disease which often spread locally to neighboring tissues and they presented predominantly with nasal symptoms  
class9	3278	nasal lymphoma appeared to carry a poor prognosis  
class9	3278	although our patients with clinically localized disease had significantly better prognosis than those with advanced disease  the 5 year survival of stage i and ii patients was only 55   
class9	3278	chemotherapy did not appear to be more effective than radiotherapy alone in preventing relapses but the patient number was too small to allow a firm conclusion to be made  
class9	3278	patients with advanced disease had even poorer prognosis with a 5 year survival of only 17   
class9	3278	innovative therapy has to be developed for these patients  
class9	3279	osteosarcoma of the maxilla in hong kong chinese postirradiation for nasopharyngeal carcinoma  a report of four cases  
class9	3279	postirradiation osteosarcoma of the maxilla was seen in four hong kong chinese patients treated for nasopharyngeal carcinoma  
class9	3279	these cases represent four of 42  9   cases of osteosarcoma at all sites in this institution during the period 1979 to 1989  when more than 1000 patients were treated with radiotherapy for nasopharyngeal carcinoma  
class9	3279	the latent periods varied from 8 to 11 years from completion of radiotherapy treatment to development of osteosarcoma  
class9	3279	the radiation dosage varied from 6000 to 6280 cgy in three of the patients  
class9	3279	these cases fit the criteria for diagnosis of postirradiation sarcomas  
class9	3279	maxillary osteosarcomas after irradiation for nasopharyngeal carcinoma do not appear to have been described  
class9	3279	the very high incidence of nasopharyngeal carcinoma  for which radiotherapy is the treatment of choice  in hong kong chinese would make the occurrence of such tumors more likely in hong kong  although the small risk does not contraindicate the use of radiation in the treatment of nasopharyngeal carcinoma in view of its well documented efficacy  
class9	3280	possible involvement of the retinoblastoma gene in undifferentiated sinonasal carcinoma  
class9	3280	retinoblastoma tumor formation is initiated by the loss of function of both alleles of the rb 1 gene on chromosome 13  
class9	3280	patients with the hereditary form of retinoblastoma carry a germ line mutation at one of the two homologous gene loci in all cells and have an increased risk for nonocular tumors  mainly osteosarcoma and other mesenchymal tumors  in later life  
class9	3280	the authors studied a 38 year old patient with sinonasal undifferentiated carcinoma  snuc  who had been treated for bilateral retinoblastoma by enucleation  left eye  and irradiation  right eye   respectively  
class9	3280	using molecular probes for the rb 1 gene and other loci on chromosome 13  the authors detected a deletion at the rb 1 locus in metastatic snuc cells that was not present in normal tissue  
class9	3280	these findings indicate that somatic mutations at rb 1 locus may be involved in the formation or progression of ectodermal tumors  
class9	3281	informed consent in head and neck surgery  
class9	3281	informed consent is the fastest growing problem in the medical negligence debate  
class9	3281	it was highlighted recently in the united kingdom in the sidaway case  
class9	3281	informed consent comprises the advice you would give the patient  the consequences of not taking your advice  the specific risks of the surgery or treatment you have in mind  and the risks of surgery in general  
class9	3281	in an attempt to identify what the present practice in otolaryngology was  a postal survey was carried out of the members of the scottish and north of england otolaryngological societies  
class9	3282	hearing aids for high frequency hearing loss  
class9	3282	this cross over study compares the relative benefits of a standard nhs contracted hearing aid with a high frequency emphasis commercial aid in subjects with high frequency hearing loss  
class9	3282	disability questionnaires and free field speech in noise  faaf ii  tests were used to assess subjects unaided and after 6 weeks of wearing each aid  
class9	3282	total faaf ii test scores showed no significant difference with either aid  but analysis of frequency specific subscores demonstrated less use of low frequency information when using the high frequency emphasis aid  
class9	3282	overall questionnaire responses relating to conversation showed more benefit with the high frequency emphasis aid  
class9	3282	subjects generally preferred this aid  possibly due to less low tone gain than the standard nhs aid  
class9	3283	analgesia and removal of nasal packing  
class9	3283	we present a prospective controlled trial  comparing methods of analgesia for the relief of discomfort on removing nasal packing  including a general discussion on the considerations for  and methods of  nasal tamponade  
class9	3283	on the basis that nasal packing is likely to continue to be used frequently  nitrous oxide  as entonox  is advocated as a safe and relatively cheap means of pain relief with a statistically significant advantage over papaveretum  
class9	3284	sensorineural hearing loss in bullous myringitis  a prospective study of eighteen patients  
class9	3284	eighteen patients were seen over a period of 3 years  
class9	3284	twenty of their ears were diagnosed as having bullous myringitis  
class9	3284	pure tone audiograms and stapedial reflexes were performed within 48 h of referral  
class9	3284	six ears demonstrated sensorineural hearing loss  7 ears mixed loss and 4 conductive loss  
class9	3284	recovery of sensorineural hearing loss complete in 8 out of 13 ears  
class9	3284	stapedial reflexes were elicited in 5 patients and all showed recruitment  
class9	3284	the findings of this study confirms the fact that sensorineural hearing loss is more common in bullous myringitis than previously thought and that it is temporary in many cases  
class9	3284	the stapedial reflex results suggest that the site of the lesion is in the cochlea  
class9	3285	chest infection following head and neck surgery  a pilot study  
class9	3285	this paper reports the results of a pilot study which examined factors associated with chest infection following head and neck surgery  
class9	3285	the overall rate of chest infection was 11   but was 20  in those patients having a tracheotomy  
class9	3285	no infection developed in patients with an intact airway  
class9	3285	other factors which emerged as possibly important were the duration of surgery and heavy regular alcohol intake  
class9	3285	we recommend that prophylactic antibiotics be continued for at least 48 h in patients requiring a tracheotomy as part of their head and neck surgery  
class9	3285	this is against the trend of shorter antibiotic regimens recommended for prevention of wound infections  
class9	3286	the presence of human papillomavirus  hpv  in solitary adult laryngeal papillomas demonstrated by in situ dna hybridization with sulphonated probes  
class9	3286	human papilloma virus  hpv  types 6 and 11 have been repeatedly demonstrated in multiple laryngeal papillomas  and there is little doubt that these lesions are caused by hpv  
class9	3286	it has been clearly demonstrated in recent reports that the clinical course of solitary adult onset laryngeal papillomas is entirely different from that of multiple papillomas of juvenile as well as of adult onset  
class9	3286	we here report the presence of hpv types 6 and 11 in 19 out of 20 solitary papillomas from 16 patients  while hpv types 16 and 18 were totally absent  
class9	3286	we conclude that the milder clinical course in such patients is most likely to be due to host factors  rather than to viral factors  
class9	3287	urinary n tau methylimidazole acetic acid excretion in respiratory disease  
class9	3287	n tau methylimidazole acetic acid  n tau miaa  is the principal urinary metabolite of histamine  
class9	3287	the basal urinary excretion rate of n tau miaa was determined as 0 117     0 008  se  mg h  with a renal clearance for n tau miaa of 273     27 ml min implying active secretion  
class9	3287	after subpharmacological infusion of histamine  50 ng kg 1 min 1 over 2 h  in five volunteers that increased plasma histamine from 0 28     0 04 to 0 71     0 15 ng ml  urinary excretion of n tau miaa over 8 h was increased by less than 17  compared with a control saline infusion  
class9	3287	urinary n tau miaa excretion in normal controls  273     14 micrograms mmol creatinine  was similar to that observed in patients with severe acute asthma  253     22 micrograms mmol   antigen induced bronchoconstriction  269     21 micrograms mmol   seasonal allergic rhinitis  304     31 micrograms mmol   and clinically stable bronchiectasis  270     22 micrograms mmol   
class9	3287	in contrast  large increases in metabolite excretion  greater than 7 000 micrograms mmol creatinine  were observed in a patient with systemic mastocytosis where very high plasma histamine levels were recorded  greater than 500 ng ml  and marked systemic hemodynamic effects occurred  
class9	3287	we conclude that urinary n tau miaa will only be increased in pathologies where sustained hyperhistaminemia occurs and that increased local histamine production in the lung or the upper airway does not cause a measurable change in the basal urinary excretion of this metabolite  
class9	3288	vasopressin and oxytocin responses to illusory self motion and nausea in man  
class9	3288	vasopressin and oxytocin are nonapeptides secreted from the neurohypophysis  increases in vasopressin are associated with nausea and vomiting in some  but not all  species  
class9	3288	our aim was to determine whether plasma vasopressin and oxytocin levels were altered in healthy volunteers who did or did not develop nausea during vection  an optokinetic stimulus which produces the illusion of self motion  
class9	3288	vection was produced by rotating a drum with an inner surface of black and white vertical stripes around the seated stationary subject  
class9	3288	gastric myoelectrical activity was recorded continuously throughout the experiment with electrodes positioned on the abdominal surface  
class9	3288	plasma samples were obtained before vection and after drum rotation stopped when nausea and tachygastria were present  
class9	3288	vasopressin and oxytocin were extracted from plasma and quantified by ria  
class9	3288	during vection six subjects reported nausea and developed gastric dysrhythmias  six other subjects had no nausea and remained in normal 3 cpm myoelectrical rhythms  
class9	3288	vasopressin and oxytocin values before vection were similar in each group of subjects  
class9	3288	one minute after vection stopped  plasma vasopressin levels were significantly greater  p less than 0 05  in subjects experiencing nausea and tachygastrias  35 4     26 7 pmol l  than in those without symptoms  2 7     0 47 pmol l   
class9	3288	oxytocin levels were unchanged by either vection or nausea  
class9	3288	it is concluded that 1  vasopressin  not oxytocin  neurons in the magnocellular neurohypophyseal system are activated during vection induced nausea and gastric dysrhythmias  and 2  illusory self motion may be used safely to study the neuroendocrine responses to brain gut interactions and nausea in man  
class9	3289	sensitivity of digoxigenin and biotin labelled probes for detection of human papillomavirus by in situ hybridisation  
class9	3289	the sensitivity of digoxigenin and biotin labelled dna probes for the detection of human papillomavirus  hpv  by dot blotting and in situ hybridisation was compared in tissues from cervical  laryngeal  and anogenital neoplasia  
class9	3289	probes were either labelled with digoxigenin by the random primer technique and detected with anti digoxigenin antibody  or labelled with biotin by nick translation and detected with streptavidin  both methods having a common final visualisation procedure using alkaline phosphatase  
class9	3289	digoxigenin labelled probes proved two to 10 fold more sensitive by quantitative dot blotting and four fold more sensitive in detecting hpv 16 dna in a series of 31 anal carcinomas  compared with biotinylated probes  
class9	3289	the digoxigenin method also produced less non specific background staining of tissue sections than biotin labelled probes  
class9	3289	it is concluded that digoxigenin dna labelling and detection provides a simple  reliable  and efficient alternative to the use of biotin or radioactive isotopes for the detection of hpv dna by in situ hybridisation  
class9	3289	digoxigenin labelled probes also offer the possibility of double labelling in situ hybridisation procedures when used with biotin labelled probes to provide simultaneous identification of different dna sequences  
class9	3290	different prevalence and degree of nonspecific bronchial hyperreactivity between seasonal and perennial rhinitis  
class9	3290	from the patients observed at our respiratory allergology service  we selected patients with rhinitis only  without any past or present respiratory symptoms  for our study  
class9	3290	all these patients had normal pulmonary function  were administered carbachol or methacholine bronchial challenges  and had one or more skin reactions to perennial or seasonal allergens  
class9	3290	patients were allocated to three groups  group a  patients with seasonal rhinitis who were administered nonspecific challenges out of season  group b  patients with seasonal rhinitis tested during the season  and group c  patients with perennial rhinitis  
class9	3290	the three groups were divided into subgroups according to the duration in years of rhinitis and to the degree of nonspecific bronchial responsiveness  
class9	3290	the distribution into four groups of reactivity  arbitrarily defined as normal and mildly  moderately  and severely increased reactivity  was as follows  group a  124  21  30  22  group b  75  15  7  and 21  and group c  69  17  39  and 72  respectively  
class9	3290	the patients of group c  perennial rhinitis  demonstrated a distribution significantly  p less than 0 001  different from subjects with seasonal rhinitis  both group a and group b  
class9	3290	our results are consistent with the hypothesis that perennial rhinitis is much more important than seasonal rhinitis as a risk factor for developing nonspecific bronchial hyperresponsiveness  
class9	3291	the role of histamine in allergic diseases  
class9	3291	histamine  which is stored mainly in mast cells and basophils  is a prominent contributor to allergic disease  
class9	3291	elevations in plasma or tissue histamine levels have been noted during anaphylaxis and experimental allergic responses of the skin  nose  and airways  
class9	3291	of the four cardinal signs of asthma  bronchospasm  edema  inflammation  and mucus secretion   histamine is capable of mediating the first two through its h1 receptor and mucus secretion through its h2 receptor  
class9	3291	of the five cardinal signs of allergic rhinitis  pruritus  mucosal edema  sneezing  mucus secretion  and late phase inflammatory reactions   histamine is capable of mediating the first three through its h1 receptor  
class9	3291	in the nose  mucus secretion can be reflexively mediated by h1 and possibly also by h2 receptors  
class9	3291	in the skin the cardinal features of urticaria  vasodilation  vascular permeability  and pruritus  can be mediated by stimulation of the h1 receptor  
class9	3291	in anaphylaxis histamine h1 receptor stimulation can mediate vascular permeability  smooth muscle contraction  and tachycardia  whereas h2 receptor stimulation can mediate mucus secretion  
class9	3291	stimulation of both receptors can mediate vasodilation and reduce peripheral vascular resistance  
class9	3291	thus although histamine is only one of many mediators of allergic disease  it plays a primary role in allergic rhinitis  urticaria  anaphylaxis  and to a lesser degree  asthma  
class9	3292	the role of histamine in allergic rhinitis  
class9	3292	studies using nasal provocation followed by nasal lavage have demonstrated that histamine plays an important role in the mediation of allergic rhinitis but not of rhinovirus infection  
class9	3292	the response to antigen challenge is often biphasic  
class9	3292	during the early response  increases in histamine levels appear to be associated with activation of mast cells  
class9	3292	in a subset of persons who exhibit an additional late response  however  the rise in histamine is concomitant with an increase in the number of basophils  
class9	3292	further evidence of the role of histamine in allergic rhinitis has emerged from nasal provocation experiments involving pretreatment with a variety of drugs known to antagonize or affect release of histamine  
class9	3292	nasal provocation with histamine causes sneezing  itching  rhinorrhea  and nasal congestion  
class9	3292	most h1 antihistamines have been found to inhibit sneezing and to lessen the increase in vascular permeability  but they do not affect histamine release  
class9	3292	the h1 antihistamine terfenadine  however  inhibits histamine release during the early response  effects on late response remain unknown  
class9	3292	prednisone decreases histamine levels during the late  but not the early  response  
class9	3292	one week pretreatment with topical steroids  on the other hand  affects both the early and the late response  
class9	3293	the role of antihistamines in otitis  
class9	3293	chronic and recurrent otitis media can manifest as otitis media with effusion  
class9	3293	both infection and eustachian tube obstruction  eto  have been found to play an important role in its pathogenesis  
class9	3293	eto can be demonstrated during both early  and late phase reactions in patients with allergic rhinitis after intranasal challenge with an allergen  
class9	3293	intranasal challenge with either histamine or prostaglandin d2 also provokes eto  with the latter mediator perhaps more potent than the former  
class9	3293	middle ear effusions from patients with chronic or recurrent otitis media have been found to contain dramatically increased concentrations of histamine relative to the concentrations in their plasma  
class9	3293	the development of nasal and eustachian tube obstruction in allergic rhinitis patients has been prevented by pretreatment with an antihistamine plus decongestant before intranasal challenge with pollen allergen  
class9	3293	investigations are currently under way to assess the effect of antihistamine pretreatment on nasal and eustachian tube obstruction in patients undergoing intranasal histamine challenge  
class9	3294	immunotherapy abrogates the generation of eosinophil and neutrophil chemotactic activity during pollen season  
class9	3294	in a group of 40 birch pollen allergic patients with a history of rhinoconjunctivitis and wheezing during the pollen season  20 were immunotherapy  it  treated preseasonally with birch pollen extract  pharmacia  uppsala  sweden   
class9	3294	blood samples for determination of the levels of heat labile eosinophil chemotactic activity  hl eca   heat labile neutrophil chemotactic activity  hl nca   and heat stable neutrophil chemotactic activity were collected before the season  at the beginning of the study  at the start of the season  at the peak  at the end  and after the birch pollen season  
class9	3294	the symptoms from rhinoconjunctivitis and airways  peak expiratory flow  and use of medication were recorded throughout the season  
class9	3294	significant increases of hl eca and hl nca were observed in untreated compared with it treated patients at the start of the season  p less than 0 0001 for both activities  and at the peak of the birch pollen season  p less than 0 0005 and p less than 0 01  respectively   
class9	3294	at the end of the season  hl eca levels were not significantly different between the patient groups  whereas hl nca levels were still higher in untreated patients  p less than 0 005   
class9	3294	we conclude that it completely abrogates the generation of hl eca and hl nca during a pollen season  
class9	3295	unterberger stepping test  a useful indicator of peripheral vestibular dysfunction  
class9	3295	deviation of gait in a stepping test has been proposed as a useful indicator of peripheral labyrinthine dysfunction  
class9	3295	a prospective study of 26 patients suspected of having uncompensated peripheral labyrinthine dysfunction and 49 normal patients with normal labyrinthine dysfunction showed no significant difference in performance of the unterberger stepping test between patients with electronystagmographically significant canal paresis and those with normal vestibular function  
class9	3296	ligmaject system for local anaesthesia in otology  
class9	3296	the ligmaject syringe for local anaesthetic injection incorporates a pistol grip handle and a ratchet system designed to inject a very tiny aliquot of anaesthetic per  click   
class9	3296	this instrument was used to provide local anaesthesia for 22 otological procedures on consenting adults  
class9	3296	the performance of the ligmaject syringe compared favourably with that of the conventional dental syringe in terms of patient acceptability and user convenience  
class9	3297	comparison of the goode t tube with the armstrong tube in children with chronic otitis media with effusion  
class9	3297	treatment of otitis media with effusion is focused on reaeration of the middle ear cavity  
class9	3297	in achieving long term aeration  the insertion of ventilation tubes that have a long duration of stay can be beneficial  
class9	3297	the results are presented of a trial in which the goode t tube was compared with the armstrong tube  
class9	3297	fifteen children were treated between 1981 and 1986 with a t tube in one ear and a conventional tube in the other  
class9	3297	the results are different with regard to duration of stay in the tympanic membrane  
class9	3297	re insertions were necessary in 47 per cent in the armstrong group and in 20 per cent in the t tube group  
class9	3297	otorrhoea occurred in 20 per cent of the armstrong and 13 per cent of the t tube intubated ears  
class9	3297	a persistent perforation was present in 6 per cent of the ears in both groups  
class9	3297	it is concluded that the goode t tube is indicated primarily in cases when long term ventilation is needed  
class9	3298	long term results of revision endolymphatic sac surgery  
class9	3298	the results of revision endolymphatic sac surgery on 30 patients with unilateral meniere s disease are presented  
class9	3298	good control is achieved in 73 3 per cent of cases at six months  falling to 56 7 per cent at one year and only 33 3 per cent by four years  
class9	3298	the long term results are disappointing but are more favourable if the initial surgery was successful  if the hearing remains fluctuant and improves on glycerol dehydration prior to the revision procedure and also if the sac is intubated  
class9	3298	the current place of endolymphatic sac surgery is discussed and revision surgery only recommended for carefully selected cases  
class9	3299	comparison of electro and chemical cautery in the treatment of anterior epistaxis  
class9	3299	in the ent department of the royal victoria hospital  belfast  the impression  supported only by anecdotes  was that electro cautery was superior to chemical cautery in the treatment of simple anterior epistaxis  
class9	3299	since no evaluation of the relative merits of electro and chemical cautery has been reported  a prospective randomized study was conducted to assess the effectiveness of electro cautery and cautery with silver nitrate  
class9	3299	the results of the study showed that there was no statistically significant difference between the two methods in either controlling the epistaxis or in the incidence of complications  
class9	3299	it is concluded that since cautery with a silver nitrate tipped applicator is simpler  and of equal effectiveness  it would appear to be the treatment of choice for simple anterior epistaxis  
class9	3300	role of endoscopy in diagnosing scleroma in its uncommon sites  
class9	3300	eighty cases suffering from rhinoscleroma were studied  
class9	3300	suspected cases were examined by sinoscopy  nasopharyngoscopy and bronchoscopy for detection of secondary involvement in these sites  
class9	3300	antroscleroma  salpingoscleroma and tracheo bronchoscleroma have been found in a relatively high percentage of cases  
class9	3300	the role of endoscopy in early diagnosis  initial symptomatic treatment and follow up cases is discussed  
class9	3301	smoking cessation in chronic reinke s oedema  
class9	3301	in evaluating the long term results of surgical treatment of reinke s oedema  there has been found to be a high incidence of recurrence  
class9	3301	the recurrence rate is significantly lower amongst those patients who gave up smoking after treatment  
class9	3301	a group of patients with chronic reinke s oedema were followed for six months  
class9	3301	maximum efforts were made to help the patients to stop smoking  
class9	3301	twenty nine patients entered the study  but only eight of them  28 per cent  refrained from smoking  all were women  39 70 years  and all experienced reduced discomfort  although none of the voices were restored to normal  
class9	3301	diffuse laryngitis disappeared completely  but the oedema did not disappear entirely in any patient  
class9	3301	before treatment of chronic reinke s oedema patients must be well advised and informed  and if surgery is decided upon  they must be urged most strongly to stop smoking  if they wish to enhance the possibility of satisfactory long term results  
class9	3302	second primary tumours of the larynx following bronchial carcinoma  
class9	3302	the occurrence of multiple primary malignancies in patients with laryngeal cancer is well known  
class9	3302	the possibility that lung cancer patients may be at risk of subsequent laryngeal cancer is less well recognized  
class9	3302	the possibility of laryngeal cancer developing later has implications for the follow up of lung cancer patients  
class9	3302	three cases of subsequent laryngeal primary cancer occurring in survivors of bronchial cancer are presented and the implications are discussed  
class9	3303	endolymphatic hydrops precipitated by haemodialysis  
class9	3303	we report a case of endolymphatic hydrops preceded by haemodialysis in the contralateral ear of a patient with known meniere s disease  and discuss the possible mechanism  
class9	3303	it is suggested that the sudden decrease of plasma osmolality during haemodialysis acts as a reverse glycerol test  
class9	3303	the audiometric and electrophysiological recordings pre  and post dialysis and the induction of the meniere s triad of symptoms during dialysis  were strongly indicative of the presence of endolymphatic hydrops  
class9	3304	epistaxis as an unusual presentation of an antrochoanal polyp  
class9	3304	antrochoanal polyps rarely present with severe epistaxis  
class9	3304	we present the case of a young male patient who presented in such a manner  thus leading to the suspicion of an angiofibroma as the underlying pathology  
class9	3304	the radiological investigations  treatment and pathological features are discussed  
class9	3305	infectious mononucleosis complicated by lingual tonsillitis  
class9	3305	although upper airway obstruction and superimposed infection are well known complications of infectious mononucleosis  lingual tonsillitis in this context has not been mentioned in the literature  
class9	3305	we describe a case of acute bacterial lingual tonsillitis with airway obstruction complicating infectious mononucleosis  
class9	3305	the role of the base of tongue region in the pathophysiology of infectious mononucleosis is discussed  
class9	3306	acute upper airway obstruction following teflon injection of a vocal cord  the value of nebulized adrenaline and a helium oxygen mixture in its management 
class9	3306	a 67 year old man presented with a 45 year history of a week voice  
class9	3306	this was result of polio which had left him with a right vocal cord palsy  
class9	3306	the patient underwent a teflon injection of the right vocal cord under general anaesthesia to improve the quality of his voice  
class9	3306	in the immediate post operative period  he suffered acute upper airway obstruction  
class9	3306	the problem of acute upper airway obstruction following teflon injection is considered and its management with nebulized adrenaline and a helium oxygen mixture is discussed  
class9	3307	adenoid cystic carcinoma  a comparison between ct  mr and gd mr imaging techniques  
class9	3307	nasopharyngeal carcinoma continues to be a difficult diagnostic problem in many patients  
class9	3307	it is well known that amongst the many and varied manifestations of this disease  a unilateral middle ear effusion in an adult should be regarded with suspicion  
class9	3307	such a case in a 42 year old patient is presented  
class9	3307	in this case the benefit of gadolinium enhanced magnetic resonance imaging over and above computerized tomography is demonstrated  
class9	3308	dysequilibrium and otitis media with effusion  what is the association  
class9	3308	an association between non suppurative otitis media  nsom  and symptoms of dysequilibrium has been observed but not previously quantified in children  gates  1980  busis  1983  blayney and coleman  1984   
class9	3308	this study compared the incidence of balance related problems in 154 children with surgically proven glue ear and 51 children with normal ear function  
class9	3308	symptoms ranging from true vertigo to mild ataxia were discovered in 22 per cent of the children with nsom but in none of those within the control group  p less than 0 001   
class9	3308	periods of dysequilibrium were associated with episodes of otalgia in 64 per cent of the children but were not increased in those with unilateral compared to those with bilateral effusions  
class9	3308	complete resolution of symptoms occurred in 85 per cent of children following the insertion of grommets  
class9	3308	a history of balance disturbance should be actively sought in all children with otitis media with effusion  and when present  provides a strong indication for early operative intervention  
class9	3309	mucosal thickening on sinus x rays and its significance  
class9	3309	mucosal thickening is commonly seen on x rays of the paranasal sinuses taken in the ent department  
class9	3309	this sometimes leads to a sinus washout  which is clear  even though the x rays were strongly suggestive of disease  
class9	3309	this paper examines the prevalence of sinus x ray anomalies in a general population  having facial x rays for conditions other than possible sinus disease  
class9	3309	the study suggests that up to 50 per cent of the so called normal population may have sinus x ray appearances consistent with sinus disease  and this may partly explain clear returns on sinus washout  
class9	3310	multiple primary malignancies in patients with malignant tumours of the nasal cavities and paranasal sinuses  
class9	3310	the incidence of multiple primary malignancies  mpm  was analysed in 1297 patients with malignant tumours of the nasal cavities and paranasal sinuses  
class9	3310	the patients were followed for a minimum of six years or until death  
class9	3310	the incidence of mpm was 3 4 per cent  44 1297  which is lower in patients with malignant tumours of other regions in the upper aerodigestive tract  
class9	3310	five of the 44 patients had second malignancies within previously irradiated areas  
class9	3310	there was a difference between the proportion of histologies occurring in irradiated tissues compared with the overall 1297 patients  
class9	3310	this finding suggests that radiotherapy may induce a second cancer  
class9	3311	radiation therapy of laryngeal cancer  a twenty year experience  
class9	3311	this paper reviews a 20 year experience of radiation treatment of 286 laryngeal cancers and presents results with a minimum five year follow up  
class9	3311	all cases presented had glottic or supraglottic squamous cell carcinomas with no clinical evidence of nodal metastasis  
class9	3311	a policy of primary radiotherapy with surgery for salvage of treatment failures  produced control of primary disease and prevention of metastases superior to most other regimes documented in the literature  
class9	3312	effect of microwave and ionizing radiation in patients with recurrent laryngeal carcinoma  
class9	3312	this study describes the treatment and survival of 54 patients with gross recurrent laryngeal carcinoma after radiotherapy  
class9	3312	twenty six patients were treated with local ultra high frequency hyperthermia in combination with radiotherapy and chemotherapy  hrch   
class9	3312	twenty eight control patients were treated with radiotherapy and chemotherapy  rch   
class9	3312	eight patients  33 per cent  in hrch showed a three year survival but no patient in the rch group  
class9	3312	at two years 18 patients  75 per cent  in hrch and two  7 per cent  in rch survived  
class9	3313	another hazard of ear syringing  malignant external otitis  
class9	3313	a case of malignant external otitis is presented  
class9	3313	this occurred in a healthy 72 year old non diabetic  non immuno compromised man after ear syringing  
class9	3313	the infection was treated with oral ciprofloxacin for eight weeks with complete resolution  
class9	3314	laryngeal metastasis from colonic adenocarcinoma  
class9	3314	metastases to the larynx from distant primaries are very rare  
class9	3314	usually the secondary lesion comes from an hypernephroma or malignant melanoma  
class9	3314	a case of metastatic laryngeal tumour from a colonic adenocarcinoma  occurring in a 59 year old woman  is presented and the routes for laryngeal spread are discussed  
class9	3314	the poor survival rate of these patients justified only conservative surgery  
class9	3315	intralaryngotracheal thyroid  
class9	3315	a case of intralaryngotracheal thyroid in a 57 year old man is presented  
class9	3315	the treatment modalities are considered and the previous literature is reviewed  
class9	3316	efficacy and morbidity of partial laryngectomy and postoperative radiation therapy  
class9	3316	in recent years  we have seen increasing use of partial laryngectomies for larger lesions that were previously treated by total laryngectomy  
class9	3316	the resultant closer margins have made postoperative radiation therapy an important adjuvant treatment to conservation laryngeal surgery  
class9	3316	we review the university of california  los angeles  experience with combination partial laryngectomy and postoperative radiation therapy between 1973 and 1987 for treatment of carcinoma of the larynx  
class9	3316	twenty four such patients who underwent partial laryngectomies and postoperative radiation therapy are examined  
class9	3316	techniques of treatment  complications  and the functional ability of the remaining larynx are discussed  
class9	3316	the locoregional control rate at 5 years was 80   
class9	3316	risk factors associated with an increased risk of recurrence were positive margins  vascular invasion  and extranodal spread  
class9	3316	there were no major problems with postoperative wound healing or airway management during the radiation treatment  
class9	3316	vocal and swallowing function were well preserved in most cases  
class9	3316	we conclude that combination partial laryngectomy and radiation therapy permits preservation of laryngeal function without serious complications  and therefore is an effective treatment for selected patients with carcinoma of the larynx  
class9	3317	computed tomography staging of the paranasal sinuses in chronic hyperplastic rhinosinusitis  
class9	3317	in this study  the computed tomography scans of 100 patients with chronic hyperplastic rhinosinusitis were reviewed to establish a clinical staging system  
class9	3317	fourteen percent of the patients were classified as stage i  single focus disease   36  as stage ii  multifocal disease responsive to conservative therapy   32  as stage iii  diffuse disease partially responsive to medication   and 16  as stage iv  diffuse disease associated with bony changes and poorly responsive to conservative treatment   
class9	3317	the incidence of recurrent or persistent disease ranged from 13  for stage ii to 30  for stage iv  
class9	3317	stage i and iii patients had 13  and 18  recurrence rates  respectively  
class9	3317	computed tomography staging is shown to be useful in outlining operative strategies and is a reliable prognosticator of the disease process  
class9	3318	intraoral extramaxillary sinus approach for ligation of the maxillary artery  an anatomic study with clinical correlates  
class9	3318	surgical control of severe epistaxis is usually reserved for cases refractory to more conservative techniques  
class9	3318	we present our experience with intraoral ligation of the maxillary artery as it courses through the buccal fat pad before it enters the pterygopalatine fossa and branches posterior to the maxilla  
class9	3318	this technique has been found useful in the control of nasal hemorrhage as well as an adjunct to other surgical procedures  such as removal of benign and malignant neoplasms involving the maxilla and paranasal sinuses  
class9	3318	this technique was used for ligation of the maxillary artery in 20 patients  
class9	3318	the artery was readily identified in some cases  but required more extensive dissection in others  therefore  an anatomic study in 18 preserved and fresh cadaver specimens was undertaken to investigate the variability of the maxillary artery in the region of the buccal fat pad  
class9	3318	there appeared to be significant variation in the distance from the buccal mucosal incision site  as well as variation in the relationship to the pterygoid muscles  
class9	3318	this relationship to the pterygoids explains the occasional difficulty in locating the artery for ligation  
class9	3318	this technique represents a reasonable alternative to the more traditional transantral approach to ligation of the maxillary artery  as long as the surgeon understands the anatomy of the region  its variations  and where the artery may be located if not immediately apparent  
class9	3318	no major complications have been experienced  
class9	3319	vocal cord paralysis in children  
class9	3319	bilateral vocal cord paralysis is a common cause of stridor in infants and children  
class9	3319	there are significant differences in this entity between children and adults with regard to etiology  diagnosis  management  and outcome  
class9	3319	a review of 10 years  experience at children s hospital of philadelphia identified 51 children seen with the diagnosis of vocal cord paralysis  
class9	3319	these cases were evaluated with respect to etiology of paralysis  whether unilateral or bilateral  delay in diagnosis  need for tracheotomy  abnormality of voice  surgical treatment  and outcome  
class9	3319	guidelines for management for a child with vocal cord paralysis are presented with emphasis on flexible endoscopic evaluation and conservative management  
class9	3320	myogenic influences on the electrical auditory brainstem response  eabr  in humans  
class9	3320	two cases demonstrating the effects of myogenic artifact on the electrical auditory brainstem response  eabr  when using a promontory stimulation site are presented  
class9	3320	intensity response functions were obtained in the unparalyzed condition  then repeated after infusion of a neuromuscular paralyzing agent  
class9	3320	in both cases  the myogenic response was observed at lower stimulus intensities than the eabr components  
class9	3320	as intensity increased  the myogenic responses grew at extremely rapid rates and made any subsequent identification of auditory responses virtually impossible  
class9	3320	to alleviate the adverse influence of myogenic components  general anesthesia and a paralyzing agent must be incorporated into the test protocol when acquiring the eabr using a promontory site of stimulation  
class9	3321	evaluation of neonatal subglottic stenosis  a 3 year prospective study  
class9	3321	subglottic stenosis is the most common cause of chronic airway obstruction  
class9	3321	it results in prolonged tracheal cannulation of infants and children  
class9	3321	following the widespread adoption over the past 20 years of prolonged intubation for respiratory support in neonates  the incidence of acquired subglottic stenosis increased dramatically  
class9	3321	on january 1  1987  we began a 3 year prospective study to delineate potential etiologic factors involved in the development of subglottic stenosis in neonates  
class9	3321	the present study analyzes data from 289 infants  
class9	3321	relationships between birth weight  gestational age  endotracheal tube size  duration of intubation and ventilation  number and difficulty of intubations  and the subsequent need for medical and surgical therapy are discussed  
class9	3321	whole organ larynges from autopsy specimens provide histological correlation  
class9	3322	the efficacy of comprehensive neck dissection with or without postoperative radiotherapy in nodal metastases of squamous cell carcinoma of the upper respiratory and digestive tracts  
class9	3322	neck recurrence free curves corrected for local recurrence were compared for 494 patients who underwent 565 comprehensive neck dissections  
class9	3322	in 42 dissections  no radicality could be obtained  
class9	3322	of the 523 histologically radical dissections  examination revealed tumor in 352 cases  
class9	3322	patients in whom three or more positive nodes or extranodal spread in one or more nodes were found received postoperative radiotherapy  
class9	3322	in the histologically n0 group  the incidence of neck recurrence after 5 years was 3   in the n  group as a whole  it was 10   
class9	3322	analysis of the influence of extranodal spread and the number of positive nodes showed that the group with one or two positive nodes without extranodal spread  that did not receive postoperative radiotherapy  did not statistically differ from the other groups  
class9	3322	this suggests that the results of the group with one or two positive nodes without extranodal spread can be improved by postoperative radiotherapy  
class9	3323	esthesioneuroblastoma  surgical treatment without radiation  
class9	3323	this study compares the treatment of two groups of patients diagnosed with esthesioneuroblastoma limited to the nasal cavity without evidence of cribriform plate erosion  
class9	3323	five patients were treated with radiation and extracranial excision  and eight patients were treated by craniofacial resection only  
class9	3323	the incidences of local recurrence were 60  and 12   respectively  
class9	3323	the paper also presents a new staging classification for these tumors  
class9	3324	artificial restoration of voice  i  experiments in phonatory control of the reinnervated canine larynx  
class9	3324	coordinated electronic pacing of implanted nerve pedicles into paralyzed laryngeal muscles has allowed selective dynamic control of abduction  adduction  and elongation of the vocal cords  
class9	3324	modifications of the original circuit in a cervical muscle model has added fine tuning to basic  all or none  pacing  
class9	3324	rehabilitation of phonation illustrated the sophisticated nature of voice and the need for restoration of fine tuning  
class9	3324	five mongrel dogs received nerve muscle pedicles into the thyroarytenoideus  cricothyroideus  and posterior cricothyroideus after denervation of one hemilarynx  
class9	3324	following appropriate reinnervation time  pedicles and intact recurrent laryngeal nerves were injected with currents of variable amplitudes and pulse widths to achieve graded vocal fold control while air was blown intratracheally towards the glottic chink  
class9	3324	videoscopic and spectral analyses indicated that artificial phonation could be restored to frequencies measured in the normal state  
class9	3324	these experiments suggested that rehabilitation of the impaired voice by servocontrol might eventually be feasible  
class9	3325	an in vivo canine model for testing treatment effects in laryngeal hyperadduction disorders  
class9	3325	adductor spastic dysphonia is a voice disorder characterized by a strained  squeezed  effortful voice produced by true and false cord hyperadduction  
class9	3325	an in vivo canine model has been developed to simulate hyperadduction of the true cords  
class9	3325	using this model  the thyroarytenoid muscle was found to have a greater effect on intraglottic and subglottic pressure than cricothyroid muscle contraction  
class9	3325	the intraglottic and subglottic pressure was reduced after simulated recurrent laryngeal paralysis  
class9	3325	this model can be used in future studies to compare laryngeal treatment modalities for disorders that have a component of vocal cord hyperadduction  such as spastic dysphonia  
class9	3326	lasers for otosclerosis  which one if any and why  
class9	3326	laboratory stapedotomy and stapedectomy revisions were performed in human temporal bones while pyroelectric wave energy analyzers and ultrasensitive thermocouples measured energy absorption at the stapes footplate and in the vestibule  
class9	3326	analysis of these data shows that the visible lasers  argon and ktp 532  possess ideal optical properties and precision for otosclerosis surgery but conversely have less than ideal tissue characteristics  
class9	3326	the co2 laser possesses ideal tissue characteristics  
class9	3326	recent advances in optical engineering and pulsing the energy have increased the precision of this laser to now provide the accuracy required for delicate microsurgery  
class9	3326	two clinical studies analyze the long term hearing results and complications in patients who had undergone co2 laser stapedectomy revision  59 patients  and co2 laser stapedotomy  153 patients   
class9	3326	the advantages that these laser techniques provide over conventional surgery methods are discussed  
class9	3327	extrapulmonary pneumocystosis  clinical features in human immunodeficiency virus infection  
class9	3327	pneumocystis carinii infection is reported with increasing frequency as a cause of disease outside of the respiratory tract in patients with human immunodeficiency virus  hiv  infection  
class9	3327	extrapulmonary pneumocystosis is not limited to patients in any discrete risk group for hiv infection  
class9	3327	patients with hiv infection who develop extrapulmonary pneumocystosis frequently do not have concurrent p  
class9	3327	carinii pneumonia  
class9	3327	signs and symptoms of extrapulmonary pneumocystosis are nonspecific but when present are frequently referable to the tissues or organs involved  
class9	3327	extrapulmonary pneumocystosis can be diagnosed by examination of tissue biopsies from affected sites using standard histologic techniques  
class9	3327	therapy with antimicrobial agents used to treat p  
class9	3327	carinii pneumonia has been effective in some patients  
class9	3327	an association between use of aerosolized pentamidine for prevention of p  
class9	3327	carinii pneumonia and development of extrapulmonary pneumocystosis has been suggested but remains unconfirmed  
class9	3327	other factors such as the use of zidovudine and duration of immunodeficiency may also be important to the pathogenesis of extrapulmonary pneumocystosis  
class9	3327	further studies are needed to better identify risk factors that may predispose patients to the development of extrapulmonary pneumocystosis  
class9	3328	chronic lyme disease with an expansive granulomatous lesion in the cerebellopontine angle  
class9	3328	expansive granulomatous lesions in the posterior cranial fossa are rare and have not been reported in conjunction with lyme disease  
class9	3328	we report a patient with verified borrelia burgdorferi infection who developed a tumor in the cerebellopontine angle  
class9	3328	rapid growth of the tumor led to signs of cerebral compression and to hydrocephalus  
class9	3328	surgical intervention was required despite florid meningitis  
class9	3328	the histological examination showed inflammatory  nonspecific granulation tissue  
class9	3328	the origin of this tissue is almost certainly causally related to the b  
class9	3328	burgdorferi infection  
class9	3328	signs of inflammation resolved rapidly after subtotal resection  
class9	3328	the clinical  radiological  and biochemical course is documented  
class9	3328	this is the first report of an expansive cerebral lesion in the chronic phase of lyme disease  
class9	3329	management of chronic middle ear effusion with prednisone combined with trimethoprim sulfamethoxazole  
class9	3329	fifty three patients were enrolled and evaluable in a randomized  double blinded controlled clinical trial comparing prednisone for 7 days plus trimethoprim sulfamethoxazole  tmp smz  for 30 days vs  
class9	3329	tmp smz alone in treating chronic middle ear effusion  mee   
class9	3329	clearing of the effusion in both ears or in one when only one was involved was called complete resolution  clearing in one of two affected ears was called partial resolution  
class9	3329	the outcomes 2 weeks after initiation of therapy of 26 patients initially treated with prednisone plus tmp smz were complete resolution in 20  partial resolution in three  and unchanged in three  
class9	3329	the outcomes in 27 patients initially treated with tmp smz alone were complete resolution in eight  partial resolution in three  unchanged in 13 and development of acute otitis media in three  p less than 0 01 for complete resolution   
class9	3329	two weeks after initiation of therapy  patients with a mee that failed to clear were crossed over to the alternative regimen  
class9	3329	overall 29 of 41 patients  71   who received oral prednisone plus tmp smz initially or after the crossover had complete resolution of their middle ear effusion at 2 weeks after starting prednisone and tmp smz  
class9	3329	five of 35  14   patients treated with prednisone plus tmp smz and one of six  17   patients treated with tmp smz alone who had complete resolution at 4 weeks required subsequent referrals for tympanostomy tubes  
class9	3329	a course of prednisone for 7 days plus tmp smz for 30 days with monthly follow up should be considered in children with mee persisting beyond 6 8 weeks before referral for tympanostomy tube placement  
class9	3330	improved technique for a one stage repair of significant defects of the ear  
class9	3330	an improved technique for repair of severe acquired partial defects of the auricle in one stage is described  
class9	3330	the common postauricular flap with its base on the margin of the auricular defect is usually unable to repair a severe partial auricular defect in one stage because of the limited length of the flap  
class9	3330	the authors developed this technique by means of lengthening the flap with a piece of subcutaneous tissue of the scalp  so that the ear framework can be covered completely in one stage  
class9	3330	all flaps in this group survived totally  
class9	3330	seven patients with severe acquired partial defects of the auricle underwent this procedure  and good results were obtained  
class9	3331	nasolaryngoscopy for family physicians  
class9	3331	nasolaryngoscopy is easy to learn and safe and convenient to perform  
class9	3331	it is readily accepted by patients and is a rich source of clinical information  
class9	3331	the flexible nasolaryngoscope allows the physician to directly observe the anatomy of the nasal passages  pharynx and larynx  
class9	3331	the procedure is helpful for identifying the etiology of chronic nasal complaints and hoarseness  
class9	3331	other possible indications for nasolaryngoscopy include suspected nasal foreign body  recurrent nasal or pharyngeal bleeding  and epiglottitis  
class9	3331	with the use of this instrument  treatment of otolaryngologic conditions may be more specific  thereby reducing unnecessary referral or delay in treatment  
class9	3332	laryngeal oedema from a neck haematoma  a complication of internal jugular vein cannulation  
class9	3332	laryngeal oedema occurred after formation of a neck haematoma after attempted internal jugular vein cannulation  
class9	3332	this resulted in complete respiratory obstruction and respiratory arrest and it was impossible to ventilate her lungs manually or intubate her trachea  
class9	3332	oxygenation of the patient was only possible using transtracheal ventilation  
class9	3333	toxic streptococcal syndrome  
class9	3333	the streptococcal toxic shocklike syndrome is a recently recognized  multisystem disorder that shares many of the features of staphylococcal toxic shock syndrome  but is caused by toxins elaborated by group a beta hemolytic streptococcus  
class9	3333	we describe a patient who fulfilled the major criteria for the clinical diagnosis of toxic shock syndrome  fever  hypotension  multisystem dysfunction  and diffuse macular erythroderma followed by desquamation  and who demonstrated serologic evidence suggesting streptococcal infection  
class9	3333	in patients presenting with clinical findings consistent with a toxic shocklike syndrome  the emergency physician should consider streptococcal infection as a potential etiology  
class9	3334	human basophil releasability  vi  changes in basophil releasability in patients with allergic rhinitis or bronchial asthma  
class9	3334	we evaluated basophil releasability in two groups of allergic patients with positive skin tests to dermatophagoides pteronyssinus major allergen  der p l   29 adults with bronchial asthma and 17 with allergic rhinitis  and in 31 age matched normal donors  
class9	3334	both basophil reactivity  maximal percent histamine release  and basophil sensitivity  the concentration that causes 50  of maximal percent histamine release  hc50  to der p l in patients with asthma were similar to those in patients with allergic rhinitis  
class9	3334	on the contrary  basophil reactivity to anti ige was significantly higher in patients with asthma  58 0     3 6   than in patients with allergic rhinitis  46 3     5 2   p less than 0 05   
class9	3334	both groups of patients showed an increased releasability compared to control subjects  27 3     4 6   p less than 0 001   whereas there were no significant differences in basophil sensitivity to anti ige among the three groups of donors  
class9	3334	differences were also found with respect to basophil reactivity and sensitivity to f met peptide  whereas no differences appeared when basophils from the three groups of donors were challenged with the ca2  ionophore a23187  
class9	3334	there was a significant correlation between basophil reactivity and sensitivity to der p l and to anti ige in both asthmatic and allergic rhinitis patients  
class9	3334	a significant correlation was found between basophil reactivity and sensitivity to anti ige and serum ige level only in patients with bronchial asthma  whereas no correlations were found in patients with allergic rhinitis  
class9	3334	there was no correlation between in vivo mast cell releasability and in vitro basophil releasability in response to der p l in either group of allergic patients  
class9	3335	delayed endolymphatic hydrops and its relationship to meniere s disease  
class9	3335	delayed endolymphatic hydrops  eh  can be characterized as having ipsilateral and contralateral types  
class9	3335	they are similar in that both have early and late phases of otologic symptoms and that the early phase is a profound hearing loss in one ear  
class9	3335	the late phases differ  however  in that the ipsilateral type develops the symptoms of eh  episodic vertigo  in the deaf ear and the contralateral type develops the symptoms of eh  fluctuating hearing loss and or episodic vertigo  in the hearing ear  
class9	3335	in more than half the cases of both types of delayed eh  the profound hearing losses in the early phase are simply discovered to be present in early childhood without a known time of onset  
class9	3335	the temporal bones of two patients with contralateral delayed eh show pathologic changes in the deaf ears that are similar to those known to occur in mumps and measles labyrinthitis  whereas the pathologic changes in the hearing ears are similar to those known to occur in meniere s disease  
class9	3335	these observations support the proposition that meniere s disease may occur as a delayed sequela of inner ear damage sustained during an attack of subclinical viral labyrinthitis occurring in childhood  
class9	3336	head stability and gaze during vertical whole body oscillations  
class9	3336	to understand head and eye stabilities during upright locomotion  we investigated head and eye movements during vertical whole body oscillations of various amplitudes  1 to 10 cm  and frequencies  1 to 3 hz  in both normal subjects  n   10  and patients with bilateral labyrinthine loss  n   5   
class9	3336	vertical oscillations produced pitching motions of the head  of which the amplitude was markedly altered by a change in the oscillation frequency or the displacement  
class9	3336	vertical eye movements  being correlated with pitching head movements  were scarcely modified by gaze at 2 and 3 hz  
class9	3336	acquired bilateral lesions presented deteriorated head stability and physically induced eye movements under stronger stimulations  
class9	3336	however  significant increase of head movement upon stepping and suppression of pitching motion upon running  both characteristically found in bilateral lesions  were not reproduced by passive oscillations  
class9	3336	thus  these features during active locomotion may result from imbalance produced by alternate bipedal motions and from adaptation to minimize oscillopsia  respectively  
class9	3337	facial nerve monitoring in otologic surgery  clinical indications and intraoperative technique  
class9	3337	while identification of the intratemporal portion of the facial nerve is mandatory in most otologic surgical procedures  inadvertent instrumentation  traction  or thermal injury may still result from inaccurate delineation  purposeful avoidance  or false protection of this critical structure  
class9	3337	improved functional preservation of the facial nerve has been achieved in acoustic neuroma surgery through the monitoring of evoked facial electromyographic activity  
class9	3337	this technique may also be used during otologic procedures in which facial nerve manipulation is anticipated in the management of recurrent cholesteatoma  temporal bone trauma  congenital deformity  or purposeful access for cochlear implantation  
class9	3337	potential indications for using facial nerve monitoring in contemporary otologic surgery are detailed through illustrative case presentations  and necessary instrumentation and techniques are briefly reviewed  
class9	3337	intraoperative monitoring can assist the surgeon in isolating the facial nerve when chronic inflammation  traumatic injury  or anomalous development has resulted in distortion or absence of microanatomic landmarks  
class9	3338	titration streptomycin therapy for bilateral meniere s disease  follow up report  
class9	3338	initial reports of the use of parenteral streptomycin for bilateral meniere s disease  md  have demonstrated success in reducing the vestibular symptoms and  in some patients  stabilizing hearing  
class9	3338	the long term follow up  mean  5 1 years  of 19 patients treated with intramuscular streptomycin for bilateral md is presented  
class9	3338	the amount of streptomycin administered  5 to 50 g  was determined by clinical symptoms and by serial testing of the reduction in the slow phase velocity on electronystagmography  
class9	3338	episodic vertigo was totally relieved in 12 patients and improved in severity and frequency in an additional 4 patients  
class9	3338	permanent posttreatment dysequilibrium occurred in 47  of the patients treated  
class9	3338	the changes in hearing  speech reception threshold  were independent of the therapeutic effect of streptomycin on the vestibular system  
class9	3338	the overall results suggest that the intramuscular titration of streptomycin should continue to be considered as one of the therapeutic options in patients with disabling vertigo due to bilateral md  
class9	3339	drop attacks with meniere s syndrome  
class9	3339	we report the clinical features of 12 patients with drop attacks associated with meniere s syndrome  
class9	3339	each described a sensation of being pushed  thrown  or knocked to the ground or a sudden illusion of movement of the environment that led to a fall  
class9	3339	these episodes were not accompanied by symptoms of their typical attacks of meniere s syndrome  
class9	3339	the drop attacks occurred early and late in the course of the disease  they were the initial manifestation in 1 patient  
class9	3339	in the majority the episodes spontaneously remitted  although meniere s syndrome continued to progress  
class9	3339	these attacks probably result from a sudden mechanical deformation of the otolithic membrane of the utricle or saccule due to pressure gradients within the inner ear  
class9	3339	they are important to recognize because their prognosis is relatively benign compared to other causes of drop attacks  
class9	3340	the nasolabial flap as a single stage procedure  
class9	3340	the nasolabial flap is a useful reconstructive technique for the repair of defects on the nose  
class9	3340	an improved technique used in 32 patients is presented  which allows use of this procedure as a single stage rather than the more commonly seen two stage procedure  
class9	3340	the alterations include the following   1  the excision of a burow s triangle superior edge of the defect toward the inner canthus   2  the use of a periosteal or suspension suture to minimize tenting across the concave junction of the nose and cheek   3  wide undermining of the skin surrounding the defect to create a stabilizing platelike scar   4  significant thinning of the donor flap  and  5  adjust the size of the flap to recreate the original preincisional skin tension on the flap after suturing  
class9	3340	none of the 32 patients presented required a second stage procedure to correct trapdoor defects or to recreate natural folds or creases  
class9	3341	left recurrent laryngeal nerve paralysis  an unusual presentation of histoplasmosis  
class9	3341	a case of histoplasmosis seen as left recurrent laryngeal nerve paralysis in a 49 year old man is described  
class9	3341	the patient had roentgenographic findings of a solitary  noncalcified left upper lobe mass and mediastinal adenopathy  
class9	3341	tissue diagnosis of histoplasmosis was obtained using a thoracotomy  allowing institution of appropriate treatment  
class9	3342	lovastatin  warfarin interaction  
class9	3342	two patients who developed hypoprothrombinemia and bleeding due to lovastatin warfarin drug interaction are described  
class9	3342	because of the wider use of lovastatin and warfarin  heightened clinical awareness of this potentially serious interaction must be publicized  
class9	3342	therefore  prothrombin time should be monitored diligently when warfarin is prescribed to patients receiving lovastatin  
class9	3343	leiomyosarcoma of the sinonasal tract  a clinicopathologic study of nine cases  
class9	3343	the clinicopathologic features of nine cases of sinonasal tract leiomyosarcoma  sntl  referred to the armed forces institute of pathology  washington  dc  during the period from 1970 through 1988 are described  
class9	3343	this report represents the largest study to date on sntl  and our results are compared with the 21 previously reported cases of sntl  
class9	3343	of the nine cases described  patients ranged in age from 22 to 86 years  mean  55 years   
class9	3343	the most frequent clinical presentation was nasal obstruction unilaterally  
class9	3343	the neoplasms were limited solely to the nasal cavity in four cases  44   and involved both the nasal cavity and paranasal sinuses in the remaining five cases  
class9	3343	light microscopic  immunocytochemical  and ultrastructural features served to characterize these tumors as malignant neoplasms of smooth muscle origin  
class9	3343	in contrast with previous studies  immunocytochemistry was employed to differentiate sntl from other spindle cell malignancies of the region  using newly available monoclonal antibodies to smooth muscle antigens  
class9	3343	treatment was surgical  
class9	3343	radiotherapy or chemotherapy did not appear to affect the progression of the disease  
class9	3343	furthermore  no relationship was found between the aggressiveness of sntl and morphologic parameters  eg  mitotic count and tumor size   
class9	3343	instead  prognosis was dependent on the distribution of disease at presentation  
class9	3343	of all 30 patients with sntl described to date  10 had the neoplasm confined solely to the nasal cavity  
class9	3343	the 10 neoplasms did not recur  
class9	3343	we conclude that sntl may best be regarded as a locally aggressive neoplasm with only limited metastatic potential and that it could be curable by complete surgical excision  
class9	3344	epstein barr virus related antibody  changes in titers after therapy for nasopharyngeal carcinoma  
class9	3344	using long term follow up data from a prospective  collaborative study of 182 north american patients  we evaluated the significance of various serologic tests for antibody to epstein barr virus in predicting outcome after treatment in patients with nasopharyngeal carcinoma  
class9	3344	we restudied these patients by examining repeated measurements of each titer at various times after diagnosis and treatment  
class9	3344	we looked for associations between trends of titers  measured as the slope of log titer  against time  and titer level  measured as the mean of log titer   with the outcome  alive and no evidence of disease  alive with recurrence  or dead of nasopharyngeal carcinoma  
class9	3344	we found that posttreatment sequential measurements do not predict outcome  
class9	3345	distortion product otoacoustic emissions in normal and impaired adult ears  
class9	3345	distortion product otoacoustic emissions  dpoes  were recorded in a group of normally hearing subjects  29 ears  and a group of subjects whose conditions were diagnosed as sensorineural hearing loss  23 ears  to study any correlation that might exist between dpoe characteristics and hearing impairment of different configurations  
class9	3345	three different dpoe paradigms have been used to investigate the influence of different test parameters on the dpoe data for normal and hearing impaired ears  
class9	3345	all normally hearing ears demonstrated detectable dpoes  provided that the primary tone level was above a certain value  
class9	3345	hearing impaired ears produced substantially reduced dpoes compared with normally hearing subjects when the primary frequencies f1 and f2 corresponded to the region of hearing loss  
class9	3345	our data also suggested that  in general  more than one f2 f1 ratio is needed to examine any particular frequency region  
class9	3345	the dpoes provide frequency specific information about cochlear function  which after further development  may form a basis for a noninvasive  objective method of evaluating cochlear function  
class9	3346	a patient oriented approach to perilymph fistula  
class9	3346	the subject of perilymph fistula is controversial in part because the preoperative diagnosis of perilymph fistula is difficult  
class9	3346	patients suffering auditory and vestibular symptoms secondary to perilymph fistula  therefore  present a dilemma to the practicing physician  
class9	3346	in some instances  patients with auditory and vestibular symptoms in the absence of perilymph fistula will be subjected to middle ear exploration without benefit  while in other instances patients with auditory and vestibular symptoms secondary to perilymph fistula will be denied surgical treatment  
class9	3346	auditory and vestibular symptoms are a quality of life issue  
class9	3346	therefore  in an effort to provide care of the highest quality the patient must be actively involved in the decision process  
class9	3346	such involvement can be meaningful only after the patient is carefully counseled as to the pros and cons of surgery  as well as the alternatives  
class9	3346	a prognostic paradigm based on the personal experience of one of us  w l m   with perilymph fistula patients is described and is used in patient consultation in an effort to facilitate decision making  
class9	3347	chondrosarcoma of the larynx  diagnosis with magnetic resonance imaging and computed tomography  
class9	3347	chondrosarcomas are the most common sarcomas of the larynx  
class9	3347	they are generally slow growing lesions with insidious onset of symptoms  
class9	3347	we are presenting a case of chondrosarcoma that recurred 10 years after excision of a presumed chondroma  
class9	3347	computed tomographic and magnetic resonance imaging  mri  scans were performed  
class9	3347	both studies delineated the lesion nicely  
class9	3347	to the best of our knowledge  this is the first report on mri characteristics of chondrosarcoma of the larynx  
class9	3347	a review of the literature regarding the use of computed tomography in the management of chondrosarcoma is presented  
class9	3347	the mri characteristics are discussed and the two scanning modalities are compared  
class9	3347	computed tomography is an excellent study in its ability to demonstrate the extent of the lesion within the laryngeal skeleton  
class9	3347	furthermore  it is more highly sensitive than plain roentgenograms in the detection of calcifications that are highly suggestive of chondrosarcoma  
class9	3347	alternatively  mri can also demonstrate the lesion within the larynx but it has the added advantage of superior contrast resolution of the tumor and paralaryngeal tissues  
class9	3347	when the three dimensional imaging capacity of mri is considered as well  mri seems to be the superior study  
class9	3348	small fenestra stapedotomy using a fiberoptic hand held argon laser in obliterative otosclerosis  
class9	3348	obliterative otosclerosis has been a challenge since the advent of stapes surgery  
class9	3348	 drill out  procedures have had a generally poorer prognosis than conventional stapes surgery because of excessive bleeding  acoustic trauma from the burr  and reclosure of the oval window by otosclerosis  
class9	3348	in this report  we describe our early experience using a hand held fiberoptic argon laser for small fenestra stapedotomy in 10 cases of obliterative otosclerosis  
class9	3348	closure of the air bone gap to within 10 db was seen in 100  of the patients  
class9	3348	there was no significant sensorineural hearing loss  vertigo  or facial weakness  
class9	3348	argon laser stapedotomy using a hand held fiberoptic system is a safe and effective alternative to drill out stapedotomy in cases of obliterative otosclerosis  
class9	3349	chondrogenic potential of tragal perichondrium  a cause of hearing loss following stapedectomy  
class9	3349	tragal perichondrium is a widely used tissue seal in the oval window following stapes surgery  
class9	3349	autogenous and easily accessible  it is a suitable substance to cover the vestibule in total stapedectomy  and to seal around the prosthesis in small fenestra stapedotomy  
class9	3349	the incidence of complications from the use of perichondrium in this manner is exceedingly low  
class9	3349	we report a case where tragal perichondrium in the oval window resulted in the proliferation of cartilage  
class9	3349	the cartilage displaced the stapes prosthesis  resulting in a conductive loss  
class9	3349	although the chondrogenic potential of perichondrium is known  we are not aware of other reports implicating this as a cause of failure in stapes surgery  
class9	3349	the pertinent clinical and experimental literature regarding chondrogenesis is reviewed  
class9	3349	this information suggests that the formation of cartilage from perichondrium in the oval window might be influenced by mechanical trauma and tissue orientation  
class9	3350	selective management of early glottic cancer  
class9	3350	seventy patients with stage i and ii glottic cancer were treated at the university of utah school of medicine hospitals from 1980 through 1987  
class9	3350	forty four patients had stage i cancer and 26 patients had stage ii  
class9	3350	the overall survival in the stage i group was 82   
class9	3350	primary site control was 93  with only three deaths due to laryngeal cancer  
class9	3350	local control rates were 93  with co2 laser excision  80  with co2 laser and irradiation  and 67  with radiation alone  
class9	3350	stage ii glottic patients had an overall survival of 61 5  with a local control rate of 76   
class9	3350	twenty one of 24 patients were treated by full course irradiation  
class9	3350	of the eight patients who recurred at the primary site  all were irradiation failures who had initial bulky disease and impaired vocal cord mobility  
class9	3350	selective co2 laser excision was highly effective  whereas radiation therapy results were somewhat disappointing  
class9	3350	open partial laryngectomy should be considered in bulky stage ii disease patients  
class9	3351	allograft tympanoplasty  predictive value of preoperative status  
class9	3351	the functional and anatomical results of a series of 181 consecutive allograft tympanoplasties for ears with drum perforation and an intact ossicular chain were retrospectively reviewed and related to preoperative factors  
class9	3351	drum closure was realized in 92   166 of 181 cases evaluated 1 year after surgery   and 96 6  of the reconstructed drums were still intact 3 years after surgery  118 cases evaluated   
class9	3351	an air bone gap of less than 21 db was reached in 79 6   of a total of 162 cases  1 year after surgery  and in 78   of a total of 118 cases  3 years after surgery  
class9	3351	age  contralateral pathology  the wet or dry status of the ear preoperatively  and the preoperative air bone gap had no influence on anatomical results  
class9	3351	the preoperative air bone gap did not predict the postoperative air bone gap  
class9	3351	the influence of age and existence of contralateral pathology on hearing gain was only visible in some of the strictly defined patient groups  
class9	3351	the wet preoperative status of the ear generally predicted lower functional gain  
class9	3352	otologic disease in aids patients  ct correlation  
class9	3352	the contrast enhanced computed tomographic  ct  scans of the temporal bone and brain in 18 patients with otologic disease and acquired immunodeficiency syndrome  aids  were retrospectively reviewed  
class9	3352	seven scans revealed middle ear and mastoid disease  three scans were consistent with central nervous system  cns  pathology  and eight scans demonstrated no abnormalities  
class9	3352	ct scanning was found useful in localizing otopathology and diagnosing cns toxoplasmosis  aural polyps  osteomyelitis  mastoiditis  and middle ear effusion due to hypertrophic lymphoid tissue  
class9	3352	the authors conclude that aids patients with sensorineural hearing loss should undergo contrast enhanced brain ct scans to rule out cns pathology  aids status does not alter criteria for ct scanning in patients with conductive hearing loss  and that images of the nasopharynx should be included on temporal bone ct scans of patients with conductive hearing loss in order to exclude eustachian tube obstruction by hypertrophic lymphoid tissue  
class9	3353	the inferiorly based superior tympanomeatal flap for removal of congenital cholesteatoma  
class9	3353	we believe that the ib stmf is preferable to the p tmf for removal of a congenital cholesteatoma from the anterior superior portion of the mesotympanum  
class9	3353	though developing an ib stmf may require extra time and special care to avoid tearing the flap  the exposure that is achieved affords the best chance for complete removal of the mass  thus decreasing the chance for persistence or recurrence of the lesion  
class9	3354	children with special needs in england and wales  the care of hearing impairment  myelomeningocele  and adolescent pregnancy  
class9	3354	services for children with special needs in england and wales are described briefly  with attention to the services provided by the national health service  local authorities  the social security system  and voluntary organizations  
class9	3354	for illustrative purposes  particular reference is made to children with hearing impairments and myelomeningoceles  
class9	3354	a separate account is given of the provision for pregnant adolescents  again addressing services provided by all major sources of assistance  
class9	3355	children with special needs in the netherlands  impaired hearing  adolescent pregnancy  and myelomeningocele  
class9	3355	in the netherlands  treatment and management of children with special needs is characterized by the absence of financial barriers to care and the existence of a number of specialized services  
class9	3355	for hearing impaired children  there are special audiologic centers and special schools  
class9	3355	adolescents at risk of unintended pregnancy are protected through education and a dedicated system of family planning clinics  
class9	3355	children with multiple handicaps  such as those associated with myelomeningocele  face greater difficulties but still have an array of services available to them at little or no cost  
class9	3355	families are sheltered from excessive expense through social insurance  
class9	3356	aminoglycosides  assessing the potential for nephrotoxicity  
class9	3356	although aminoglycosides have been a mainstay of antibiotic therapy in postsurgical infections  certain patients may be at risk for potential aminoglycoside induced toxicities  
class9	3356	aminoglycoside nephrotoxicity is one of the most frequent causes of iatrogenic renal failure  
class9	3356	a narrow toxicity to therapeutic ratio  a relatively long serum half life and concentration in the renal cortex all contribute to renal dysfunction  
class9	3356	patients at greatest risk for aminoglycoside induced nephrotoxicity include the elderly  patients with pre existing renal disease and those who are volume depleted  
class9	3356	calculations based on the results of a multicenter study demonstrate that the average additional cost incurred for each patient who had aminoglycoside related nephrotoxicity was  2 501  
class9	3356	methods are reviewed for prospectively assessing the potential for development of nephrotoxicity to identify patients for whom effective therapeutic substitutes for aminoglycosides should be sought  
class9	3357	asymptomatic congenital cytomegalovirus infection  audiologic  neuroradiologic  and neurodevelopmental abnormalities during the first year  
class9	3357	twenty eight infants with asymptomatic congenital cytomegalovirus infection and 13 control infants were followed up prospectively  
class9	3357	congenital sensorineural hearing loss was documented by auditory brain stem responses in four infected infants  two had mild bilateral loss  one had mild unilateral loss  and one had extreme unilateral loss  but in no controls  
class9	3357	four infected infants had diffuse periventricular radiolucencies on computed tomographic scan  none had calcifications or ventriculomegaly  
class9	3357	no differences between groups were noted on neurologic examination results or on the bayley mental developmental index  however  one infected infant had a severely delayed bayley psychomotor developmental index score  
class9	3357	in addition  the mean mental developmental index score of the four infected infants with diffuse periventricular radiolucencies was significantly below that of the remaining infected infants  93     8 vs 109     13   
class9	3357	these data suggest that asymptomatic congenital cytomegalovirus infection may be associated with a broad range of audiologic  subtle neuroradiologic  and neurodevelopmental differences in early infancy  
class9	3358	endoscopic management of early supraglottic cancer  
class9	3358	an initial endoscopic surgical approach to early supraglottic cancer provides the surgeon with the ability to accurately stage these lesions  avoiding possible undertreatment while allowing for a valuable treatment option for those supraglottic cancers with histologically incontrovertibly superficial disease  
class9	3358	early invasion of the preepiglottic and paraglottic spaces can be determined accurately without altering or delaying any treatment option  open surgical excision  radiotherapy  or chemotherapy   
class9	3358	the tendency of supraglottic cancers to transgress the natural foramina of the epiglottis is well established  and the concern about this depth of invasion is reflected by the 1977 revised staging criteria  which required assessment of the preepiglottic space  pes   
class9	3358	along with the microscope and the carbon dioxide laser  the adjustable supraglottiscope facilitates the determination of pes invasion and facilitates en bloc excision of superficial supraglottic cancers  
class9	3358	the resulting morbidity typically is no different from that with routine direct endoscopy and biopsy  
class9	3359	bilateral semicircular canal aplasia with near normal cochlear development  two case reports  
class9	3359	congenital malformations of the vestibular labyrinth  pars superior  are rare  
class9	3359	we present two patients with computed tomographic findings of bilateral semicircular canal aplasia with normal or near normal cochleas  
class9	3359	initial bone conduction thresholds were within normal limits  although both patients had significant conductive hearing losses due to congenital middle ear malformations  
class9	3359	bithermal caloric responses were absent in both  
class9	3359	to our knowledge these are the first reports of vestibular aplasia concomitant with normal or near normal cochlear development  
class9	3359	these findings conflict with conventional hypotheses that state that inner ear malformations result from arrested development during the normal stages of inner ear embryogenesis  
class9	3360	effects of cyclophosphamide on the pathogenesis of cytomegalovirus induced labyrinthitis  
class9	3360	cyclophosphamide was used in this study to define the contribution of the inflammatory response relative to direct cytopathic effects of guinea pig cytomegalovirus  gpcmv  in inducing sensorineural hearing loss in the guinea pig  
class9	3360	the eighth nerve compound action potential  cap  threshold on day 7 after inoculation of gpcmv into the scala tympani was an average of 35 db greater for control animals than for those that were immunosuppressed with daily intraperitoneal injections of cyclophosphamide  20 mg kg body weight   
class9	3360	the amount of gpcmv antigen in the cochlea  detected immunohistochemically did not correlate with the cap threshold  
class9	3360	however  the greater the inflammatory response to gpcmv in the cochlea  the higher the cap threshold and thus the greater the hearing loss  
class9	3360	this study demonstrates that the inflammatory response to gpcmv may be more important than direct cytopathic effects of the virus in producing sensorineural hearing loss in gpcmv induced labyrinthitis  
class9	3361	idiopathic sudden sensorineural hearing loss and postnatal viral labyrinthitis  a statistical comparison of temporal bone findings  
class9	3361	although the cause of idiopathic sudden sensorineural hearing loss remains uncertain  a viral origin has been suggested in many cases on the basis of anamnestic microbiologic and pathologic data  
class9	3361	twenty two temporal bone specimens from 18 patients who during life suffered a sudden partial or complete sensorineural hearing loss were studied  
class9	3361	on the basis of clinical data  these cases were assigned to one of three diagnostic categories  and the temporal bones were studied by light microscopy and serial section analysis  
class9	3361	the implications of the histopathologic findings for the pathogenesis of idiopathic sudden sensorineural hearing loss are discussed  
class9	3362	immunohistochemical study of cytokeratin expression in normal and pathologic middle ear mucosa of the rat  
class9	3362	the expression of cytokeratins in the epithelium of the middle ear and external auditory meatus of the rat was studied on cryosections of ethylenediaminetetraacetic acid decalcified specimens by use of a panel of monoclonal antibodies  
class9	3362	the normal middle ear epithelium revealed a complex cytokeratin profile  including regional differences  
class9	3362	the induction of sterile middle ear effusions resulted in increased cytokeratin expression  
class9	3362	infective effusions were accompanied by both quantitative and qualitative changes in the cytokeratin expression patterns  
class9	3362	the differences observed between the cytokeratin profiles of external meatal skin and those of middle ear epithelium may form a useful tool for research into cholesteatoma development  
class9	3363	the association of selected cancers with service in the us military in vietnam  iii  hodgkin s disease  nasal cancer  nasopharyngeal cancer  and primary liver cancer  the selected cancers cooperative study group 
class9	3363	as part of a series of investigations into the health of vietnam veterans  we conducted case control studies involving 310 men with hodgkin s disease  48 with nasal carcinoma  80 with nasopharyngeal carcinoma  130 with primary liver cancer  and 1776 controls between 1984 and 1988  
class9	3363	all men born between 1929 and 1953 and diagnosed in an area covered by eight cancer registries were considered eligible as cases  controls were recruited by random digit dialing  
class9	3363	whereas the study had excellent power  96   to detect a twofold increase in risk for hodgkin s disease among vietnam veterans  its ability to detect a similarly elevated risk in the other cancers was limited  ranging from 38   nasal carcinoma  to 75   primary liver cancer   
class9	3363	analyses showed that risks among vietnam veterans relative to other men were 1 1  hodgkin s disease   0 7  nasal carcinoma   0 5  nasopharyngeal carcinoma   and 1 2  primary liver cancer   
class9	3363	none of these relative risks was significantly different from 1 0  
class9	3363	similar results were obtained if vietnam veterans were compared with  1  other veterans or  2  men who never served in the military  
class9	3363	an examination of several attributes of military service in vietnam  eg  branch  duration of service  and other characteristics that may have been associated with the use of agent orange  failed to identify any groups of veterans who were at increased risk for hodgkin s disease  
class9	3363	small numbers limited further analyses of nasal  nasopharyngeal  and liver cancer  
class9	3363	these results provide no evidence that  15 to 25 years following service in vietnam  the risk of these malignant neoplasms is higher among veterans  
class9	3364	angiocentric immunoproliferative lesion t cell non hodgkin s lymphoma and the acquired immune deficiency syndrome  a case report and review of the literature  
class9	3364	the lesions known as lymphocytic vasculitis  polymorphic reticulosis  midline malignant reticulosis  lethal midline granuloma   lymphomatoid granulomatosis  and angiocentric lymphoma form what have been collectively termed the angiocentric immunoproliferative lesions  ail   
class9	3364	because of recent reports demonstrating clonal rearrangements of the t cell receptor in these lesions  the ail are now thought to represent a continuous spectrum of post thymic t cell non hodgkin s lymphoma  nhl   
class9	3364	nhl associated with the acquired immune deficiency syndrome  aids  represents intermediate or high grade b cell malignancies in hiv infected patients that may be etiologically related to the epstein barr virus  ebv   
class9	3364	there have been reports of ebv associated t cell nhl  ail  and large granular lymphocyte  lgl  proliferations  as well as hiv associated t cell neoplasia  lgl t cell proliferations  and ail  
class9	3364	we describe a case of polymorphic reticulosis  lethal midline granuloma  arising in an hiv infected individual  who later progressed to aids  and review the literature on hiv associated and ebv associated t cell neoplasia  lgl t cell proliferations  and ail  
class9	3364	the etiology of this ail t cell nhl  especially in relation to ebv and hiv  is discussed  
class9	3365	ear involvement in the yellow nail syndrome  
class9	3365	recognized features of the yellow nail syndrome include yellow nails  lymphedema  and pleural effusions  
class9	3365	we report a patient with the additional feature of keratosis obturans  which may be a manifestation of this syndrome in the external ear  
class9	3366	osteoma of the middle ear  
class9	3366	osteomas involving the middle ear and causing a functional disturbance are rare  
class9	3366	we report a case of a patient with an osteoma arising from the lateral semicircular canal  
class9	3366	the main symptom was vertigo and to halt this the defect of the canal was obliterated with a bone chip and fibrin glue after removal of the tumour  
class9	3367	hearing loss due to cranio metaphysial dysplasia  
class9	3367	craniometaphysial dysplasia is a rare cause of conductive hearing loss  
class9	3367	it is a genetic disorder of bone due to decreased osteoclastic activity in the endosteal and periosteal regions of craniofacial and long bones  
class9	3367	the characteristic temporal bone abnormalities are attic fixation  abnormally shaped ossicles and obliterated foramina ovale  
class9	3367	computerised tomography is helpful in predicting operative findings  surgery should be reserved for those with a severe hearing loss  
class9	3368	auro nasopharyngeal polyp and cholesteatoma  
class9	3368	we report the association of an auronasopharyngeal polyp arising in a congenitally abnormal middle ear and eustachian tube  
class9	3368	subsequently  ten years after removal of the polyp and insertion of a ventilation tube  there was recurrence of the polyp in association with cholesteatoma of the middle ear  
class9	3369	chronic sinusitis and the yellow nail syndrome  
class9	3369	diagnosing syndromes that include chronic sinusitis can expedite the management of both conditions  
class9	3369	yellow nail syndrome is usually described as the combination of yellow nails  lymphoedema and often respiratory manifestations such as chronic sinusitis  bronchiectasis and pleural effusions  
class9	3369	the pathology responsible for the syndrome is believed to be lymphatic hypoplasia  
class9	3369	diagnosis of yellow nail syndrome is clinical not requiring any specialized tests  
class9	3369	in the two cases described  the respiratory tract manifestations required the most active investigation and management  
class9	3369	the significance of this syndrome to the otolaryngologist is discussed  
class9	3370	direct extension of laryngeal carcinoma to the skin of the neck  
class9	3370	invasion of the skin of the neck by laryngeal carcinoma is relatively uncommon  
class9	3370	twelve cases of cancer of the larynx fungating through the cervical skin are presented  
class9	3370	they mostly followed initial treatment by deep x ray therapy or partial laryngectomy  
class9	3370	a high tracheostomy was also considered to be a contributing cause for the occurrence of such a mishap  
class9	3370	the management and follow up of these patients is described  
class9	3371	reduced allergen induced nasal congestion and leukotriene synthesis with an orally active 5 lipoxygenase inhibitor 
class9	3371	background and methods  
class9	3371	the clinical importance of leukotrienes in human allergy has not been defined  in part because there have been no selective 5 lipoxygenase inhibitors that have been effective and safe for use in humans  
class9	3371	to address the hypothesis that stimulated leukotriene synthesis causes symptoms of immediate hypersensitivity reactions in vivo  i investigated the effects of a new 5 lipoxygenase inhibitor  a 64077  on provoked allergic nasal symptoms and mediator release in a double blind  randomized  placebo controlled study  
class9	3371	eight subjects with allergic rhinitis underwent nasal challenge on two occasions after an oral dose of 800 mg of a 64077 or an identical appearing placebo  
class9	3371	results  
class9	3371	allergen induced nasal congestion was significantly attenuated  p less than 0 02  by a 64077  peak levels of leukotriene b4  median  684 pg per milliliter  and 5 hydroxyeicosatetraenoic acid  median  704 pg per milliliter  in nasal rinse fluids were markedly reduced  to 67 and 185 pg per milliliter  respectively  p less than 0 01   whereas levels of prostaglandin d2 were not  
class9	3371	histamine release and sneezing were not reduced significantly by a 64077  but there was a significant correlation  p less than 0 01  between the changes in these variables within subjects  
class9	3371	the mean      sem  stimulated synthesis of leukotriene b4 in whole blood ex vivo was markedly reduced by a 64077  from 153     19 to 20     9 ng per milliliter  p less than 0 01   and the specificity of a 64077 for 5 lipoxygenase inhibition was verified by its lack of effect on the synthesis of serum thromboxane b2 or 12 hydroxyeicosatetraenoic acid  
class9	3371	conclusions  
class9	3371	these results provide direct evidence of an important role for the 5 lipoxygenase products of arachidonic acid in allergic rhinitis and support the notion that further experiments in this area may lead to new therapeutic approaches to allergic disorders  
class9	3372	sensorineural hearing loss  a reversible effect of valproic acid  
class9	3372	we report 2 patients over the age of 70 who  while on valproate  vpa  for complex partial seizures  developed sensorineural hearing loss  
class9	3372	following discontinuation of vpa for nonaudiologic reasons  the patients reported improved hearing which was confirmed by audiometry  
class9	3372	these findings represent vpa induced sensorineural hearing loss  possibly in preexisting presbycusis  
class9	3373	the efficacy of oral steroids in the treatment of persistent otitis media with effusion  
class9	3373	one hundred thirty six children with otitis media with effusion of at least 2 months  duration were investigated in a strict  double blind  randomized prospective study to evaluate the efficacy of oral steroids in the treatment of this disease  
class9	3373	the results of our study showed a significant complete and partial recovery from otitis media with effusion in the group treated by a combination of antibiotics  amoxicillin  and oral steroids  prednisone   compared with an amoxicillin treated group and a placebo treated group  
class9	3373	we believe that this treatment mostly benefits children aged 4 to 10 years without oversized adenoids  
class9	3373	the findings of our study imply that a combined course of antibiotics and oral steroids deserves its place as a routine conservative trial before surgery  
class9	3374	localized antigen challenge of the nasal mucosa  
class9	3374	we describe a localized nasal antigen challenge and the measurement of mediators found at the same site  
class9	3374	eight ragweed allergic subjects were challenged on 2 days  1 week apart  
class9	3374	challenges consisted of six sequential provocations  beginning with two control challenges  diluent for antigen phenol buffered saline  followed by four increasing antigen doses  0 6  6  60  and 160 protein nitrogen units   antigen day  or an additional four control challenges  control day   
class9	3374	the number of sneezes and the symptom scores increased significantly with increasing antigen doses  
class9	3374	the levels of histamine and n alpha tosyl l arginine methyl ester esterase activity increased in the eluted secretions on the antigen day  but not on the control day  
class9	3374	the amount of secretions collected also increased per unit of time on the antigen day  
class9	3374	we found no significant increase in the concentration level of either histamine or n alpha tosyl l arginine methyl ester esterase in nasal secretions on either day  
class9	3374	we conclude that the total amount of histamine and n alpha tosyl l arginine methyl ester esterase activity increased per unit of time while their concentration did not  
class9	3375	genetics of asthma and hay fever in australian twins  
class9	3375	the occurrence of self reported asthma wheezing and hay fever among 3 808 pairs of twins from the australian national health and medical research council twin registry was examined for evidence of genetic transmission by path analytic methods  
class9	3375	the cumulative prevalence of asthma or wheezing was 13 2  and of hay fever  32   
class9	3375	there were significant correlations in liability to reported disease among twins  and these were higher in monozygotic twins  mz   r   0 65  than in dizygotic twins  dz   r   0 25   and in male mz twins  r   0 75  compared with female mz twins  r   0 60   
class9	3375	analysis under the assumptions of the classic twin model suggested that there were genetic factors common to asthma and hay fever  with a correlation in genetic liability to the traits of 0 52 for men and 0 65 for women  
class9	3375	these genes acted substantially in a nonadditive fashion in men but not in women  
class9	3375	as the genetic correlation was significantly less than unity  this implied additional genetic factors influencing either or both diseases individually  
class9	3375	the estimated heritability of these diseases was 60 to 70  in this population  
class9	3375	environmental causes of both diseases also were correlated  r   0 53 for men and 0 33 for women   
class9	3375	cigarette smoking was only weakly associated with wheezing  
class9	3376	excitation thresholds for nerves reinnervating the paralyzed canine larynx  
class9	3376	electrical stimulation of paralyzed laryngeal muscles implanted with nerve muscle pedicles  nmp  has resulted in documented return of motion  
class9	3376	no study  however  has yet determined how nmp excitability correlates with that of normal muscle or nerve  
class9	3376	in six anesthetized dogs  one hemilarynx was denervated and the paralyzed thyroarytenoid  cricothyroid  and posterior cricoarytenoid muscles were reinnervated via nmps originating from the ansa hypoglossi nerve  
class9	3376	after 4 6 to 5 7 months  an electric stimulator delivering biphasic pulses of variable amplitude and widths was used to test thresholds for contraction in nine stimulatable nmps  six intact recurrent laryngeal nerves  rln   and five normal cervical muscles  
class9	3376	with one exception  2 1 ma   nmp rheobases varied between 0 0002 and 0 04 ma  mean   0 020 sd     0 012  n   6   
class9	3376	two nmps belonging to animals stimulated for several hours had higher values  0 1 ma   
class9	3376	rheobase varied from 0 01 to 0 09 ma for control rlns  mean   0 058 sd     0 025   and from 0 05 to 0 35 ma for muscles  mean   0 144 sd     0 109   
class9	3376	histologic correspondence with reinnervation was established in implanted muscles by type grouping on atpase stains  
class9	3376	these data suggest that 1  nerve pedicles may offer promise for the eventual construction of implantable low energy consuming laryngeal devices  and 2  the appropriate charge to be injected over time remains to be determined  
class9	3377	sphenoid sinusitis  a cause of debilitating headache  
class9	3377	we present a case of sphenoid sinusitis resulting in a debilitating headache refractory to both oral and intramuscular analgesics  
class9	3377	despite an aggressive evaluation in the emergency department  the correct diagnosis and appropriate treatment were delayed  
class9	3377	recognition of sphenoid sinusitis  the complications associated with it  and the need for aggressive management are addressed  
class10	3378	excitatory amino acids in the developing brain  ontogeny  plasticity  and excitotoxicity  
class10	3378	besides their role as neurotransmitters  excitatory amino acids  eaas  in the developing brain are crucially involved in plasticity and excitotoxicity which are modified by their distinct ontogeny  
class10	3378	along with incomplete neuritogenesis and synaptogenesis  presynaptic markers of the eaa system are immature in the developing brain  however  postsynaptic eaa system activities  particularly of the n methyl d aspartate and quisqualate receptors  are transiently enhanced early in life  
class10	3378	this transient enhancement is presumably beneficial to the immature brain because physiologic activation of the eaa system plays a critical role in plasticity of early learning and morphogenesis  
class10	3378	at the same time  this transient hypersensitivity renders the immature brain vulnerable to pathologic excitation of the eaa system  excitotoxicity  as observed during neonatal hypoxia ischemia  
class10	3379	periventricular hyperintensity detected by magnetic resonance imaging in infancy  
class10	3379	twenty one infants younger than 12 months of age were diagnosed as having periventricular hyperintensity  pvh  on t2 weighted magnetic resonance imaging  
class10	3379	ten infants had experienced neonatal asphyxia  6 intracranial hemorrhage  2 bacterial meningitis  and 3 apnea  
class10	3379	pvh was classified according to its extent  
class10	3379	round foci of pvh surrounding the frontal and occipital horns of the lateral ventricles were observed in 4 infants  pvh pattern i   
class10	3379	continuous pvh was observed in 17 infants  pvh patterns ii and iii   
class10	3379	fourteen infants with continuous pvh had spastic diplegia or quadriplegia  
class10	3379	developmental delay was demonstrated in 15 infants with continuous pvh  
class10	3379	no pvh pattern i infants had cerebral palsy  only 1 such infant had mild developmental delay  
class10	3379	our study suggests that the extent of pvh reflects the severity of brain damage in neonates with cerebral injuries  
class10	3380	anencephaly  clinical determination of brain death and neuropathologic studies  
class10	3380	twelve liveborn anencephalic infants were serially examined to determine if they would meet our clinical criteria for whole brain death within a 7 day period  protocol 1 infants  6  received intensive care including intubation from birth  and protocol 2 infants  6  received intensive care during the period in which death was imminent  
class10	3380	brain death was determined by absence of brainstem function  including loss of all cranial nerve responses and sustained apnea  pco2 greater than 60 torr  for 48 hours with confirmation of findings by an outside consulting child neurologist  
class10	3380	the initial examinations of these 12 infants revealed spontaneous movements and startle myoclonus  12   suck  root  and gag responses  7   increased tone  8   deep tendon reflexes  9   absent pupillary responses  9   absent oculocephalic and corneal responses  6   absent auditory moro responses  7   and nonvisualization of the optic nerve  8   
class10	3380	mild depression of neurologic function occurred during the first several days of life  subsequently  the infants  responses were easier to elicit and more sustained  
class10	3380	only 2 infants met the clinical criteria for brain death  
class10	3380	neuropathologic findings indicated that observed complex motor responses were not based upon cortical activity because no infant had a normally formed cerebrum  
class10	3380	brainstem neuronal activity may have accounted for these motor responses in some patients but even at this level neurons were scanty or absent  
class10	3380	our findings suggest that  although rare  clinical brain death can be determined in liveborn anencephalic infants  ophthalmologic and otologic developmental abnormalities may confound examination of cranial nerve function  and absence of cortical neurons supports the widely held opinion that these infants do not experience sensation  
class10	3381	acth therapy in infantile spasms  relationship between dose of acth and initial effect or long term prognosis  
class10	3381	the relationship between the dose of acth and the initial effect was investigated in 41 children with infantile spasms  
class10	3381	more than 0 015 mg  0 6 iu  kg day of acth was needed for a good initial response of seizures and electroencephalographic abnormalities  
class10	3381	the relationship between the dose of acth and long term prognosis was investigated in 29 patients  
class10	3381	there was no relationship between the daily or total acth dosage  provided the dose was greater than 0 015 mg  0 6 iu  kg day  and the outcome of seizures and electroencephalographic abnormalities  however  acth 0 04 0 06 mg  1 6 2 4 iu  kg day and a total acth dose of 1 1 1 5 mg  44 60 iu  kg resulted in better mental development than smaller doses of acth  
class10	3381	side effects of acth increased with dosage  
class10	3381	too small or too large a dose of acth does not lead to better mental development  
class10	3381	the proper dose of acth should be used with careful attention to potential side effects  
class10	3382	gross motor patterns in children with cerebral palsy and spastic diplegia  
class10	3382	rolling  sitting  and crawling patterns were motoscopically analyzed in 72 children with cerebral palsy and spastic diplegia  the relation between these patterns and the severity of the locomotive disability was studied  
class10	3382	in rolling  trunk rotation and elbow support were difficult for the most severely diplegic children  
class10	3382	when sitting  most patients had a between heel sitting pattern in which the thighs were adducted and the knees were flexed  
class10	3382	when crawling  the reciprocal thigh movements were insufficient and accompanied by lateral bending of the trunk in many patients  
class10	3382	in the more impaired patients  the thighs supported the weight in flexion and did not move reciprocally  
class10	3382	creeping on the elbows without reciprocal leg movements was demonstrated in the most severely affected children after 2 years of age  
class10	3383	multiple intracranial mucoceles associated with phaeohyphomycosis of the paranasal sinuses  
class10	3383	the purpose of this article is to alert clinicians to a new pathogenic fungus of the paranasal sinuses called exserohilum rostratum  
class10	3383	exserohilum species are one of the etiologic agents of phaeohyphomycosis  a constellation of entities caused by dematiaceous fungi  
class10	3383	this class of fungal sinus infection has emerged only in the past decade  it occurs primarily in immunocompetent individuals and produces a tenacious  progressive pansinusitis  
class10	3383	to our knowledge  this study describes the first case of multiple intracranial mucoceles secondary to e rostratum  
class10	3383	the diagnostic workup includes computed tomography and magnetic resonance imaging followed by direct microscopic examination of tissue biopsy specimens  
class10	3383	a craniotomy followed by a bilateral external ethmoidectomy was necessary for complete extirpation of the infected mucoceles  
class10	3383	aggressive surgical management of this mycotic infection is described  
class10	3384	hyponatraemia secondary to an inappropriately high release of antidiuretic hormone in cardiac tamponade  
class10	3384	a spontaneous intrapericardial haemorrhage caused cardiac tamponade in a 29 year old paraplegic man who was being treated with warfarin  
class10	3384	the associated persistent hyponatraemia  which was believed to be caused by an inappropriately high release of antidiuretic hormone  rapidly resolved after pericardiocentesis  
class10	3385	primary leptomeningeal b cell lymphoma in a 8 year old child  
class10	3385	a case of primary leptomeningeal b cell lymphoma in an 8 year old  previously healthy child is described  
class10	3385	the child was found to have hypogammaglobulinemia  and the epstein barr virus genome was identified in cultured tumor cells despite blood serology being negative for the virus  
class10	3385	the patient was treated with cyclophosphamide  doxorubicin  vincristine  and dexamethasone  plus intrathecal methotrexate  and initially improved  
class10	3385	before the initiation of craniospinal radiation  the patient developed progressive disease  deteriorated  and died 9 months after the onset of symptoms  
class10	3386	epidural morphine for analgesia after caesarean section  a report of 4880 patients 
class10	3386	this retrospective study was undertaken to assess the efficacy and safety of epidural morphine in providing analgesia following caesarean section under epidural anaesthesia  
class10	3386	the morphine was administered as a single bolus  following delivery  in doses ranging from 2 to 5 mg  
class10	3386	the charts of 4880 caesarean sections  performed on 4500 patients  were reviewed  
class10	3386	the duration of analgesia and the occurrence of any symptoms which might be side effects of the epidural morphine were recorded  
class10	3386	the duration of analgesia was 22 9     10 1 hr and was not correlated with the dose of epidural morphine  
class10	3386	eleven per cent of the patients required no supplemental analgesia during the first 48 hr  
class10	3386	twelve patients  0 25 per cent  had respiratory rates less than 10 breaths per minute  on at least one occasion  
class10	3386	no serious sequelae resulted from these periods of bradypnoea  
class10	3386	pruritus occurred in 58 per cent of patients  nausea and vomiting in 39 9 per cent and dizziness in ten per cent  
class10	3386	herpes simplex labialis was recorded in 3 5 per cent of patients  
class10	3386	epidural morphine is thus confirmed as an effective analgesic technique post caesarean section with 3 mg being the optimal dose  
class10	3386	even in this young healthy patient population  clinically detectable respiratory depression occurs so clinical respiratory monitoring is indicated  
class10	3387	ethyl chloride and venepuncture pain  a comparison with intradermal lidocaine  
class10	3387	one hundred and twenty unpremedicated patients undergoing gynaecological surgery were randomly allocated to one of three equal treatment groups to assess the effectiveness of ethyl chloride in producing instant skin anaesthesia to prevent the pain of venepuncture from a 20 g cannula  
class10	3387	they received either no anaesthetic  0 2 ml one per cent lidocaine plain intradermally or a ten second spray of ethyl chloride at the cannulation site  
class10	3387	ethyl chloride produced skin anaesthesia that significantly reduced the pain of venepuncture  
class10	3387	however  it was not as effective as intradermal lidocaine  
class10	3387	it had no effect on vein visualisation or ease of cannulation  
class10	3387	ethyl chloride can be recommended as a method of producing instant skin anaesthesia  
class10	3388	brain protection  physiological and pharmacological considerations  part i  the physiology of brain injury  
class10	3388	ischaemia  whether focal or global in nature  produces a sequence of intracellular events leading to increased cell permeability to water and ions including ca    
class10	3388	there is a loss of cellular integrity and function  with increased production of prostaglandins  free radicals  and acidosis with lactate accumulation  
class10	3388	these events may be exacerbated by glucose administration  
class10	3388	pharmacological agents aimed at alleviating ischaemic injury could be directed at decreasing cerebral metabolic requirements for oxygen  improving flow to ischaemic areas  preventing ca     induced injury  inhibition of free radical formation  lactate removal  inhibition of prostaglandin synthesis  and prevention of complement mediated leukocyte aggregation  
class10	3388	part i of this paper describes some of the pathophysiological events leading to ischaemic brain injury  
class10	3388	part 2 of this paper will consider the current agents available for brain protection  
class10	3389	transoesophageal pacing for perioperative control of neonatal paroxysmal supraventricular tachycardia  
class10	3389	the perioperative management of a 16 day old infant with recurrent supraventricular tachycardia  svt  is discussed  
class10	3389	vagal manoeuvres and medication were not adequate in controlling the svt  
class10	3389	since the patient was scheduled for extensive surgery in the prone position  it was decided to use transoesophageal pacing as the method of choice for conversion of svt  
class10	3389	transoesophageal pacing succeeded several times in overriding the svt and restoring normal heart rate and haemodynamic variables  
class10	3389	the advantages and disadvantages of various methods of treating svt in the newborn are discussed  
class10	3390	hospital admissions from the surgical day care centre of vancouver general hospital 1977 1987  
class10	3390	the admissions to vancouver general hospital from its surgical day care centre were reviewed for the period 1977 to 1987  
class10	3390	the overall mean rate of admission for the period was 0 28 per cent  for surgically related admissions 0 22 per cent and for anaesthesia related admissions 0 07 per cent  
class10	3390	the principal reasons for surgery related admissions were postoperative bleeding  complications  the need for further surgery  the requirement for prolonged postoperative care  and pain  
class10	3390	urology had a particularly high percentage of admissions compared with its workload  because of the diagnostic nature of much of the work  
class10	3390	anaesthesia related admissions included  syncope   lack of an accompanying adult  aspiration pneumonitis and coincident acute disease  
class10	3390	twelve of the 14 patients admitted with syncope had surgery in the afternoon and had received less than ideal amounts of intravenous fluid  
class10	3390	seven of the 12 asa physical status ii patients admitted had an admission diagnosis related to the coincident disease  
class10	3391	two siblings with phenotypes mimicking peroxisomal disorders but with discordant biochemical findings  
class10	3391	the authors present a report on two sibling with a nearly identical phenotype mimicking peroxisomal disorder but with totally discordant biochemical findings  
class10	3391	in an attempt to confirm the diagnosis of a peroxisomal disorder  plasma levels of very long chain fatty acids  vlcfa  and phytanic acid were determined  
class10	3391	in addition  fibroblasts profile of vlcfa and plasmalogen levels were evaluated for case 2  
class10	3391	pathomorphological examinations represented by lymph node and kidney biopsies as well as postmortem examinations of liver  adrenals and brain were performed in case 1  
class10	3391	the phenotypes of both siblings showed marked resemblance to those observed in children with zellweger syndrome  
class10	3391	the results of biochemical tests performed in case 1  together with abundant peroxisomes in the liver and the wide spectrum of clinical abnormalities suggest pseudo zellweger or zellweger like syndromes  but no conclusive data have been found  
class10	3391	the plasmalogen level in fibroblasts as well as the fibroblasts profile of vlcfa noted in case 2 were within the normal range  thus excluding the possibility of a peroxisomal disorder  
class10	3391	the striking phenotype resemblance of the siblings mimicking zellweger  together with discordant biochemical findings  are difficult to explain on the basis of currently available tests  
class10	3392	the exeter dysphagia assessment technique  
class10	3392	the exeter dysphagia assessment technique  edat  uses noninvasive equipment to record  simultaneously   feeding respiratory patterns   the time drink entered the mouth  and associated swallow sounds during feeding  
class10	3392	the easily portable equipment enabled patients  swallowing ability to be tested  at the bedside if necessary  using a small amount of fruit flavored drink  
class10	3392	the results appear in chart form  
class10	3392	edat findings from groups of normal subjects aged 2 90 years were compared with those from patients with dysphagia of neurologic origin and normal subjects under experimental feeding conditions  
class10	3392	the results revealed maturation of the feeding respiratory pattern in the teenage years and remarkable consistency thereafter  
class10	3392	differences in the recordings between the normal and abnormal subjects were sufficiently marked to allow the findings to be used in the diagnosis of other patients with dysphagia of doubtful neurologic cause  
class10	3392	interpretation of the charts and recorded timings of the oral and pharyngeal stages of swallowing permitted a more accurate identification of sensory nerve  motor nerve  and functional involvement causing dysphagia of neurologic origin and may be used as a guide to the origin of the sensory deficit  
class10	3393	transient neuromuscular impairment resulting from prolonged inhalation of halothane and enflurane  
class10	3393	inhalation anesthesia first with halothane followed by enflurane relieved a patient with status asthmaticus who was refractory to conventional therapy including mechanical ventilation  
class10	3393	after 13 days of anesthesia while on mechanical ventilation and employing nondepolarizing muscle relaxants  significant neuromuscular impairment  manifested by tetraplegia and sensory disturbance  developed  
class10	3393	anesthesia was discontinued on day 14  and the patient was weaned from mechanical ventilation on day 16  
class10	3393	over the next two months  the neuromuscular impairment markedly improved  
class10	3393	halothane was associated with cardiac arrhythmias and hepatitis necessitating replacement by enflurane  
class10	3393	enflurane appeared to be as effective a treatment for refractory asthma as halothane  
class10	3393	the most probable cause of the neuromuscular impairment in our patient was the long term use of inhalation anesthetics or nondepolarizing muscle relaxants  
class10	3394	resolution of the adult respiratory distress syndrome following colectomy and liver transplantation  
class10	3394	a 32 year old woman with liver failure from end stage cirrhosis and ulcerative colitis developed septicemia and severe ards  
class10	3394	subtotal colectomy and a successful liver transplantation resulted in complete resolution of the ards  
class10	3395	barrett s esophagus in children and young adults  frequent association with mental retardation  
class10	3395	since few data are available on epidemiologic features of barrett s esophagus in young persons  we reviewed the case records of patients undergoing esophageal biopsies at children s hospital  boston  from 1982 through 1986  
class10	3395	there were 1423 esophageal biopsies obtained from 1173 patients  and histological evidence of esophagitis was present in 397 cases  barrett s epithelium was diagnosed in 10 patients  0 9  of total and 2 5  of esophagitis cases   
class10	3395	specialized columnar epithelium was present in seven of these 10 patients  
class10	3395	the mean age of those with barrett s epithelium was 19 0     7 9 years  range 3 7 27 years  compared to 8 7     6 7 years  range 4 days to 31 years  for all patients biopsied  p less than 0 0001   80   8 10  of the barrett s cases were male compared to 54  of all cases  
class10	3395	the relative importance of the possible risk factors was assessed by comparing the 10 patients with barrett s with the 541 patients that had esophageal biopsies in calendar years 1984 1985  
class10	3395	mental retardation  a risk factor not previously described for young persons with barrett s esophagitis  was present in 70   7 10  of the barrett s patients but in only 15  of all patients biopsied  p less than 0 0002   
class10	3395	the frequency of mental retardation was also higher  but not significantly so  p greater than 0 07   in patients with biopsies that were positive for esophagitis  19   than in those with normal biopsies  14    
class10	3395	no significant differences were found between the barrett s group and all patients biopsied in regards to racial origin  prior stricture  or fundoplication  
class10	3396	scintigraphic measurement of oropharyngeal transit in man  
class10	3396	scintigraphic studies of the oropharyngeal transit of a liquid bolus were performed in 15 healthy controls  12 patients with symptoms of oral pharyngeal dysphagia  and 13 patients with neuromuscular disease  who did not have dysphagia  
class10	3396	gamma camera imaging of the head  neck  and upper thorax was undertaken  in the lateral projection  during the swallowing of the radiolabeled bolus of water  
class10	3396	inspection of summed images permitted the selection of regions of interest  roi  to represent the mouth  pharynx  and upper esophagus  
class10	3396	transit times between each roi were calculated and compared  
class10	3396	significant prolongation of bolus transit time between the mouth and esophagus was present in both patients with and without dysphagia  0 59     0 38 sec and 0 33     0 7 sec  mean     sd  respectively  compared with controls  0 26     0 04 sec p less than 0 001  p less than 0 01  respectively  mann whitney u test   
class10	3396	repeat studies in 25 individuals indicated that the transit measurements were more reproducible between swallows in normal subjects than in patients with symptoms  
class10	3396	deglutitive scintigraphy provides a noninvasive technique for the quantitative study of swallowing and its disorders  
class10	3397	irritable bowel syndrome in women having diagnostic laparoscopy or hysterectomy  relation to gynecologic features and outcome  
class10	3397	we identified irritable bowel syndrome  ibs  in 47 7  of 86 women having diagnostic laparoscopy for chronic pelvic pain  39 5  of 172 women having elective hysterectomy  and 32 0  of 172 controls age matched for the hysterectomy group  p   ns   
class10	3397	constipation and pain subtype ibs were more common in hysterectomy patients than controls  p less than 0 05   
class10	3397	in laparoscopy patients  dyspareunia was more common in those with ibs than in those without it  p less than 0 05   
class10	3397	in the hysterectomy group  more ibs patients had chronic pelvic pain  p less than 0 005   and abnormal menses  p less than 0 01   
class10	3397	chronic pelvic pain was more frequently the only prehysterectomy diagnosis in ibs patients  p less than 0 05   and ibs was present more often when pain was a reason for hysterectomy  p less than 0 01   
class10	3397	one year after laparoscopy  ibs patients gave lower overall status ratings  p less than 0 01  and lower pain improvement ratings  p less than 0 05  than non ibs patients  
class10	3397	in women who had a hysterectomy for pain  there was less pain improvement one year later in those with the pain subtype of ibs than in non ibs patients  p less than 0 05   
class10	3397	ibs is associated with gynecologic symptoms and affects the symptomatic outcome of diagnostic laparoscopy and hysterectomy  
class10	3398	myasthenia gravis  
class10	3398	myasthenia gravis is a disorder of neuromuscular function resulting from an immunologically based premature destruction of acetylcholine receptors  
class10	3398	the disease is characterized clinically by variable weakness accentuated by repetitive muscular activity and usually responding to the administration of acetylcholinesterase inhibitors  
class10	3398	myasthenia gravis is a complex disease and requires understanding of the many facets of its natural history and immunological basis to ensure optimal individual patient management  
class10	3398	the long term goal is control of the immunological imbalance  treatment regimens include thymectomy  corticosteroids  azathioprine  and plasmapheresis  
class10	3398	the common use of acetylcholinesterase inhibitors provides symptomatic relief during variable daily muscular activity  
class10	3398	disability due to myasthenia gravis is to a large extent reversible and death is preventable  
class10	3398	early recognition of myasthenia gravis and appropriate treatment are often rewarded by remission that may be permanent  
class10	3399	anorectal function in incontinent patients with cerebrospinal disease  
class10	3399	anorectal manometry and the electrical activity of the external anal sphincter were measured in 20 patients with well defined  incomplete spinal lesions who were referred because of fecal incontinence and in 30 normal subjects  
class10	3399	six patients had a high spinal lesion  11 had a low spinal lesion  and 3 had mixed high and low spinal lesions  
class10	3399	patients with high spinal lesions had normal basal pressures but abnormally low squeeze pressures and impaired rectal sensation  
class10	3399	unlike normal subjects  there was no relationship between the depth of sphincter relaxation and the distention volumes  
class10	3399	the external sphincter responses to rectal distention and increases in intraabdominal pressure were enhanced  and leakage of perfusion fluid was uncommon  
class10	3399	patients with low spinal lesions had abnormally low basal and squeeze pressures  blunted rectal sensation  and showed impaired external anal sphincter responses to rectal distention or increases in intraabdominal pressures  
class10	3399	most of these patients leaked the infused fluid during these maneuvers  
class10	3399	sphincter function in patients with mixed lesions was more severely impaired than in patients with low and high spinal lesions  
class10	3399	patients with mixed lesions showed abnormally low basal and squeeze pressures  impaired rectal sensation  and no external anal sphincter responses to either rectal distention or increases in intraabdominal pressure  
class10	3399	leakage occurred during these maneuvers in all patients with mixed lesions  
class10	3400	dementia  depression  or grief  the differential diagnosis  
class10	3400	depression  grief  and dementia are conditions frequently encountered among the community living elderly  
class10	3400	this review offers a primary care perspective of the distinguishing features for each and discusses the special issues of managing the elderly  
class10	3400	major depression in the elderly usually responds to antidepressant medication  whether the depression occurs alone  endogenous  or as a response to another condition  reactive   
class10	3401	semantic deterioration in alzheimer s  the patterns to expect  
class10	3401	differentiating language changes between the normal aged and those in the early stages of dementia is never simple  
class10	3401	knowing the differences and what to expect can aid in making this diagnosis  
class10	3402	the auditory p300 event related potential  an objective marker of the encephalopathy of chronic liver disease  
class10	3402	recently many variants of electroencephalogram evoked responses have been studied as potential diagnostic aids in the detection and evaluation of hepatic encephalopathy  
class10	3402	this study assesses the value of the auditory p300 event related potential  a slow component of the auditory evoked response  as a tool in this field  
class10	3402	twenty one nonencephalopathic and 12 encephalopathic  grade 1 2  cirrhotic patients and 26 controls were assessed clinically and psychometrically  
class10	3402	electroencephalogram spectral analysis and visual evoked response recordings were also conducted  
class10	3402	an auditory p300 wave was elicited using the standard two tone discrimination paradigm  
class10	3402	the latency and amplitude of this wave were measured  
class10	3402	the latency of the p300 was found to be significantly increased in the encephalopathic patients compared with both nonencephalopathic cirrhotic and control groups  p less than 0 05   
class10	3402	amplitude of the wave was decreased in both nonencephalopathic and encephalopathic patients  but this was not statistically significant  
class10	3402	this study suggests that the latency of the p300 is a good marker of grades 1 and 2 clinical hepatic encephalopathy  
class10	3402	the delays in the p300 latency may indicate that encephalopathic patients have a deterioration of their stimulus evaluation abilities  
class10	3403	increased serotoninergic and noradrenergic activity in hepatic encephalopathy in rats with thioacetamide induced acute liver failure  
class10	3403	functional changes of various neurotransmitter systems have been implicated in the pathogenesis of hepatic encephalopathy  
class10	3403	in this study the role of brain monoaminergic neurotransmitter systems in hepatic encephalopathy was investigated in rats with thioacetamide induced acute liver failure  
class10	3403	concentrations of serotonin  dopamine  noradrenaline and of their metabolites 5 hydroxyindoleacetic acid  dihydroxyphenylalanine  following inhibition of dihydroxyphenylalanine decarboxylase   dihydroxyphenylacetic acid  homovanillic acid and 3 methoxy 4 hydroxyphenyl glycol  were measured in the cerebral cortex  striatum and hippocampus by high performance liquid chromatography with electrochemical detection  
class10	3403	in hepatic encephalopathy concentrations of 5 hydroxyindoleacetic acid were increased in all three brain areas  196   204  and 264  of saline treated controls  p less than 0 01   and concentrations of serotonin were increased in the frontal cortex  121   p less than 0 01   
class10	3403	in the frontal cortex and hippocampus of encephalopathic rats dopamine levels were increased  157  and 289   p less than 0 05   and levels of noradrenaline  53  and 46   p less than 0 05  were decreased associated with increased 3 methoxy 4 hydroxyphenylglycol levels  173  and 206   p less than 0 05   
class10	3403	the extent of these changes correlated with the stage of hepatic encephalopathy  
class10	3403	in hepatic encephalopathy dihydroxyphenylalanine accumulation was increased in the hippocampus and unchanged in the cerebral cortex  
class10	3403	dopamine  noradrenaline  dihydroxyphenylacetic acid and homovanillic acid concentrations were unchanged in the striatum  
class10	3403	the results of this study indicate that hepatic encephalopathy in thioacetamide induced acute liver failure in rats is associated with neurochemical changes  suggesting an increased activity of the noradrenergic and serotoninergic neurotransmitter systems  
class10	3404	pain experiences of intensive care unit patients  
class10	3404	the purpose of this study was to describe various dimensions of the pain experiences of intensive care unit  icu  patients  
class10	3404	a purposive  primarily surgical sample of 24 icu patients from two hospitals was interviewed after transfer from icu  
class10	3404	all but one patient remembered their icu stay  
class10	3404	although this and six other patients had no recall of pain  63  of the sample rated their pain as being moderate to severe in intensity  
class10	3404	in a subgroup of nine patients having cardiac surgery  mean morphine sulfate administration during the first three postoperative days was 14 mg day  
class10	3404	this group of patients reported a lack of total pain relief from analgesics  
class10	3404	patients also described various sources of their pain  difficulties they had in communicating their pain  and nonpharmacologic methods that helped relieve their pain  
class10	3404	results of this study clearly indicate that not only pain but its communication and treatment were significant problems for a substantial portion of this icu sample  
class10	3404	further descriptive and experimental research of pain characteristics and treatment practices for icu patients is urgently needed  
class10	3404	improvements in nursing practice that result from such research may make a substantial difference in the comfort and well being of critically ill patients  
class10	3405	fungal pseudomeningitis superimposed on escherichia coli meningitis  
class10	3405	pseudomeningitis is the demonstration of microorganisms from the cerebrospinal fluid by stain or culture in a patient with symptoms suggesting meningitis  
class10	3405	this is a report of fungal pseudomeningitis superimposed on a case of nosocomial escherichia coli meningitis resulting from a neurosurgical procedure  
class10	3405	critical care personnel need to be aware of the possibility of pseudomeningitis with or without associated meningitis in the appropriate setting  
class10	3406	evaluating oxygen delivery and oxygen utilization with mixed venous oxygen saturation monitoring  a case study approach  
class10	3406	three cases studies are presented to demonstrate clinical application of mixed venous oxygen saturation  svo2  monitoring in critical care nursing practice  
class10	3406	examples of critically ill patients are used to demonstrate how svo2 monitoring can be used in clinical practice to reflect an imbalance between oxygen delivery and oxygen utilization  
class10	3406	in the first case  the patient had a problem with oxygen delivery  
class10	3406	continuous svo2 data aided nurses in guiding  adjusting  and assessing therapy  
class10	3406	the second case demonstrates how svo2 monitoring can provide an early sign of a life threatening complication  
class10	3406	the final case is one in which the patient had a problem with oxygen utilization  
class10	3406	in all the cases  continuous svo2 data provided important information about the balance between oxygen delivery and oxygen utilization  
class10	3407	the effect of improved cementing techniques on component loosening in total hip replacement  an 11 year radiographic review  
class10	3407	improved cementing techniques have been shown to decrease the rate of aseptic loosening of femoral components of cemented total hip replacements at five to seven years  
class10	3407	we now report our results in 105 hips in 93 patients at 10 to 12 7 years  mean 11 2   
class10	3407	the improved techniques included use of a medullary plug  a cement gun  a doughy mix of simplex p and a collared stem of chrome cobalt  
class10	3407	only three femoral components had definitely loosened  none were probably loose and 24 were graded as possibly loose  
class10	3407	in contrast  the incidence of radiographic loosening on the acetabular side was 42   
class10	3407	improved cementing techniques have produced a marked reduction in the rate of aseptic loosening of the femoral component  but the incidence of acetabular loosening is unchanged  
class10	3408	chiari pelvic osteotomy for osteoarthritis  the influence of the torn and detached acetabular labrum  
class10	3408	we assessed the results of chiari pelvic osteotomy in 64 hips with early osteoarthritis in terms of acetabular labral detachment detected pre operatively by arthrography  
class10	3408	at an average follow up of four years  assessment by the merle d aubigne score showed 83  excellent or good results  
class10	3408	these satisfactory results were achieved in only half the cases with a detached labrum  but in nearly all cases with normal or torn acetabular labra  
class10	3408	other factors such as the acetabular index  the level and angle of osteotomy  and the displacement following osteotomy did not affect the results  
class10	3408	chiari pelvic osteotomy is a worthwhile procedure for early osteoarthritis in selected cases  but a detached acetabular labrum increases the risk of clinical failure  
class10	3409	the hastings bipolar hemiarthroplasty for subcapital fractures of the femoral neck  a 10 year prospective study  
class10	3409	in a 10 year prospective study  561 displaced subcapital fractures of the femoral neck in 546 patients were treated with the hastings bipolar hemiarthroplasty  
class10	3409	within six months of their operations  148 patients had died  
class10	3409	in 322 hips followed up  243 with adequate serial radiographs separated by more than one year  only 14  5 6   showed acetabular erosion  
class10	3409	a group of 91 had been reviewed for between three and nine years  mean  4 years 10 months  and of these  95  had no pain or slight pain only  
class10	3409	comparison with an earlier series of conventional hemiarthroplasties reported from this institution showed that the clinical results were similar  but that the erosion rate had been halved  
class10	3410	reduction of post traumatic swelling and compartment pressure by impulse compression of the foot  
class10	3410	following the discovery of a powerful venous pump in the foot that is activated by weight bearing independently of muscular action  a pneumatic impulse device was developed to actuate this pump artificially  
class10	3410	in a multicentre international trial the device was shown to reduce post traumatic and postoperative swelling  pain also was alleviated  
class10	3410	evidence is also presented that dangerously high compartment pressures may be reduced to acceptable levels and fasciotomy avoided  
class10	3410	we present an explanation of the clinical effects of activation of the venous footpump  based on recent improved understanding of the physiology of the microcirculation  
class10	3410	the hyperaemic response that follows the liberation of endothelial derived relaxing factor  edrf  by sudden changes of pressure after weight bearing or impulse compression is particularly important  
class10	3411	the management of the painful first metatarsophalangeal joint in the older patient  arthrodesis or keller s arthroplasty  
class10	3411	we report a prospective randomised trial comparing keller s arthroplasty and arthrodesis of the first metatarsophalangeal joint for the management of symptomatic hallux valgus and hallux rigidus in the older patient  
class10	3411	in 81 patients  110 feet   with a minimum of two years follow up  both procedures gave a similar degree of patient satisfaction and symptom relief  
class10	3411	the incidence of metatarsalgia was also similar  
class10	3411	as there were no obvious advantages to arthrodesis  and since six out of 50 arthrodesed toes required revision  we suggest that keller s arthroplasty is the better operation in these patients  
class10	3412	the modified schollner costoplasty  
class10	3412	the modified schollner costoplasty is a cosmetic procedure for the correction of rib prominence deformity in scoliosis  
class10	3412	we present the results of the procedure in 21 patients who had previously undergone spinal fusion for scoliosis  
class10	3412	we found the procedure to be well tolerated without major complications  
class10	3412	objective cosmetic improvement was achieved in all but one case  
class10	3412	all but one patient considered the procedure to have been of cosmetic benefit  
class10	3413	a surgical approach to the cervicothoracic spine  
class10	3413	we describe a method for approaching the lower cervical and upper thoracic spine  the brachial plexus and related vessels  
class10	3413	the method involves the elevation of the medial corner of the manubrium  the sternoclavicular joint  and the medial half of the clavicle on a pedicle of the sternomastoid muscle  
class10	3413	we have used this exposure in 17 cases with few complications and good results  
class10	3413	its successful performance requires high standards of anaesthesia  surgical technique and postoperative care  
class10	3414	operative and conservative treatment of moderate spondylolisthesis in young patients  
class10	3414	we made a retrospective study of 149 children and adolescents with moderate spondylolisthesis  slip less than or equal to 30    77 treated by fusion and 72 conservatively at an average follow up of 13 3 years  
class10	3414	both groups were fully comparable with regard to age at diagnosis  sex distribution  46  girls   and mean slip  
class10	3414	the patients who were treated operatively had more pain before treatment and showed more initial progression of the slip  
class10	3414	they had better clinical results and less pain at latest review  but the total progression of the slip over the whole follow up showed no statistical differences between the two groups  
class10	3414	patients with a pseudarthrosis after attempted fusion had had a longer period of postoperative pain  but at the latest review had no more pain than those with sound fusion  
class10	3414	none of those treated conservatively came to fusion later and the long term results in 18 patients who had refused the advised operation were no worse than those for other conservatively treated patients  
class10	3414	our results suggest that a moderate grade of spondylolisthesis in adolescents usually has a benign course  
class10	3414	it seems that spontaneous segmental stabilisation occurs as a result of degeneration of the disc at the level of the slip  
class10	3415	combined epidural and general anesthesia in aortic surgery  
class10	3415	the perioperative course of 144 consecutive patients undergoing aortic reconstructive surgery was studied to assess the potential benefit of employing a combined epidural and light general anesthesia technique  
class10	3415	a group of 67 patients had general anesthesia alone  ga   while in the group of 77 remaining patients  a combined epidural and general anesthesia  epi ga  was employed  
class10	3415	the two groups were similar in regards to age  medical risk factors  preoperative assessment of cardiac and pulmonary function  and type of surgical reconstruction  
class10	3415	there was no significant difference in the anesthetic  operative time  or operative fluid requirements between the two groups  
class10	3415	there was a lower rate pressure product in the epi ga group during aortic cross clamping  p less than 0 05   
class10	3415	more patients in the ga group required a prolonged ventilatory support  p less than 0 05  and a high parenteral narcotic administration  p less than 0 025  during the first 48 hours  
class10	3415	while the mortality rate was similar for the two groups  3 0  for ga group vs 5 2  for epi ga group   there was a higher percent of postoperative pulmonary complications observed in the ga group  7 6   compared to the epi ga group  2 6    
class10	3415	by facilitating early extubation and a decreased need for systemic narcotics in the early postoperative period  epi ga may be beneficial in the high risk pulmonary patient undergoing aortic reconstruction  
class10	3416	unusual haemostasis for an unusual tumour  catastrophic bleeding from a tactile neurofibroma affecting the thoracic vertebrae  case report  
class10	3416	the symptomatology of a typical acute descending thoracic aorta dissection was imitated by profuse haemorrhage caused by a benign tumour composed almost exclusively of wagner meissner like tactile corpuscles and fatty tissue  
class10	3416	the tumour caused extensive destruction of the bodies of the fifth and sixth thoracic vertebrae at the level of the vertebro costal articulation  
class10	3416	emergency cross clamping of the descending aorta and haemostasis of the bleeding from osteal defects by tamponade with bone polymethyl methacrylate appeared the only way to control the life threatening haemorrhage  
class10	3416	it seems that an intrathoracic tactile neurofibroma with a similar case history has not been reported till now  
class10	3417	deletion of alu sequences in the fifth c sis intron in individuals with meningiomas  
class10	3417	an abnormality in the c sis protooncogene was identified in leukocyte dna from members of a family predisposed to the development of meningioma  and was found to be associated with the development of the tumor in those individuals  
class10	3417	molecular analysis of this abnormality demonstrated a deletion within the fifth intron of the c sis gene  
class10	3417	the normal c sis gene has an alu sequence in this region which includes two perfect 130 nucleotide repeated sequences separated by 5 bp  
class10	3417	the deleted c sis allele is missing precisely one copy of the 130 bp repeat and the intervening 5 bp  
class10	3417	an identical deletion was also found in dna from 1 of 13 sporadic meningiomas  
class10	3418	cheilitis granulomatosa  report of six cases and review of the literature  
class10	3418	six cases of cheilitis granulomatosa  a rare inflammatory disorder of unknown origin  are reported  
class10	3418	the condition produces nontender  persistent swelling of one or both lips and affects primarily young adults  
class10	3418	histologically  nonnecrotizing granulomatous inflammation is seen  
class10	3418	the clinical findings and results of therapy in these six cases are presented  
class10	3418	one patient was treated with hydroxychloroquine sulfate  plaquenil  that stabilized the process  
class10	3418	one of our patients had vesicular appearing lesions  
class10	3418	microscopic examination showed the lesions to be dilated superficial lymphatic channels  a finding that to our knowledge has not been previously described  
class10	3419	the relationship of pemphigus to neoplasia  
class10	3419	a statistically increased incidence of malignancy has been observed in patients with pemphigus  
class10	3419	a review of the literature reveals 42 cases of nonthymic malignancies and 18 cases of thymic malignancies  
class10	3419	a significant predominance of men  with mean age at onset of 50 years  was observed  
class10	3419	pemphigus vulgaris is more common in patients with nonthymic neoplasms  whereas pemphigus foliaceus or pemphigus erythematosus and pemphigus vulgaris are equally common in patients with thymic neoplasms  
class10	3419	lymphoreticular malignancies  especially kaposi s sarcoma  are most frequently observed  
class10	3419	the majority of patients with nonthymic neoplasms have pemphigus before the detection of the malignancy and have a favorable 5 year survival rate after tumor resection  
class10	3419	the majority of the patients with thymic neoplasms have a thymoma before the development of pemphigus  
class10	3419	in some patients pemphigus develops after thymectomy and myasthenia gravis is often associated  
class10	3419	overall  37 of the 60 patients  or 61   had a neoplasm of the immune system  
class10	3420	prevalence and characteristics of multiple analgesic drug use in an elderly study group  
class10	3420	with few exceptions  use of multiple analgesic drugs achieves dubious increases in analgesia while placing elders at increased risk of the many potential adverse effects of analgesic drugs  
class10	3420	the potential for duplication of analgesic therapy among the elderly is great due to prevalent painful chronic conditions and the variety of prescription and nonprescription analgesic remedies available  
class10	3420	the prevalence of multiple analgesic product use and patterns of concurrent use of different analgesic categories was investigated in a geographically defined population of persons 65 years of age and older  
class10	3420	the demographic characteristics of users of multiple analgesic drug products were examined  as were their smoking status  alcohol use  lifetime history rates of major illnesses  physical functioning  pain experiences  memory performance  and depressive symptoms  
class10	3420	a substantial proportion of analgesic users reported taking multiple products in the preceding 2 weeks  14 4  of female and 10 5  of male analgesic users   
class10	3420	men who reported pain in the preceding year were more likely to use multiple analgesic products  
class10	3420	women who experienced pain or limited physical functioning  or who had higher depressive symptom scores or a life time history of ulcers were most likely to use multiple analgesic products  
class10	3420	thus  although some users of multiple analgesic products reported significant pain  several other factors were shown to be related to the phenomenon of multiple use  
class10	3421	pelvic pain  lessons from anatomy and physiology  
class10	3421	pelvic pain is often a difficult differential diagnosis in the emergency department  
class10	3421	for physiologic reasons  pain in the pelvis is difficult to localize to a specific organ  and pelvic peritonitis is hard to recognize  
class10	3421	on the other hand  differences in types of pain can be very useful in arriving at a correct diagnosis  
class10	3421	the clinician must learn to recognize superficial and deep somatic pain  and differentiate between various types of visceral pain which originate from inflammation  ischemia  or colic  
class10	3421	a review of the anatomy and physiology of pelvic pain helps identify some of the problems as well as potential aids in approaching the patient with pelvic pain  
class10	3422	treatment of phenobarbital poisoning with multiple dose activated charcoal in an infant  
class10	3422	a 28 day old infant developed lethargy  hypotonia  and hypothermia following a phenobarbital overdose secondary to a pharmacist s error  
class10	3422	he was treated with multiple dose activated charcoal  mdac  and alkalinization of the urine  which resulted in prompt recovery with rapid elimination of the drug  t1 2 11 2 hours  expected 45 to 118 hours   
class10	3422	the use of mdac in this newborn was safe and effective  
class10	3422	we suggest that age should not pose a barrier to the use of mdac  when indicated  
class10	3423	extrageniculate vision in hemianopic humans  saccade inhibition by signals in the blind field  
class10	3423	the functional competence of extrageniculate visual pathways in hemianopic humans was demonstrated by showing that distractor signals in the blind half of the visual field could inhibit saccades toward targets in the intact visual field  
class10	3423	this inhibitory effect of unseen distractors in patients occurred only when distractors were presented in the temporal half of the visual field  was specific to oculomotor responses  and did not occur in normal subjects  
class10	3423	these results show that a peripheral visual signal activates retinotectal pathways to prime the oculomotor system and that these pathways can mediate orienting behavior in hemianopic humans  
class10	3424	dementia  what to do  
class10	3424	dementia is a syndrome of acquired intellectual deterioration that interferes with personal or social functioning  
class10	3424	diagnosis requires historical information from the family and the mental status evaluation of orientation  recent memory  comprehension  calculation  and abstraction  
class10	3424	most dementias create permanent  even progressive cognitive deterioration  yet there are some presentations for which remission exists  
class10	3424	common reversible conditions include depression  drug toxicity  normal pressure hydrocephalus  hypothyroidism  subdural hematoma  and neoplasm  
class10	3424	screening laboratory studies consist of urinalysis  chemistry profile  blood count  thyroid survey  vitamin b12 and folate measurements  serology  chest roentgenogram  computerized tomographic scan of the head  electroencephalogram  and electrocardiogram  
class10	3424	treatment focuses on potential reversibility  psychosocial issues  restoring deficits  and specific symptoms  
class10	3425	hematoma of the optic nerve sheath after penetrating trauma  
class10	3425	we have presented a case involving the diagnosis and management of optic nerve sheath hematoma  
class10	3425	our patient s positive outcome demonstrates the usefulness of megadose steroid therapy for acute optic nerve injury  
class10	3426	relationship between duration of spinal cord ischemia and postoperative neurologic deficits in animals  
class10	3426	twenty hogs were administered the following procedures before  during  and after overdistraction of the spinal column at t5 t6  somatosensory  sep  and neurogenic motor evoked potentials  nmeps   hydrogen clearance procedures  stagnara wake up tests  and aortic injection of silastic plastic  
class10	3426	to ensure that overdistraction was possible  a nonosseous  circumferential osteotomy was made at t5 t6 and distraction applied in one ratchet increments using harrington instrumentation  
class10	3426	overdistraction was maintained for 3  5  6  10  15  20  25  or 30 minutes  
class10	3426	results indicated that the duration of overdistraction  as represented by lost nmeps  was always correlated with the animal s clinical status on wake up test  
class10	3426	if overdistraction was maintained more than 6 minutes  100  of the animals demonstrated positive wake up results  if maintained between 5 and 6 minutes  75  demonstrated positive wake up results  and if maintained less than 5 minutes  only 25  demonstrated positive wake up results  
class10	3426	time to loss of the nmeps and seps  after onset of overdistraction  fell within two groups  slow and fast  
class10	3426	in the slow group  it required slightly more than 20 minutes  mean   20 6  for the potentials to be lost  while in the fast loss group data were lost in slightly less than 4 minutes  mean   3 6   
class10	3426	blood flow studies and inspection of the spinal cord revealed that the mechanism of action for the slow group appeared to be ischemia of the spinal cord that extended several centimeters above and below the site of maximum distraction  
class10	3426	in the fast loss group  it appeared that gross structural damage  with some very localized ischemia  were the mechanisms of actions influencing the integrity of the spinal cord  
class10	3427	histopathologic correlation of magnetic resonance imaging signal patterns in a spinal cord injury model  
class10	3427	magnetic resonance imaging  mri  provides a noninvasive method of monitoring the pathologic response to spinal cord injury  
class10	3427	specific mr signal intensity patterns appear to correlate with degrees of improvement in the neurologic status in spinal cord injury patients  
class10	3427	histologic correlation of two types of mr signal intensity patterns are confirmed in the current study using a rat animal model  
class10	3427	adult male sprague dawley rats underwent spinal cord trauma at the midthoracic level using a weight dropping technique  
class10	3427	after laminectomy  5  and 10 gm brass weights were dropped from designated heights onto a 0 1 gm impounder placed on the exposed dura  
class10	3427	animals allowed to regain consciousness demonstrated variable recovery of hind limb paraplegia  
class10	3427	magnetic resonance images were obtained from 2 hours to 1 week after injury using a 2 tesla mri spectrometer  
class10	3427	sacrifice under anesthesia was performed by perfusive fixation  spinal columns were excised en bloc  embedded  sectioned  and observed with the compound light microscope  
class10	3427	magnetic resonance axial images obtained during the time sequence after injury demonstrate a distinct correlation between mr signal intensity patterns and the histologic appearance of the spinal cord  
class10	3427	magnetic resonance imaging delineates the pathologic processes resulting from acute spinal cord injury and can be used to differentiate the type of injury and prognosis  
class10	3428	cerebral cysticercosis  
class10	3428	we studied 143 cases of cerebral cysticercosis over a 30 year period  
class10	3428	in 46 there was hydrocephalus due to cysts obstructing the cerebrospinal fluid pathways  with signs of hydrocephalus and cerebellar dysfunction  
class10	3428	in 97 there were cysts in the cerebral parenchyma  causing symptoms of intracranial hypertension alone in 22 cases  with additional neurological deficits in the remainder  
class10	3428	before 1980 diagnosis was made by pneumoencephalography and ventriculography  but since then it has mostly been done by computed tomography  
class10	3428	in 28 cases scanned  typical abnormalities were present in 25  
class10	3428	complement fixation tests were positive in serum in 74  of cases and in cerebrospinal fluid in 73   and the enzyme linked immunosorbent assay test was positive in serum in 90  and in cerebrospinal fluid in 92   
class10	3428	treatment of cases with hydrocephalus was by removal of the cysts at craniotomy  with placement of a shunt where necessary  
class10	3428	intracranial hypertension caused by parenchymal cysts was treated with steroids and osmotic agents  if possible  
class10	3428	in resistant cases subtemporal decompression was needed  unilateral in 55 cases and bilateral in eight  
class10	3428	mortality in the acute stage was 11   with a further 20  at follow up  
class10	3429	intractable complex partial seizures associated with occult temporal lobe encephalocele and meningoangiomatosis  a case report  
class10	3429	occult congenital temporal lobe encephalocele has rarely been reported in association with medically intractable complex partial seizures  
class10	3429	the four previously reported cases were unsuspected preoperatively  
class10	3429	we present the case of an 18 year old woman with intractable complex partial seizures since age 13  
class10	3429	seizure onset was electrically localized to the right temporal lobe  
class10	3429	preoperative neuroimaging studies revealed a middle fossa defect and inferior herniation of the right temporal lobe  
class10	3429	pathologic examination of the resected encephalocele revealed prominent features of meningoangiomatosis  
class10	3429	we believe this to be the first case of temporal lobe encephalocele and epilepsy to be diagnosed preoperatively  and the first case also to be associated with meningoangiomatosis  
class10	3429	the relevant literature on meningoangiomatosis and on temporal lobe encephalocele as a cause of epilepsy is reviewed  
class10	3430	cavernous carotid thrombosis and ocular motor paresis 
class10	3430	a 64 year old man presented with the acute onset of unilateral blindness and ipsilateral ocular motor paresis  
class10	3430	occlusion of the central retinal artery associated with thrombosis of the internal carotid artery in the cavernous sinus was demonstrated by angiography and magnetic resonance imaging  
class10	3430	cases of carotid thrombosis associated with ipsilateral ocular motor paresis are rare  
class10	3430	the pathophysiology of intracavernous carotid thrombosis is discussed in connection with blood supply of the cranial nerves in the cavernous sinus  
class10	3431	value of magnetic resonance imaging in spontaneous extradural spinal hematoma due to vascular malformation  case report  
class10	3431	a case of spinal cord compression due to spontaneous extradural spinal hematoma is reported  
class10	3431	a spinal arteriovenous malformation was suspected on the basis of magnetic resonance imaging  
class10	3431	early surgical exploration allowed a complete neurological recovery  
class10	3431	the vascular malformation was histopathologically confirmed  
class10	3431	the role of magnetic resonance imaging in the evaluation of acute spinal cord compression syndromes is stressed  
class10	3432	naloxone and spinal fluid drainage as adjuncts in the surgical treatment of thoracoabdominal and thoracic aneurysms  
class10	3432	forty seven patients who were treated for thoracoabdominal or thoracic aneurysms over a 5 1 2 year period were analyzed for neurologic deficit risk  
class10	3432	patients were divided into two groups for analysis  
class10	3432	twenty four patients  who were treated from january 1984 to december 1986  did not undergo spinal fluid drainage or naloxone administration  group a   
class10	3432	twenty three patients  who were treated from january 1987 to august 1989  had spinal fluid drainage  group b   12 patients in this group also received naloxone as an intravenous drip at 1 microgram kg hr for 48 hours after surgery  
class10	3432	permanent neurologic deficits occurred in seven  29   group a patients but in only one  4   group b patient  who did not receive naloxone  p less than 0 03   
class10	3432	the first two group b patients to receive naloxone showed complete reversal of neurologic deficits on waking from anesthesia  
class10	3432	this significant reduction in neurologic deficit was associated with an increased 1 year survival rate  72  in group a  91  in group b   
class10	3432	we conclude that the use of naloxone and spinal fluid drainage reduces the incidence of neurologic deficit that is associated with repair of thoracoabdominal and thoracic aortic aneurysms  
class10	3432	this reduction in neurologic deficit is associated with improved survival in the long term  
class10	3432	the observed reversal of postoperative neurologic deficits with naloxone implicates opiates as a major factor in the pathophysiology of spinal cord ischemia  
class10	3433	stroke and its modification in parkinson s disease  
class10	3433	previous studies have not agreed on the incidence of ischemic stroke in persons with parkinson s disease  
class10	3433	there are epidemiologic and neurochemical facets of parkinson s disease that might confer some benefit or protection against ischemic stroke  
class10	3433	we used a case control method to determine the lifetime history of ischemic stroke in 200 patients with parkinson s disease and 200 controls of a similar age range  
class10	3433	analysis was also carried out for myocardial infarction as a marker of generalized atherosclerotic disease and for stroke risk factors  
class10	3433	the cumulative incidence of ischemic stroke was significantly less in the patients with parkinson s disease than in the controls  as was the cumulative incidence of myocardial infarction  
class10	3433	among risk factors  significantly fewer patients with parkinson s disease used tobacco than controls  
class10	3433	the decreased incidence of ischemic stroke in the patients with parkinson s disease appears to be related to their less severe generalized atherosclerosis  possibly due to their lower incidence of tobacco use  
class10	3433	in view of the known potential for dopamine to exacerbate experimental ischemic tissue damage  the possibility that the dopamine deficiency in the central nervous system of persons with parkinson s disease confers an additional specific protective benefit against ischemic stroke cannot be excluded and requires further study  
class10	3434	acute and long term changes in serum lipids after acute stroke  
class10	3434	we studied serum lipid profiles in 171 patients less than or equal to 48 hours after the onset of acute stroke and 3 months later  
class10	3434	the 83 patients suffering cerebral infarction had significantly higher serum concentrations of total cholesterol  low density lipoprotein cholesterol  and apolipoprotein b and significantly lower serum concentrations of triglycerides and lipoprotein  a  less than or equal to 48 hours after ictus than 3 months later  
class10	3434	the lipid profiles of the 53 patients suffering lacunar infarction were similar on both occasions  the only significant differences being higher total cholesterol and low density lipoprotein cholesterol concentrations less than or equal to 48 hours after ictus  
class10	3434	no significant changes were observed among the 35 patients suffering cerebral hemorrhage apart from a significantly higher concentration of high density lipoprotein3 cholesterol less than or equal to 48 hours after ictus  
class10	3434	our study  with many patients classified according to stroke subtype  gives results different from those of previous studies with much fewer patients  
class10	3434	we conclude that in studies of serum lipid and lipoprotein concentrations as risk factors for cerebral infarction  comparing values obtained less than or equal to 48 hours after admission with control values may incorrectly identify certain lipid fractions as risk factors  
class10	3435	risk factors for white matter changes detected by magnetic resonance imaging in the elderly  
class10	3435	we found increased age  p   0 001  and history or evidence of stroke  p   0 016  to be significant independent multivariate predictors of the presence and severity of leukoencephalopathy on magnetic resonance imaging brain scans in a mixed population of 35 elderly psychiatric patients and 25 neurologically healthy elderly volunteers  
class10	3435	these results suggest that subcortical ischemia  as well as age related changes that may not be vascular in origin  contribute to the emergence of periventricular and other deep white matter hyperintensities that are commonly seen on the magnetic resonance imaging brain scans of older adults  
class10	3436	evidence for platelet activating factor as a novel mediator in experimental stroke in rabbits  
class10	3436	platelet activating factor is a potent mediator of inflammation  which has untoward effects on cerebrovascular and neural elements  
class10	3436	while several investigators have reported attenuation of ischemic damage after treatment with antagonists of platelet activating factor  no study has proved endogenous production of platelet activating factor in ischemia of the central nervous system  
class10	3436	we hypothesized that endogenous production of platelet activating factor participates in the early pathologic manifestations of deteriorating stroke  
class10	3436	in 12 rabbits  we found tissue levels of platelet activating factor measured by the release of serotonin from washed platelets to be elevated by approximately 20 fold in spinal cord injured by 25 minutes of ischemia and 2 hours of reperfusion  2 80     0 98 ng g  compared with that in normal spinal cord  0 15     0 06 ng g  p less than 0 01   
class10	3436	given during ischemia to seven rabbits  10 mg kg i p  
class10	3436	of a highly selective and potent antagonist of platelet activating factor  bn 50739  accentuated the early postischemic hyperemia and prevented the delayed hypoperfusion measured by on line laser doppler flowmetry   35     7  of baseline  n   7  without versus 33     14  with treatment  p less than 0 01  and the edema formation measured as the increase in tissue water content  4 4     0 7  without  n   6  versus 2 1     0 6  with  n   7 treatment  p less than 0 05  after 2 hours of reperfusion  
class10	3436	this neurochemical and pharmacologic evidence emphasizes a new perspective of ischemia induced phospholipid degradation and suggests an important role for platelet activating factor in the early manifestations of stroke  
class10	3437	beneficial effect of 1 3 butanediol on cerebral energy metabolism and edema following brain embolization in rats  
class10	3437	we assessed the effect of 1 3 butanediol on cerebral energy metabolism and edema after inducing multifocal brain infarcts in 108 rats by the intracarotid injection of 50 microns carbonized microspheres  
class10	3437	an ethanol dimer that induces systemic ketosis  25 mmol kg i p  
class10	3437	butanediol was injected every 3 hours to produce a sustained increase in the plasma level of beta hydroxybutyrate  
class10	3437	treatment significantly attenuated ischemia induced metabolic changes by increasing the concentrations of phosphocreatine  adenosine triphosphate  and glycogen and by reducing the concentrations of pyruvate and lactate  
class10	3437	lactate concentration 2  6  and 12 hours after embolization decreased by 13   44   and 46   respectively  
class10	3437	brain water content increased from 78 63  in six unembolized rats to 80 93  in 12 saline treated and 79 57  in seven butanediol treated rats 12 hours after embolization  
class10	3437	 p less than 0 05   
class10	3437	the decrease in water content was associated with significant decreases in the concentrations of sodium and chloride  
class10	3437	the antiedema effect of butanediol could not be explained by an osmotic mechanism since equimolar doses of urea or ethanol were ineffective  
class10	3437	our results support the hypothesis that the beneficial effect of butanediol is mediated through cerebral utilization of ketone bodies arising from butanediol metabolism  reducing the rate of glycolysis and the deleterious accumulation of lactic acid during ischemia  
class10	3438	retinal infarction during sleep and wakefulness  
class10	3438	brain and retinal infarctions during sleep have been attributed to focal hypoperfusion caused by systemic hypotension combined with underlying arterial stenosis  rather than to embolism  
class10	3438	because some retinal emboli may be visualized on ophthalmoscopy  we studied 24 consecutive patients  18 men and six women  aged 26 78  mean 58  years with recent retinal infarction and determined whether the infarction had occurred during sleep or wakefulness  
class10	3438	all patients underwent dilated ophthalmoscopy and a carotid artery study  arteriography in 20  duplex ultrasound in the remaining four   and 12 had echocardiography  
class10	3438	retinal infarction occurred during sleep at an unexpectedly rate  14 of 24 observed compared with eight of 24 expected  p   0 02   
class10	3438	retinal cholesterol emboli were seen in one half of the patients regardless of whether the retinal infarction had occurred during sleep or wakefulness  
class10	3438	carotid artery disease was found in seven of the 14 patients in whom infarction had occurred during sleep and in eight of the 10 patients in whom infarction had occurred during wakefulness  p   0 21   
class10	3438	cerebrovascular occlusive disease was not found in the five patients aged less than 50 years  
class10	3438	our findings suggest that embolism is a common mechanism of retinal infarction during sleep or wakefulness  that in patients aged greater than 50 years extracranial carotid artery disease is a common source of retinal emboli  and that the retina may be especially susceptible to infarction during sleep  
class10	3439	etiologic importance of the intimal flap of the external carotid artery in the development of postcarotid endarterectomy stroke  
class10	3439	a technically unsatisfactory end point  transition from the removed diseased plaque to normal distal intima  leading to an intimal flap of the external carotid artery has been identified as a source of perioperative stroke  
class10	3439	the mechanism involves thrombus formation with retrograde propagation of the thrombus and subsequent embolization of the internal carotid artery  
class10	3439	this report describes three cases illustrating this mechanism and methods of identification and correction  
class10	3439	this mechanism of postoperative stroke adds further justification for the routine use of intraoperative surveillance studies to document the technical result of endarterectomy involving the internal and external carotid arteries  
class10	3439	when an unsatisfactory end point is identified in the external carotid artery  it should be corrected with the same sense of concern as a similar finding in the internal carotid artery  
class10	3440	transitional cell carcinomatous meningitis after m vac  methotrexate  vinblastine  doxorubicin  and cisplatin  chemotherapy  
class10	3440	the m vac  methotrexate  vinblastine  doxorubicin  and cisplatin  regimen has been utilized at our two institutions to treat 17 patients with advanced stage transitional cell carcinoma of the bladder  
class10	3440	we report 2 cases of carcinomatous meningitis resulting from metastatic transitional cell carcinoma which occurred in patients treated with m vac  
class10	3440	review of the literature suggests that our experience with central nervous system metastases is not unique  and that treatment of advanced stage transitional cell carcinoma of the bladder with m vac may enhance the incidence of meningeal metastases  
class10	3440	carcinomatous meningitis  although rare  is a rapidly fatal manifestation of metastatic transitional cell carcinoma if left untreated  
class10	3440	however  prompt diagnosis and early aggressive therapy may result in palliation and stabilization of neurologic status  
class10	3440	we review the pathophysiology  diagnosis  and treatment of transitional cell carcinomatous meningitis  
class10	3441	neurologic complications of cardiac transplantation  
class10	3441	between 1984 and 1989  orthotopic cardiac transplantations were done in 90 patients from 10 to 65 years of age for end stage  refractory congestive cardiomyopathy  
class10	3441	two patients had had ischemic strokes 5 months and 18 years  respectively  before transplantation  
class10	3441	six patients  7   suffered acute neurologic events perioperatively  
class10	3441	three patients suffered cerebral infarctions  
class10	3441	in 1 case this occurred 10 days before transplantation  probably as a result of systemic hypoperfusion  with the placement of ventricular assist devices  
class10	3441	two others suffered infarctions 5 and 21 days  respectively  after transplantation  each of probable embolic origin  
class10	3441	two patients had an acute intracerebral hemorrhage 21 and 36 days  respectively  after transplantation  both were located within the basal ganglia and subcortical regions  
class10	3441	both patients had moderate to severe hypertension  and in 1  renal failure and a coagulopathy developed before hemorrhage  
class10	3441	tremor  seizures  and an altered level of consciousness developed in 1 patient as an apparent toxic reaction to cyclosporine treatment  
class10	3441	only 1 patient died as a result of the neurologic complication  of an acute intracerebral hemorrhage  
class10	3441	three patients recovered fully  2 partially  
class10	3441	only the case of drug toxicity could be directly attributed to the transplantation procedure itself  
class10	3441	we conclude that the risk of an acute neurologic insult with orthotopic cardiac transplantation is low but may result from drug toxicity  cerebral ischemia  or hemorrhagic mechanisms  
class10	3442	tryptophan induced eosinophilia myalgia syndrome 
class10	3442	eight patients who became ill while taking tryptophan had myalgia  fatigue  rash  fever  edema  alopecia  arthralgias  diminished joint motion  skin tightening  muscle cramping  and distal paresthesias  
class10	3442	three had shortness of breath  and one had pulmonary hypertension  
class10	3442	laboratory abnormalities included peripheral eosinophilia  leukocytosis  thrombocytosis  raised erythrocyte sedimentation rate  and elevated serum levels of aldolase  lactate dehydrogenase  and liver enzymes  
class10	3442	of 4 chest radiographs  3 were abnormal  
class10	3442	of 5 skin and muscle biopsies  4 showed sclerosis or mixed inflammatory cell infiltration of the dermis  subcutis  and fascia  
class10	3442	eosinophils were often present  but vasculitis was absent  
class10	3442	muscle inflammation was minimal  
class10	3442	we conclude that the  eosinophilia myalgia syndrome  is related to the ingestion of tryptophan and that abnormalities in the secretion of lymphokines may be important in its pathogenesis  
class10	3443	does paramedic base hospital contact result in beneficial deviations from standard prehospital protocols  
class10	3443	we reviewed written and audio records of paramedic base hospital radio contact to determine whether care differed from that suggested in standard prehospital care protocols  
class10	3443	records of all 659 contacts for seizure  syncope  abdominal pain  or altered mental state during 1987  28 4  of all contacts  were scored for the use of standard therapies  such as intravenous access  oxygen  naloxone hydrochloride  and unanticipated therapies  intubation  nitroglycerin   
class10	3443	cases that involved unanticipated treatments were reviewed to determine whether they could have been prospectively identified by simple clinical findings  
class10	3443	standard therapies were used in the majority of patients  
class10	3443	unanticipated therapies were administered to 13 patients  all of whom had abnormal vital signs  diaphoresis  respiratory distress  or a second prominent symptom  
class10	3443	data suggest that protocols could replace radio contact for most patients and that the few who might benefit from radio contact can be easily identified  
class10	3443	a 90  reduction in radio contacts in los angeles county could save  3 million each year  
class10	3444	analysis of programmed stimulation methods in the evaluation of ventricular arrhythmias in patients 20 years old and younger  
class10	3444	the purpose of this study was to systematically evaluate programmed ventricular stimulation in patients less than 21 years of age undergoing electrophysiologic testing  
class10	3444	a standardized protocol was applied in 55 consecutive patients  mean age 14 years  with the following clinical presentations  sustained ventricular tachycardia  vt   n   17   ventricular fibrillation  vf   n   7   syncope with heart disease  n   10   nonsustained vt  n   6   and syncope with an ostensibly normal heart  n   15   
class10	3444	the stimulation protocol consisted of 1 and 2 ventricular extrastimuli during sinus rhythm  followed by 1 to 4  s2  s3  s4  s5  extrastimuli during pacing at 2 ventricular sites  
class10	3444	of the 17 patients with sustained vt  12 had induction of the arrhythmia  sensitivity   71    
class10	3444	overall  18 of 55 patients had inducible sustained vt  with this response significantly enhanced by use of s4 or s5 protocols  p   0 02   
class10	3444	although no syncope patients with an ostensibly normal heart had inducible sustained vt  7 had polymorphic nonsustained vt in response to ventricular stimulation  
class10	3444	the mean number of extra stimuli preceding the induction of nonsustained or sustained vt or vf did not differ  
class10	3444	the induction of vf in 5 cases during this study was preceded in each case by extrastimuli intervals less than or equal to 190 ms  
class10	3444	thus  data indicate that aggressive stimulation protocols appear to be required for induction of sustained vt in most young patients  nonsustained polymorphic vt as a response to aggressive programmed stimulation is of uncertain significance  and that coupling intervals less than or equal to 190 ms may correlate with the induction of vf  
class10	3445	aortic calcified plaques and cardiovascular disease  the framingham study   
class10	3445	the relation between the presence of calcified plaques in the thoracic aorta  as detected on chest x rays  and the development of cardiovascular disease is examined during 12 years of follow up of the framingham cohort  n   5 209   
class10	3445	the prevalence of aortic calcified plaques approximately doubled with each decade of age  with only a trivial male predominance  
class10	3445	its presence was associated with a twofold increase in risk of cardiovascular death in men and women younger than age 65  even after other risk factors were taken into account  
class10	3445	similar increases in risk were found for coronary artery disease  stroke and intermittent claudication among middle aged women  
class10	3445	in middle aged men these risks were less marked  
class10	3445	the predictive value of aortic calcified plaques generally diminished with age  
class10	3445	risk of sudden coronary death in men with calcified plaques in the thoracic aorta ranged from a sevenfold increase at age 35 to no excess risk at age 70 years  
class10	3445	these results support the view that atherosclerosis is a generalized process  
class10	3445	the finding of aortic calcified plaques in a relatively young subject on a routine chest x ray should be regarded as a sign for potential development of clinically manifest atherosclerotic disease in the cardiac  cerebral and peripheral arterial circulation  
class10	3446	atlanto occipital disarticulation  accident characteristics  
class10	3446	a retrospective study of cases of atlanto occipital disarticulation was conducted to describe incident characteristics  24 cases were identified  including nine motor vehicle drivers  two passengers  seven pedestrians  and five motorcyclists  one other person had fallen four stories  
class10	3446	the highest rates were found among motorcyclists and pedestrians  
class10	3446	atlanto occipital disarticulations occur in high energy impacts and collisions and are associated with aortic laceration in 25  and basilar skull fracture in 21  of such cases  
class10	3446	current restraint systems and motorcycle helmets do not appear to prevent this generally rapidly fatal injury  
class10	3447	accidental death from a black powder rifle breech plug  
class10	3447	authentic black powder muzzle loader weapons and replicas are used today primarily for hunting game such as deer and hogs  
class10	3447	the following is a case presentation of accidental death from cerebral trauma caused by a  45 caliber black powder rifle breech plug implanting in the victim s brain  
class10	3448	frequency of three hex a mutant alleles among jewish and non jewish carriers identified in a tay sachs screening program  
class10	3448	mutations in the hex a gene  encoding the alpha subunit of beta hexosaminidase a  hex a   are the cause of tay sachs disease as well as of juvenile  chronic  and adult gm2 gangliosidoses  
class10	3448	we have examined the distribution of three mutations  a 4 nucleotide insertion in exon 11  a g    c transversion at a 5  splice site in intron 12  and a 269gly    ser amino acid substitution in exon 7  among individuals enzymatically diagnosed as carriers of hex a deficiency  
class10	3448	mutation analysis included polymerase chain reaction  pcr  amplification of the relevant regions of genomic dna  followed by allele specific oligonucleotide hybridization  another test for heterozygosity of the exon 11 insertion was based on the formation of heteroduplex pcr fragments of low electrophoretic mobility  
class10	3448	the percentage distribution of the exon 11  intron 12  exon 7  and unidentified mutant alleles was 73 15 4 8 among 156 jewish carriers of hex a deficiency and 16 0 3 81 among 51 non jewish carriers  
class10	3448	regardless of the mutation  the ancestral origin of the jewish carriers was primarily eastern and  somewhat less often  central europe  whereas for the non jewish carriers it was western europe  
class10	3448	because a twelfth of the jewish carriers and four fifths of the non jewish carriers of hex a deficiency had mutant alleles other than the three common ones tested  enzyme based tests cannot be replaced by dna based tests at the present time  
class10	3448	however  dna based tests for two carrier couples could identify those at risk for the chronic adult gm2 gangliosidoses rather than for infantile tay sachs disease  
class10	3449	more than one mutant allele causes infantile tay sachs disease in french canadians  
class10	3449	two tay sachs disease  tsd  patients of french canadian origin were shown by myerowitz and hogikyan to be homozygous for a 7 6 kb deletion mutation at the 5  end of the hexosaminidase a alpha subunit gene  
class10	3449	in order to determine whether all french canadian tsd patients were homozygotes for the deletion allele and to assess the geographic origins of tsd in this population  we ascertained 12 tsd families of french canadian origin and screened for occurrence of mutations associated with infantile tsd  
class10	3449	dna samples were obtained from 12 french canadian tsd families  
class10	3449	samples were analyzed using polymerase chain reaction  pcr  amplification followed by hybridization to allele specific oligonucleotides  aso  or by restriction analysis of pcr products  
class10	3449	in some cases southern analysis of genomic dna was performed  
class10	3449	eighteen of the 22 independently segregating mutant chromosomes in this sample carried the 7 6 kb deletion mutation at the 5  end of the gene  
class10	3449	one chromosome carried the 4 nucleotide insertion in exon 11  a  jewish  mutation   
class10	3449	in this population no individuals were detected who had the substitution at the splice junction of exon 12 previously identified in ashkenazi jews  
class10	3449	one chromosome carried an undescribed b1 mutation  this allele came from a parent of non french canadian origin  
class10	3449	patients in three families carried tsd alleles different from any of the above mutations  
class10	3449	the 5  deletion mutation clusters in persons originating in southeastern quebec  gaspe  and adjacent counties of northern new brunswick  
class10	3450	laparoscopic ventrosuspensions  a review of 72 cases  
class10	3450	laparoscopic ventrosuspension is simple to perform after diagnostic laparoscopy  
class10	3450	serious postoperative complication is unlikely  
class10	3450	however  patient follow up over 6 months has not confirmed the usefulness of laparoscopic ventrosuspension in the management of deep dyspareunia or pelvic pain in association with a retroverted uterus  
class10	3450	the success rate of laparoscopic ventrosuspension at 6 months varies from 18 6  to 46 5   
class10	3450	the prior use of a hodge pessary does not predict the success of laparoscopic ventrosuspension  
class10	3451	magnetic resonance imaging of radiation optic neuropathy  
class10	3451	three patients with delayed radiation optic neuropathy after radiation therapy for parasellar neoplasms underwent magnetic resonance imaging  
class10	3451	the affected optic nerves and chiasms showed enlargement and focal gadopentetate dimeglumine enhancement  
class10	3451	the magnetic resonance imaging technique effectively detected and defined anterior visual pathway changes of radionecrosis and excluded the clinical possibility of visual loss because of tumor recurrence  
class10	3452	auditory hallucinations and smaller superior temporal gyral volume in schizophrenia  
class10	3452	recent neuropathologic investigations in schizophrenia report smaller volume of medial temporal lobe structures  
class10	3452	these findings are confirmed by preliminary magnetic resonance imaging  mri  studies  
class10	3452	direct stimulation of lateral temporal lobe structures in the region of the superior temporal gyrus provokes hallucinations  
class10	3452	the authors  mri study of young schizophrenic patients demonstrates smaller volume of the superior temporal gyrus  an auditory association area  and of the left amygdala  
class10	3452	smaller size of the left superior temporal gyrus and left amygdala is not accounted for by smaller size of the overall brain or temporal lobe  
class10	3452	shrinkage of the left superior temporal gyrus is strongly and selectively correlated with severity of auditory hallucinations  
class10	3453	a discriminant validity study of negative symptoms with a special focus on depression and antipsychotic medication  
class10	3453	if the construct validity of the negative symptom syndrome is to be established  the conceptual and operational overlap between negative symptoms and other syndromes such as depression and the effects of medication must be explained  
class10	3453	the author assessed 26 patients with schizophrenia and 21 patients without schizophrenia  most of whom had depression  at the end of an average 2 week drug washout period and after approximately 2 months of psychotropic medication administration  
class10	3453	negative symptoms were remarkably consistent in patients with schizophrenia despite pharmacological intervention  
class10	3453	in contrast  the patients without schizophrenia manifested significant decreases in negative symptoms  
class10	3454	depression in dementia of the alzheimer type and in multi infarct dementia  
class10	3454	the authors used the hamilton rating scale for depression and a rating of depressed mood to investigate the prevalence of depression in 55 patients with alzheimer s disease  37 patients with multi infarct dementia  and 30 nondemented comparison subjects  
class10	3454	the prevalence of depressed mood depended on the severity of dementia as measured by the mini mental state examination and was significantly lower among patients in more severe stages of alzheimer s disease but not among patients with severe multi infarct dementia  
class10	3455	panic disorder and cardiovascular cerebrovascular problems  results from a community survey  
class10	3455	follow up studies of psychiatric patients with panic disorder have shown an abnormally high mortality rate in men due to cardiovascular and cerebrovascular events  
class10	3455	the authors report that in the new haven portion of the epidemiologic catchment area program the risk for stroke in persons with lifetime diagnoses of panic disorder was over twice that in persons with other psychiatric disorders or no psychiatric disorder  
class10	3455	after adjustments for demographic differences between groups  the risk was even higher  
class10	3455	while the results should be interpreted cautiously because of the small sample and absence of medical examinations  these findings are consistent with clinical studies showing an association between panic disorder and cardiovascular cerebrovascular events  
class10	3456	nitrous oxide does not alter infarct volume in rats undergoing reversible middle cerebral artery occlusion  
class10	3456	this experiment was designed to determine if nitrous oxide alters neurologic and pathologic outcome from temporary focal cerebral ischemia in spontaneously hypertensive rats deeply anesthetized with a barbiturate  
class10	3456	two groups of rats were given intravenous methohexital such that a stable eeg pattern of burst suppression was achieved  
class10	3456	in one group of rats  n   11   the lungs were mechanically ventilated with 70  n2o 30  o2  and in the other group  n   10   ventilation was done with 70  nitrogen 30  o2  
class10	3456	the middle cerebral artery was then occluded for 2 h  during which time mean arterial pressure  blood gases  hematocrit  plasma glucose  and head temperature were held constant between groups  
class10	3456	the total doses of methohexital administered were similar in both groups as were the plasma methohexital concentrations immediately prior to onset of ischemia  
class10	3456	after reperfusion of the middle cerebral artery  the animals were allowed to awaken  
class10	3456	neurologic evaluations were performed prior to ischemia and at 24 and 96 h postischemia  
class10	3456	cerebral infarct volume was measured at 96 h postischemia using triphenyl tetrazolium chloride staining and computer imaging techniques  
class10	3456	there were no neurologic differences between the n2o and nitrogen groups at any experimental interval although both groups exhibited deficits at both 24 and 96 h postischemia relative to preischemic values  
class10	3456	the two groups also had nearly identical cerebral infarct volumes  n2o   231     97 mm3  nitrogen   226     75 mm3  mean     sd   
class10	3457	resistance to d tubocurarine in lower motor neuron injury is related to increased acetylcholine receptors at the neuromuscular junction 
class10	3457	the hypothesis that lower motor neuron injury  with its associated proliferation of acetylcholine receptors  achr   induces resistance to the neuromuscular effects of d tubocurarine  dtc  was tested in the rat  
class10	3457	the left gastrocnemius was denervated by a 75 80  lesion of the sciatic nerve  
class10	3457	the effective dose for 95  twitch depression  ed95  was studied in the denervated gastrocnemius and compared to the contralateral undenervated and sham injured  control  gastrocnemius muscles approximately 2 weeks after injury  
class10	3457	the achr number was quantitated by the specific ligand 125i alpha bungarotoxin  125i alpha bt   
class10	3457	plasma dtc concentrations  measured by high performance liquid chromatography  hplc   were correlated to twitch tension during spontaneous recovery from neuromuscular blockade in the denervated animal  
class10	3457	the ed95  mean     se  of dtc for the denervated leg was significantly  p less than 0 05  higher  0 26     0 06 mg kg 1  than contralateral  0 16     0 03  and sham operated left  0 13     0 03  legs  
class10	3457	the twitch tension recovered to 50  of control twitch height at significantly  p less than 0 05  higher plasma dtc concentrations in the denervated  0 78 micrograms ml 1  compared to contralateral  0 24 micrograms ml 1  limb  
class10	3457	the achr number was significantly increased in the denervated limb  1041     96 fmol mg protein 1  compared to contralateral right  109     4  and control left limb  113     11   
class10	3457	there was a significant  p less than 0 05  positive correlation  r2   0 73  between ed95 and achr number  that is  73  of the variability in ed95 could be explained by changes in achr  
class10	3457	this study  therefore  confirms the hypothesis that proliferation of achr after nerve denervation results in resistance to the neuromuscular effects of dtc  
class10	3458	a comparative trial of three agents in the treatment of acute migraine headache  
class10	3458	study objectives  a study was conducted to evaluate the relative efficacy of three non narcotic agents  chloropromazine  lidocaine  and dihydroergotamine  in the treatment of migraine headache in an emergency department setting  
class10	3458	design  the trial was randomized and single blinded  
class10	3458	setting  the study was conducted in two university affiliated eds  
class10	3458	type of participants  all patients had an isolated diagnosis of common or classic migraine  
class10	3458	interventions  patients were pretreated with 500 ml  iv  normal saline before randomization  
class10	3458	study drugs as administered were dihydroergotamine 1 mg iv repeated after 30 minutes if the initial response was inadequate  lidocaine 50 mg iv at 20 minute intervals to a maximum total dose of 150 mg as required  or chloropromazine 12 5 mg iv repeated at 20 minute intervals to a total maximum dose of 37 5 mg as required  
class10	3458	patients were asked to grade headache severity on a ten point scale before and one hour after the initiation of therapy  
class10	3458	follow up by phone was sought the following day  
class10	3458	measurements and main results  of 76 patients completing the trial  24 were randomized to receive chloropromazine  26 to receive dihydroergotamine  and 26 to receive lidocaine  
class10	3458	reduction in mean headache intensity was significantly better among those treated with chloropromazine  p less than  005   
class10	3458	persistent headache relief was experienced by 16 of the chloropromazine treated patients  88 9   contacted at 12 to 24 hours follow up compared with ten of the dihydroergotamine treated patients  52 6   and five of the lidocaine treated group  29 4    
class10	3458	conclusion  the relative effectiveness of these three antimigraine therapies appears to favor chloropromazine in measures of headache relief  incidence of headache rebound  and patient satisfaction with therapy  
class10	3459	a prospective  double blind study of metoclopramide hydrochloride for the control of migraine in the emergency department 
class10	3459	study objective  to determine the effectiveness of iv metoclopramide as sole therapy for relieving the pain of acute migraine in the emergency department  
class10	3459	design  prospective study  
class10	3459	fifty patients were divided randomly into subjects and placebo controls with blinding of the treating physician and the patient  
class10	3459	participants  patients presenting to the ed with migraine requiring parenteral treatment  
class10	3459	interventions  subjects received 10 mg iv metoclopramide and controls received iv normal saline  patient assessment of relief was followed by means of a numerical scale  
class10	3459	measurements and main results  sixty seven percent of subjects compared with 19  of controls had effective pain relief within one hour  p less than  001   
class10	3459	subjects achieved mean relief scores of 2 46 compared with 1 69 for controls  p less than  02   
class10	3459	no significant side effects were observed  
class10	3459	conclusion  iv metoclopramide as a single agent is effective and safe therapy for migraine in the ed  
class10	3460	brain water content  brain blood volume  blood chemistry  and pathology in a model of cerebral edema  
class10	3460	study objectives  the objective was to correlate regional changes during brain water content with alterations in blood chemistry and cerebral pathology during hypo osmotic edema  
class10	3460	participants  sprague dawley male adult rats were used in these studies  
class10	3460	design  animals were block randomized to receive either an intraperitoneal distilled water injection equivalent to 5  or 15  of their body weight or no injection  controls   
class10	3460	rats were sacrificed 15 or 60 minutes after water injection or at an equivalent time for controls  
class10	3460	interventions  no interventions were performed  
class10	3460	measurements and main results  water content of cerebral cortical gray and white matter was calculated from measurements of tissue specific gravity  
class10	3460	blood plasma osmolality and sodium and potassium concentrations were determined at various times after water injection  
class10	3460	an index of blood brain barrier permeability was obtained by measuring brain red blood cell and plasma volumes  
class10	3460	a qualitative assessment of edema was made from light and electron micrographs of the cerebral cortex  
class10	3460	we found that water injection produced a dose dependent decrease in plasma osmolality and sodium concentration within 15 minutes  
class10	3460	cortical water content was unchanged after this period  
class10	3460	an influx of water into cerebral gray  and  less readily  into cerebral white matter occurred during the next 15 minutes  
class10	3460	whole blood specific gravity and brain blood content were unchanged and thus did not confound the measurement of cerebral water content  
class10	3460	hematocrit was increased 60 minutes after a 15  water injection  
class10	3460	the blood brain barrier remained intact throughout this period  
class10	3460	microscopy revealed astrocytic swelling with slight extracellular fluid accumulation 60 minutes after the water injection  
class10	3460	conclusions  homeostatic mechanisms in the cerebral cortex can maintain constant water content for at least 15 minutes during maintained intravascular hypo osmolality  
class10	3460	fluid that subsequently moves into the tissue primarily enters an intracellular compartment  
class10	3460	this model will be useful in investigating physiological mechanisms of brain water regulation and the pathogenesis of brain edema  a common clinical entity in emergency conditions  
class10	3461	spectral electroretinography in thioridazine toxicity  
class10	3461	in three patients with thioridazine toxicity  the electroretinogram  erg  to red light was found to be below the average normal range  
class10	3461	a significant increase in its amplitude appeared with cessation of therapy in two cases  
class10	3461	a further deterioration of the erg amplitude to all stimulus conditions  white  blue  and red lights  occurred when the dose of the medication was increased in the third patient  
class10	3462	a case of unilateral posterior ischemic optic neuropathy after radical neck dissection  
class10	3462	we present a case of unilateral posterior ischemic optic neuropathy after bilateral radical neck dissection  
class10	3462	etiologic factors are discussed  
class10	3463	auditory brain stem implant  effect of tumor size and preoperative hearing level on function  
class10	3463	the auditory brain stem implant is an investigational device designed to provide hearing sensations to patients without functioning auditory nerves  
class10	3463	we analyzed results from 17 implants in 15 patients to determine if tumor size or preoperative hearing level might be related to proper device function  
class10	3463	we found no significant correlation between preoperative hearing level or tumor size and device function  
class10	3463	we also found no significant correlation between preoperative hearing level and tumor size in these 15 patients  
class10	3464	cholinergic deficiency and frontal dysfunction in parkinson s disease  
class10	3464	to investigate the influence of central cholinergic deficit on cognitive function in parkinson s disease  pd   we compared the neuropsychological performance of a group of 20 patients who were treated with anticholinergic drugs  mean daily dose  10 2 mg  with that of a group of 20 patients who received no anticholinergics  
class10	3464	the two groups were matched for all the variables of parkinsonism and levodopa therapy  
class10	3464	at the dose used  there was no significant difference between the two groups of patients for intellectual  visuospatial  instrumental  and memory function  
class10	3464	in contrast  in the group that received anticholinergics severe impairment was observed on tests believed to assess frontal lobe function  
class10	3464	these results suggest that the lesion of the ascending cholinergic neurons  which has been demonstrated post mortem in pd  may play a role in the subcorticofrontal behavioral impairment of this disease  
class10	3465	posthypoxic glucose supplement reduces hypoxic ischemic brain damage in the neonatal rat  
class10	3465	we evaluated the effect of posthypoxic glucose supplement in a neonatal hypoxic ischemic animal model  
class10	3465	seven day old rats underwent bilateral ligation of the carotid arteries  followed by exposure to an 8  oxygen atmosphere for 1 hour  
class10	3465	the extent of hypoxic ischemic brain damage was assessed histologically 72 hours later  
class10	3465	glucose load immediately after the end of the hypoxic exposure reduced the volume of neocortical infarction to 37  of the unsupplemented value  and attenuated ischemic damage in the striatum and the dentate gyrus  
class10	3465	at the end of the hypoxic exposure  the brain level of glucose was 0 3 mmol kg and the level of lactate 9 mmol kg  
class10	3465	glucose supplement produced a rapid rise in brain glucose level to 3 to 5 mmol kg over the next 2 hours  
class10	3465	lactate in both brain and plasma gradually fell toward the baseline level during the first hour of recovery  
class10	3465	posthypoxic glucose supplement slightly retarded lactate restitution  
class10	3465	at any period of this neonatal model  brain lactate levels did not exceed the toxic level  which is postulated to be responsible for cerebral infarction in adult ischemic models  
class10	3465	these results illustrate the important role of glucose in the development of neonatal hypoxic ischemic encephalopathy and the fact that full cortical infarction can develop even if brain lactate levels are low  
class10	3466	relation of hyperglycemia early in ischemic brain infarction to cerebral anatomy  metabolism  and clinical outcome  
class10	3466	we studied the relation of serum glucose level measured in the first 12 hours of symptoms to the clinical findings  results of computed tomography  ct   and patterns of cerebral metabolism in 39 patients who had acute ischemic cerebral infarction  
class10	3466	structural damage was assessed by ct  
class10	3466	metabolic disruption was assessed using 18f fluorodeoxyglucose and positron emission tomography  pet   
class10	3466	median initial serum glucose concentration was 155 mg dl  6 7 mm   
class10	3466	clinical recovery was significantly poorer in patients with initial serum glucose levels higher than the median  p less than 0 05  chi square   
class10	3466	pet tended to show normal results or minor abnormalities in patients with initial glucose levels less than the median  as opposed to lobar or multilobe abnormalities in patients with levels that were higher than the median  p less than 0 05  kendall s tau b   
class10	3466	the severity of hypometabolism in the ischemic region  expressed as the percent asymmetry of local cerebral glucose metabolism between homologous brain regions  was greater in patients with initial glycemia concentrations higher than the median  p less than 0 001  t test   
class10	3466	relationships of serum glucose level with metabolic derangement and structural damage  but not outcome  held true in patients without a history of diabetes mellitus  
class10	3467	a clinical triad to diagnose paraneoplastic retinopathy  
class10	3467	two elderly men developed photosensitivity and light induced glare  transient visual symptoms  and progressive visual loss several months before small cell carcinoma of the lung was discovered  
class10	3467	both patients had impaired visual acuity and color vision  ring scotomas  and attenuated retinal arteriole caliber  
class10	3467	electroretinography demonstrated abnormal cone and rod mediated responses  
class10	3467	antiretinal antibodies were identified in their serum  
class10	3467	their visual sensory function improved following therapy with immunosuppressive agents  
class10	3467	the triad of photosensitivity  ring scotomatous visual field loss  and attenuated retinal arteriole caliber should alert one to a paraneoplastic disorder affecting the retina  
class10	3468	soluble interleukin 2 receptors in cerebrospinal fluid from individuals with various neurological disorders  
class10	3468	soluble interleukin 2  il 2r  levels in the cerebrospinal fluid  csf  were studied in infectious  inflammatory  degenerative  and neoplastic disorders to evaluate their usefulness as a marker for the presence of activated t cells  thus indicating an inflammatory process  
class10	3468	csf from control subjects and patients with stationary  progressive  and treated multiple sclerosis  ms   aseptic meningitis  lymphoid and nonlymphoid central nervous system  cns  tumors  alzheimer s disease  as well as serum from ms patients and control subjects were studied for levels of soluble il 2r  
class10	3468	a significant increase in csf il 2r levels was observed in patients with ms  meningitis  and lymphoid cns tumors  the ms group showed the highest values  
class10	3468	csf from individuals with alzheimer s disease and from patients with nonlymphoid tumors did not show significantly elevated values  
class10	3468	serum il 2r levels were significantly higher in ms patients than in control subjects  but there was no significant correlation between individual serum and csf il 2r levels  
class10	3468	this study suggests the presence of activated t lymphocytes in the cns of patients with ms  
class10	3469	ubiquitin immunoreactivity in kuru plaques in creutzfeldt jakob disease  
class10	3469	cerebellar kuru plaques in 2 cases of creutzfeldt jakob disease were studied immunohistochemically  
class10	3469	similar to cerebellar senile plaques in alzheimer s disease  many kuru plaques contained ubiquitin positive  tau negative small granular elements  presumably representing dystrophic neurites  
class10	3469	our results suggest that similar mechanisms are involved in neuritic changes in cerebellar plaques in creutzfeldt jakob and alzheimer s diseases despite differences of amyloid proteins in the plaques  
class10	3470	middle cerebral artery strokes causing homonymous hemianopia  positron emission tomography  
class10	3470	eight patients were evaluated with 18f fluorodeoxyglucose positron emission tomography between 3 and 30 days after isolated stroke involving the middle cerebral artery territory that caused homonymous hemianopia  
class10	3470	diffuse hypometabolism was present throughout the damaged cerebral hemisphere  even in cortical areas not obviously ischemic by clinical examination or neuro imaging  
class10	3470	glucose metabolism in primary and association visual cortex of the damaged hemisphere was decreased by more than 47   p less than 0 01   
class10	3470	metabolism in the undamaged hemisphere was less profoundly affected  but significant decrements were found in calcarine  40   p less than 0 01  and lateral occipital cortex  35   p less than 0 05   
class10	3471	vasoactive peptide release in the extracerebral circulation of humans during migraine headache  
class10	3471	the innervation of the cranial vessels by the trigeminal nerve  the trigeminovascular system  has recently been the subject of study in view of its possible role in the mediation of some aspects of migraine  
class10	3471	since stimulation of the trigeminal ganglion in humans leads to facial pain and flushing and associated release of powerful neuropeptide vasodilator substances  their local release into the extracerebral circulation of humans was determined in patients who had either common or classic migraine  
class10	3471	venous blood was sampled from both the external jugular and cubital fossa ipsilateral to the side of headache  
class10	3471	plasma levels of neuropeptide y  vasoactive intestinal polypeptide  substance p  and calcitonin gene related peptide were determined using sensitive radioimmunoassays for each peptide  and values for the cubital fossa and external jugular and a control population were compared  
class10	3471	a substantial elevation of the calcitonin gene related peptide level in the external jugular but not the cubital fossa blood was seen in both classic and common migraine  
class10	3471	the increase seen in classic migraine was greater than that seen with common migraine  
class10	3471	the other peptides measured were unaltered  
class10	3471	this finding may have importance in the pathophysiology of migraine  
class10	3472	richner hanhart s syndrome  electron microscopic study of the skin lesion  
class10	3472	the plantar hyperkeratotic skin lesion in a case of richner hanhart s syndrome was investigated using ultrastructural examination  
class10	3472	light microscopic examination showed remarkable hyperkeratosis and some aberrant keratinocytes with multiple nuclei  
class10	3472	on ultrastructural examination  some abnormal structures were seen in the affected keratinocytes  aggregations of tonofilaments and intracytoplasmic inclusions  
class10	3472	the inclusions were needle shaped and were considered to be  crystal ghosts   presumably of tyrosine  
class10	3472	the formation of tyrosine crystalline inclusions seems to be an important factor in the pathogenesis of the cutaneous lesions in richner hanhart s syndrome  
class10	3473	magnetic resonance imaging in neurological disorders  
class10	3473	to investigate the role of magnetic resonance imaging  mri  in neurological disorders  115 children were studied in two groups  
class10	3473	group a  78 patients  was studied by paired computed tomography and mri cranial scans  
class10	3473	group b  37 patients  was studied by paired computed tomography assisted myelography  ctm  and mri spinal scans  
class10	3473	in group a  the scans were generally equivalent for supratentorial tumours and for investigating fits  hydrocephalus  benign intracranial hypertension  and cerebral atrophies  but mri scanning was superior for posterior fossa tumours and cysts  
class10	3473	in group b  mri scans were superior for intramedullary spinal tumours  spinal dysraphic problems with tethering or syrinx  and were complementary to ctm in diastematomyelia  
class10	3474	slow release carbamazepine in treatment of poorly controlled seizures  
class10	3474	thirty three children with poorly controlled epilepsy  and six new patients  were treated with slow release carbamazepine  
class10	3474	twelve of the former had a reduction in the number of seizures of more than half  and 10 had fewer side effects  
class10	3474	three of the new patients stopped having seizures  
class10	3474	variations in plasma concentrations between doses was significantly less when patients took the slow release preparation  22   compared with the standard preparation  41    
class10	3474	slow release carbamazepine may improve the conditions of children whose seizures are poorly controlled  
class10	3475	the iris in williams syndrome  
class10	3475	forty three children with williams syndrome and 124 control subjects had their eyes photographed  
class10	3475	the photographs were examined by three ophthalmologists and four geneticists of varying experience  
class10	3475	a stellate pattern was noted more often in the irides of patients with williams syndrome  51   than in those of the control subjects  12    and was more difficult to detect  or was absent  in heavily pigmented irides  
class10	3475	we conclude that the stellate pattern is of diagnostic importance  particularly if the pattern is carefully defined and the clinician is experienced  
class10	3476	analysis of prognostic factors and clinicopathological staging of thymoma 
class10	3476	the prognostic value of four clinical variables  age and sex of patients  association with myasthenia gravis  and clinical stage  and histological type was analyzed in 83 consecutive patients with thymoma  histologically classified as cortical  medullary  and mixed  
class10	3476	age  sex  and association with myasthenia gravis did not prove to represent significant prognostic factors  clinical stage and histological type  on the contrary  had a highly significant prognostic value  p less than 0 001   
class10	3476	a model of clinicopathological staging  based on both clinical stage and histological type  in which three major prognostic groups are considered is proposed  
class10	3476	the degree of significance of this model is higher  p less than 0 0001  than that of clinical stage and histological type considered individually  its validity is further supported by the results of multivariate analysis according to the cox regression model  p   0 0001   
class10	3476	we think it represents a prognostically valuable approach to the problem of management of thymoma  
class10	3477	intraoperative ultrasonic imaging of the ascending aorta in ischemic heart disease  
class10	3477	in an attempt to locate any atherosclerotic lesion in the ascending aorta and to prevent embolization  intraoperative b mode ultrasonography was performed in 100 patients with ischemic heart disease  31 women and 69 men   
class10	3477	ultrasonography was carried out with a 10 mhz probe placed directly on the ascending aorta  
class10	3477	ultrasonic imaging demonstrated an atherosclerotic lesion in the lower half of the aorta in 76 patients  76    a lesion in the upper half of the aorta in 89 patients  89    and a lesion at the orifice of the innominate artery in 99 patients  99    
class10	3477	prospective palpation identified an atherosclerotic lesion in 12  25   of 48 patients  
class10	3477	thoracic computed tomography in 79 patients showed calcification in the lower half of the aorta in 6 patients  7 6   and in the upper half of the aorta in 11  13 9    
class10	3477	palpation and thoracic computed tomography underestimated the frequency of atherosclerotic lesions  
class10	3477	intraoperative ultrasonography accurately identified atherosclerotic disease  
class10	3477	this technique allows the surgeon to modify cannulation  aortic clamping  and operative technique to reduce the risk of perioperative stroke due to embolization of atherosclerotic debris from the ascending aorta  
class10	3478	prevention of paraplegia during aortic operations  
class10	3478	ischemic spinal cord injury after aortic cross clamping may be produced by a steal phenomenon  
class10	3478	the present study investigates this possibility by directly measuring the oxygen tension on the spinal cord surface in pigs  
class10	3478	after simple clamping of the aorta  oxygen tension decreased significantly distal to the clamping site both after occlusion of the thoracic aorta at t3 4  group 1  and after occlusion of the abdominal aorta at l 1  group 2   
class10	3478	exclusion of the thoracic aorta by a second clamp at t 13 restored oxygen tension almost to the original level  whereas segmentation of the abdominal aorta up to s 1 hardly affected oxygen tension in the area of the artery of adamkiewicz in most of the animals  
class10	3478	we conclude that after aortic cross clamping  blood tends to drain away from the spinal cord rather than supplying it longitudinally  
class10	3478	without knowledge of the position of the adamkiewicz artery in humans as well as of the competence of the collateral circulation in the excluded segment  it is necessary to develop a new strategy for repair of the aorta  
class10	3478	we describe and discuss two surgical techniques for the prevention of paraplegia after aortic cross clamping  the counterocclusion technique and the bypass fractionated technique  
class10	3479	diagnostic imaging and surgical treatment of dumbbell tumors of the mediastinum  
class10	3479	we describe the diagnostic procedures and surgical approaches employed in 5 patients with dumbbell tumors of the mediastinum  
class10	3479	magnetic resonance imaging accurately described the existence and longitudinal extension of the intraspinal component of the tumor and assisted in choosing the appropriate surgical approach  
class10	3479	both the intrathoracic and intraspinal components of the tumor were resected at one time by a thoracic and neurosurgical team  
class10	3479	we employed the grillo technique three times and a separate laminectomy and thoracotomy approach  
class10	3479	magnetic resonance imaging proved the most useful diagnostic technique for suspected dumbbell mediastinal tumors  
class10	3479	in our experience  the extended thoracotomy proposed by grillo and co workers worked well for small tumors involving only one foramen in which the intraspinal extension was limited to 2 to 3 cm  and when no more than two laminectomies were required  
class10	3479	on the other hand  thoracotomy and a longitudinal paravertebral incision are preferable for larger tumors  more than 4 cm  involving more than one foramen in which the intraspinal extension exceeds 2 to 3 cm  for tumors requiring multiple laminectomy  and when bony infiltration is present  
class10	3480	coexisting thymic carcinoid tumor and thymoma  
class10	3480	thymic carcinoid tumors are unusual neoplasms that are different from thymomas  
class10	3480	we report a case of coexisting thymic carcinoid tumor and thymoma associated with myasthenia gravis  
class10	3480	the clinicopathological findings are discussed with a review of the literature  
class10	3481	electroencephalography should not be routine in the evaluation of syncope in adults 
class10	3481	we reviewed the reports of all electroencephalograms obtained at the nashville  tenn  veterans administration hospital from september 1987 to august 1989  
class10	3481	seventy three patients were referred for evaluation of syncope or near syncope  
class10	3481	of these 73 patients  10  13 7   had abnormal findings  
class10	3481	twenty six patients were referred for other complaints similar to syncope  ie  blackouts  loss of consciousness  falling out  passing out  and fainting   
class10	3481	of these 26 patients  five  19 2   had abnormal findings  
class10	3481	we reviewed the medical records of the patients with abnormal findings and found that the final diagnosis or treatment of the syncope was affected by electroencephalogram in only one patient  
class10	3481	these findings suggest that routine electroencephalography is not of significant value in the evaluation of syncope in adults  
class10	3482	the influence of age vs peak serum concentration on life threatening events after chronic theophylline intoxication  
class10	3482	to identify risk factors for the development of seizures and cardiac arrhythmias after chronic  unintentional theophylline intoxication we monitored the clinical course of 72 consecutive patients referred to a regional poison center with chronic theophylline intoxication  serum theophylline concentration  greater than or equal to 167 mumol l after protracted use   
class10	3482	the median age of the sample was 47 5 years  range  4 days to 91 years   
class10	3482	median peak theophylline concentration was 239 mumol l  with a range of 167 to 722 mumol l  
class10	3482	a life threatening event  lte  occurred in 28 patients  39   that included seizures in eight and a major cardiac arrhythmia in 22  
class10	3482	the median peak  theophylline  of patients who had an lte vs those who did not was 235 8 vs 238 7 mumol l  
class10	3482	however  the median age of patients with an lte compared with those without an lte was significantly greater  70 5 vs 18 0 years   
class10	3482	stratification of data by chronologic age revealed a stepwise increase in the frequency of lte with advancing years  patients more than 75 years old had a 16 7 fold greater risk of lte than patients less than 25 years old  95  confidence interval  3 56  77 5  despite comparable intergroup median serum  theophylline   
class10	3482	these data suggest the primary determinant of ltes after chronic theophylline intoxication is chronologic age  
class10	3482	elderly patients have an inordinately greater risk of lte than younger patients  
class10	3482	peak serum theophylline concentration cannot predict which patients with chronic theophylline intoxication will have an lte  
class10	3482	finally  these data indicate that theophylline should be used cautiously and with frequent monitoring of serum theophylline concentrations in elderly patients  
class10	3483	morbidity  mortality  and quality of life for patients treated with levothyroxine 
class10	3483	in a population study of 1462 middle aged women initiated in 1968 and 1969 we identified 29 women treated with levothyroxine from 1 to 28 years  
class10	3483	in a 12 year follow up in 1980 and 1981 we investigated the subjects for end point myocardial infarction  diabetes mellitus  stroke  cancer  and death  the status of 99 7  of the initial participants was established   
class10	3483	the women treated with levothyroxine showed no increase in morbidity or mortality  
class10	3483	of the 24 women still receiving levothyroxine in 1980 and 1981  22 had serum thyrotropin and triiodothyronine concentrations with in reference limits  
class10	3483	these individuals were compared with the 968 women from the population study having no history of thyroid disease  and appeared identical as to laboratory and clinical data  with the exception of a slightly higher body mass  taller stature  and lower serum cholesterol concentration  
class10	3483	the treated group did not differ in a life quality estimate based on 19 questions regarding life satisfaction and sensory function  
class10	3483	we conclude that the levothyroxine treated woman suffers no side effects from her life long therapy  
class10	3484	an immunofluorescence study of cerebral malaria  a correlation with histopathology  
class10	3484	histopathologic and immunopathologic features of cerebral malaria have been defined in a study of six autopsy cases with severe plasmodium falciparum infection  
class10	3484	in five cases  immunofluorescent studies demonstrated intense deposition of p falciparum antigen  igg  and fibrin in cerebral vessels associated with the histopathologic finding of hemorrhage in the white matter of cerebrum and cerebellum regardless of the presence of parasitized erythrocytes in the cerebral vessels  
class10	3484	immunofluorescent study also demonstrated the extravascular deposits of p falciparum granular antigen associated with acute inflammatory lesion in cerebral tissue in one case  
class10	3484	these findings suggested that the immunopathogenic mechanism may in some way play a role in the pathogenesis of cerebral malaria  
class10	3485	physiologic responses to prolonged electrically stimulated leg cycle exercise in the spinal cord injured  
class10	3485	this study determined the physiologic responses to prolonged functional neuromuscular stimulation  fns  leg cycle exercise in seven quadriplegic and seven paraplegic subjects  
class10	3485	each subject completed 30 minutes of continuous fns leg cycling during which open circuit spirometry  impedance cardiography  auscultation  and fingertip capillary blood sampling were used to assess metabolic and hemodynamic responses  
class10	3485	compared with resting values  oxygen uptake  carbon dioxide production  respiratory exchange ratio  rer   pulmonary ventilation  heart rate  hr   left ventricular stroke volume  sv   cardiac output  qt   and blood lactate  la  concentration were significantly  p less than  05  elevated  whereas plasma volume  bicarbonate concentration  and ph were significantly decreased in both groups during prolonged fns leg cycle exercise  
class10	3485	mean arterial pressure remained unchanged in quadriplegic and paraplegic subjects during the prolonged fns leg cycle exercise bout  
class10	3485	persons with quadriplegia elicited significantly lower map and tended to have lower sv and qt responses than persons with paraplegia  probably due to a higher degree of sympathetic dysfunction and circulatory hypokinesis during fns leg cycle exercise  
class10	3485	all other physiologic variables responded similarly between groups  
class10	3485	we speculate that the relative increases observed for hr  33  to 60    sv  45  to 69    and qt  113  to 142   during prolonged fns leg cycle exercise create a sufficient cardiac volume load to promote central cardiovascular conditioning in persons with both quadriplegia and paraplegia  
class10	3485	the la accumulation  4 7 to 5 2 mmol l 1  in the spinal cord injured during prolonged fns leg cycling is unusually high for the power output attained  5 2w and 6 1w for quadriplegia and paraplegia  respectively   
class10	3486	rehabilitation of chronic stroke patients  changes in functional performance  
class10	3486	forty stroke patients who were at least one year post onset completed a one month intensive rehabilitation program  
class10	3486	the month before the program served as a control period  
class10	3486	during the program  patients received individual sessions in occupational and physical therapy four days a week  and they participated in group activities on the fifth day  
class10	3486	therapy emphasized instruction in motor planning  balance and weight shift  and the use of adaptive equipment  these motor abilities were then practiced within real life situations  
class10	3486	the patients demonstrated significant improvement in the outcome measures of weight shift  balance  and adl scores after the one month rehabilitation program  weight shift  f   16 1  p    0001  balance  f   6 26  p    0007  adl  f   13 8  p    0001   
class10	3486	they retained these new skills during a three month follow up period  
class10	3487	manual stretch  effect on finger movement control and force control in stroke subjects with spastic extrinsic finger flexor muscles  
class10	3487	this study evaluated the effects of manual stretch of extrinsic finger flexor muscles on finger extension movement control and force control in 16 spastic hemiparetic subjects  
class10	3487	these subjects were randomly divided into a control group and an experimental group  
class10	3487	a group of able bodied subjects also participated  
class10	3487	a joint movement tracking test  jmtt  quantified control of active finger extension movement at the metacarpophalangeal joint of the index finger within the available range of active movement  and a force tracking test  ftt  quantified control of isometric finger extension force at the same joint within the subject s available force range  
class10	3487	electromyographic activity was monitored in the extensor digitorum and flexor digitorum superficialis muscles during both tracking tests  
class10	3487	manual stretch was applied to the extrinsic finger flexor muscles of the experimental group between the pretest and posttest tracking tests  
class10	3487	the jmtt performances of both control  p less than  025  and experimental  p less than  05  groups were significantly subnormal on the pretest as were ftt performances of controls  p less than  01  and study subjects  p less than  03   
class10	3487	the jmtt improvement on posttest was significantly greater  p less than  05  in subjects than in controls  
class10	3487	however  the change in ftt performance was not significantly different between the two groups  
class10	3487	manual stretch treatment  properly applied to extrinsic finger flexor muscles  is an effective method of temporarily improving the control of finger extension movement in spastic hemiparetic subjects  
class10	3488	strapless oral nasal interface for positive pressure ventilation  
class10	3488	a custom fabricated strapless oral nasal interface  soni  is described  
class10	3488	it was used in the long term administration of intermittent positive pressure ventilation  ippv  by 18 patients with paralytic or restrictive pulmonary insufficiency  
class10	3488	this interface is an acrylic shell which is firmly fixed to an orthodontic bite plate  it is designed to form a seal over the nose and mouth for the entry of ippv  
class10	3488	eight patients were ventilator dependent 24 hours a day  
class10	3488	the ten patients who required only nocturnal aid had improvement in daytime arterial blood gases  
class10	3488	although nine of these patients could manage less than 15 minutes of unassisted breathing  free time  supine  all slept supine on soni ippv  
class10	3488	the 13 patients who underwent sleep monitoring maintained a mean oxygen saturation of 95 3      1 7  and acceptable end tidal pco2  30 to 45 mmhg   
class10	3488	these 13 patients have used soni ippv for an average of 22 months  range   3 to 63 months   
class10	3488	impediments to successful long term use of a soni include the presence of a hyperactive gag reflex or stimulation of excessive oral secretions  
class10	3488	when combined with mouth ippv  glossopharyngeal breathing  the intermittent abdominal pressure ventilator  or the cuirass ventilator for daytime use  soni ippv is an option for the patient who prefers total ventilatory support by noninvasive means  
class10	3489	stroke rehabilitation  a geropsychological perspective  
class10	3489	rehabilitation medicine and geriatric medicine are similar in their concern for functional improvement in the face of chronic medical conditions  
class10	3489	although many patients served by rehabilitation medicine fall within the geriatric age range  a knowledge of normal aging does not necessarily inform clinical decision making or research practices in rehabilitation  
class10	3489	using stroke as an example of a disorder affecting primarily geriatric patients and requiring the technology of rehabilitation  ways in which age might affect assessment of outcome are examined  
class10	3489	three areas dealing with conceptual and methodologic issues  depression  neurochemical interventions  and family  are highlighted  
class10	3489	the final section outlines recommendations for research on rehabilitation outcome of geriatric stroke patients  
class10	3490	childhood stroke after minor neck trauma  case report  
class10	3490	cerebral infarction after minor trauma to the neck has rarely been reported  
class10	3490	a case is presented of a child with trauma to the vertebrobasilar artery resulting in stroke  
class10	3490	computerized tomography scan and angiography results are presented  
class10	3490	despite two subsequent  separate transient episodes of vertigo  the child had good functional recovery with complete restoration of language and cognitive function  
class10	3490	after 28 months  residual impairments identified were a mild right sided ataxia and hemiparesis  
class10	3491	failure to detect human t cell leukemia virus related sequences in multiple sclerosis blood  
class10	3491	we tested 11 patients with multiple sclerosis for the presence of human t cell leukemia virus type i  htlv i   or type ii  htlv ii  related sequences  
class10	3491	dna from blood mononuclear cells was analyzed by the polymerase chain reaction utilizing three different oligonucleotide primer pairs  
class10	3491	two of these primer pairs detect sequences shared between htlv i and htlv ii in either p24  gag protein  or in p21  env transmembrane protein  
class10	3491	the third primer pair was synthesized based on regions in the pol gene where amino acid sequences are conserved between htlv i  htlv ii  and the related bovine leukemia virus  
class10	3491	the multiple sclerosis samples were consistently negative while appropriate control samples were positive  
class10	3491	we conclude that viruses related to htlv i  htlv ii  or bovine leukemia virus are not present in the blood of patients with multiple sclerosis and  therefore  that htlv bovine leukemia virus related viruses are not likely to be involved in the pathogenesis of multiple sclerosis  
class10	3492	apneic oxygenation in apnea tests for brain death  a controlled trial  
class10	3492	we performed a prospective controlled study of apneic oxygenation on 15 patients undergoing apnea tests for brain death  
class10	3492	all patients were preoxygenated with 100  oxygen at existing respirator settings  
class10	3492	during the 10 minute apnea tests  nine patients were given continuous apneic oxygenation by tracheal cannula  
class10	3492	the other six patients had tracheal tubes open to room air  
class10	3492	the patients given apneic oxygenation had little or no hypoxia by the end of the test  
class10	3492	the patients given room air during the test became hypoxic  
class10	3492	many neurologists perform apnea tests with no oxygenation or with preoxygenation alone  
class10	3492	this is the first prospective controlled study  to our knowledge  of apneic oxygenation  it shows that preoxygenation alone does not prevent hypoxia during apnea tests for brain death  
class10	3492	we recommend that all apnea tests be performed with apneic oxygenation  
class10	3493	geographic patterns of parkinsonism dementia complex on guam  1956 through 1985  
class10	3493	average annual age adjusted incidence rates of parkinsonism dementia complex were obtained for the 19 election districts of guam from 1956 through 1985  
class10	3493	the highest rates were found in the southern and central districts  and the lowest rates were found in the northern and western districts  
class10	3493	geographic and temporal patterns of incidence were associated with socioeconomic status but not with geochemical factors  
class10	3493	the risk of parkinsonism dementia complex in susceptible sibships was much higher than that in the general population  even in districts with the highest incidence rates  but especially in districts with the lowest incidence rates  
class10	3493	our evidence tends to support the hypothesis that multiple factors linked to cycad use play an important role in the cause of pdc  
class10	3493	hypotheses related to metal exposure and simple genetic factors were unsatisfactory explanations for the epidemiologic patterns observed  
class10	3494	racial differences in the anterior circulation in cerebrovascular disease  how much can be explained by risk factors  
class10	3494	the entry characteristics of 1367 patients enrolled into the extracranial intracranial bypass study were examined to determine if site differences in intracranial and extracranial arterial lesions among racial groups could be explained by differences in risk factors  
class10	3494	blacks were more often hypertensive  diabetic  or cigarette smokers  while whites had higher systolic blood pressure and hemoglobin values  
class10	3494	orientals had the lowest prevalence of vascular risk factors  
class10	3494	despite these differences in risk factors  multivariate analysis showed race to be an independent and strong predictor of the location of cerebrovascular lesions  
class10	3494	to our knowledge  this study is unique in documenting risk factors prospectively and systematically in three racial groups simultaneously  
class10	3494	although generalization is limited by possible biases related to patient selection  the results affirm previous tentative conclusions about the role of race in determining the location of cerebrovascular disease  
class10	3495	the large striatocapsular infarct  a clinical and pathophysiological entity  
class10	3495	we examined 29 patients with strictly subcortical large striatocapsular infarctions  
class10	3495	eight of them had aphasia or neglect  
class10	3495	all patients underwent transcranial doppler ultrasonography or selective carotid angiography  magnetic resonance imaging  and single photon emission tomography for assessment of cerebral blood flow  blood volume  and cerebral perfusion reserve  
class10	3495	the signs were compatible with cortical territorial infarctions rather than lacunes  
class10	3495	on both magnetic resonance imaging and computed tomographic scans  the lesions corresponded to the territories of the medial and lateral group of the lenticulostriate arteries  heubner s artery  or the anterior choroidal artery  
class10	3495	the infarctions were either due to cerebral embolization into the m1 segment of the middle cerebral artery or due to stenosis at the same site  ie  lesions that acutely and simultaneously occluded the orifices of the lenticulostriate or neighboring arteries  
class10	3495	persistent occlusion of the middle cerebral arteries and a decrease of cortical regional cerebral blood flow were only found in patients with aphasia or neglect  
class10	3495	all patients without aphasia or neglect showed a rapid recanalization of the middle cerebral artery occlusion or a stenosis of the m1 segment and no cortical regional cerebral blood flow decrease  
class10	3495	large striatocapsular infarctions occur due to occlusive disease of the middle cerebral artery  large vessel disease  and not due to a disseminated in situ occlusion of the long penetrating arteries  small vessel disease   as in lacunes  
class10	3495	neuropsychological deficits can be explained by decreased cortical blood flow due to a persistent occlusive lesion of the middle cerebral artery  
class10	3496	brain imaging abnormalities in mental disorders of late life  
class10	3496	psychiatric inpatients with dementia  n   61  or depression  n   67  in late life were 2 6 times more likely to manifest magnetic resonance imaging abnormalities of the brain than were elderly controls  n   44   
class10	3496	controlling for the effects of age and gender  demented patients were distinguishable from controls by an increased prevalence of cortical atrophy and infarction  while depressed patients exhibited an increased prevalence of cortical infarctions and leukoencephalopathy  
class10	3496	patients with dementia were distinguishable from those with major depression by an increased prevalence of cortical atrophy  
class10	3496	these results indicate that major depression in late life  like dementia  is associated with a remarkable increase in overt pathologic changes in the brain  
class10	3497	adjuvant chemotherapy for primary lymphoma of the central nervous system  
class10	3497	ten immunocompetent patients with primary non hodgkin s lymphoma of the central nervous system were treated by the neuro oncology service at the university of california at san francisco  ucsf   
class10	3497	after undergoing surgery for biopsy or removal of their tumors  these patients  group 1  received irradiation with hydroxyurea followed by adjuvant chemotherapy with the combination of procarbazine  lomustine  ccnu   and vincristine  
class10	3497	the outcome of treatment in this group was compared with that in three other groups of patients with primary cns lymphoma  patients treated at the ucsf cancer research institute who underwent surgery and radiation therapy  rt   group 2   patients described in the literature who had surgery and rt  group 3   or patients described in the literature who had surgery  rt  and chemotherapy  group 4   
class10	3497	median and quartile survival times were greater in patients who received adjuvant chemotherapy  group 1  30 and 50 months  group 4  20 and 25 months  than in patients who did not receive chemotherapy after rt  group 2  13 and 20 months  group 3  15 and 24 months   
class10	3497	these results suggest that adjuvant chemotherapy is useful in the treatment of primary cns lymphoma  
class10	3498	x linked spinal muscular atrophy  kennedy s syndrome   a kindred with hypobetalipoproteinemia  
class10	3498	kennedy s syndrome  x linked adult onset bulbospinal muscular atrophy  has been described in over 30 families  
class10	3498	the characteristic distribution of weakness creates a recognizable syndrome  augmented by frequent findings of testicular atrophy and gynecomastia  
class10	3498	type iv or type ii hyperlipoproteinemia has been found in some families  
class10	3498	we have studied another family with kennedy s syndrome  this one with hypobetalipoproteinemia  
class10	3498	the diversity of serum patterns suggests that lipoprotein abnormalities are not causally related to either the endocrinopathy or the spinal muscular atrophy  
class10	3498	however  gene linkage studies indicate proximity of the gene for kennedy s syndrome and the gene encoding the androgen receptor  which could explain the combination of a motor neuron disorder and the endocrine abnormalities  
class10	3499	unusual cause of  piriformis muscle syndrome   
class10	3499	the piriformis muscle syndrome is a controversial  clinical  syndrome primarily characterized by signs and symptoms of sciatic nerve compression at the region of the piriformis muscle as it passes through the greater sciatic notch  
class10	3499	the syndrome is often referred to  however  cases are rarely reported  and it is generally an uncommon diagnosis  
class10	3499	of those cases reported  the incidence is six times more frequent in females than in males  and is typically temporally related to minor pelvic or buttock trauma  
class10	3499	we describe a case of a 40 year old woman presenting with signs and symptoms suggestive of piriformis muscle syndrome following a gynecologic procedure performed in the dorsal lithotomy position  
class10	3499	electromyographic findings were consistent with this clinical entity  
class10	3499	operative exploration  however  revealed the source of neural compression to be a pseudoaneurysm of the inferior gluteal artery adjacent to the piriformis muscle  
class10	3499	the diagnostic features of this clinical syndrome are discussed  
class10	3500	botulinum vs adjustable suture surgery in the treatment of horizontal misalignment in adult patients lacking fusion  
class10	3500	thirty patients were treated with either botulinum toxin or adjustable suture surgery in a prospective  randomized clinical trial  
class10	3500	all patients had horizontal deviations greater than 10 prism diopters and absent fusion  
class10	3500	seventeen patients were assigned to toxin treatment  and 13 were assigned to surgical treatment  
class10	3500	follow up at 6 months after either procedure indicated that surgery was superior  with patient alignment showing a 92 7  average net change  compared with a 50 50  net change in the botulinum treated group  
class10	3500	there was no difference in response between those patients with a starting deviation of 20 pd or less and greater than 20 pd in the surgery group  
class10	3500	however  in the botulinum treated group  those patients with a starting deviation of 20 pd or less seemed to show better responses than those patients with greater than 20 pd  
class10	3500	patients with esotropia showed an 88 89  change with surgery and a 51 55  change with toxin treatment  
class10	3500	patients with exotropia had a 95 83  change with surgery but a 50 3  change with toxin treatment  
class10	3500	since we had 20 patients with exotropia and 10 patients with esotropia  a more formal comparison would require larger numbers  
class10	3501	experimental alcoholic skeletal muscle myopathy is characterised by a rapid and sustained decrease in muscle rna content  
class10	3501	an investigation was made into the effects of ethanol feeding  36  of total calories  on skeletal muscle  
class10	3501	from 7 to 42 days  muscle weights and protein and dna contents of alcohol treated rats were significantly lower  10 23   than pair fed controls  with glucose as 36  of total calories   
class10	3501	ethanol feeding markedly reduced muscle rna content by 22 34   when compared to controls  
class10	3501	muscle rna content of ethanol fed rats at 7  14  28 and 42 days of treatment was significantly lower than initial values  i e  
class10	3501	at 3 days  by 22 38   
class10	3501	thus  ethanol feeding caused an initial net loss and thereafter a reduction in the rate of accretion of rna  
class10	3501	the marked and sustained loss in the muscle protein synthetic apparatus may be a precipitating event in the development of experimental skeletal muscle myopathy  
class10	3502	epidural hematoma  an unusual presentation  
class10	3502	the authors present a patient with a traumatic epidural hematoma who complained only of headache and presented to the emergency department 48 hours after a fall  
class10	3502	mental status and neurological examination were normal  
class10	3502	this delayed presentation is more commonly seen when a subdural hematoma is present but may result from epidural bleeding  
class10	3502	delayed formation of a traumatic epidural hematoma may occur when the following are present  elevated intracranial pressure  hypovolemic shock  a concomitant mass lesion  coagulopathy  bleeding from dural or diploic veins  a dural sinus laceration  a traumatic pseudoaneurysm  or an arteriovenous fistula  
class10	3502	although criteria for computed tomography of patients with head injuries remain variable in the literature  delayed presentation of epidural bleeding must be considered in the differential diagnosis of posttraumatic headache irregardless of the time interval or neurological presentation  
class10	3503	cardiac arrhythmias from a malpositioned greenfield filter in a traumatic quadriplegic  
class10	3503	a case study is presented of premature greenfield filter discharge with intracardiac migration and resulting life threatening arrhythmias  
class10	3503	these arrhythmias also interfered with the patient s transition from ventilatory support via orotracheal intubation to noninvasive positive airway pressure ventilatory support methods  
class10	3503	the patient s arrhythmias were controlled by a demand cardiac pacemaker and cardiac glycoside therapy  
class10	3503	no anticoagulants were used  
class10	3503	she had no further filter migration nor significant complications for 16 months after hospital discharge  
class10	3504	the supraspinal anxiolytic effect of baclofen for spasticity reduction  
class10	3504	recent studies in the psychiatric literature indicate that baclofen has an anxiolytic action in certain psychopathologic conditions  
class10	3504	clinical observation has shown that manifestations of spasticity are increased in anxious individuals  implicating a supraspinal site of mediation for these responses  
class10	3504	the purposes of this study were to determine if baclofen reduced anxiety in individuals with traumatic spinal cord lesions and whether that reduction was correlated with decreased spasticity from the baclofen  
class10	3504	five adult males with traumatic spinal cord injury were randomly assigned to the study protocol  
class10	3504	a double blind  repeated measures  multiple base line  single case research design was employed  
class10	3504	the independent variable was dose of medication with the three levels being placebo  40 mg day of baclofen and 80 mg day of baclofen  in four evenly divided doses  
class10	3504	the dependent variable was the score obtained on the beck inventory a anxiety scale  bia   
class10	3504	the subjects were administered the bia twice per week for a nine week period of time  during which they received the doses of medication as described  
class10	3504	quantitative measurements of spasticity were also taken at each session  
class10	3504	visual inspection analysis of the data showed that two subjects had no measurable anxiety of the bia throughout the study  
class10	3504	three subjects had measurable anxiety on the bia during the base line placebo phase  
class10	3504	they showed a decreased level of their bia scores with 40 mg day of baclofen  and a further level reduction with 80 mg day of baclofen  
class10	3504	the reduction in bia scores was statistically significant using the standard deviation band test in one of these subjects  
class10	3504	these data indicate that bia probably has an anxiolytic effect for individuals status post traumatic spinal cord injury  
class10	3505	effect of flumazenil on midazolam induced amnesia  
class10	3505	we have studied the effect of i v  
class10	3505	flumazenil 0 01 mg kg 1 on the amnesia and sedation caused by midazolam 2 mg and 5 mg i v  
class10	3505	in volunteers in order to determine the relationship between the actions of the antagonist on these two effects  
class10	3505	midazolam caused dose dependent central neural depression as assessed by critical flicker fusion frequency  and dose dependent amnesia for word cards  
class10	3505	in subjects given flumazenil 5 min after administration of midazolam  fusion frequency readings and memory were restored to levels comparable to those before midazolam administration  
class10	3505	these two effects of flumazenil were similar in time course and extent  suggesting that they share the same mechanism of action  
class10	3505	flumazenil given alone had no effect on memory  
class10	3505	the study has demonstrated anterograde amnesia following benzodiazepine administration and antagonism by flumazenil  
class10	3505	there was neither retrograde amnesia nor retrograde antagonism of amnesia  
class10	3506	double blind comparison of topical lignocaine prilocaine cream  emla  and lignocaine infiltration for arterial cannulation in adults  
class10	3506	in a double blind  double dummy study  the efficacy of topical 5  emla cream was compared with that of lignocaine infiltration in alleviating the pain of arterial cannulation  
class10	3506	forty unpremedicated adults were allocated randomly to four groups to receive emla cream alone  emla and 0 9  saline infiltration  emla and 1  lignocaine infiltration or placebo cream and 1  lignocaine infiltration  
class10	3506	following arterial cannulation  pain was assessed by the patient using a visual analogue score and by an independent observer using a four category verbal rating score  
class10	3506	significantly lower pain scores were observed in all patients receiving emla compared with those receiving placebo cream and lignocaine infiltration by both patient  p less than 0 01  and observer  p less than 0 001  assessments  
class10	3506	there were no significant differences between the three emla groups  
class10	3507	cerebral effects of sevoflurane in the dog  comparison with isoflurane and enflurane  
class10	3507	the cerebral effects of sevoflurane were compared in dogs with those of enflurane and isoflurane  
class10	3507	initially  the minimum alveolar concentrations  mac  of sevoflurane and enflurane were determined and the electroencephalographic  eeg  responses to increasing doses of sevoflurane  1 5  2 0 and 2 5 mac  or enflurane  1 5 and 2 0 mac  in unparalysed animals were examined  
class10	3507	administration of sevoflurane was not associated with seizure activity at any concentration either during normocapnia  paco2 5 3 kpa  or hypocapnia  paco2 2 7 kpa   even in the presence of intense auditory stimuli  
class10	3507	all dogs anaesthetized with enflurane demonstrated sustained eeg and motor evidence of seizure activity induced by auditory stimuli at concentrations of enflurane greater than 1 mac  particularly during hypocapnia  
class10	3507	in a separate group of dogs  the effects of increasing concentrations of sevoflurane and isoflurane  0 5  1 5 and 2 15 mac  were compared directly on arterial pressure  cardiac output and heart rate  cerebral blood flow and the cerebral metabolic rate for oxygen  cmro2  using the venous outflow technique  
class10	3507	sevoflurane  in common with isoflurane  had minimal effects on cerebral blood flow at the concentrations studied  but significantly reduced the cmro2 at end tidal concentrations sufficient to produce a burst suppression pattern on the eeg  approximately 2 15 mac   
class10	3507	both sevoflurane and isoflurane significantly decreased arterial pressure in a dose dependent manner  but neither drug significantly altered cardiac output  
class10	3508	homocystinuria presenting as central retinal artery occlusion and longstanding thromboembolic disease  
class10	3508	a case of central retinal artery occlusion in a patient with a 10 year history of unexplained thromboembolic disease due to a secondary hypercoagulable state is presented  
class10	3508	ophthalmological examination led to the final diagnosis  
class10	3509	immunophenotypic characteristics of cerebrospinal fluid cells in children with acute lymphoblastic leukemia at diagnosis  
class10	3509	the presence of meningeal involvement in children with acute lymphoblastic leukemia  all  may have important prognostic and therapeutic implications  
class10	3509	conventional methods of diagnosing central nervous system  cns  leukemia rely on the interpretation of cerebrospinal fluid  csf  cell morphology  which may produce ambiguous results in the presence of minimal leukemic involvement  
class10	3509	a methodology has been developed for immunophenotyping small numbers of csf cells while preserving cell morphology  
class10	3509	csf samples from 33 children with cd10  common all antigen  calla   positive all were examined at initial presentation using both conventional morphology and this combined immunohistopathologic technique  
class10	3509	six  18   of the samples contained lymphoblasts or cells considered morphologically suspicious for leukemic involvement  
class10	3509	nine additional samples  27  of the total  had normal csf morphology  but contained increased numbers of calla positive cells  
class10	3509	twelve of the 33 samples were also examined for the simultaneous presence of nuclear terminal deoxynucleotidyl transferase  tdt  and demonstrated increased numbers of cells positive for both tdt and cd10  
class10	3509	these data suggest that a large proportion of children with all may have abnormalities of csf cells at initial diagnosis consistent with the presence of occult leukemic involvement  
class10	3510	unawareness of hypoglycaemia and inadequate hypoglycaemic counterregulation  no causal relation with diabetic autonomic neuropathy 
class10	3510	objective  to examine the traditional view that unawareness of hypoglycaemia and inadequate hypoglycaemic counterregulation in insulin dependent diabetes mellitus are manifestations of autonomic neuropathy  
class10	3510	design  perspective assessment of unawareness of hypoglycaemia and detailed assessment of autonomic neuropathy in patients with insulin dependent diabetes according to the adequacy of their hypoglycaemic counterregulation  
class10	3510	setting  one routine diabetic unit in a university teaching hospital  
class10	3510	patients  23 patients aged 21 52 with insulin dependent diabetes mellitus  seven with symptoms suggesting autonomic neuropathy  nine with a serious clinical problem with hypoglycaemia  and seven without symptoms of autonomic neuropathy and without problems with hypoglycaemia  and 10 controls with a similar age distribution  without a personal or family history of diabetes  
class10	3510	main outcome measures  presence of autonomic neuropathy as assessed with a test of the longest sympathetic fibres  acetylcholine sweatspot test   a pupil test  and a battery of seven cardiovascular autonomic function tests  adequacy of hypoglycaemic glucose counterregulation during a 40 mu kg h insulin infusion test  history of unawareness of hypoglycaemia  and response of plasma pancreatic polypeptide during hypoglycaemia  which depends on an intact and responding autonomic innervation of the pancreas  
class10	3510	results  there was little evidence of autonomic neuropathy in either the 12 diabetic patients with a history of unawareness of hypoglycaemia or the seven patients with inadequate hypoglycaemic counterregulation  
class10	3510	by contrast  in all seven patients with clear evidence of autonomic neuropathy there was no history of unawareness of hypoglycaemia and in six out of seven there was adequate hypoglycaemic counterregulation  
class10	3510	unawareness of hypoglycaemia and inadequate hypoglycaemic counterregulation were significantly associated  p less than 0 01   
class10	3510	the response of plasma pancreatic polypeptide in the diabetic patients with adequate counterregulation but without autonomic neuropathy was not significantly different from that of the controls  change in plasma pancreatic polypeptide 226 8 v 414 pmol l   
class10	3510	the patients with autonomic neuropathy had a negligible plasma pancreatic polypeptide response  3 7 pmol l   but this response was also blunted in the patients with inadequate hypoglycaemic counterregulation  72 4 pmol l  compared with that of the controls  p less than 0 05   
class10	3510	conclusions  unawareness of hypoglycaemia and inadequate glucose counterregulation during hypoglycaemia are related to each other but are not due to autonomic neuropathy  
class10	3510	the blunted plasma pancreatic polypeptide responses of the patients with inadequate hypoglycaemic counterregulation may reflect diminished autonomic activity consequent upon reduced responsiveness of a central glucoregulatory centre  rather than classical autonomic neuropathy  
class10	3511	diffuse idiopathic skeletal hyperostosis  dish  of the shoulder  a cause of shoulder pain  
class10	3511	shoulder pain is a common complaint and shoulder hyperostosis a frequent radiological condition  
class10	3511	however  little is known about the association between the clinical and radiological findings  
class10	3511	to evaluate the clinical relevance of shoulder hyperostosis we performed a controlled  blind study of 99 hospitalized probands with and without thoracospinal hyperostosis on lateral chest x rays  
class10	3511	the study included grading of the shoulder hyperostosis on the basis of three bilateral standard radiographs  assessing shoulder pain in a standardized way by an interviewer and recording extraskeletal causes of shoulder pain  
class10	3511	the prevalence of shoulder hyperostosis was doubled in probands with thoracospinal hyperostosis compared to controls  chi 2   5 90  p less than 0 025  n   99   
class10	3511	shoulder hyperostosis  irrespective of thoracospinal hyperostosis  predisposed to shoulder pain  40  versus 18   chi 2   4 06  p less than 0 05  n   74   
class10	3511	shoulder hyperostosis in combination with thoracospinal hyperostosis  shoulder dish  predisposed to shoulder pain to an even greater extent  46  versus 12   chi 2   6 64  p less than 0 01  n   47   
class10	3511	we conclude that shoulder hyperostosis is a radiological finding of potential clinical relevance  
class10	3512	does primary fibromyalgia exist  
class10	3512	twenty one of 25 consecutive primary fibromyalgia or fibrositis patients  identified during a 5 year period in a tertiary care day ward for pain syndromes  were re examined  
class10	3512	fifteen fulfilled criteria for fibromyalgia but unexpectedly  all cases had either psychiatric disturbance or thyroid dysfunction  
class10	3512	of the four patients not seen at follow up  two had developed neurological diseases  another rheumatoid arthritis and one other hypothyroidism  
class10	3512	thus  after 5 years no patient fulfilled the criteria for primary fibromyalgia  
class10	3512	women occupied as manual workers were over represented  
class10	3512	most patients reported beneficial effects of physiotherapy  
class10	3512	none of the patients has been able to return to full time work  
class10	3513	lesions of the mid shaft of the humerus presenting as shoulder capsulitis  
class10	3513	we describe three patients who presented with pain and restriction of movement at the shoulder suggestive of capsulitis  but proved to have lesions of the mid shaft of the humerus  
class10	3513	it is important to be aware of the possibility of this cause of a  frozen shoulder   since radiographs of the shoulder are usually cropped at the mid humerus and lesions at this level may easily be missed  
class10	3513	a radiograph of the entire humerus  or an isotope bone scan  may be more useful than repeated shoulder radiographs in patients whose shoulder symptoms do not respond to standard treatment  
class10	3514	mastalgia refractory to drug treatment  
class10	3514	management of the patient with mastalgia who fails to respond to first line therapy is a difficult problem and there is a group of patients who do not respond to any therapy  
class10	3514	a group of 126 patients with mastalgia who failed to respond to first line therapy and completed further treatment options was studied  
class10	3514	the response rate of those with cyclical mastalgia fell to 57 and 25 per cent for second and third line therapy respectively  
class10	3514	equivalent figures for non cyclical mastalgia were 24 and 21 per cent  
class10	3514	danazol maintains a high response rate after the failure of other drugs  whereas the second line response to bromocriptine and evening primrose oil is poor  
class10	3514	unresponsive patients were matched to a group of patients who responded to first line therapy  and reproductive and historical factors were compared using the chi 2 test  but failed to identify which patients would respond to therapy  
class10	3515	abdominal wall pain  an alternative diagnosis  
class10	3515	the cause of abdominal pain need not necessarily reside in the viscera  the abdominal wall is another source of symptoms  
class10	3515	some causes of abdominal wall pain are obvious  e g  
class10	3515	hernias  but not so others such as nerve entrapment syndromes  
class10	3515	this review is concerned with causes of abdominal wall pain which  although common  may be easily overlooked  
class10	3516	elevated serum bromide concentrations following repeated halothane anaesthesia in a child  
class10	3516	a 20 month old child received 25 brief halothane general anaesthetics over a five week period to allow cranial irradiation treatments for a posterior fossa ependymoma  
class10	3516	personality change during the last week of the treatment protocol raised the question of possible bromide intoxication  
class10	3516	serum bromide concentrations  using a gold chloride assay technique  were monitored at that time  and at four  and six week intervals thereafter  
class10	3516	serum bromide concentrations demonstrated a four fold change during this period ranging from peak levels of 2 2 meq l 1  176 micrograms kg 1  during the fifth week of treatment decreasing to less than 0 5 meq l 1  less than 40 micrograms ml 1  six weeks following the end of treatments  
class10	3516	this demonstrates the possibility for repetitive  short halothane exposures to result in elevations of serum bromide and the potential of bromide intoxication in paediatric neuro oncology patients  
class10	3517	anaesthetic management of the brain dead for organ donation  
class10	3517	an increasing number of anaesthetists is being called upon to manage organ donors during organ retrieval procedures  
class10	3517	we briefly describe the technical aspects of the surgical procedure together with a guide to the anaesthetic management  
class10	3517	the aims of the latter may be summarized as the  rule of 100   systolic blood pressure greater than 100 mmhg  urine output greater than 100 ml hr 1  pao2 greater than 100 mmhg  haemoglobin concentration greater than 100 g l 1  
class10	3517	common management problems  hypotension  arrhythmias  diabetes insipidus  oliguria  and coagulopathy  are discussed in detail  
class10	3517	the intraoperative management of the brain dead organ donor provides the anaesthetist with the challenge of a major surgical procedure in a subject with important physiological derangements  
class10	3518	left ventricular ejection fraction may not be useful as an end point of thrombolytic therapy comparative trials  
class10	3518	in the era of comparative and adjunctive trials in reperfusion therapy  the need to develop alternative end points for mortality reduction is clear  
class10	3518	left ventricular ejection fraction  which has been commonly used as a surrogate  is problematic due to missing values  technically inadequate studies  and lack of correlation with mortality results in controlled reperfusion trials performed to date  
class10	3518	in this paper  we present a composite clinical end point that includes  in order  severity of adverse outcome death  hemorrhagic stroke  nonhemorrhagic stroke  poor ejection fraction  less than 30    reinfarction  heart failure  and pulmonary edema  
class10	3518	such a composite index may be useful to detect true therapeutic benefit in reperfusion trials without necessitating greater than 20 30 000 patient enrollment  
class10	3519	neurological and ophthalmological phenomena after aortic conduit surgery  
class10	3519	transient neurological and visual signs have been observed in some patients after valved conduit replacement of the aortic valve and ascending aorta  
class10	3519	twenty seven patients having valved conduit replacement between february 1982 and october 1988 were compared with 21 patients having combined aortic valve replacement  avr  and ascending aorta  aa  graft replacement  
class10	3519	follow up in 100  of both groups was obtained for 0 3 6 6 years  mean  2 6     0 3 years   
class10	3519	among 20 surviving valved conduit patients  10  50 0   experienced repetitive neurological and visual signs  including scotomata  seven   transient motor ischemic attacks  two   amaurosis fugax  four   and recurring attention lapses suggesting petit mal seizures  one   
class10	3519	no patient with avr   aa graft experienced any events  p   0 004   
class10	3519	all valved conduit and seven  53 8   of avr   aa graft patients were on warfarin  p   0 0016   
class10	3519	these events retained the same pattern although they diminished in frequency after 12 months in seven patients  70 0   and after initiation of dipyridamole in two patients  
class10	3519	rehabilitation was similar in both groups  18 of 20  90 0   valved conduit and 12 of 16  75 0   avr   aa graft patients  p   ns   
class10	3519	transient  repetitive  nonprogressive neurological and ophthalmological phenomena are frequent after valved conduit replacement  
class10	3519	the pathophysiological mechanism is unclear  but antiplatelet therapy may provide symptomatic control  
class10	3520	obstructive sleep apnoea in children undergoing routine tonsillectomy and adenoidectomy  
class10	3520	sleep screening was used to discover the incidence of sleep apnoea in 50 children undergoing routine adenotonsillectomy for recurrent upper respiratory tract infections  randomly selected from the waiting list  
class10	3520	preoperative assessment included a detailed parental history  physical examination  and lateral cephalometry  in order to identify factors that might alert the clinician to a diagnosis of obstructive sleep apnoea  
class10	3520	there were 2 equal groups of snorers and non snorers  grade 0   1 patient was found to have the sleep apnoea syndrome  iv   9 patients had obstructive snoring with apnoeic episodes  iii   3 patients had snoring with a disrupted sleep pattern  ii   and 12 patients snored with no disruption of sleep  i   
class10	3520	in identifying patients with apnoea  a history of snoring was unhelpful  whereas one of breathing irregularities was found to be highly specific  
class10	3520	nasal obstruction correlated poorly  however  there was a significant relationship between tonsillar position and size and sleep grade  chi squared p less than 0 01   
class10	3520	stepwise regression analysis showed a large contribution to the grading was made by the size of the oropharyngeal airway measured by lateral cephalometry  
class10	3520	the children in grade ii iv were re studied 3 months post operatively and all reverted to grades 0 or i  
class10	3521	a randomized comparison of manipulation of the fractured nose under local and general anaesthesia  
class10	3521	reduction of simple nasal fractures may be performed under local or general anaesthesia  the latter is by far the most popular method in britain  though why is hard to define  
class10	3521	we have attempted to compare the 2 approaches by means of a randomized  prospective trial  
class10	3521	fifty consecutive  adult patients with radiologically proved fractures of the nasal bones were randomized to a local or general anaesthesia group and underwent manipulation with asch s and walsham s forceps between 7 and 15 days post injury  
class10	3521	analysis of results at 4 h and 8 weeks post operatively showed no significant benefit conferred by fracture reduction under general anaesthesia as opposed to local anaesthesia with respect to post operative airway patency or cosmesis  
class10	3521	it is suggested that significant benefits can be obtained in terms of patient convenience and cost effectiveness if nasal fractures are reduced under local anaesthesia as an outpatient procedure  
class10	3522	patellar resurfacing in total knee arthroplasty  
class10	3522	technical errors in patellar resurfacing at the time of total knee arthroplasty  tka  are responsible for many of the complications that affect the patellofemoral joint  
class10	3522	instability  patellar fracture  and wear of metal backed patellar implants are significantly affected by errors of patellar resurfacing  
class10	3522	a review of 50 tkas using a condylar prosthesis and a standardized technique for patellar resurfacing was performed to evaluate the accuracy of the technique  
class10	3522	the patients were evaluated at a mean of 2 5 years  range  two to five years  after surgery  
class10	3522	the hospital for special surgery knee score improved from a preoperative mean of 56 to 92 at the last evaluation  
class10	3522	the hospital for special surgery knee scores were excellent in 92  and good in 8   
class10	3522	the knee society knee score improved from a preoperative mean of 28 for pain and 49 for function to a last evaluation mean of 96 for pain and 85 for function  
class10	3522	none of the patients had symptoms referable to the patellofemoral joint  
class10	3522	there were no patellar fractures  dislocations  or instances of implant loosening of the patella  
class10	3522	roentgenograms revealed nine asymmetrically resurfaced patellae and five tilted patellae  
class10	3522	there were no patellar subluxations  
class10	3522	patellar thickness was maintained at the preoperative level of 21 mm  
class10	3522	joint line height was elevated 1 mm  
class10	3522	the patellar height was decreased 2 mm from the preoperative height  
class10	3522	using a standard technique  satisfactory clinical results can be achieved  but minor errors in resurfacing and alignment will still occur  
class10	3523	cemented total knee arthroplasty for gonarthrosis in patients 55 years old or younger  
class10	3523	the results of 68 cemented total knee arthroplasties  tkas  in 50 patients with gonarthrosis who were 55 years old or younger at the time of surgery were reviewed  
class10	3523	these patients were operated on between 1979 and 1987 and were followed for an average of 6 2 years  
class10	3523	the average age of the patients was 50 years  
class10	3523	patients were evaluated by the hospital for special surgery knee score  
class10	3523	the average preoperative score was 53  and the average follow up score was 90  
class10	3523	overall  55 tkas were rated as excellent and 13 as good  
class10	3523	using the knee rating score advocated by the knee society  the average postoperative score was 92 for pain and 84 for function  
class10	3523	there were four successful reoperations for patellar component loosening  all in metal backed patellae  
class10	3523	the femoral and tibial components in these patients were intact  and at the follow up period  two knees were rated as excellent and two as good  
class10	3523	detailed roentgenographic evaluation demonstrated that 20  of tibial components had radiolucencies in at least one zone on the anteroposterior roentgenogram and in 11  on the lateral roentgenogram  
class10	3523	femoral radiolucencies occurred in only 2  of knees  
class10	3523	patellar radiolucencies in one or more zones occurred in 20  of knees that had not had patellar revision  
class10	3523	no complete or progressive radiolucencies at the bone cement interface were noted for any component  and no components were considered to be roentgenographically loose  
class10	3523	cemented tkas can achieve excellent long term results in patients younger than 55 years old with gonarthrosis of the knee  
class10	3523	these results compare with those obtained in published reports on older age groups  
class10	3524	htlv i viral associated myelopathy after blood transfusion in a multiple trauma patient  
class10	3524	this may be the first documented case in the united states and in the orthopedic literature of transfusion transmitted human t cell leukemia virus type i  htlv i  associated myelopathy  ham   
class10	3524	progressive myelopathy occurred in a 58 year old white man with serologic and molecular evidence of htlv i infection after multiple trauma and subsequent transfusion with multiple units of banked blood products  
class10	3524	symptoms of myelopathy occurred 15 months after the transfusions  
class10	3524	myelopathy from htlv i infection simulates a disorder of orthopedic interest  
class10	3524	physicians should be aware of the symptoms of ham and unexplained myelopathy  
class10	3525	anterior acromioplasty for treatment of the shoulder impingement syndrome  
class10	3525	between 1975 and 1979  anterior acromioplasty was performed in 65 patients with 66 involved shoulders  
class10	3525	the procedure appears to be safe and reasonably effective  
class10	3525	of the 65 patients in this study  50 had chronic tendon inflammation with fibrosis  and 16 also had a small supraspinatus tendon tear  
class10	3525	these 16 had rotator cuff repairs  
class10	3525	twenty six patients were also treated with distal clavicle excision  and seven had tenodesis of the long head of the biceps brachii  
class10	3525	the average age of the patients was 50 years  range  23 75 years   
class10	3525	all patients were followed for an average of eight years  range  three to 13 years   
class10	3525	at final evaluation  no or slight pain was present in 77  of the shoulders  39 of 50 without tendon tearing and 12 of 16 with tendon tearing and repair  
class10	3525	active shoulder abduction averaged 167 degrees  
class10	3525	ninety two percent returned to employment  including 18  with some job modification  
class10	3525	eighty six percent returned to recreational athletics  20  with some modification of activities  
class10	3525	seven patients had additional surgical treatment  
class10	3525	the progression of rotator cuff disease is not always prevented  but the need for subsequent shoulder treatment generally decreases  
class10	3526	long term morphology of spastic or flaccid muscles in spinal cord transected rabbits  
class10	3526	despite difficulty in long term maintenance of spinalized rabbits  muscular pathologic changes in chronic spinalized rabbits could be observed for a period of four weeks  
class10	3526	rabbits were prepared by spinal cord transection at t10  spastic paralysis  or by spinal cord removal below l7  flaccid paralysis   
class10	3526	spastic preparations showed hind limb spasticity and reflex incontinence one to two days after operation  
class10	3526	hypertrophic fibers began to appear in spastic muscles after two weeks  
class10	3526	this hypertrophy  thought to be caused by phasic repetitive contraction  was verified by electron microscopy to be different from normal exercise hypertrophy  
class10	3526	flaccid preparations maintained hind limb flaccidity and overflow incontinence  
class10	3526	in flaccid muscle  marked muscle fiber necrosis indicated rapid atrophy  
class10	3526	spinal deformity and joint contracture inactivate spinalized rabbits  and cause pressure sores  
class10	3526	however  feeding assistance and avoidance of complications make long term maintenance possible  
class10	3527	total knee arthroplasty fixation  comparison of the early results of paired cemented versus uncemented porous coated anatomic knee prostheses  
class10	3527	the results of 18 matched pairs of porous coated anatomic knee prostheses were studied to compare the early clinical and functional performance of cemented versus uncemented fixation with an average five year follow up period for both  
class10	3527	the knee score improved from a preoperative average of 35 points to a postoperative average of 90 points in the cemented group  and from 38 points to 93 points in the uncemented group  
class10	3527	in particular  the individual pain scores and the range of motion values were well matched at the three   six   and 12 month follow up visits and showed a steady improvement  
class10	3527	subjectively  all patients were pleased with the results of surgery  one third preferred the cemented side  one third preferred the uncemented side  and one third found no difference in the performance of either knee  
class10	3527	the clinical and functional performance of knee prostheses in patients who had one cemented knee and one uncemented knee were comparable and possibly unrelated to the type of fixation method  
class10	3528	cemented and ingrowth fixation of the miller galante prosthesis  clinical and roentgenographic comparison after three  to six year follow up studies  
class10	3528	one hundred thirty nine cemented and 132 cementless miller galante total knee prostheses were followed between three and six years  average  43 44 months   
class10	3528	the fixation technique was based on patient age  bone quality  and ability to delay full weight bearing  
class10	3528	clinical follow up studies were possible on 116 cemented knees  
class10	3528	fifteen knees were lost because of death before the three year follow up study  and eight knees required component removal  
class10	3528	one hundred twenty three cementless knees were available for clinical follow up studies  there were three deaths  and six failures required component removal  
class10	3528	no cemented failure was due to fixation  and three cementless failures were due to lack of tibial ingrowth in two and pain of undetermined etiology in one  
class10	3528	preoperative knee scores were slightly significant with cemented knees averaging 48 points and cementless knees averaging 52 points  
class10	3528	a similar significant difference was maintained at the final follow up study  
class10	3528	no significant differences were noted for pain  limp  or support scores  
class10	3528	average range of motion was similar in the two groups  
class10	3528	radiolucent lines about the femoral component were rare  
class10	3528	cementless tibial radiolucencies were partial in up to 20  of examined zones  and complete tibial tray radiolucency was seen in only three patients  
class10	3528	no correlation between radiolucency and knee scores was seen  
class10	3529	seizures in the alcoholic patient  
class10	3529	the first international symposium on alcohol and seizures  september 1988  washington  dc  convened experts from north america and europe to discuss the basic and clinical research findings in this field  
class10	3529	most of the observations communicated at this symposium are included in this article  
class10	3529	emergency physicians are familiar with the alcoholic patient who presents during or after a seizure s   
class10	3529	this familiarity must not obscure the fact that a significant minority of these patients will have an underlying process that can cause morbidity or mortality if the unsuspecting physician does not have an organized and methodic approach to the evaluation and management of the seizing alcoholic patient  
class10	3529	status epilepticus should be evaluated and treated in a similar fashion  whether or not the patient is an alcoholic  
class10	3529	otherwise  almost without exception  there are nuances and controversies with respect to the evaluation and management of the alcoholic patient with a seizure s   from the indications for ct scan  to the proper role of sedatives and anticonvulsants  and the need for admission  
class10	3529	the emergency physician must remain a patient advocate  
class10	3529	the great majority of alcoholic patients with seizures who require admission can be treated satisfactorily at the hospital of presentation  
class10	3530	neurologic complications of alcoholism  
class10	3530	neurologic and myopathic complications of alcoholism are multiple and diverse  affecting both the central and peripheral nervous systems  
class10	3530	in the ed  initial concern is for diagnosing readily reversible causes and ruling out possible life  or limb threatening etiologies  
class10	3530	a rapid assessment of the abcs  a fingerstick blood glucose determination  and  in cases of ams  the administration of intravenous naloxone is indicated  
class10	3530	in almost every instance of a potential neurologic complication  intravenous thiamine replacement is indicated initially  along with the parenteral administration of folic acid and the other b vitamins  including nicotinic acid and pyridoxine  
class10	3530	metabolic screening with electrolytes  glucose  blood urea nitrogen  creatinine  calcium  magnesium  liver enzymes  ast  alkaline phosphatase   bilirubin  arterial blood gases with carboxyhemoglobin determination  and a complete blood count are often warranted  
class10	3530	special tests such as ct scan  ck  ammonia  or toxicologic screens are indicated in specific instances  
class10	3530	in terms of physical examination  attention to the presence of focal neurologic findings is paramount because of the possibility of a subdural or epidural hematoma  
class10	3530	it is important not to miss meningitis and a low threshold for treatment or lumbar puncture should be maintained  
class10	3530	specialized consultation and referral are needed only after stabilization and appropriate tests are performed  
class10	3530	if an organized approach to the evaluation of an alcoholic with neurologic symptoms is undertaken  occult disease will not be missed and outcomes will be improved  
class10	3531	anatomical  physiological  and theoretical basis for the antiepileptic effect of vagus nerve stimulation  
class10	3531	the vagus is a mixed nerve carrying somatic and visceral afferents and efferents  
class10	3531	the majority of vagal nerve fibers are visceral afferents and have a wide distribution throughout the central nervous system  cns  either monosynaptically or via the nucleus of the solitary tract  
class10	3531	besides activation of well defined reflexes  vagal stimulation produces evoked potentials recorded from the cerebral cortex  the hippocampus  the thalamus  and the cerebellum  
class10	3531	activation of vagal afferents can depress monosynaptic reflexes  decrease the activity of spinothalamic neurons  and increase pain threshold  
class10	3531	depending on the stimulation parameters  vagal afferent stimulation in experimental animals can produce electroencephalographic  eeg  synchronization or desynchronization and has been shown to affect sleep states  
class10	3531	the desychronization of the eeg appears to depend on activation of afferent fibers that have conduction velocities of less than or equal to 15 m s  
class10	3531	vagal afferent stimulation can also influence the activity of interictal cortical spikes produced by topical strychnine application  and either attenuate or stop seizures produced by pentylenetetrazol  3 mercaptoproprionic acid  maximal electroshock  and topical alumina gel  
class10	3531	the mechanisms for the antiepileptic effects of vagal stimulation are not fully understood but probably relate to effects on the reticular activating system  
class10	3531	the vagus provides an easily accessible  peripheral route to modulate cns function  
class10	3532	feasibility and safety of vagal stimulation in monkey model  
class10	3532	the feasibility  safety  and preliminary effects of chronic vagal stimulation were studied in an aluminagel monkey model  
class10	3532	pilot studies to perfect the equipment  determine stimulation thresholds  and insure the comfort and safety of the animals preceded this study  
class10	3532	four monkeys were equipped with an indwelling  2 electrode cuff  titanium bands spaced 7 mm apart  silicone encased  1 5 cm total length  in contact around the right vagus nerve  avoidance of the cardiac branch was confirmed by electrocardiograms  
class10	3532	after postsurgical recovery  the intact and awake animals received constant current stimulation  5 ma  83 hz  143 hz  or 50 250 hz randomly  0 5 ms pulse width  at the onset of every spontaneous seizure for the duration of the seizure or every 3 h for 40 s if stimulation had not occurred in the preceding hour  
class10	3532	stimulation periods of 2 6 weeks  with differing levels of stimulation  were preceded and followed by at least a 2 week baseline period of no stimulation  
class10	3532	during the stimulation periods  the seizure rate decreased to zero in two monkeys and the interseizure intervals became invariable in the remaining two monkeys  
class10	3532	these effects carried over temporarily into the poststimulation baseline periods  
class10	3532	vagal stimulation had no consistent effects on seizure severity or eeg interictal spikes  
class10	3532	histological studies of six vagus nerves were unable to separate electrode cuff damage from any direct effects stimulation may have had on the nerves  
class10	3532	although it appears that chronic vagal stimulation is feasible and that epileptogenic processes are influenced  the safety and efficacy of the procedure are still in question  
class10	3533	an implantable neurocybernetic prosthesis system  
class10	3533	the neurocybernetic prosthesis  cyberonics  inc   is an implantable  multiprogrammable pulse generator that delivers constant current electrical signals to the vagus nerve for the purpose of reducing the frequency and or severity of epileptic seizures  
class10	3533	the device is implanted in a subcutaneous chest pocket just below the clavicle  similar to cardiac pacemaker placement  
class10	3533	the stimulation signal is transmitted from the prosthesis to the vagus nerve through a stimulation lead  
class10	3533	the prosthesis can be programmed using any ibm compatible personal computer with programming software and a programming wand  
class10	3533	the electrodes used in the first group of patients were found to break at an unacceptable rate  
class10	3533	design modifications appear to have resolved this problem  
class10	3534	surgical technique for implantation of the neurocybernetic prosthesis  
class10	3534	the surgical technique for the implantation of the neurocybernetic prosthesis is described in detail  
class10	3534	this procedure is straightforward and is easily carried out by surgeons familiar with carotid surgery  
class10	3535	efficacy and safety of vagus nerve stimulation in patients with complex partial seizures  
class10	3535	a clinical trial of chronic intermittent vagal stimulation in five patients suggests that the procedure may be safe and effective as adjunctive treatment of medically intractable seizures of partial onset  
class10	3535	patients tolerated well the implantation of the neurocybernetic prosthesis and the vagal stimulation without serious physiological or lifestyle changes  
class10	3535	stimulation of the vagus nerve either reduced the seizure frequency or decreased the duration or intensity of seizures  
class10	3535	adverse side effects were limited to a tingling sensation in the throat and hoarseness during stimulation  
class10	3535	a major complication was mechanical interruption of the wire electrode circuitry  with consequent cessation of stimulation  
class10	3535	the small number of patients and the relatively short follow up period make this a pilot study  but the results are promising  
class10	3536	vagus nerve stimulation in humans  neurophysiological studies and electrophysiological monitoring  
class10	3536	evidence from studies of experimental animals indicates that electrical stimulation of the vagus nerve alters behavioral and electrographic seizure activity  
class10	3536	we report on effects of electrical stimulation of the vagus nerve in five patients with medically intractable seizures as part of a clinical trial of chronic vagal stimulation for control of epilepsy  
class10	3536	the mechanism of action of the vagal antiepileptic effect is unknown  and it is hoped that analysis of electrophysiological effects of vagal nerve stimulation will help elucidate which brain areas are affected  
class10	3536	stimulation of the left vagus nerve in the neck was accomplished with a programmable implanted stimulator  
class10	3536	effects of stimulus amplitude  duration  and rate were studied  
class10	3536	noncephalic reference recording of the vagus nerve evoked potential showed some unusual properties  a scalp negative component occurred with latency of 12 ms  very high amplitude  up to 60 microv   and widespread scalp distribution  
class10	3536	field distribution studies indicate that this potential is generated in the neck  in the region of the stimulating electrodes  
class10	3536	muscle paralysis confirms this observation  
class10	3536	stimulation at various frequencies had no noticeable effect on electroencephalographic  eeg  activity regardless of whether the patient was under general anesthesia  awake  or asleep  
class10	3537	effects of vagal stimulation on experimentally induced seizures in rats  
class10	3537	repetitive stimulation of the vagus nerve inhibits chemically induced seizures in dogs  
class10	3537	we report here the results and conclusions from studies designed to answer some of the immediate questions raised by this finding  
class10	3537	 1  maximal stimulation of vagal c fibers at frequencies greater than 4 hz prevents or reduces chemically and electrically induced seizures in young male rats  
class10	3537	 2  antiepileptic potency is directly related to the fraction of vagal c fibers stimulated  
class10	3537	 3  vagal stimulation shortens but does not shut down a chemical seizure once it has begun  
class10	3537	 4  in rats  optimal stimulus frequency is approximately 10 20 hz  duration of stimulus  0 5 1 ms  and stimulus strength  0 2 0 5 ma mm2 of nerve cross section  
class10	3537	these results  when taken together with similar results obtained from dogs  monkeys  and humans  strongly suggest that periodic stimulation of the vagus nerve using appropriate stimulation parameters is a powerful method for preventing seizures  
class10	3537	the data from the literature suggest that the antiepileptic actions of vagal stimulation are largely mediated by widespread release of gaba and glycine in the brainstem and cerebral cortex  
class10	3537	the probable pathway is via projections from the nucleus of the solitary tract to the reticular formation and thence by diffuse projections to the cortex and other areas  
class10	3537	intermittent vagal stimulation has the potentiality of reducing the number and or the intensity of seizures in patients with intractable epilepsy  
class10	3537	these results indicate that feasibility studies in humans should be continued and expanded  
class10	3538	gene mapping and other tools for discovery  
class10	3538	genetic mapping provides a means of understanding the molecular basis of inherited diseases whose biochemistry is unknown  
class10	3538	adequate pedigrees  informative genetic markers  and accurate identification of the disease phenotype are necessary  
class10	3538	for dominant inheritance  mapping studies can be done in a single large pedigree  the larger the number of affected individuals sampled the better the estimate of recombination between the gene causing the disease and one or more nearby genetic markers  
class10	3538	for recessive inheritance  nuclear families with more than one affected sibling provide the best information  
class10	3538	the development of many polymorphic dna markers on the human genome has contributed to the success of mapping unknown genes because  as the genome is now densely covered with markers  the probability is good that at least one marker will be linked to the disease locus in a family that is segregating a disease allele  
class10	3538	most genetic markers now in use depend upon restriction fragment length polymorphisms  rflps   which are either the result of single base pair substitution or the presence of a variable number of tandemly repeated oligonucleotide units at a locus  vntrs   
class10	3538	rflps can be recognized by digesting dna with restriction enzymes and separating the fragments by size on an electrophoretic gel  
class10	3538	vntrs can vary widely among individuals  and they provide more linkage information than single site polymorphic markers because family members are more likely to be heterozygous  
class10	3538	genetic maps of each chromosome  constructed from linkage data relating marker loci to one another in normal reference families  permit rational choices of markers for disease mapping studies  
class10	3539	the epilepsies  clinical implications of the international classification  
class10	3539	from the earliest days of neurology  the classification of epileptic seizures into those generalized from the beginning and those with a definable localization in the cortex from the onset has added to knowledge about the function of the nervous system  
class10	3539	further elaboration of the classification of seizures into those localized to the six layered isocortex and those whose elaboration involves regions of the brain involved with consciousness and memory has provided the basic focus for the burgeoning subspecialty of epilepsy surgery  
class10	3539	it is increasingly apparent that the etiology of a seizure disorder is of at least equal or of greater significance than the nature of the seizures it spawns and is the product not only of localization in the nervous system but also of causative factors with implications reaching into areas of genetics  higher cortical function  and intelligence  
class10	3539	the prognosis concerning the outcome of the epilepsy under consideration is based on all of these facets  
class10	3539	this pathophysiological substratum  of which the seizure is only the presenting symptom  constitutes the epilepsy or epileptic syndrome on which the formulation of a rational treatment plan is based  
class10	3540	experimental models of temporal lobe epilepsy  new insights from the study of kindling and synaptic reorganization  
class10	3540	temporal lobe epilepsy is a common localization related epileptic syndrome characterized by complex partial seizures  ictal and interictal epileptic discharges arising from limbic structures of the temporal lobe  and association with hippocampal sclerosis  
class10	3540	temporal lobe epilepsy may follow perinatal injury and febrile convulsions  may be progressive  and frequently becomes refractory to standard antiepileptic therapy  
class10	3540	the neurobiology that underlies these features of temporal lobe epilepsy is not known  
class10	3540	recent studies in experimental models have provided new insights that may help clarify the relationship of seizures  hippocampal sclerosis  and temporal lobe epilepsy  
class10	3540	observations from the study of the hippocampus with kainic acid induced lesions  the kindling model  and other experimental models of epilepsy have demonstrated that seizures induce structural and electrophysiologic alterations in hippocampal pathways that may lead to increased excitability and could play a role in the development and progression of temporal lobe epilepsy  
class10	3540	these alterations include mossy fiber synaptic reorganization  induction of nmda mediated synaptic transmission  and progressive hippocampal neuronal loss induced by brief kindled seizures  
class10	3540	some of the structural alterations induced by kindling have also been observed in the human epileptic temporal lobe  raising the possibility that mechanisms operative in kindling may play a role in the pathogenesis of hippocampal sclerosis and in the syndrome of human temporal lobe epilepsy  
class10	3541	mesial temporal sclerosis  pathogenesis  diagnosis  and management  
class10	3541	mesial temporal sclerosis  mts  is probably the most common symptomatic pathologic entity  alone or mixed with other pathologic features  for seizures of temporal lobe origin  
class10	3541	the pathophysiology of mts  including any genetic influence  needs clarification  
class10	3541	a characteristic ictal expression for seizures of mts origin appears not to exist  
class10	3541	the majority of patients  78   with postresection mts who are seizure free have tightly localized interictal abnormalities restricted to f7 f8  sp1 sp2  t3 t4  and t5 t6 more than 96  of the time  
class10	3541	mri abnormalities may be seen in 55  of patients with mts if both  hard  and  soft  criteria are used or in 20  when only  hard  criteria are used  
class10	3541	the neuropsychologic evaluation of patients with mts  which includes intracarotid amobarbital test  iat   may prove to be increasingly useful in identifying patterns of cognitive deficit that correlate with enhancement of both lateralizing and localizing preoperative information  
class10	3542	post traumatic epilepsy  cellular mechanisms and implications for treatment  
class10	3542	epilepsy complicates severe head trauma  
class10	3542	development of persistent seizures appears to correlate with the extent of trauma  
class10	3542	although early reports suggested that prophylactic administration of antiepileptic drugs would prevent epileptogenesis  controlled studies have failed to corroborate this assumption  
class10	3542	head trauma initiates a sequence of responses that includes altered blood flow and vasoregulation  disruption of the blood brain barrier  increases in intracranial pressure  focal or diffuse ischemia  hemorrhage  inflammation  necrosis  and disruption of fiber tracts  
class10	3542	the presence of an intracranial hematoma has a robust association with the development of post traumatic epilepsy  
class10	3542	extravasation of blood is followed by hemolysis and deposition of heme containing compounds into the neuropil  initiating a sequence of univalent redox reactions and generating various free radical species  including superoxides  hydroxyl radicals  peroxides  and perferryl ions  
class10	3542	free radicals initiate peroxidation reactions by hydrogen abstraction from methylene groups adjacent to double bonds of fatty acids and lipids within cellular membranes  
class10	3542	intrinsic enzymatic mechanisms for control of free radical reactions include activation of catalase  peroxidase  and superoxide dismutase  
class10	3542	steroids  proteins  and tocopherol also terminate peroxidative reactions  
class10	3542	tocopherol and selenium are effective in preventing tissue injury initiated by ferrous chloride and heme compounds  
class10	3542	treatment strategies for prevention or prophylaxis of post traumatic epilepsy must await absolute knowledge of mechanisms  
class10	3542	antioxidants and chelators may be useful  given the speculation that peroxidative reactions may be an important component of brain injury responses  
class10	3542	however  potential treatment strategies involving gamma aminobutyric acid  gaba  agonists  nmda receptor antagonists  and barbiturates need further scientific assessment  
class10	3543	transient hyperprolactinemia is associated with a midcycle luteinizing hormone surge  
class10	3543	this study demonstrates that lh surge cycles in ivf patients were associated with significantly higher serum prl concentrations than cycles in which a spontaneous lh surge did not occur  
class10	3543	our findings support the hypothesis of concomitant lh and prl release at the time of the midcycle gonadotropin surge  as well as that of estrogen sensitization of pituitary lactotropes  and suggest a possible mechanism for transient midcycle hyperprolactinemia  
class10	3544	local anesthesia for neonatal circumcisions  are family practice residents likely to use it  
class10	3544	dorsal penile nerve block with lidocaine  dpnb  is a local anesthetic technique for neonatal circumcision which is both effective and consistent with ethical concerns for infant welfare  
class10	3544	as such  it should be included in training programs that prepare residents to care for newborns  
class10	3544	to assess the current level of dpnb use by residents in a family practice training program and to identify attitudes and other factors that relate to use  a survey was sent to 127 residents in the department of family practice and community health  university of minnesota  
class10	3544	of the 101 respondents  55  had used dpnb  and 17  could be characterized as high users  employing the technique for over one half of the circumcisions they performed  
class10	3544	residents with comprehensive understanding of the newborn s capacity to feel pain were more likely to be using dpnb than their less well informed counterparts  
class10	3544	four factors were identified as predicting use  cooperation of nursery staff for the procedure  accessibility of instruction in pnb technique  belief that pnb is effective in reducing infant pain  and likelihood of parents giving consent for pnb  
class10	3544	these results suggest strategies which may be implemented by family practice educators who wish to promote the principles and techniques of dpnb  
class10	3545	fulminant hepatitis after lisinopril administration  
class10	3545	a case of fulminant hepatitis in a patient taking lisinopril for 5 weeks for arterial hypertension is reported  
class10	3545	jaundice  fever  myalgia  and marked increase in serum aminotransferase activities occurred after 2 weeks of treatment  
class10	3545	continuation of lisinopril administration for 3 weeks after the onset of jaundice was associated with the development of grade iii encephalopathy and a marked decrease in prothrombin and proaccelerin levels  
class10	3545	this case strongly suggests that lisinopril may induce acute hepatitis and that continuation of the treatment after the onset of jaundice can lead to life threatening hepatic failure  
class10	3546	heterotopic liver transplantation for fulminant wilson s disease  
class10	3546	wilson s disease may present with severe acute hepatocellular failure  
class10	3546	the only effective treatment for fulminant wilson s disease is liver transplantation  which may lead to reversal of the underlying disease  
class10	3546	some patients with cirrhosis who are too ill to undergo orthotopic liver transplantation have been treated with heterotopic liver transplantation  
class10	3546	however  use of heterotopic liver transplantation for fulminant hepatocellular failure has not been successful  
class10	3546	this case study involves a patient in whom a heterotopic liver transplant was successfully used for treatment of wilson s disease presenting with fulminant hepatocellular failure  
class10	3547	pain on common bile duct injection during ercp  does it indicate sphincter of oddi dysfunction  
class10	3547	the reproduction of a patient s biliary type pain upon initial injection of contrast material into the common bile duct during diagnostic ercp is a dramatic experience for both patient and physician  
class10	3547	the significance of this phenomenon is not clear  but it is touted by some to be a provocative test for sphincter of oddi dysfunction  
class10	3547	sphincter of oddi manometry was performed on 224 consecutive patients referred over a 2 year period for evaluation of post cholecystectomy syndrome and suspected sphincter of oddi dysfunction  
class10	3547	all patients received only intravenous diazepam as premedication for ercp  
class10	3547	delayed drainage time  greater than 45 min   bile duct dilation  greater than or equal to 12 mm   and a basal sphincter of oddi pressure of greater than 40 mm hg  mean     3 sd  were considered elevated  
class10	3547	we observed a reproduction of pain in 15 of 224 patients  6 7   immediately following contrast injection  
class10	3547	there was no correlation between pain on contrast injection and elevated basal sphincter of oddi pressure  delayed common bile duct drainage  bile duct dilation  or abnormal liver enzymes  
class10	3547	therefore  we feel that reproduction of the patient s biliary type pain associated with contrast injection of ercp is not a provocative test for sphincter of oddi dysfunction  
class10	3548	atrial fibrillation in the elderly  management update  
class10	3548	non valvular atrial fibrillation is associated with a markedly increased risk of embolic stroke in elderly persons  
class10	3548	evidence is accumulating that anticoagulation with warfarin or aspirin may be effective in reducing this risk  
class10	3549	serious migraine  a study of some epidemiological aspects  
class10	3549	data are scant concerning some epidemiological aspects of those severe headaches which cause serious personal and economic morbidity  
class10	3549	our purpose was to study the incidence and other epidemiological features of patients suffering from severe migraine exacerbations  in an unselected population  
class10	3549	the 64 patients who suffered from severe migraine bouts represented 10 5  of all the new walk in neurological consultations in the area covered in this study  
class10	3549	70  of these patients were between 10 and 39 years old  
class10	3549	although females clearly predominated in all ages after fifteen  below this age there was a slight male predominance  
class10	3549	the calculated incidence of serious migraine exacerbations was 90 per 100 000 people per year  the corrected incidence for females being 143 100 000 and for males 37 100 000  
class10	3549	the highest incidence for females was in 15 19 year olds  377 100 000  and for males in 10 14 year olds  166 100 000   
class10	3549	our data seem to confirm the periodic nature of this condition since in 80  of patients the migraine bouts  ie  groups of attacks  lasted between two and nine months  
class10	3549	also they support the reported existence of genetic and hormonal factors in the susceptibility to migraine exacerbations  
class10	3549	our results may help in planning the public health aspect of migraine and add some light to the natural history of this common condition  
class10	3550	swimmer s migraine  
class10	3550	three cases of sudden  severe headache occurring during swimming are described  
class10	3550	a 51 year old female had been engaging in a swimming exercise for about 20 minutes when she suddenly experienced a pulsating headache in the parietotemporal region  accompanied by nausea  
class10	3550	a few days later  she experienced a similar episode  again during swimming practice  
class10	3550	a 45 year old male developed a pulsating headache with nausea immediately after diving into a swimming pool  and had a similar attack during diving practice 1 week later  
class10	3550	a 32 year old male developed a pulsating headache accompanied by nausea while swimming in the sea  
class10	3550	in all three cases  blood pressure  pulse rate  neurological findings  cervical spinal x rays  brain ct scans  and hematological findings were normal and the outcome was good  
class10	3550	although these patients  headaches were diagnosed as benign exertional headache  pathophysiologically they appeared to resemble the headache associated with sexual activity  
class10	3551	platelet monoamine oxidase activity in female migraine patients  
class10	3551	platelet monoamine oxidase activity  mao  in a group  n   17  of white  female migraineurs during an acute migraine attack was similar to both the values obtained for the same group of patients two to three weeks after the headache episode  pain free period  and to the results obtained for a group  n   18  of sex and race matched  age comparable  drug free healthy volunteers  blind study  substrate p tyramine  38 7     5 7  41 9     8 8 and 43 0     3 4 or p methoxybenzylamine  178 9     11 3  177 2     6 9 and 181 0     9 7 nmole hr 10 9  platelets     sd respectively   
class10	3551	with each patient serving as its own control  mao activity during the migraine episode and when pain free failed to show a significant trend  
class10	3551	neither a number of other medical conditions nor the use of several medications appeared to significantly influence our results  
class10	3551	the present work  while dealing only with a small but well defined patient population  argues against the possible usefulness of platelet mao activity as a biological marker for migraine headaches  
class10	3552	a protocol for butalbital  aspirin and caffeine  bac  detoxification in headache patients  
class10	3552	the abuse of the combination drug containing butalbital 50 mg  aspirin 325 mg and caffeine 40 mg  or bac   is commonly recognized by headache specialists as causing headaches  
class10	3552	despite this widespread problem  there is not a published treatment regimen for the bac detoxification of patients  
class10	3552	i describe such a protocol which was used four times in three patients  
class10	3552	these patients fulfilled the diagnostic criteria of the ihs headache classification for headaches induced by chronic substance abuse  8 2  and analgesics abuse headache  8 2 2   
class10	3552	these patients took between 150 and 420 bac month for 2 15 years  
class10	3552	two patients had previously undergone inpatient detoxification  
class10	3552	one patient unsuccessfully tried detoxification twice as an outpatient  
class10	3552	all patients were required to have psychological support prior to hospitalization for this protocol  
class10	3552	bac was discontinued  
class10	3552	a pentobarbital challenge test corroborated butalbital dosage  
class10	3552	the patients were given phenobarbital and caffeine which were tapered over several days  
class10	3552	dihydroergotamine  dhe  with metoclopramide was used  raskin   
class10	3552	propranolol 60 mg bid was started  
class10	3552	no narcotics were permitted  
class10	3552	after hospital discharge  patients were allowed to continue subcutaneous dhe  as needed  
class10	3552	one patient restarted bac use after 8 months without it  
class10	3552	the other two patients were still bac free 18 and 14 months after detoxification  
class10	3553	thermographic findings in cranio facial pain  
class10	3553	this work assesses the differences in the thermographic findings in the craniofacial and neck areas between normal individuals and patients with craniofacial pain or headache  and investigates the influence of muscle contraction on such findings  
class10	3553	thermographic records were taken in 10 healthy subjects and 47 patients suffering from craniofacial pain or headache of different kinds  
class10	3553	in the patients with painful episodes the record was taken between attacks  
class10	3553	in all the normal subjects and in 19 patients lateral thermograms were also taken during and after maximal tooth clenching for three minutes  
class10	3553	the majority of the patients  as compared to the normal group  showed some thermal alterations and asymmetry  
class10	3553	such alterations seem to be due both to vascular instability and muscle contraction  these two factors may be variably superimposed in the different conditions  
class10	3553	in patients with cluster headache or chronic paroxysmal hemicrania the presence on the symptomatic side of a cold spot along the supraorbital area and or the inner orbital canthus  was a constant finding  
class10	3553	we conclude that thermography is useful as an additional diagnostic means in patients with head and face pain  and that the clenching test may increase the amount of information provided  
class10	3554	dissociation between pain and autonomic disturbances in cluster headache  
class10	3554	the relationship between pain and autonomic disturbances in cluster headache was studied in 54 patients whose attack always recurred on the same side  and in 7 others whose attack had affected either side on different occasions  
class10	3554	in one of these seven patients  facial flushing and ocular sympathetic deficit was observed on the original side of headaches  
class10	3554	in most patients  the orbital region was warmer on the painful side but in three cases this region was cooler during and between attacks  
class10	3554	lacrimation and rhinorrhoea were more common in severe attacks  and the temperature difference between the orbits increased with increasing severity of pain  
class10	3554	these findings support the view that certain autonomic disturbances in cluster headache are provoked by pain  
class10	3554	residual autonomic dysfunction could influence autonomic activity during cluster headache  
class10	3554	if so  residual dysfunction on the pain free side could explain the dissociation between autonomic disturbances and pain observed in a few cases  
class10	3555	a study of the seasonal variation of migraine  
class10	3555	available evidence supports the contention that migraine involves a disturbance in serotonin function  
class10	3555	several parameters of serotonin function in humans have been found to vary seasonally and may underlie the seasonal fluctuations observed in many clinical neuropsychiatric phenomena that are thought to involve serotonin dysfunction  
class10	3555	we therefore postulated that migraine headaches might also vary seasonally and examined the admissions to our hospital over a 20 year period with a primary diagnosis of migraine  
class10	3555	peak admissions were found to occur most frequently in the spring for females in comparison to males  p less than or equal to 0 04  chi square   
class10	3555	the implications of these findings are discussed  
class10	3556	clinical characteristics of migraine and episodic tension type headache in relation to old and new diagnostic criteria  
class10	3556	eighty one patients were diagnosed as having migraine  tension headache or both according to previously used criteria  
class10	3556	then we performed a standardized interview to determine the frequency and severity of headache characteristics used in the new operational diagnostic criteria of the international headache society  ihs   
class10	3556	in every patient the original diagnosis fulfilled also the ihs criteria  but in 9 patients the criteria were only fulfilled in half or less of the attacks  and applying the ihs criteria they also achieved an additional diagnosis  
class10	3556	in one patient these attacks did not fulfill the pain criteria and in 8  4 migraine  4 tension headache  they did not fulfill the criteria for accompanying symptoms  
class10	3556	overall the ihs criteria are sensitive and specific  but they may possibly be improved with regard to accompanying symptoms  
class10	3556	the present study suggests that recording of frequency and graded severity of characteristics using a headache diary may further improve the distinction between the different types of headache  
class10	3557	fluctuation in timing of upper airway and chest wall inspiratory muscle activity in obstructive sleep apnea  
class10	3557	an imbalance in the amplitude of electrical activity of the upper airway and chest wall inspiratory muscles is associated with both collapse and reopening of the upper airway in obstructive sleep apnea  osa   
class10	3557	the purpose of this study was to examine whether timing of the phasic activity of these inspiratory muscles also was associated with changes in upper airway caliber in osa  
class10	3557	we hypothesized that activation of upper airway muscle phasic electrical activity before activation of the chest wall pump muscles would help preserve upper airway patency  
class10	3557	in contrast  we anticipated that the reversal of this pattern with delayed activation of upper airway inspiratory muscles would be associated with upper airway narrowing or collapse  
class10	3557	therefore the timing and amplitude of midline transmandibular and costal margin moving time average  mta  electromyogram  emg  signals were analyzed from 58 apnea cycles in stage 2 sleep in six osa patients  
class10	3557	in 86  of the postapnea breaths analyzed the upper airway mta peak activity preceded the chest wall peak activity  
class10	3557	in 86  of the obstructed respiratory efforts the upper airway mta peak activity followed the chest wall peak activity  
class10	3557	the onset of phasic electrical activity followed this same pattern  
class10	3557	during inspiratory efforts when phasic inspiratory emg amplitude did not change from preapnea to apnea  the timing changes noted above occurred  
class10	3557	even within breaths the relative timing of the upper airway and chest wall electrical activities was closely associated with changes in the pressure flow relationship  
class10	3557	we conclude that the relative timing of inspiratory activity of the upper airway and chest wall inspiratory muscles fluctuates during sleep in osa  
class10	3558	effect of sleep and sleep deprivation on ventilatory response to bronchoconstriction  
class10	3558	to characterize ventilatory responses to bronchoconstriction during sleep and to assess the effect of prior sleep deprivation on ventilatory and arousal responses to bronchoconstriction  bronchoconstriction was induced in eight asthmatic subjects while they were awake  during normal sleep  and during sleep after a 36 h period of sleep deprivation  
class10	3558	each subject was bronchoconstricted with increasing concentrations of aerosolized methacholine while ventilatory patterns and lower airway resistance  rla  were continually monitored  
class10	3558	the asthmatic patients maintained their minute ventilation as rla increased under all conditions  demonstrating a stable tidal volume with a mild increase in respiratory frequency  
class10	3558	inspiratory drive  as measured by occlusion pressure  p0 1   increased progressively and significantly as rla increased under all conditions  slopes of p0 1 vs  
class10	3558	rla   0 249  0 112  and 0 154 for awake  normal sleep  and sleep after sleep deprivation  respectively  p less than 0 0006   
class10	3558	chemostimuli did not appear to contribute significantly to the observed increases in p0 1  
class10	3558	prior sleep deprivation had no effect on ventilatory and p0 1 responses to bronchoconstriction but did significantly raise the arousal threshold to induced bronchoconstriction  
class10	3558	we conclude that ventilatory responses to bronchoconstriction  unlike extrinsic loading  are not imparied by the presence of sleep  nor are they chemically mediated  
class10	3558	however  prior sleep deprivation does increase the subsequent arousal threshold  
class10	3559	rat soleus muscle ultrastructure after hindlimb suspension  
class10	3559	the aim of the present investigation was to determine  by quantitative electron microscopy  the effects of a 5 wk tail suspension period on rat soleus muscle ultrastructure  
class10	3559	a marked decline   60   in muscle mass occurred  
class10	3559	the mean fiber cross sectional area decreased to a greater extent   75   than the capillary to fiber ratio   37    leading to a higher capillary density   148   after hypokinesia  
class10	3559	the total mitochondrial volume density remained unchanged  whereas the volume density of myofibrils was slightly but significantly reduced   6    
class10	3559	a shift from subsarcolemmal to interfibrillar mitochondria occurred  
class10	3559	interfibrillar mitochondrial volume density was highest near the fiber border and decreased toward the fiber center  
class10	3559	an increase in volume density of satellite cells suggested muscle regenerative events  
class10	3559	soleus atrophy with tail suspension greatly decreases the muscular volume but leaves the ultrastructural composition of muscle fibers relatively unaffected  
class10	3560	cardiovascular responses to arm cranking and fns induced leg exercise in paraplegics  
class10	3560	twelve spinal cord injured males performed arm crank exercise  ace  with and without concurrent functional neuromuscular stimulation  fns  of paralyzed leg muscles to investigate the hypothesis that fns would augment cardiovascular performance during submaximal ace  
class10	3560	six men who exhibited vigorous isometric contractions of thigh and calf muscles were classed as  responders  to fns  r   and the remaining subjects with poor or nonexistent contractions served as  nonresponder controls   c   
class10	3560	steady state heart rate and oxygen uptake during ace at 30  60  and 90 w were not appreciably different from the ace   fns condition  
class10	3560	however  cardiac outputs in r were augmented by 30  during fns at rest  from 4 9 to 6 4 l min   by 18  during 30 w ace   fns  from 8 6 to 10 1 l min   and by 28  during 90 w ace   fns  from 12 1 to 15 6 l min   
class10	3560	similarly  resting stroke volumes were increased by 18   9 ml  and by 23   19 ml  at 60 w during fns in the r group  
class10	3560	calculated total peripheral resistance was reduced at rest and during 90 w ace   fns by approximately 24   
class10	3560	in contrast  no alterations of circulatory hemodynamics were observed for c subjects  
class10	3560	these data indicate that fns induced contractions of paralyzed leg muscles augment venous return to aid central cardiovascular control during upper body submaximal exercise in paraplegics  
class10	3561	results of treatment of displaced patellar fractures by partial patellectomy  
class10	3561	the results of partial patellectomy as a treatment for displaced patellar fractures were assessed retrospectively with use of clinical  radiographic  and isokinetic strength testing criteria  
class10	3561	forty patients who had been followed for an average of 8 4 years were studied  
class10	3561	in the extremity that had been operated on  the mean active range of motion was 94 per cent  the circumference of the thigh was 100 per cent  and the strength of the quadriceps was 85 per cent of these measurements in the contralateral extremity  
class10	3561	the over all result was rated as excellent in twenty patients  good in eleven  fair in six  and poor in three  
class10	3561	there was a significant statistical correlation between the type of fracture and the outcome  
class10	3561	the results of this study indicate that partial patellectomy can be an effective treatment for selected patellar fractures  
class10	3562	comparison of a hybrid with an uncemented total hip replacement  a retrospective matched pair study  
class10	3562	the efficacy of a type of uncemented total hip replacement was compared with that of a hybrid total hip replacement in which an uncemented acetabular and a cemented femoral component were used  
class10	3562	twenty five patients who had had a hybrid total hip replacement were matched  by age  weight  sex  and diagnosis  with twenty five patients who had had an uncemented total hip replacement  
class10	3562	all of the operations were done by one surgeon  who used the same operative approach and the same regimen of postoperative rehabilitation  
class10	3562	all of the patients were followed for at least two years  
class10	3562	the mean postoperative hip score was 96 points for the hybrid group and 84 points for the cementless group  p less than 0 02   
class10	3562	twenty four  96 per cent  of the patients who had a hybrid prosthesis reported no or only slight pain postoperatively  
class10	3562	in the uncemented group  of the six patients  24 per cent  who reported mild to severe pain  five had pain in the thigh  a limp occurred more frequently  five femoral components had migrated  and four hips needed reoperation  
class10	3562	the results with the hybrid replacement that had a cemented femoral component were superior to those with the uncemented femoral component over the relatively brief period for which these patients were followed  
class10	3563	the patellofemoral joint after total knee arthroplasty without patellar resurfacing  
class10	3563	one hundred total knee replacements with a total condylar prosthesis and without patellar resurfacing were followed for a minimum of two years  
class10	3563	eighty four per cent of the knees were affected by osteoarthrosis  
class10	3563	graded according to the knee rating system of the hospital for special surgery  there were eighteen excellent  fifty three good  eighteen fair  and eleven poor results  
class10	3563	at the most recent follow up  twenty nine knees  29 per cent   nine of which were affected by rheumatoid arthritis  were still painful in the patellofemoral area  
class10	3563	the height and weight of the patient definitely influenced the amount of patellofemoral pain postoperatively  
class10	3563	small patients who had osteoarthrosis were exceptionally free of pain  regardless of sex  age  or level of activity  
class10	3563	it seems that the best approach to patellofemoral replacement includes resurfacing of the patella in all patients who have rheumatoid arthritis and in patients who have osteoarthrosis if they have preoperative patellofemoral pain  are more than 160 centimeters tall  weigh more than sixty kilograms  and have advanced changes in the patella at the time of the operation  
class10	3564	intraoperative assessment of cerebral ischemia during carotid surgery  
class10	3564	one of the problems in carotid surgery is the intraoperative detection of brain ischemia  
class10	3564	none of the methods  eeg  stump pressure  applied so far have been successful  
class10	3564	branston et al  
class10	3564	 1974  found a threshold relationship between cortical cerebral blood flow and cortical somatosensory evoked potential  sep   
class10	3564	as the local blood flow fell below about 16 ml 100 g min a progressive reduction occurred in the amplitude of the cortical evoked potential  n20 p25   implying a fundamental failure of neuronal function in the somatosensory cortex  
class10	3564	we have monitored cortical sep  somatosensory evoked potential  during 734 cea s  carotid endarterectomies  in order to find an index of risk of incipient cerebral ischemia during carotid cross clamping  to determine the need for shunting and the causes of early irreversible neurologic deficits  
class10	3564	in 59 cases evaluation of sep was not possible because of technical difficulties  
class10	3564	during 586 cea s no alteration of sep occurred  
class10	3564	however  4 patients had an immediate postoperative neurologic deficit  while the sep remained normal  
class10	3564	abnormal sep occurred in 89 cases and in 6 of these an irreversible loss of sep was seen  
class10	3564	these patients awoke with a new neurologic deficit  
class10	3564	we found a reversible abnormal sep in 83 cases  
class10	3564	reversible changes of sep occurred mainly during carotid clamping  
class10	3564	the diagnostic sensitivity of intraoperative sep monitoring in predicting neurologic outcome was 60  with a specificity of 100   
class10	3565	reappraisal of surgical treatment of traumatic transection of the thoracic aorta  
class10	3565	since crawford s report in 1973  repair of traumatic transection of the thoracic aorta without shunt or bypass has emerged as a popular technique which simplifies the operation and avoids use of heparin  
class10	3565	growing evidence  however  indicates that the incidence of paraplegia is higher with this method and may outweigh its advantages  
class10	3565	with this in mind  we have examined our experience with 40 patients who underwent repair of aortic transection from 1975 1988  
class10	3565	the operated patients in our series all survived  
class10	3565	fourteen were repaired using some type of bypass or shunt  none of whom developed paraplegia  
class10	3565	the remaining 26 patients were repaired without a shunt and 9  34 6   developed paraplegia or paraparesis  p less than 0 02   
class10	3565	paraplegia was related to aortic occlusion time  p less than 0 002   
class10	3565	it did not occur in 11 patients with times less than 27 minutes  but happened in 2 of 8 patients with times between 28 and 35 minutes and in all 7 patients with clamp times over 35 minutes  
class10	3565	these data suggest that shunt or bypass should be used in most cases of aortic transection  
class10	3566	clonal origin of pituitary adenomas  
class10	3566	as the pathogenesis of pituitary adenomas remains unclear  the tumor clonal composition of these common neoplasms was studied  
class10	3566	clonality was determined in female patients by analysis of restriction fragment length polymorphisms of the x chromosome genes hypoxanthine phosphoribosyl transferase and phosphoglycerate kinase in conjunction with their respective methylation patterns  
class10	3566	peripheral lymphocyte dna was screened from 62 female patients undergoing transsphenoidal surgery for pituitary adenoma  
class10	3566	eleven patients were heterozygous for the bgli site on pgk  4 for the bamhi site on hprt  and 1 patient for both sites  
class10	3566	of these 16 patients  3 had acromegaly  4 had cushing s disease  7 had hyperprolactinemia  and 2 were clinically nonfunctional  
class10	3566	after surgery  morphological study  including immunohistochemistry and electron microscopy of the pathological specimens  allowed a direct comparison between clonality and tumor cell type  
class10	3566	control fresh normal pituitary tissue was found to be polyclonal  
class10	3566	the following tumors were monoclonal  all 3 somatotroph adenomas  4 of 4 lactotroph tumors  3 of 4 corticotroph cell adenomas  a gonadotroph adenoma  and a nonsecretory adenoma  
class10	3566	a mixed plurihormonal adenoma was polyclonal  as were 2 tumors consisting of adenomatous lactotrophs interspersed with nontumorous adenohypophyseal pituitary tissue and one corticotroph adenoma mixed with normal pituitary tissue  
class10	3566	functional pituitary adenomas derived from somatotrophs  corticotrophs  or lactotrophs and nonsecretory tumors are monoclonal in nature  suggesting that somatic cell mutations precede clonal expansion of these cells and play a major role in pituitary tumorigenesis  
class10	3567	severe lidocaine intoxication by cutaneous absorption  
class10	3567	a severe lidocaine intoxication by cutaneous absorption is described  
class10	3567	data are presented to show a significant absorption of lidocaine through diseased skin when lidocaine cream is used as a local anesthetic  
class10	3567	awareness of this route of intoxication might be important in patients in whom neurologic or psychiatric symptoms develop while large amounts of lidocaine cream are being used  
class10	3568	traumatic asphyxia  
class10	3568	traumatic asphyxia is a distinctive clinical syndrome characterized by cervicofacial cyanosis and edema  multiple petechiae  and subconjunctival hemorrhage after a severe crush injury of the thorax or of the upper part of the abdomen  
class10	3568	a case of traumatic asphyxia is reported  and its clinical and pathophysiologic features are discussed  
class10	3569	mandibular osteomyelitis in a patient with sickle cell anemia  report of case  
class10	3569	a case is presented in which mandibular osteomyelitis and mental nerve paresthesia developed in a patient with sickle cell anemia  
class10	3569	this infection appeared to precipitate a sickle cell crisis  
class10	3569	the mechanisms for these patients  propensity to infection and the diagnosis and management of sickle cell osteomyelitis of the jaws are discussed  
class10	3570	lip paresthesia associated with a jaw mass  
class10	3570	a case is reported in which mandibular swelling and lower lip numbness were the first signs of a metastatic adenocarcinoma of the lung  
class10	3570	the development of paresthesia  with or without other oral symptoms  requires that a diagnosis of malignancy be considered until confirmed or ruled out by tissue biopsy  
class10	3570	a thorough head and neck examination in all patients  especially in those whose history or habits may indicate increased risk of malignancy is necessary  
class10	3571	plasma homocyst e ine levels in men with premature coronary artery disease  
class10	3571	plasma homocyst e ine  that is  the sum of free and bound homocysteine and its oxidized forms  homocystine and homocysteine cysteine mixed disulfide  levels were determined in 170 men  mean age     sd 50     7 years  with premature coronary artery disease diagnosed at coronary angiography and in 255 control subjects clinically free of coronary artery disease  mean age 49     6 years   
class10	3571	patients with coronary artery disease had a higher homocyst e ine level than control subjects  13 66     6 44 versus 10 93     4 92 nmol ml  p less than 0 001   
class10	3571	high density lipoprotein  hdl  cholesterol levels were lower  32     10 versus 46     13 mg dl  p less than 0 001  and triglycerides levels were higher  193     103 versus 136     106 mg dl  p less than 0 001  in the coronary disease group  
class10	3571	plasma total cholesterol and low density lipoprotein  ldl  cholesterol levels were not significantly different between patients with coronary disease and control subjects  
class10	3571	the presence of hypertension  smoking or diabetes mellitus did not significantly alter homocyst e ine levels in the patient or the control group  
class10	3571	patients who were not taking a beta adrenergic blocking drug  n   70  had a nonsignificantly higher homocyst e ine level than did patients taking this class of drugs  n   100   14 67     8 92 versus 12 95     3 77 nmol ml  p   0 087   
class10	3571	by design  none of the control subjects were taking a beta blocker  
class10	3571	no significant correlations were observed between homocyst e ine and age  serum cholesterol  ldl cholesterol  hdl cholesterol or triglyceride levels  
class10	3571	it is concluded that an elevated plasma homocyst e ine level is an independent risk factor for the development of premature coronary atherosclerosis in men  
class10	3572	prolonged anginal perceptual threshold in diabetes  effects on exercise capacity and myocardial ischemia  
class10	3572	anginal perceptual threshold  the time from onset of 0 1 mv of st segment depression to onset of angina during treadmill exercise  is prolonged in diabetic patients with coronary artery disease  
class10	3572	in the present study  the functional significance of this perceptual abnormality was evaluated by analysis of its effect on exercise capacity and the severity of myocardial ischemia  
class10	3572	treadmill exercise in 32 diabetic patients and 36 nondiabetic control patients showed a close linear correlation between the time to onset of electrical ischemia  st segment depression  and exercise capacity in both groups  r   0 8 and 0 9  respectively  p less than 0 001   
class10	3572	however  the slope of the relation was flatter in the diabetic group because prolongation of the anginal perceptual threshold permitted continued exercise as ischemia intensified  
class10	3572	the anginal perceptual threshold itself showed a close linear correlation with exercise capacity in the diabetic group  r   0 8  p less than 0 001   although in the nondiabetic group these variables were unrelated  
class10	3572	the permissive effect of a prolonged anginal perceptual threshold on exercise capacity is undesirable as reflected by its correlation with ischemia at peak exercise  r   0 6  p less than 0 001   the longer the threshold  the greater the exercise capacity and the more severe the ischemia  
class10	3572	indeed  the inverse relation between the severity of ischemia at peak exercise and exercise capacity in the nondiabetic group  r   0 4  p less than 0 02  was completely lost in the diabetic group  
class10	3572	thus  in diabetic patients with coronary artery disease  anginal perceptual threshold is a major determinant of exercise capacity  
class10	3573	the role of antihistamine therapy in vascular headaches  
class10	3573	migraine  vascular  headache is a complex syndrome that involves vascular hyperreactivity  
class10	3573	the functions of systemic mediators in migraine are not fully understood  
class10	3573	it is unclear which mediators provoke this probably atopic disorder and which represent an attempt to correct an imbalance  
class10	3573	however  it has been demonstrated fairly conclusively that increased histamine levels correlate with migraine attacks in susceptible persons  
class10	3573	recent studies showing that histamine seems to have many different receptors and to adopt different conformations for different receptors may serve as a useful guide to future scientific investigation  
class10	3573	further impetus may come from ongoing studies of h3 histamine receptors  which indicate that h3 agonists offer promise as prophylactic agents for people who suffer from vascular headaches  
class10	3574	cognitive function testing in comprehensive geriatric assessment  a comparison of cognitive test performance in residential and clinic settings  
class10	3574	tests of cognitive function are frequently used in geriatric assessment  but the effect of test setting has rarely been explored  
class10	3574	to determine the effect of testing site on the performance of elderly patients undergoing a comprehensive geriatric assessment  we administered the mini mental state exam to 116 geriatric patients in the clinic and at their residence  
class10	3574	their cognitive abilities varied from normal to severely impaired  
class10	3574	the patients  scores were 1 5     3 6  mean     sd  higher at their residence  
class10	3574	the clinical importance of a difference in score of 1 5 is not clear  
class10	3574	for this reason a second analysis was performed in which a difference in scores of five points or greater between settings was considered clinically meaningful  
class10	3574	twenty five percent  29 of 116  differed by five points or more  
class10	3574	of these 29 patients  22  76   tested better in the residential setting  
class10	3574	these differences were statistically significant  p    001   
class10	3574	we conclude that the testing site may affect test performance and that in home assessment may reveal the optimal cognitive function of geriatric patients  
class10	3575	reference values for the mini mental state examination  mmse  in octo  and nonagenarians 
class10	3575	the mini mental state examination  mmse  was used in a population survey of all inhabitants of leiden  the netherlands  over 85 years  n   1258   
class10	3575	in this paper we report on 532 subjects without neurological or psychiatric disease  
class10	3575	results show that the median score and lowest quartile cut off score remain high until the tenth decade  median score   28  lowest quartile cut off score   26   
class10	3575	thus age  in itself  is not a major limitation in using the mmse  
class10	3575	in this study a comparatively low level of education  the majority had 6 to 7 years of education  did not affect the results on the mmse in a negative way  nor did we find an association with the use of psychoactive drugs  
class10	3576	foci of increased t2 signal intensity in mr images of healthy elderly subjects  a follow up study  
class10	3576	an 18 month follow up study was conducted on 26 healthy elderly subjects with and without foci of increased t2 signal intensity on mr imaging  
class10	3576	the subjects did not differ with respect to health status or cognitive performance as measured by the cognitive subscale of the cambridge mental disorders of the elderly examination and the mini mental state examination at follow up  
class10	3576	there was a significant decline in performance on the digit symbol substitution test in subjects who had evidence of t2 foci compared to the performance of subjects without t2 foci  
class10	3576	this may indicate that the presence of t2 foci is correlated with subtle difficulties in learning and memory  
class10	3577	characteristics of an elderly driving population referred to a geriatric assessment center  
class10	3577	a retrospective  case control study was performed to determine the characteristics of elderly drivers referred to an outpatient geriatric assessment center  
class10	3577	it was hypothesized that the driving population was operating at a higher cognitive and functional level than nondrivers  
class10	3577	one hundred eighty two subjects meeting the entry criteria were studied  
class10	3577	twenty three percent of the subjects were driving at the time of their assessment  
class10	3577	compared to nondrivers  drivers were younger  p    0001   were more likely to be male  p    003   scored higher on a mental status examination  p    0001   and were more independent in physical and instrumental activities of daily living  p less than  0001   
class10	3577	despite these findings  the mean folstein mini mental score for drivers  23 7  was below normal  40  of drivers were diagnosed as having alzheimer s dementia at the time of their evaluation  and over 26  of the drivers needed help with either dressing or bathing  
class10	3577	the frequency of impaired elderly drivers in this referral setting was high  
class10	3577	the authors conclude that conditions that affect the driving task are common in geriatric assessment centers  
class10	3577	prospective studies of elderly drivers are needed to answer the difficult question of who among the elderly should drive  
class10	3578	bacterial meningitis in the united states  1986  report of a multistate surveillance study  the bacterial meningitis study group  
class10	3578	a prospective  laboratory based surveillance project obtained accurate data on meningitis in a population of 34 million people during 1986  
class10	3578	haemophilus influenzae was the most common cause of bacterial meningitis  45    followed by streptococcus pneumoniae  18    and neisseria meningitidis  14    
class10	3578	rates of h  
class10	3578	influenzae meningitis varied significantly by region  from 1 9 100 000 in new jersey to 4 0 100 000 in washington state  
class10	3578	the overall case fatality rates for meningitis were lower than those reported in several studies from the early 1970s  suggesting that improvements in early detection and antibiotic treatment may have occurred since that time  
class10	3578	concurrent surveillance was also performed for all invasive disease due to the five most common causes of bacterial meningitis  
class10	3578	serotypes of group b streptococcus other than type iii caused more than half of neonatal group b streptococcal disease and mortality  suggesting that an optimal vaccine preparation must be multivalent  
class10	3578	of the organisms evaluated  group b streptococcus was the second most common cause of invasive disease in persons greater than 5 years old  
class10	3579	decline in the prevalence of childhood deafness in the jewish population of jerusalem  ethnic and genetic aspects  
class10	3579	a longitudinal study was performed on 147 jewish children with bilaterally sensorineural hearing loss of moderately severe to profound degree  born in jerusalem during the eighteen years 1968 85  
class10	3579	the prevalence rate of these children declined during the years 1977 85  and at the same time the rate of consanguinity of their parents decreased  this decline was more evident in the genetic group among children with non ashkenazi ethnic origin  
class10	3579	no such decline was found among the ashkenazi children and no consanguinity among parents of these children was recorded  
class10	3579	our study supports the assumption that restriction of consanguineous matings may affect the prevalence of genetic deafness in children in a well defined population  
class10	3579	we have tried to remain unbiased and concede certain shortcomings in our present study  
class10	3580	hoarseness as the sole presenting symptom of foramen magnum meningioma  
class10	3580	foramen magnum tumours are rare  
class10	3580	they may present with bizarre symptoms and mimic many conditions  
class10	3580	we report a presentation with the sole complaint of hoarseness  never previously described in the literature  
class10	3580	voice returned to normal after surgical removal of the foramen magnum meningioma  
class10	3581	compliance  reliability  and validity of self monitoring for physical disturbances of parkinson s disease  the parkinson s symptom diary  
class10	3581	previous clinical research in parkinson s disease has recognized the value of self monitoring procedures in which patients observe and record the frequency and severity of their own symptoms as these occur within the patient s social and work environment  
class10	3581	we discuss issues of methodology and report a study of compliance  test retest reliability  and validity with a new self monitoring instrument  the parkinson s symptom diary  
class10	3581	two recordings of frequency  loss of balance  hesitation freezing  and two ratings of severity  tremor  difficulty walking  were made four times daily for one week by patients  n   73  who were without apparent loss of cognitive or memory functions  
class10	3581	a total of 91  of the diaries received  97  of requested  met strict compliance criteria so that independent sampling over days could be assumed  
class10	3581	test retest stability over one month was demonstrated for each score  all spearman rho greater than  85  in a representative subsample of 28 patients  
class10	3581	criterion validity was demonstrated for each score by an expected pattern of correlations with independently obtained observer ratings of the same or related indices of disease  and by comparison with hoehn and yahr disability stages  
class10	3581	by its simplicity  this self assessment device can be an invaluable complement to traditional methods of clinical and laboratory assessment in the care and evaluation of parkinson patients  
class10	3582	articulatory impairment associated with tardive dyskinesia  
class10	3582	the speech of two patients with tardive dyskinesia was studied  and one neuroleptic treated patient having no signs of overt tardive dyskinesia served as control  
class10	3582	a structured interview  including reading  repetition of sentences  and spontaneous conversation  was performed  
class10	3582	a phonetic transcription and analysis of abnormal phonemes was done by a linguist under blind conditions  
class10	3582	both patients with tardive dyskinesia had abnormal phonemes whereas the control patient had none  
class10	3582	these differences could not be explained by age  direct neuroleptic effect  or neuroleptic exposure time  
class10	3582	the abnormal phonemes were all consonants  
class10	3582	the authors conclude that tardive dyskinesia may cause articulatory communication problems  
class10	3583	untying the gordian knot  the genetics of tourette syndrome  
class10	3583	a review of the current status of the genetics of tourette syndrome is presented  
class10	3583	over the course of the 104 years since gilles de la tourette described the syndrome that bears his name  a body of carefully collected  described  and analyzed data has produced a model of the genetics that implicates a single dominant gene that is variably penetrant in males and females  
class10	3583	moreover  the locus of action of this gene is most likely in the dopaminergic system of the midbrain  
class10	3583	a systematic search for this gene using recombinant dna techniques is under way  
class10	3584	dexamethasone increases plasma levels of albendazole  
class10	3584	therapy of neurocysticercosis with cysticidal drugs is frequently complicated by the exacerbation of symptoms that follows the inflammation triggered by the acute destruction of cysticerci  
class10	3584	treatment of such adverse reactions with dexamethasone is highly effective  
class10	3584	however  it has been shown that dexamethasone lowers the plasma levels of praziquantel  thus reducing its cysticidal efficacy  
class10	3584	we measured plasma levels of albendazole  another strong cysticidal drug  when dexamethasone was given simultaneously  
class10	3584	we found that dexamethasone increased the plasma levels of albendazole by about 50   p less than 0 002   hence  it seems that cysticercosis and the ensuing inflammation can be treated simultaneously with albendazole and dexamethasone without diminishing the efficacy of the cysticidal drug  
class10	3585	herpes simplex virus type 2 meningitis without genital lesions  an immunoblot study  
class10	3585	two sexually active female patients presented with acute meningitis  
class10	3585	the csf abnormalities were severe and persistent  
class10	3585	in spite of the absence of genital lesions  serological studies revealed a primary infection by herpes simplex virus type 2  
class10	3585	an immunoblot study revealed intrathecal synthesis of anti herpes antibodies early in the course of the disease  
class10	3586	headaches and multiple sclerosis  a clinical study and review of the literature  
class10	3586	whether multiple sclerosis  ms  can cause headaches is controversial  
class10	3586	to clarify the association between headaches and ms we prospectively analyzed 104 consecutive ms patients using detailed headache evaluations  
class10	3586	fifty four patients  52   reported headaches  compared with 5 of 35  14   patients initially suspected to have ms but subsequently proven to have other disorders  and 18 of 100  18   matched general neurology patients  
class10	3586	the ms patients had tension headaches or vascular headaches of the migraine type  there was no distinctive  ms headache   seven of these patients had headaches with their first ms symptoms  but in only one did headaches recur with disease activity  
class10	3586	headaches did not correlate with any clinical features of ms  
class10	3586	we conclude that an association between headaches and ms may exist  
class10	3587	fatal or severely disabling cerebral infarction during hospitalization for stroke or transient ischemic attack  
class10	3587	six  1   of 578 patients admitted for cerebral infarction or transient ischemic attack  tia  suffered a fatal or severely disabling in hospital cerebral infarction following a period of stabilization or improvement lasting more than 1 day  
class10	3587	these infarctions were characterized by the sudden onset of stupor or coma and subsequent development of transtentorial herniation due to carotid or middle cerebral artery territory infarction  or widespread brain stem infarction due to basilar occlusion  
class10	3587	only one patient survived  
class10	3587	four patients had large vessel disease documented by doppler  angiography  or at autopsy  
class10	3587	each of these six infarcts occurred during the morning hours  4 9 days after the initial event  3 8 days after initiation of intravenous heparin  and within 4 8 h after intravenous heparin had been discontinued  
class10	3587	no coagulation abnormalities were documented  
class10	3587	we believe that these cases indicate that among patients admitted for cerebral infarction or tia  fatal or severely disabling in hospital cerebral infarction after a period of stabilization or improvement may occur in patients having an initially mild to moderate clinical deficit  that those suffering large artery disease may be at greater risk  and that there may be a relationship between heparin withdrawal and cerebral infarction in some patients  
class10	3588	unusual blink reflex with four components in a patient with periodic ataxia  
class10	3588	characteristic findings in blink reflex are reported in a 55 year old female with periodic ataxia  
class10	3588	the blink reflexes on the side ipsilateral to the stimulation consisted of four components with latencies of 11  21  35 and 47 ms  instead of the usual two components seen in normal subjects  
class10	3588	on the contralateral side  the last three components were also present  
class10	3588	the second component was different from the normal r2 response in that its latency was shorter than normal and it did not habituate by stimulation at a rate of 10 hz  
class10	3588	in addition  it was more affected by diazepam than the third or fourth components  
class10	3588	it is considered that r2 may have consisted of three components and that a shorter latency of the second component could be explained by facilitation  
class10	3589	treatment of chronic relapsing inflammatory demyelinating polyneuropathy by cyclosporin a and plasma exchange  a case report  
class10	3589	a patient with chronic relapsing inflammatory demyelinating polyneuropathy was successfully treated with plasma exchanges and cyclosporin a  csa   
class10	3589	dynamometric measurements of hand force during the time of csa treatment showed a highly significant correlation between hand force and csa blood levels  
class10	3589	the largest influence of csa on hand force occurred 11 13 days after csa uptake  
class10	3590	alcohol dependent unilateral vestibular impairment persisting after a closed head injury  
class10	3590	a 20 year old man suffered a closed head injury followed by symptoms of right sided labyrinthine concussion with complete clinical recovery within 3 weeks  
class10	3590	episodic vertigo and ataxic gait occurred after the ingestion of small amounts of alcohol over the next 2 years  
class10	3590	electro oculography revealed a right sided peripheral type vestibular lesion  only after taking alcohol  
class10	3590	this was interpreted as an alcohol induced impairment of central compensation following an incomplete recovery from right sided labyrinthine trauma  
class10	3591	questionable role of cns radioprophylaxis in the therapeutic management of childhood rhabdomyosarcoma with meningeal extension  
class10	3591	a series of 15 consecutive children with head and neck nonorbital rhabdomyosarcoma  rmsa  with meningeal extension were prospectively treated with chemotherapy consisting of adriamycin  doxorubicin  adria laboratory  columbus  oh   adm   vincristine  vcr   cyclophosphamide  cpm   and dactinomycin  dact  followed by radiotherapy  60 gy  to the primary tumor volume  along with intrathecal methotrexate  it mtx   
class10	3591	thirteen of 15 responded to preradiation chemotherapy  
class10	3591	four of 13 relapsed  
class10	3591	relapse occurred at the level of the primary tumor in three of four  
class10	3591	the 3 year progression free survival  pfs  was 59   similar to that achieved in a previous series treated with a comparable therapeutic approach that also included whole brain radiotherapy as a prophylaxis of possible occult meningeal seeding  
class10	3591	it is concluded that cns prophylaxis with radiotherapy is questionable in the management of childhood rmsa with meningeal extension  
class10	3592	magnetic resonance imaging contrast agents  theory and application to the central nervous system  
class10	3592	the theoretical aspects of magnetic resonance  mr  imaging contrast agents are reviewed  and their current applications to the central nervous system  cns  and their future applications are discussed  
class10	3592	profound differences exist between contrast agents used for mr imaging and computerized tomography  ct   
class10	3592	in mr imaging  the contrast agents are not imaged directly but rather act on adjacent protons to shorten t1 and t2 relaxation times  
class10	3592	this in turn results in signal intensity changes  
class10	3592	the lanthanide metal  gadolinium  in the form of gadopentetate dimeglumine  has been found to be both safe and efficacious as the only currently approved contrast agent for mr imaging  
class10	3592	magnetic resonance imaging revolutionized the detection and treatment of disease affecting the brain and spine  
class10	3592	initially  it was thought that signal characteristics on mr imaging would allow differentiation of specific pathology  
class10	3592	it was soon found that mr studies were able to detect more abnormalities but were less able to characterize them  
class10	3592	the recent development of contrast agents for mr imaging has allowed this modality to surpass ct for the evaluation of most cns lesions  
class10	3592	at present  contrast enhanced mr imaging is generally accepted as the study of choice for evaluating acoustic neurinomas  pituitary lesions  meningeal disease  primary and secondary brain tumors  active multiple sclerosis  intradural spinal neoplasms  intramedullary spinal disease  and postoperative states in both the spine and brain  
class10	3592	even when contrast enhanced ct can detect the same abnormalities  evaluation of the lesions in multiple planes on mr imaging can sometimes yield invaluable information  especially prior to surgery  
class10	3592	future developments of contrast material for mr imaging include non gadolinium compounds  intrathecal contrast media  cerebral blood flow and volume evaluation  and  possibly  antibody labeled contrast agents  
class10	3593	clinoidal meningiomas  
class10	3593	anterior clinoidal meningiomas are frequently grouped with suprasellar or sphenoid ridge meningiomas  masking their notorious association with a high mortality and morbidity rate  failure of total removal  and recurrence  
class10	3593	to avoid injury to encased cerebral vessels  most surgeons are content with subtotal removal  
class10	3593	without total removal  however  recurrence is expected  
class10	3593	recent advances in cranial base exposure and cavernous sinus surgery have facilitated radical total removal  
class10	3593	the author reports 24 cases operated on with vigorous attempts at total removal of the tumor with involved dura and bone  
class10	3593	this experience has distinguished three groups  i  ii  and iii  which influence surgical difficulties  the success of total removal  and outcome  
class10	3593	these subgroups relate to the presence of interfacing arachnoid membranes between the tumor and cerebral vessels  
class10	3593	the presence or absence of arachnoid membranes depends on the origin of the tumor and its relation to the naked segment of carotid artery lying outside the carotid cistern  
class10	3593	total removal was impossible in the three patients in group i  with postoperative death occurring in one patient and hemiplegia in another  
class10	3593	total removal was achieved in 18 of the 19 patients in group ii  with one death from pulmonary embolism  
class10	3593	in the two patients in group iii  total removal without complications was easily achieved  
class10	3594	characterization of periventricular edema in normal pressure hydrocephalus by measurement of water proton relaxation times  
class10	3594	the magnetic resonance longitudinal relaxation time  t1  and transverse relaxation time  t2  of the water proton of the periventricular white and cortical gray matter were measured for 17 control patients and 21 patients with suspected normal pressure hydrocephalus  nph   
class10	3594	of the latter group  14 showed good response to shunting  true nph group  and seven showed no response  false nph group   
class10	3594	in the true nph group  both the t1 and the t2 of the periventricular white matter were significantly prolonged compared to the control values  and slowly shortened after cerebrospinal fluid  csf  shunting  
class10	3594	the true nph group showed significantly longer t1 and t2 of the white matter than did the false nph group  
class10	3594	the t1 and t2 of the white matter were longer than those of the gray matter in this group  which was the reverse of the relationship observed in the control patients  
class10	3594	in the white matter of the false nph group  there was a significant prolongation of t1 only  no difference was seen in the t2 compared to control values  
class10	3594	there was no change in either t1 or t2 of this region after csf shunting  
class10	3594	the false nph group showed no significant difference in either t1 or t2 between the white and the gray matter  
class10	3594	there was no difference in either t1 or t2 of the gray matter between the false nph and control groups or between preshunt and postshunt measurements in each patient group  
class10	3594	it is suggested that a distinction between true  and false nph  which cannot be made from the radiographic appearance alone  may be possible from measurement of relaxation times  
class10	3594	the mechanism of varied relaxation behavior between two entities may be explained by a difference in properties of the biological water and its environment  
class10	3595	systems analysis of cerebrovascular pressure transmission  an observational study in head injured patients  
class10	3595	in an observational study in head injured patients  cerebrovascular pressure transmission was investigated using a systems analysis approach whereby the blood pressure  bp  waveform was used as a measure of an input stimulus to the cerebrovascular bed  cvb  and the intracranial pressure  icp  waveform as the response to that stimulus  
class10	3595	the transfer function is a measure of how much pressure is transmitted through the cvb at a given frequency and is calculated using fourier analysis of the pressure waveforms  
class10	3595	the transfer function allows quantification of the pressure transmission performance of the cvb  thus providing a basis for comparison between normal and abnormal function  
class10	3595	fifteen hundred samples of icp and bp waveforms were collected from 30 head injured patients via microcomputer  
class10	3595	off line spectral analysis of the waveform database revealed four main classes of transfer function  those with an overall flat transfer function  curve type 1   those with an elevated low frequency response  curve type 2   those with an elevated high frequency response  curve type 3   and those exhibiting both an elevated low  and high frequency response  curve type 4   
class10	3595	curve types 2 and 4 were most often associated with raised icp  greater than 20 mm hg   whereas curve types 1 and 3 were most often affiliated with icp less than 15 mm hg  
class10	3595	studies of this type may provide insight into the pathophysiology of the cvb and ultimately aid in the prediction and treatment of raised icp  
class10	3596	massive increases in extracellular potassium and the indiscriminate release of glutamate following concussive brain injury  
class10	3596	an increase in extracellular k  concentration   k  c  of the rat hippocampus following fluid percussion concussive brain injury was demonstrated with microdialysis  
class10	3596	the role of neuronal discharge was examined with in situ administration of 0 1 mm tetrodotoxin  a potent depressant of neuronal discharges  and of 0 5 to 20 mm cobalt  a blocker of ca   channels  
class10	3596	while a small short lasting  k  c increase  1 40  to 2 15 fold  was observed after a mild insult  a more pronounced longer lasting increase  4 28  to 5 90 fold  was induced without overt morphological damage as the severity of injury rose above a certain threshold  unconscious for 200 to 250 seconds   
class10	3596	the small short lasting increase was reduced with prior administration of tetrodotoxin but not with cobalt  indicating that neuronal discharges are the source of this increase  
class10	3596	in contrast  the larger longer lasting increase was resistant to tetrodotoxin and partially dependent on ca    suggesting that neurotransmitter release is involved  
class10	3596	in order to test the hypothesis that the release of the excitatory amino acid neurotransmitter glutamate mediates this increase in  k  c  the extracellular concentration of glutamate   glu c  was measured along with  k  c  
class10	3596	the results indicate that a relatively specific increase in  glu c  as compared with other amino acids  was induced concomitantly with the increase in  k  c  
class10	3596	furthermore  the in situ administration of 1 to 25 mm kynurenic acid  an excitatory amino acid antagonist  effectively attenuated the increase in  k  c  
class10	3596	a dose response curve suggested that a maximum effect of kynurenic acid is obtained at a concentration that substantially blocks all receptor subtypes of excitatory amino acids  
class10	3596	these data suggest that concussive brain injury causes a massive k  flux which is likely to be related to an indiscriminate release of excitatory amino acids occurring immediately after brain injury  
class10	3597	cerebrovascular and metabolic effects on the rat brain of focal nd yag laser irradiation  
class10	3597	to investigate the effects of focal neodymium yttrium aluminum garnet  nd yag  laser irradiation  lambda   1060 nm  on regional cerebral blood flow  cerebral protein synthesis  and blood brain barrier permeability  the parietal brain surface of 44 rats was irradiated with a focused laser beam at a constant output energy of 30 j  
class10	3597	survival times ranged from 5 minutes to 48 hours  
class10	3597	laser irradiation immediately caused well defined cortical coagulation necrosis  
class10	3597	within 5 minutes after unilateral irradiation  14c iodoantipyrine autoradiographs demonstrated severely reduced blood flow to the irradiation site and perilesional neocortex  but a distinct reactive hyperemia in all other areas of the forebrain  
class10	3597	apart from a persistent ischemic focus in the vicinity of the cortical coagulation necrosis  blood flow alterations in remote areas of the brain subsided within 3 hours after irradiation  
class10	3597	autoradiographic assessment of 3h tyrosine incorporation into brain proteins revealed rapid onset and prolonged duration of protein synthesis inhibition in perifocal morphologically intact cortical and subcortical structures  
class10	3597	impairment of amino acid incorporation proved to be completely reversible within 48 hours  
class10	3597	immunoautoradiographic visualization of extravasated plasma proteins using 3h labeled rabbit anti rat immunoglobulins showed that  up to 1 hour after irradiation  immunoreactive proteins were confined to the neocortex at the irradiation site  
class10	3597	at 4 hours  vasogenic edema was present in the vicinity of the irradiation site and the subcortical white matter  and  at later stages  16 to 36 hours   also extended into the contralateral hemisphere  
class10	3597	although this was followed by a gradual decrease in labeling intensity  resolution of edema was still not complete after 48 hours  
class10	3597	analysis of sequential functional changes in conjunction with morphological alterations indicates that the evolution of morphological damage after laser irradiation does not correlate with the time course and spatial distribution of protein synthesis inhibition or vasogenic edema  
class10	3597	although the central coagulation necrosis represents a direct effect of radiation  the final size of the laser induced lesion is determined by a delayed colliquation necrosis due to persistent perifocal ischemia  
class10	3597	extent and severity of ischemia in a zone with initial preservation of neuroglial cells can be explained by the optical properties of the nd yag laser  extensive scattering of light within brain parenchyma associated with a high blood to brain absorption ratio selectively affects blood vessels outside the irradiation focus  
class10	3598	long term evaluation of hemiparkinsonian monkeys after adrenal autografting or cavitation alone  
class10	3598	autografts of adrenal medulla were implanted into preformed cavities in the caudate nuclei of four rhesus monkeys with hemiparkinsonism induced by 1 methyl 4 phenyl 1 2 3 6 tetrahydropyridine  mptp   
class10	3598	five other hemiparkinsonian monkeys underwent caudate cavitation  but received no tissue implant  
class10	3598	all of the animals had marked bradykinesia of the affected arm and stable apomorphine induced turning before cavitation or implantation  
class10	3598	moderate behavioral recovery was seen in all five monkeys with cavitation and two of the three monkey with long term adrenal autografts  the fourth adrenal recipient was sacrificed 10 days after grafting   
class10	3598	the improvement occurred months after the procedure and was not as early or as complete as that seen after fetal dopaminergic grafts  
class10	3598	surviving adrenal tissue was found only in the animal that showed no behavioral recovery  
class10	3598	the other two adrenal autograft recipients  with no surviving adrenal medulla  and all of the animals with cavitation had ingrowth of dopaminergic fibers from the area olfactoria and nucleus accumbens into the caudate  oriented toward the cavity  
class10	3598	these findings show that the mechanism of improvement after adrenal medullary implants for parkinsonism is not dopamine secretion by chromaffin cells  but may be related to the sprouted host fibers  
class10	3598	the results also indicate that the limited recovery after adrenal implants in parkinsonian patients may be a result of the cavitation  and not necessarily the result of tissue implantation  
class10	3599	cerebral venous oxygen content as a measure of brain energy metabolism with increased intracranial pressure and hyperventilation  
class10	3599	in order to test the hypothesis that the cerebral arteriovenous oxygen difference  avdo2  and venous oxygen content  vo2  could be used to monitor brain energy metabolism in the setting of increased intracranial pressure  icp   
class10	3599	12 cats were studied with 31p magnetic resonance spectroscopy  
class10	3599	six cats were subjected to intracranial hypertension by cisternal infusion of saline  
class10	3599	energy failure occurred at an average avdo2 of 8 4     3 2 vol       standard deviation   range 4 7 to 14 7 vol    
class10	3599	the vo2 at the point of metabolic failure averaged 1 45     0 6 vol  and extended over a narrower range  1 0 to 2 9 vol    
class10	3599	in an additional six cats  icp was raised to the threshold of metabolic failure and hyperventilation was then instituted  pco2 10 to 18 torr   
class10	3599	five of the six cats experienced a drop in vo2 with hyperventilation  
class10	3599	in two of these animals  hyperventilation resulted in a vo2 of 1 1 vol  or less and in metabolic failure as evidenced by a fall in phosphocreatine  
class10	3599	it is concluded that a vo2 of less than 2 vol  is correlated with brain ischemia and that the safety of hyperventilation in the setting of increased icp can be monitored by the use of vo2  
class10	3600	evidence of a local immune activation in cystic brain tumors  
class10	3600	the fluid of cystic brain tumors was characterized with regard to the protein content  
class10	3600	in most malignant tumors  the concentrations of immunoglobulins g and m  igg and igm  were higher relative to other proteins in the cyst fluid than in the serum of the same patient  
class10	3600	a markedly elevated ratio of monomeric to pentameric igm was detected in the cyst fluid of two patients with glioblastomas  
class10	3600	the results indicate a local immunoglobulin synthesis in malignant cystic brain tumors  
class10	3600	it is hypothesized that higher than expected concentrations of igg and igm in cyst fluid as compared to plasma are a sign of an ongoing immune response triggered by the tumor  
class10	3601	epithelial cyst of the fourth ventricle  case report  
class10	3601	a case of epithelial cyst in the fourth ventricle of a 4 year old child is described  
class10	3601	a single epithelial layer with a clear basement membrane lining the cyst wall was observed  
class10	3601	there were no prominent histological findings to suggest a pathogenesis for this cyst based on immunohistochemical or ultrastructural studies  however  the cyst fluid contained significant amounts of carcinoembryonic antigen  
class10	3601	it is considered that the epithelial layer lining the cyst wall was possibly of endodermal origin  
class10	3602	recurrence of acoustic neurilemoma as a malignant spindle cell neoplasm  case report  
class10	3602	a 75 year old man presented with a right cerebellopontine angle tumor 11 months after complete macroscopic resection of a right acoustic neurilemoma  
class10	3602	histological examination of the recurrent tumor showed a malignant spindle cell neoplasm with positive staining for s 100 protein  
class10	3602	the patient had no stigmata of von recklinghausen s disease  
class10	3602	it is proposed that this recurrence represents progression from a benign to a malignant acoustic nerve sheath tumor  an event that is extremely rare outside the clinicopathological context of neurofibromatosis  
class10	3603	toxoplasmosis of the conus medullaris in a patient with hemophilia a associated aids  case report  
class10	3603	toxoplasma gondii has been reported to be the most common cause of focal brain lesions in patients with acquired immunodeficiency syndrome  aids   
class10	3603	a case of intramedullary toxoplasmosis of the conus medullaris is reported in a patient with hemophilia a associated aids  
class10	3603	the diagnosis is discussed  with particular emphasis on the magnetic resonance imaging appearance  
class10	3604	subarachnoid hemorrhage caused by a fungal aneurysm of the vertebral artery as a complication of intracranial aneurysm clipping  case report  
class10	3604	intracranial aneurysms are an uncommon manifestation of fungal infection  
class10	3604	a case is described in which the formation of an aneurysm followed an intracranial intraoperative aspergillus infection attributable to a long period of preoperative antibiotic medication and immunosuppressive therapy with steroids  
class10	3605	prevention of cardiovascular disease  risks and benefits of aspirin  
class10	3605	aspirin has been tested for its benefit in preventing cardiovascular disease in randomized trials in three categories of patients  
class10	3605	in secondary prevention among those with a history of myocardial infarction  mi   stroke or transient cerebral ischemia  or unstable angina pectoris  25 randomized trials demonstrated significant reductions from aspirin of 25  for the occurrence of an  important vascular event   nonfatal mi  nonfatal stroke  or vascular death   32  for nonfatal mi  27  for nonfatal stroke  and 15  for vascular mortality  
class10	3605	among those evolving an mi  the second international study of infarct survival  isis 2  showed a significant reduction of 23  in five week vascular mortality among those started on a one month regimen of daily aspirin within 24 hours of the onset of symptoms of suspected mi  
class10	3605	aspirin also significantly reduced reinfarction  nonfatal stroke  and important vascular events  
class10	3605	finally  in primary prevention  the us physicians  health study  phs  showed a significant 44  reduction in the occurrence of a first mi among apparently healthy male physicians  numbers of strokes and vascular deaths were insufficient to permit conclusions for these endpoints  
class10	3605	thus  aspirin is of clear benefit in reducing mi  stroke  and vascular death in secondary prevention and among those evolving an mi  
class10	3605	it is also beneficial in the primary prevention of mi among men over 40  but data concerning its effects on stroke and vascular death remain inconclusive  
class10	3606	speech  velopharyngeal function  and hearing before and after orthognathic surgery  
class10	3606	articulation  voice  resonance  hearing sensitivity  and middle ear function were examined in 34 patients before and 3  6  9  and 12 months after orthognathic surgery  
class10	3606	thirty of the 34 patients had articulation errors before surgery  
class10	3606	errors on the sibilants  s  and  z  occurred most frequently  followed by those on  j zh ch  and  sh   
class10	3606	errors were predominantly distortions with both visual and acoustic components  
class10	3606	after surgery  articulation improved spontaneously in the absence of intervention  
class10	3606	most of the preoperative articulation errors were eliminated by 3 months postoperative  but  thereafter  a gradual decline was noted so that by 12 months  errors occurred on  s  and  z   
class10	3606	voice  resonance  velopharyngeal port area  and hearing sensitivity were not altered by surgery  
class10	3606	this study suggests that severe skeletal malocclusions requiring surgical correction have deleterious effects on the patients  articulation of consonants and that surgical alteration leads to the correction of most of these errors  
class10	3607	very low birth weight children  behavior problems and school difficulty in a national sample 
class10	3607	we addressed three questions concerning the behavioral and academic status of low and very low birth weight infants through a secondary analysis of the 1981 national health interview survey  child health supplement   1  in children born with very low birth weight  what is the risk of behavior problems and school difficulty compared with that in heavier low birth weight and normal birth weight children   2  what are the correlates of school difficulty   3  are behavior problems associated with school difficulty when variables are controlled for these correlates  the analysis revealed that 34  of very low birth weight children could be characterized as having school difficulty  compared with 20  and 14  of the other groups  respectively  and that they were more likely to have higher scores on the hyperactive subscale of the behavior problems index  
class10	3607	although a broad array of sociodemographic factors correlated with school difficulty  very low birth weight and hyperactivity scores contributed independently to the risk of academic problems  
class10	3607	we conclude that very low birth weight infants are at risk of having school problems that are in part associated with hyperactive behavior  
class10	3608	serial magnetic resonance imaging in neonatal hypoxic ischemic encephalopathy  
class10	3608	we prospectively performed magnetic resonance imaging  mri  studies during the neonatal period  and at 4 and 8 months of age  on 15 term infants with hypoxic ischemic encephalopathy  and compared the results with their neurodevelopmental outcome at 18 months of age  
class10	3608	cerebral palsy developed in nine infants  two infants were classified as having abnormalities of tone and delayed motor milestones that were suggestive of cerebral palsy  and four infants were normal  
class10	3608	structural abnormalities  delayed myelination  or a combination of the two were detected with mri at 8 months of age in all nine infants with later development of cerebral palsy  
class10	3608	three of the four normal infants and one infant with suggestive abnormalities had normal serial mri findings  
class10	3608	each of the remaining two infants  one normal  one with suggestive abnormalities  had isolated persistent ventricular dilation on all three mri studies  
class10	3608	our results suggest that 8 months appears to be the earliest time at which mri findings correlate well with later adverse neurodevelopmental outcome in this population  
class10	3609	intrapartum  intranasal cocaine use and acute fetal distress  a case report  
class10	3609	intrapartum  intranasal cocaine was used for relief of labor pains by a healthy woman with an uncomplicated pregnancy  
class10	3609	fetal hypoxemia and distress followed the event  
class10	3609	a causal relationship between the intrapartum use of cocaine and the fetal distress was postulated  
class10	3609	cocaine abusers could benefit from hospitalization early in labor for close surveillance and monitoring  thus avoiding exposure to cocaine and its unpredictable systemic effects  
class10	3610	facial bone fracture associated with carotid cavernous sinus fistula  
class10	3610	out of 989 cases of facial bone fracture  ten patients had carotid cavernous sinus fistulas  1 01    
class10	3610	their ages ranged from 25 to 48 years  
class10	3610	seven were male and three female  
class10	3610	two of the ten patients had lower third  three patients had middle third  three patients had upper third  and two patients had combined middle and lower third facial bone fractures  
class10	3610	the signs and symptoms of a fistula appeared from the first postinjury day up to 50 days after the injury  mean  21 days   
class10	3610	four patients had symptoms after operation for facial bone fracture  
class10	3610	most fistulae were identified by arteriography before treatment  
class10	3610	followup ranged from 1 year  8 months  to 5 years  9 months  mean  2 years  9 months   
class10	3610	one patient had a malocclusion  
class10	3610	nine patients had complete resolution of their bruits  
class10	3610	complications included unilateral complete visual loss  two   csf rhinorrhea  two   and stroke in one of the two csf rhinorrhea patients  
class10	3610	one patient expired due to a severe head injury  and there was one death from an unrelated cause  
class10	3611	alcoholic blackouts  legal implications  
class10	3611	alcoholic blackouts are defined as the temporary  complete inability to form long term memory as the result of a high blood alcohol level  
class10	3611	this means that a neuron to neuron system has been blocked  
class10	3611	since that is the case  such central nervous dysfunction should have legal implications  both from the blackout itself and also from the fact that this degree of neural interference in one system is at least suggestive that other dysfunction may be present  
class10	3611	the subject of blackouts is updated with recent developments in neuroscience  
class10	3611	the legal significance of the blackout is examined in enough depth to allow for further discussion and exploration  
class10	3612	enveloping the bladder with displacement of flap of the rectus abdominis muscle for the treatment of neurogenic bladder  
class10	3612	neurogenic bladder is a frequent occurrence  
class10	3612	a new surgical technique has been designed and was used successfully in 18 patients with ideal results  
class10	3612	the key point of the operation is to turn over a flap of rectus abdominis muscle to envelop the bladder  
class10	3612	contraction of the muscle flap and the abdominal muscles would enhance voiding ability  
class10	3612	in the meantime  the bladder is displaced forward and the resultant change in the bladder posterior urethral angle also favors voiding  
class10	3612	since the bladder is near the anterior abdominal wall manual compression during voiding is made easier  
class10	3612	all of these advantages greatly facilitate voiding  
class10	3613	urinary retention due to sacral myeloradiculitis  a clinical and neurophysiological study  
class10	3613	we report 5 cases of sacral myeloradiculitis presenting with transient urinary retention  
class10	3613	neurophysiological testing  including bulbocavernosus reflex  pudendal evoked response and external anal sphincter electromyography  was performed  
class10	3613	parasympathetic pelvic nerves  pudendal nerves as well as the spinal cord seem to be involved to various degrees in this infrequent disorder  
class10	3614	management of children with myelodysplasia  urological alternatives  
class10	3614	recent reports have suggested that the prophylactic use of clean intermittent catheterization in selected infants with myelodysplasia and with normal upper tracts may prevent their deterioration  
class10	3614	the selection of these patients at risk depends on urodynamic criteria  
class10	3614	we reviewed our experience with clean intermittent catheterization instituted when upper tract deterioration was found  
class10	3614	of 130 patients with myelodysplasia followed at our clinic 25  19   had or presented with radiological upper urinary tract deterioration  
class10	3614	a total of 21 patients had vesicoureteral reflux and 4 had hydronephrosis without reflux  
class10	3614	treatment consisted of clean intermittent catheterization alone in 5 patients and combined with anticholinergic medication in 16  
class10	3614	four patients with no post void residual urine were carefully observed without intervention  
class10	3614	urodynamic evaluation was performed selectively in 11 of these 25 patients for persistence of upper urinary tract deterioration or urinary incontinence after institution of treatment  
class10	3614	of the 21 children with reflux 19  90   had resolution or improvement for an average followup of 47 months  
class10	3614	hydronephrosis completely resolved in the 4 patients without reflux  
class10	3614	thus  the over all resolution or improvement rate was 92  for an average of 41 months  
class10	3614	although these excellent results may not be superior to the prophylactic use of clean intermittent catheterization  they validate the assumption that upper tract deterioration can be reversed  
class10	3614	the application of current urodynamic selection criteria may result in overtreating a significant number of infants who otherwise may not have upper tract deterioration  
class10	3614	further refinements in these criteria may be necessary to select better not only patients at risk but also to determine the frequency of imaging necessary in this urologically heterogeneous population  
class10	3614	in addition  careful consideration should be given to urethral dilation as a third and equally viable alternative to prevent upper tract deterioration  
class10	3615	reverse coitus  mechanism of urethral injury in male partner  
class10	3615	reverse coitus  a rarely used sexual position  makes the male urethra more vulnerable to injury from the pubic arch and symphysis pubis of the female partner  
class10	3615	severe pain  bleeding and immediate detumescence were observed in 3 patients  
class10	3615	the lesion usually occurred at the fossa navicularis  responded well to conservative management and did not hinder micturition  
class10	3615	potency has been well preserved in all 3 patients  
class10	3616	the effect of an alpha 2 agonist on bladder function and cord histology after spinal cord injury  retracted by weiss r  tomasula jj  sotologo jr jr  in  j urol 1991 aug 146 2  426  
class10	3616	spinal injury in cats is accompanied by urinary bladder and hind limb dysfunction  
class10	3616	ten cats subjected to spinal contusion at the ninth thoracic segment were treated with guanabenz  an alpha 2 agonist  intraperitoneally  0 65 mg  kg   three hours after injury  and twice daily for eight weeks  
class10	3616	an additional six spinal cats were untreated and served as controls  
class10	3616	urodynamic studies were performed on a weekly basis on all animals  
class10	3616	guanabenz modified the vesico somatic reflex  detrusor sphincter dyssynergia was either ablated or abolished  
class10	3616	in contrast  the controls demonstrated detrusor sphincter dyssynergia  high residual urine  and spasticity below the lesion  
class10	3616	histological evaluations of the spinal cords revealed that the six paraplegic animals  untreated  suffered marked cavitation of the cord and complete destruction of the grey matter  
class10	3616	the five incomplete paraplegic animals  treated  showed minimal cavitation with some preservation of the grey matter  
class10	3616	the five ambulators  treated  demonstrated some distortion of grey matter with preservation of white matter  
class10	3616	treatment with guanabenz post traumatic cord injury results in decreased cord cavitation  
class10	3616	detrusor sphincter dyssynergia is diminished and hind limb function is improved in treated animals  
class10	3617	diclofenac associated hepatotoxicity 
class10	3617	diclofenac sodium  a phenylacetic acid derived nonsteroidal anti inflammatory drug  nsaid  recently released in the united states  was associated with the development of significant hepatitis in seven patients  with one associated death  
class10	3617	signs and symptoms developed within several weeks of initiation of drug use and generally resolved 4 to 6 weeks following discontinuation of use of the drug  
class10	3617	the only patient rechallenged with the drug developed a recurrence of her hepatic abnormalities  
class10	3617	in one patient  fatal  fulminant hepatitis developed despite early withdrawal of the drug  
class10	3617	review of the european literature disclosed three additional fatalities associated with diclofenac therapy  
class10	3617	it is unclear whether the incidence of hepatotoxicity is higher with this drug compared with other nonsteroidal anti inflammatory drugs  
class10	3617	careful patient monitoring is advised  and prompt discontinuation of the drug is suggested when signs or symptoms of liver disease develop  
class10	3618	parathyroid hormone related peptide in lactation and in umbilical cord blood  
class10	3618	parathyroid hormone related peptide  pthrp  is expressed in lactating rat mammary glands after suckling  as a result of increases in prolactin rather than suckling per se  
class10	3618	in addition  pthrp produced in the fetal parathyroid glands and placenta may be responsible for stimulation of placental calcium transport  
class10	3618	in the current study  we used a radioimmunoassay for human pthrp to measure levels of the peptide in  1  human breast milk  cow s milk  and two infant formulas   2  sequential plasma samples in prepartum and postpartum lactating women   3  women with pathologic hyperprolactinemia  and  4  human umbilical cord blood  
class10	3618	in normal subjects  plasma pthrp levels ranged from less than 2 to 5 pmol liter  
class10	3618	in contrast  human breast milk contained substantially increased levels of immunoreactive pthrp  
class10	3618	similar elevations were found in cow s milk and in one infant formula  
class10	3618	column chromatography of breast milk demonstrated that pthrp immunoreactivity included a region of adenylate cyclase stimulating activity  consistent with the presence of biologically active pthrp  
class10	3618	plasma prepartum pthrp values did not differ from corresponding postpartum values in lactating women  
class10	3618	women with hyperprolactinemia had a mean plasma pthrp value in the high normal range  
class10	3618	umbilical cord blood had considerably suppressed parathyroid hormone values but pthrp levels that were indistinguishable from those in normal human plasma  
class10	3618	thus  pthrp is present in high concentrations in breast milk but apparently does not gain access to the maternal circulation in significant amounts  
class10	3618	in addition  women with pathologic hyperprolactinemia seem not to have increased levels of circulating pthrp  
class10	3619	randomised  double blind  placebo controlled trial of nimodipine in acute stroke  trust study group  
class10	3619	the value of oral nimodipine 120 mg per day for acute stroke was assessed in a randomised  double blind  placebo controlled multicentre study of 1215 patients  
class10	3619	the primary end point was independence after 6 months  defined as a score of 60 or more on an activities of daily living  adl  scale  the barthel index  
class10	3619	patients were entered into the trial if they were aged over 40  became hemiparetic in the previous 48 h  were conscious  were able to swallow  and had been living independently before the stroke  
class10	3619	at 6 months  55  of the nimodipine group and 58  of the placebo group were independent  the odds ratio for independence on nimodipine being 0 88  95  confidence limits 0 70 1 10   
class10	3619	for mortality the odds ratio with nimodipine was 1 22  95  confidence limits 0 95 1 57   
class10	3619	adl and neurological scores also suggested delayed recovery in the nimodipine group at 3 weeks  
class10	3619	the results do not support the case for oral nimodipine therapy 120 mg per day starting within 48 h of the stroke  for patients with acute stroke  
class10	3620	national general practice study of epilepsy  newly diagnosed epileptic seizures in a general population  
class10	3620	the national general practice study of epilepsy is a prospective population based cohort study of 1195 patients with newly diagnosed or suspected epileptic seizures  
class10	3620	at the time of initial classification  6 months after notification   104 patients were excluded  
class10	3620	of the remaining 1091 patients  220  20   95  confidence interval 18 23    had febrile seizures  564  52   49 55    definite epileptic seizures  and 228  21   19 23    possible epilepsy  
class10	3620	in the definite epilepsy group the proportions of males and females were similar  25   21 28   were younger than 15 years and 24   21 28   were 60 years or older  
class10	3620	the definite seizures were classified as cryptogenic in 62   58 66    remote symptomatic in 21   18 25    and acute symptomatic in 15   12 18    
class10	3620	the aetiology of epilepsy was vascular disease in 15   12 18   and tumour in 6   4 8    
class10	3620	among older subjects the proportion with an identifiable cause was much higher  49   41 58   were due to vascular disease and 11   6 16   to tumour  
class10	3620	only 252  45   41 49    of the 564 patients with definite epileptic seizures were registered at the time of their first seizure  
class10	3620	52   48 56   of the patients had partial or secondarily generalised seizures  and only 39   35 43   seizures generalised from the outset  
class10	3621	national general practice study of epilepsy  recurrence after a first seizure 
class10	3621	in the national general practice study of epilepsy 564 patients classified as having definite seizures have been followed up for 2 4 years  
class10	3621	67   95  confidence interval 63 71   had a recurrence within 12 months of the first seizure  and 78   74 81   had a recurrence within 36 months  
class10	3621	seizures associated with a neurological deficit presumed present at birth had a high rate of recurrence  100  by 12 months   whereas seizures that occurred within 3 months of an acute insult to the brain  such as head injury or stroke  or in the context of an acute precipitant such as alcohol  carried a much lower risk of recurrence  40   29 51   by 12 months   
class10	3621	other factors affecting the risk of recurrence were age the highest risk being for patients under the age of 16  83   77 89   by 36 months  or over the age of 59  83   76 90   by 36 months and type of first seizure the risk of recurrence being much higher for patients with simple partial or complex partial seizures  94   90 99   by 36 months  than for those with generalised tonic clonic seizures  72   67 77   by 36 months   
class10	3622	cerebral malaria in children 
class10	3622	cerebral malaria is a rapidly progressive encephalopathy with up to 50  mortality  
class10	3622	a cardinal feature is the massing of red cells containing mature plasmodium falciparum within the cerebral capillaries  
class10	3622	adhesion of these parasitised red cells to endothelium  an event which may initiate cerebral malaria  is being studied at the molecular level  
class10	3622	however  the relevance of these studies to the pathophysiology and treatment of human cerebral malaria is uncertain  
class10	3622	although chloroquine is still widely used to treat falciparum malaria  resistance has spread to most of the endemic zone  
class10	3622	quinine is emerging as the only effective treatment for cerebral malaria  though resistance to this drug threatens to become a problem  
class10	3622	alternative drugs are urgently needed  
class10	3623	auditory evoked responses in benign intracranial hypertension syndrome  
class10	3623	in this study  auditory brainstem evoked responses were conducted on 28 patients with otologic symptoms  pulsatile tinnitus  hearing loss  aural fullness  secondary to benign intracranial hypertension syndrome  
class10	3623	abnormalities consisting mainly of prolonged interpeak latencies were detected in one third of these patients  
class10	3623	it is speculated that the pathophysiologic mechanisms responsible for these auditory brainstem evoked abnormalities are stretching compression of the cochlear nerve and brainstem caused by the intracranial hypertension and or primary edema of the same structures due to the benign intracranial hypertension syndrome itself  
class10	3623	normalization or improvement was noticed in the majority of the patients after management  
class10	3623	since the number of patients in this study is small  it is felt that the diagnostic and prognostic value of this test needs further evaluation  
class10	3624	the efficacy of brainstem auditory evoked potentials in acoustic tumor surgery  
class10	3624	as the identification of patients with small acoustic neuromas and salvageable hearing increases  intraoperative auditory nerve monitoring has been used increasingly in an attempt to improve the hearing preservation rate  
class10	3624	far field recordings obtained by brainstem auditory evoked potentials  baep   at times enhanced by electrocochleography  have become a standard method of intraoperative auditory nerve assessment  
class10	3624	to evaluate the usefulness of this monitoring technique  the hearing preservation results of a series of unmonitored acoustic tumor removals were compared to a series of patients monitored via the standard brainstem auditory evoked potentials  
class10	3624	with comparable average tumor sizes  4 of 7 unmonitored patients had hearing preserved at preoperative levels compared to 4 of 9 monitored patients  
class10	3624	neither preoperative baep assessments nor absolute tumor size were predictive of hearing preservation  
class10	3624	this report brings into question the effectiveness of far field intraoperative baep monitoring during acoustic tumor resection and suggests that direct auditory nerve monitoring may be more appropriate  
class10	3625	circulatory and thermal adjustments to prolonged exercise in paraplegic women  
class10	3625	the circulatory and thermal responses to 90 min of wheelchair ergometer exercise were examined in five wheelchair dependent  wd  women with low level spinal dysfunction and five able bodied  ab  women who served as a comparison group  
class10	3625	metabolic rate during exercise was 221 w for wd and 255 w for ab  p greater than 0 05   
class10	3625	oral temperature  tor   mean skin temperature  tsk   oxygen uptake  vo2   heart rate  hr   and cardiac output  qc  were assessed periodically throughout the exercise period  
class10	3625	ambient conditions were 24 25 degrees c and 38 52  relative humidity  
class10	3625	a significant group x time interaction was found for tor  p less than 0 001  and tsk  p less than 0 001   
class10	3625	tor of the wd group steadily increased during the exercise  whereas the ab group showed a stable tor  
class10	3625	tsk of wd increased rapidly during the first 5 10 min of exercise and continued to rise at a slower rate throughout the exercise  
class10	3625	in contrast  tsk of ab rose to a peak during the first 10 min and then showed a decreasing trend  
class10	3625	vo2 and hr remained stable in both groups throughout the exercise period  
class10	3625	following an initial increase in qc from minute 10 to minute 20 in both groups  values for wd continually decreased until qc at 80 min was 14  lower than at 10 min  
class10	3625	the findings suggest that the wd women had greater thermoregulatory strain than the ab women as indicated by a higher tor and tsk and by an inability to maintain qc due to paralysis of the lower limbs and perhaps an increase in cutaneous blood volume  
class10	3626	coccidioidomycosis during human immunodeficiency virus infection  a review of 77 patients  
class10	3626	through a retrospective review  we identified 77 previously unreported cases of coccidioidomycosis during hiv infection  
class10	3626	patients were classified into 1 of 6 categories based on their primary clinical presentation  20 had focal pulmonary disease  group 1   31 had diffuse pulmonary disease  group 2   4 had cutaneous coccidioidomycosis  group 3   9 had meningitis  group 4   7 had extrathoracic lymph node or liver involvement  group 5   and 6 has positive coccidioidal serology without a clinical focus of infection  group 6   
class10	3626	coccidioidal serologies were positive on initial testing in 83  of the patients in whom such serologic testing was performed  
class10	3626	sera from 39  of patients were positive for tp antibodies while 74  had cf antibodies  
class10	3626	eleven of 12 seronegative patients had pulmonary disease  group 1 or 2   
class10	3626	serologic results of other patients sent to a single reference laboratory were similar  with 26  positive for immunodiffusion tp antibodies and 79  positive for immunodiffusion cf antibodies  
class10	3626	for the 77 patients in this study  the cd4 lymphocyte count was below 0 250 x 10 9  cells l in 46 of the 55 patients who had this test performed  and a low cd4 count was significantly associated with mortality  p less than 0 01   
class10	3626	at the time of follow up  32 of the 77 patients  42   had died  
class10	3626	there were significantly more deaths in those with diffuse pulmonary disease  group 2  than in other groups  p less than 0 001   
class10	3626	amphotericin b  ketoconazole  fluconazole  and itraconazole were all used as antifungal therapies  
class10	3626	outcome could not be related to the therapy used  
class10	3626	of note  3 patients developed coccidioidomycosis while receiving ketoconazole for other conditions  
class10	3627	extrapulmonary pneumocystosis  clinical features in human immunodeficiency virus infection  
class10	3627	pneumocystis carinii infection is reported with increasing frequency as a cause of disease outside of the respiratory tract in patients with human immunodeficiency virus  hiv  infection  
class10	3627	extrapulmonary pneumocystosis is not limited to patients in any discrete risk group for hiv infection  
class10	3627	patients with hiv infection who develop extrapulmonary pneumocystosis frequently do not have concurrent p  
class10	3627	carinii pneumonia  
class10	3627	signs and symptoms of extrapulmonary pneumocystosis are nonspecific but when present are frequently referable to the tissues or organs involved  
class10	3627	extrapulmonary pneumocystosis can be diagnosed by examination of tissue biopsies from affected sites using standard histologic techniques  
class10	3627	therapy with antimicrobial agents used to treat p  
class10	3627	carinii pneumonia has been effective in some patients  
class10	3627	an association between use of aerosolized pentamidine for prevention of p  
class10	3627	carinii pneumonia and development of extrapulmonary pneumocystosis has been suggested but remains unconfirmed  
class10	3627	other factors such as the use of zidovudine and duration of immunodeficiency may also be important to the pathogenesis of extrapulmonary pneumocystosis  
class10	3627	further studies are needed to better identify risk factors that may predispose patients to the development of extrapulmonary pneumocystosis  
class10	3628	responses of intercostal muscle biopsies from normal subjects and patients with myasthenia gravis  
class10	3628	in order to evaluate the mechanisms of weakness in muscles of patients with myasthenia gravis  mg   intercostal muscle biopsies were obtained from 9 normal subjects and 6 mg patients  and the compound muscle action potential  ap  and tension responses to nerve and muscle stimulation  and contracture responses on exposure to caffeine  were monitored in vitro  
class10	3628	in normal muscle  on stimulation of the nerve or muscle at 30 to 100 hz  the ap responses showed decrement in amplitude  one third of which was attributable to failure of neuromuscular transmission and two thirds to failure of muscle membrane excitation  
class10	3628	on stimulation at 1 to 5 hz  the ap responses showed very little decrement  while the contractile responses showed significant fade in tension  due to failure of e c coupling or contractility  
class10	3628	in muscle from patients with generalized mg  stimulation of the nerve at all frequencies  1 to 100 hz  caused much greater decrement in aps and fade in tension responses than in normal muscle  due mainly to failure of neuromuscular transmission  
class10	3628	however  at 100 hz  40  of the decrement in aps was due to failure of muscle membrane excitation  and at 1 to 5 hz  40  of the fade in tension was due to failure of e c coupling or contractility  as in normal muscle  
class10	3628	on direct stimulation the contraction and half relaxation times were slower and the tetanic tension was smaller than in normal muscle  especially in the mg patient with thymoma  
class10	3628	caffeine induced contractures were smaller in mg muscle than in normal muscle  
class10	3628	these results indicate that while the weakness of mg muscle is due mainly to failure of neuromuscular transmission  it is also partly due to reduced e c coupling or contractility  
class10	3629	sensitivity for detecting fibrillation potentials  a comparison between concentric and monopolar needle electrodes  
class10	3629	the sensitivity of monopolar and concentric electrodes for detecting fibrillation potentials  fp  has never been formally compared  
class10	3629	we studied 35 muscles with fp  sampling 20 sites each with concentric and monopolar needles  
class10	3629	the concentric needle identified 0 88     3 44  mean     standard deviation  more sites with spontaneous activity  
class10	3629	although statistically significant  wilcoxon signed rank test p less than  03   this difference in sensitivity did not appreciably affect diagnostic interpretation  
class10	3629	subjects described the concentric needles as more painful  
class10	3629	needle insertions in 25 other muscles demonstrated that needle movement generated the majority of fp  
class10	3629	we suggest that the increased tissue injury caused by concentric needles may account for both their increased sensitivity and discomfort  
class10	3630	a review of techniques employed to estimate the number of motor units in a muscle  
class10	3630	being the smallest functional units under neural control  motor units play an integral role in muscle physiology  
class10	3630	however  at the present time  there does not exist any widely accepted technique for quantifying or estimating the number of motor units in a muscle  
class10	3630	specifically  the existing techniques are the increment counting technique  a technique based on spike triggered averaging  and a macro emg based technique which vary in invasiveness from noninvasive to highly invasive  respectively  
class10	3630	we discuss each of these techniques  along with their associated shortcomings  in detail  
class10	3631	spatial dispersion of magnetic stimulation in peripheral nerves  
class10	3631	to assess the longitudinal dispersion of the stimulus induced by the magnetic coil  collision experiments were performed in seven normal ulnar nerves  
class10	3631	a supramaximal electrical stimulus s1 was delivered at the wrist  and followed by a supramaximal stimulus s2 in the upper arm  which was either electrical  electrical collision studies   or magnetic  magnetic collision studies   
class10	3631	the interstimulus interval was varied by 0 2 msec increments from the time of complete cancellation of the s2 evoked motor response onwards  to include the entire span of recovery of that compound motor action potential  
class10	3631	collision curves were obtained for both magnetic and electrical stimuli by plotting the amplitude of the motor response elicited by s2 as a function of the interstimulus interval  
class10	3631	in all seven normal ulnar nerves  comparison of the collision curves showed that the s2 evoked motor response is restored significantly more slowly when magnetic stimulation is used  
class10	3631	this finding is best explained by longitudinal dispersion of the stimulus induced by the magnetic coil relative to conventional electrical stimulation  the large fibers being stimulated further away from the coil than the small ones  
class10	3631	this interpretation is confirmed by the findings obtained with the same method in two cases of ulnar neuropathy  and by comparison of different intensities of magnetic stimulation  
class10	3632	aaem minimonograph  35  clinical experience with transcranial magnetic stimulation  
class10	3632	we elicited motor evoked potentials  meps  using transcortical magnetic stimulation in 150 control subjects aged 14 to 85 years and 275 patients with a variety of diseases  
class10	3632	there were no significant side effects  
class10	3632	cortex to target muscle latencies measured 20 2     1 6 ms  thenar   14 2     1 7 ms  extensor digitorum communis   9 4     1 7 ms  biceps   and 27 2     2 9 ms  tibialis anterior   
class10	3632	central motor delay between the cortex and the c 7 and l 5 measured 6 7     1 2 ms and 13 1     3 8 ms  respectively  
class10	3632	mean spinal cord motor conduction velocity measured 65 4 m s  
class10	3632	mep amplitude expressed as a percentage of the maximum m wave was never less than 20  of the m wave  
class10	3632	a value of less than 10  is considered abnormal  
class10	3632	mep latency increases linearly with age and central motor delay is longer in older subjects  
class10	3632	compound muscle action potentials and absolute mep amplitudes decreased linearly with age  
class10	3632	in multiple sclerosis  ms   mep latency and central delay were often very prolonged  
class10	3632	the mep was more sensitive than the sep in ms  
class10	3632	in amyotrophic lateral sclerosis  mep latencies were only modestly prolonged  the characteristic abnormality was reduced amplitude  
class10	3632	when pseudobulbar features predominated meps were often absent  
class10	3632	the mep was of normal latency in parkinson s disease  but age related amplitude was often increased  
class10	3632	mep latency and amplitude were normal in huntington s disease  
class10	3632	abnormal meps persisted several months after stroke despite good functional recovery  
class10	3632	the mep could be used to advantage to demonstrate proximal conduction slowing and block in demyelinating neuropathies  
class10	3632	in plexopathy  ability to elicit an mep several days after onset of paresis was good evidence of neuronal continuity in motor fibers  
class10	3633	fibrillation potential amplitude and muscle atrophy following peripheral nerve injury  
class10	3633	maximum peak to peak fibrillation potential amplitude was measured in 69 subjects between 7 days and 10 1 2 years post complete or partial peripheral nerve injury  
class10	3633	mean amplitude during the first 2 months was 612 muv  third and fourth months 512 muv  fifth and sixth months 320 muv  
class10	3633	after the first year  no population of fibrillation potentials greater than 100 muv was recorded  
class10	3633	the sciatic nerve was sectioned in 13 guinea pigs and animals studied up to 17 weeks  
class10	3633	fibrillation potential amplitude in gastrocnemius muscles declined paralleling that in humans  
class10	3633	by the end of the study  type i fibers had lost almost half of their initial diameter and type ii fibers had atrophied more than twice this amount  
class10	3633	fibrillation potential amplitude may be useful in estimating the time post nerve injury and appears to correlate with the surface area and fiber diameter of a type i muscle fiber  
class10	3634	critical review of gangliosides and thyrotropin releasing hormone in peripheral neuromuscular diseases  
class10	3634	the lack of effective therapy for many of the chronic neuromuscular diseases such as amyotrophic lateral sclerosis  hereditary motor sensory neuropathy  charcot marie tooth disease   spinocerebellar degenerations and idiopathic polyneuropathy has led to a search for substances that may stimulate peripheral nerve regeneration  
class10	3634	two such agents that have been proposed are gangliosides  mixed purified bovine brain gangliosides  cronassial  and thyrotropin releasing factor  trh   
class10	3634	studies on both of these agents were initially reported with enthusiasm to be successful  but later double blind controlled studies have failed to confirm these findings  
class10	3634	this review provides critical analysis of the designs of studies of potentially effective agents in chronic neuromuscular diseases  and emphasizes the power of the placebo response  and the importance of designing placebos which are indistinguishable from the trial medication other than in the active effect  
class10	3635	the effect of low dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation  the boston area anticoagulation trial for atrial fibrillation investigators 
class10	3635	background  
class10	3635	nonrheumatic atrial fibrillation increases the risk of stroke  presumably from atrial thromboemboli  
class10	3635	there is uncertainty about the efficacy and risks of long term warfarin therapy to prevent stroke  
class10	3635	methods  
class10	3635	we conducted an unblinded  randomized  controlled trial of long term  low dose warfarin therapy  target prothrombin time ratio  1 2 to 1 5  in patients with nonrheumatic atrial fibrillation  
class10	3635	the control group was not given warfarin but could choose to take aspirin  
class10	3635	results  
class10	3635	a total of 420 patients entered the trial  212 in the warfarin group and 208 in the control group  and were followed for an average of 2 2 years  
class10	3635	prothrombin times in the warfarin group were in the target range 83 percent of the time  
class10	3635	only 10 percent of the patients assigned to receive warfarin discontinued the drug permanently  
class10	3635	there were 2 strokes in the warfarin group  incidence  0 41 percent per year  as compared with 13 strokes in the control group  incidence  2 98 percent per year   for a reduction of 86 percent in the risk of stroke  warfarin control incidence ratio   0 14  95 percent confidence interval  0 04 to 0 49  p   0 0022   
class10	3635	there were 37 deaths altogether  
class10	3635	the death rate was markedly lower in the warfarin group than in the control group  2 25 percent as compared with 5 97 percent per year  for an incidence ratio of 0 38  95 percent confidence interval  0 17 to 0 82  p   0 005   
class10	3635	there was one fatal hemorrhage in each group  
class10	3635	the frequency of bleeding events that led to hospitalization or transfusion was essentially the same in both groups  
class10	3635	the warfarin group had a higher rate of minor hemorrhage than the control group  38 vs  
class10	3635	21 patients   
class10	3635	conclusions  
class10	3635	long term low dose warfarin therapy is highly effective in preventing stroke in patients with non rheumatic atrial fibrillation  and can be quite safe with careful monitoring  
class10	3636	seizures and other neurologic sequelae of bacterial meningitis in children  
class10	3636	background  
class10	3636	although the mortality rate among children with bacterial meningitis has decreased dramatically in recent decades  some patients are left with neurologic sequelae  
class10	3636	it has not been clearly established which features of the acute illness predict the chronic neurologic sequelae  including late seizures or epilepsy  
class10	3636	methods  
class10	3636	we followed 185 infants and children prospectively during and after acute bacterial meningitis  
class10	3636	the mean duration of follow up was 8 9 years  range  0 1 to 15 5   
class10	3636	during the first six years standard neurologic examinations were performed  telephone interviews were conducted thereafter  
class10	3636	results  
class10	3636	one month after meningitis  69 children  37 percent  had neurologic abnormalities  
class10	3636	many of these signs resolved within a year  leaving only 26 children  14 percent  with persistent deficits  18  10 percent  had only sensorineural hearing loss  and 8  4 percent  had multiple neurologic deficits  
class10	3636	thirteen children  7 percent  had one or more late seizures not associated with fever  
class10	3636	the presence of persistent neurologic deficits indicative of cerebral injury was the only independent predictor of late afebrile seizures  p less than 0 001   
class10	3636	conclusions  
class10	3636	after bacterial meningitis only children with permanent neurologic deficits are at high risk for epilepsy  
class10	3636	those with normal examinations after the acute illness have an excellent change of escaping serious neurologic sequelae  including epilepsy  
class10	3637	the sequelae of haemophilus influenzae meningitis in school age children  
class10	3637	background  
class10	3637	previous data on the consequences of haemophilus influenzae type b meningitis for school age children have been inconsistent  and much of the information on risk factors has been inconclusive  
class10	3637	the present study was designed to evaluate the sequelae of this disease with a protocol for the comprehensive assessment of neuropsychological function  
class10	3637	methods  
class10	3637	ninety seven school age children  mean age  9 6 years   each of whom had a school age sibling  were recruited from a survey of the medical records of 519 children treated for h  
class10	3637	influenzae type b meningitis between 1972 and 1984  at a mean age of 17 months  at the children s hospitals of toronto  ottawa  and montreal  
class10	3637	of the 97 children  41 had had an acute neurologic complication  
class10	3637	sequelae were assessed by comparing the index children with their nearest siblings on the basis of standardized measures of cognitive  academic  and behavioral status  
class10	3637	results  
class10	3637	only 14 children  14 percent  had persisting neurologic sequelae  sensorineural hearing loss in 11  unilateral in 6 and bilateral in 5   seizure disorder in 2  and hemiplegia and mental retardation in 1  
class10	3637	although the total sample of index children scored slightly below the siblings in reading ability  the 56 children without acute phase neurologic complications  58 percent  were indistinguishable from their siblings on all measures  
class10	3637	the differences between the groups were small even for the 41 pairs in which the index child had had an acute neurologic complication  mean full scale iq  102 for the index children vs  
class10	3637	109 for the siblings   
class10	3637	sequelae were also associated with lower socioeconomic status and a lower ratio of glucose in cerebrospinal fluid to that in blood at the time of the meningitis  
class10	3637	behavioral problems were more prominent in index boys than index girls and in those who were older at the time of testing  but sex and age were not related to cognitive or academic sequelae  
class10	3637	conclusions  
class10	3637	we find a favorable prognosis for the majority of children who are treated for meningitis caused by h  
class10	3637	influenzae type b  
class10	3638	structure  expression and function of a schwannoma derived growth factor  
class10	3638	during the development of the nervous system  cells require growth factors that regulate their division and survival  
class10	3638	to identify new growth factors  serum free growth conditioned media from many clonal cell lines were screened for the presence of mitogens for central nervous system glial cells  
class10	3638	a cell line secreting a potent glial mitogen was established from a tumour  or  schwannoma   derived from the sheath of the sciatic nerve  
class10	3638	the cells of the tumour  named js1 cells  were adapted to clonal culture and identified as schwann cells  
class10	3638	schwann cells secrete an autocrine mitogen and human schwannoma extracts have mitogenic activity on glial cells  
class10	3638	until now  neither mitogen has been purified  
class10	3638	here we report the purification and characterization of a mitogenic molecule  designated schwannoma derived growth factor  sdgf   from the growth conditioned medium of the js1 schwann cell line  
class10	3638	sdgf belongs to the epidermal growth factor family  and is an autocrine growth factor as well as a mitogen for astrocytes  schwann cells and fibroblasts  
class10	3639	posterior interosseous nerve palsies  
class10	3639	one hundred seventy patients with radial nerve disorders were reviewed at the louisiana state university medical center over a 15 year period  
class10	3639	of these  32 had involvement of the posterior interosseous nerve exclusively  
class10	3639	findings included weak wrist extension with a radial drift  inability to extend the fingers  paralysis of thumb extension  and weak thumb abduction  
class10	3639	causes included entrapment at the arcade of froshe  14 patients   laceration  6 patients   fracture  6 patients   compression or contusion  3 patients   and loss associated with tumor  3 patients   
class10	3639	the ratio of men to women was 2 1  and the right arm was involved twice as often as the left  
class10	3639	preoperative evaluation included physical examination  electrophysiological testing  electromyogram nerve conduction velocity   and roentgenograms of the elbow and forearm  
class10	3639	of the 30 patients  2 patients had bilateral lesions   26 underwent operation  
class10	3639	in the operative series  all 28 nerves had a function of grade 3 or more of a possible 5 after 4 years of follow up  
class10	3639	seventeen had achieved grade 4 5  and 7 had obtained grade 5 5  
class10	3639	at operation  23 nerves were found to be in continuity  
class10	3639	fourteen lesions of nerves in continuity were associated with entrapment and  not unexpectedly  transmitted a nerve action potential with slowed conduction and low amplitude across the lesion  
class10	3639	four nerves in continuity that had lesions caused by injury had nerve action potentials and were treated by neurolysis  and another 4 had no nerve action potentials and were treated by graft or suture repair  
class10	3639	five injured nerves were not in continuity  
class10	3639	two could be repaired by end to end suture  and 3 required graft repair  
class10	3639	a large ganglion cyst involving the posterior interosseous nerve was also resected  
class10	3640	functional results of facial nerve suture after removal of acoustic neurinoma  analysis of 25 cases  
class10	3640	the facial nerve is sometimes severed during the removal of acoustic neurinomas  either intentionally to ensure complete removal  or unintentionally because of difficulties in identification  
class10	3640	in such cases we have  if possible  sutured the nerve stumps microsurgically  either end to end or by use of an intervening nerve graft  
class10	3640	we analyzed the outcome of 25 instances of facial nerve suturing in a series of 219 patients operated on for acoustic neurinoma from 1979 to 1987  
class10	3640	the first signs of recovery appeared at an average of 12 months  and there was continued improvement for several years  
class10	3640	recovery was graded from 1 to 6  
class10	3640	the anastomosis was successful in 24 of the 25 sutured nerves  in that at least some facial movement and tone were restored  grade 5 or higher   
class10	3640	in 11 of the 25 cases  facial appearance at rest and with movement was moderately good  grade 2 or 3   
class10	3640	a grade 1 result  with no perceivable facial dysfunction  was never achieved  
class10	3640	typically  oral muscles showed the most improvement and frontal muscles the least  
class10	3640	facial appearance was better at rest than with movement  which was always complicated by some degree of synkinesis  
class10	3640	closure of the eye was so good in 13 of the 25 cases that neither tarsorrhaphy nor an eyelid spring was necessary  
class10	3640	when the facial nerve is severed  intraoperative suture is recommended  because it provides a chance for moderately good restoration of facial appearance  
class10	3641	extracranial repair of cerebrospinal fluid fistulas  technique and results in 37 patients  
class10	3641	although neurosurgeons have traditionally preferred intracranial repair for the management of cerebrospinal fluid  csf  fistulas  this approach is associated with the complications of a craniotomy  anosmia  and a high incidence of recurrent fistulas  
class10	3641	extracranial repair  on the other hand  produces no central nervous system morbidity  preserves olfaction  and is associated with a low incidence of recurrence  
class10	3641	although there have been several reports of extracranial repair of csf fistulas by otorhinolaryngologists  this approach has received scant mention in the neurosurgical literature  
class10	3641	we report here our experience with 37 patients with csf rhinorrhea or otorrhea who underwent extracranial repair  
class10	3641	the etiology of the fistula was postoperative in 22  traumatic in 6  and spontaneous in 9  
class10	3641	the fistulas were repaired using one of four techniques  external ethmoid sphenoid in 18 patients  transmastoid in 9  transseptosphenoid in 7  and osteoplastic frontal sinusotomy in 3  
class10	3641	in 32 of the 37 patients  86   the fistulas were successfully repaired with the initial procedure  
class10	3641	of the 5 patients requiring a second operation  the fistula was successfully closed in 4 for an overall success rate of 97   
class10	3641	complications were few and consisted of a transient facial paresis in a patient undergoing transmastoid repair and one death from meningitis  
class10	3641	the authors conclude that because of low morbidity and mortality and a high success rate in closing fistulas  extracranial repair is the preferred technique for the operative management of csf rhinorrhea and otorrhea  
class10	3642	whither short course chemotherapy for tuberculous meningitis  
class10	3642	short course chemotherapy is well established for the treatment of pulmonary tuberculosis but not for extrapulmonary disease  
class10	3642	we present a series of 35 cases in which chemotherapy for tuberculous meningitis was given for a period of less than 2 years  
class10	3642	short term therapy was associated with recrudescence of tuberculous meningitis and  in some cases  with the development of deep cerebral infarcts and permanent neurological deficits  
class10	3642	we think short term chemotherapy for tuberculosis of the central nervous system is inadequate  
class10	3643	mild head injury classification  
class10	3643	inconsistencies across studies concerning outcome after mild head injury may reflect differences in the diagnostic criteria used for selection of patients  
class10	3643	consequently  we compared the neurobehavioral outcome in three groups of consecutively hospitalized patients  aged 16 to 50 years  who sustained a closed head injury  chi  and had a glasgow coma scale  gcs  score in the 9 to 15 range  
class10	3643	these groups included patients with uncomplicated chi with mild impairment of consciousness as reflected by a gcs score in the 13 to 15 range  n   78   patients with initially mild impairment of consciousness complicated by brain lesion or depressed skull fracture  n   77   and patients with moderate chi  n   60   
class10	3643	tests of memory  information processing  and verbal fluency were administered within 1 to 3 months after injury  and the glasgow outcome scale was completed at 6 months  
class10	3643	neurobehavioral functioning was impaired in the groups with complicated mild chi and moderate chi as compared to the group with uncomplicated mild chi  
class10	3643	although moderate chi produced longer durations of impaired consciousness and posttraumatic amnesia than complicated mild head injury  patients in these groups did not differ in neurobehavioral performance  
class10	3643	global outcome at 6 months was better in the patients with mild chi than in patients with complicated mild and moderate injuries  
class10	3643	analysis of the various complications of mild chi revealed that the presence of an intracranial lesion was related to more severe neurobehavioral sequelae than injuries complicated by a depressed fracture  
class10	3644	diffuse axonal injury  analysis of 100 patients with radiological signs  
class10	3644	one hundred patients with head injuries who showed diffuse axonal injury on computed tomographic scans are reported  
class10	3644	evaluation of the glasgow coma score  pupillary signs  and computed tomographic findings on admission led to an improved ability to forecast outcomes  
class10	3644	our relatively good results as compared with other series  can be explained by the high proportion of children and by the liberal use of computed tomography to evaluate head injuries  thus revealing that concussion may sometimes be regarded as an early form of diffuse axonal injury  
class10	3645	chronic lyme disease with an expansive granulomatous lesion in the cerebellopontine angle  
class10	3645	expansive granulomatous lesions in the posterior cranial fossa are rare and have not been reported in conjunction with lyme disease  
class10	3645	we report a patient with verified borrelia burgdorferi infection who developed a tumor in the cerebellopontine angle  
class10	3645	rapid growth of the tumor led to signs of cerebral compression and to hydrocephalus  
class10	3645	surgical intervention was required despite florid meningitis  
class10	3645	the histological examination showed inflammatory  nonspecific granulation tissue  
class10	3645	the origin of this tissue is almost certainly causally related to the b  
class10	3645	burgdorferi infection  
class10	3645	signs of inflammation resolved rapidly after subtotal resection  
class10	3645	the clinical  radiological  and biochemical course is documented  
class10	3645	this is the first report of an expansive cerebral lesion in the chronic phase of lyme disease  
class10	3646	symptomatic pineal cyst  case report  
class10	3646	pineal cysts are being described with increasing frequency since the advent of magnetic resonance imaging  
class10	3646	although pineal cysts are incidental findings in as many as 4  of magnetic resonance imaging studies  symptomatic pineal cysts are quite rare  
class10	3646	we present a case of pineal cyst causing aqueductal obstruction with symptomatic hydrocephalus and resultant headache and syncope  which was treated by surgical resection  
class10	3646	a review of the relevant literature and discussion follow  
class10	3647	clinical study of intracranial nongerminomatous germ cell tumors producing alpha fetoprotein  
class10	3647	we present six patients with intracranial nongerminomatous germ cell tumors that produced alpha fetoprotein  afp   
class10	3647	their ages ranged from 8 to 20 years  average  11 5 years old   two were male and four were female  
class10	3647	four of the tumors originated in the pineal region and two in the suprachiasmatic region  
class10	3647	one patient treated with only radiation therapy died within 3 months of admission as a result of intraperitoneal metastasis via a ventriculoperitoneal shunt  
class10	3647	another patient  treated with radiation therapy and intrathecal administration of neocarzinostatin  died after 12 months because of tumor progression and subarachnoid dissemination  
class10	3647	two patients who received radiation and combination therapy with cisplatin  vinblastine  and bleomycin died after 13 and 25 months  
class10	3647	the remaining two patients treated with radiation therapy and adjuvant chemotherapy  cisplatin and etoposide  are now alive without recurrence after 16 and 19 months from admission  
class10	3647	adjuvant chemotherapy with cisplatin and etoposide appears to be efficacious in the treatment of intracranial nongerminomatous germ cell tumor  
class10	3648	vagal schwannoma associated with syncopal attacks and postural hypotension  a case report  
class10	3648	a case of vagal schwannoma in the cerebellomedullary angle is reported  
class10	3648	preoperatively  the patient had paroxysmal episodes of postural hypotension with syncope  
class10	3648	after total removal of the vagal tumor  her systemic blood pressure returned to normal  
class10	3649	occult vascular malformations of the optic chiasm  magnetic resonance imaging diagnosis and surgical laser resection  
class10	3649	angiographically occult vascular malformations of the optic nerve and chiasm are extremely rare  
class10	3649	before the advent of magnetic resonance imaging  mri   it was difficult to diagnose these lesions preoperatively  
class10	3649	we report mri scan findings of optic chiasm cavernous angiomas in two patients with chiasmal syndrome  
class10	3649	mri was useful in localizing the vascular malformation and delineating its characteristics  especially chronic hemorrhage  
class10	3649	one patient underwent biopsy of the lesion  
class10	3649	the other patient underwent complete microsurgical resection of the malformation with the carbon dioxide laser with preservation of vision  
class10	3649	occult vascular malformations of the optic nerve and chiasm may be a more common cause of visual deterioration than previously recognized  
class10	3649	the mri scan is the imaging modality of choice for diagnosing and following these lesions  
class10	3649	in certain patients  these vascular malformations may be amenable to complete surgical removal with stabilization or improvement of visual function  
class10	3650	cyst of the choroid plexus in the lateral ventricle  case report and review of the literature  
class10	3650	we report an intraventricular cyst in a 2 year old boy who had myoclonic jerks of the extremities  
class10	3650	the cyst had no communication with the ventricular system or subarachnoid space  
class10	3650	total removal of the cyst adhering to the choroid plexus was accomplished  
class10	3650	the glial cyst wall was lined in part by flattened or cuboidal epithelium  
class10	3650	the preoperative and postoperative computed tomographic scans and magnetic resonance images are presented  and congenital benign cysts in the lateral ventricle are reviewed and discussed  
class10	3651	traumatic aneurysm of the superior cerebellar artery  case report and review of the literature  
class10	3651	less than 10  of the 250 reported cases of traumatic intracranial aneurysms have involved the posterior circulation  
class10	3651	traumatic aneurysms of the superior cerebellar artery are extremely rare  with only three cases previously reported  
class10	3651	this is the first report of a traumatic superior cerebellar artery aneurysm in which the diagnosis was suggested by computed tomographic scan  
class10	3651	the potential for a good outcome suggests the value of early angiography when the history and diagnostic imaging studies suggest the possibility of a traumatic aneurysm  
class10	3652	intradural herniation of a thoracic disc presenting as flaccid paraplegia  case report  
class10	3652	a case of intradural herniation of a thoracic disc in a patient with a flaccid paraplegia is described  
class10	3652	intradural herniation of a thoracic disc is considered a rare event  
class10	3652	a review of the relevant patient literature revealed 14 other reports involving 28 patients  
class10	3652	no other report has described a patient with an intradural thoracic disc herniation who developed a flaccid paraplegia  
class10	3653	an unusual complication of silastic dural substitute  case report  
class10	3653	a case is presented in which a patient developed an unusual complication after the use of silastic dural substitute  
class10	3653	in 1983  the patient underwent removal of a meningioma with the involved dura  
class10	3653	five years later  he developed around the graft material a very thick connective tissue capsule  which simulated a recurrent meningioma clinically and radiologically  
class10	3654	epidermoid tumors of the 4th ventricle  report of seven cases  
class10	3654	epidermoid tumors occur very rarely in the 4th ventricle  
class10	3654	we discuss the history  clinical course  and the surgical results for seven patients  
class10	3654	one patient had a remittal of symptoms  probably due to the emergence of the tumor from the 4th ventricle into the cisterna magna  
class10	3654	total removal of the capsule was possible only in the youngest patient  
class10	3654	at present  four patients  mean follow up  6 years  enjoy good general and neurological health  
class10	3655	limited selective posterior rhizotomy for the treatment of spasticity secondary to infantile cerebral palsy  a preliminary report  
class10	3655	a limited selective posterior rhizotomy was performed on 30 children suffering from spasticity secondary to infantile cerebral palsy  
class10	3655	as opposed to standard techniques that stimulate and divide the dorsal rootlets from l2 to s1  we dissected l4  l5  and s1 dorsal roots through an l5 to s1 laminectomy  
class10	3655	eight to 12 rootlets from each root were electrically stimulated with two unipolar electrodes  pulse width  50 microseconds  10 50 v   
class10	3655	the muscle responses were observed visually and registered by electromyography  
class10	3655	those rootlets associated with an abnormal motor response as evidenced by sustained muscular contraction or by prolonged electromyographic response were divided  
class10	3655	spasticity was scored from 0 to    
class10	3655	the muscular groups assessed were those involved in the flexion of the shoulder  elbow and wrist in the upper limbs  and those involved in flexion and adduction of the hip  flexion of the leg  and plantar flexion in the lower limbs  
class10	3655	the patients were assessed 1 week before and 6 months after the operation  
class10	3655	reduction of spasticity was observed in all the muscular groups  and all the patients presented functional improvement of motor abilities  
class10	3655	these preliminary results indicate that a limited procedure that reduces the extension of the laminectomy and the length of the operation could be effective for treating spasticity secondary to infantile cerebral palsy  
class10	3656	xenon enhanced computed tomographic measurement of cerebral blood flow in patients with chronic subdural hematomas  
class10	3656	we compared clinical symptoms with extent of brain shift on computed tomographic  ct  scans and quantitative and three dimensional measurements of cerebral blood flow  cbf  on xenon enhanced ct scans in 10 patients with chronic subdural hematomas  
class10	3656	five patients had only headache and minimal or no brain shift on a ct scan  
class10	3656	the other five had hemiparesis and or mental disturbance in addition to headache and moderate or severe brain shift on a ct scan  
class10	3656	the mean hemispheric cbf decreased about 7  in patients with headache and about 35  in patients with hemiparesis and or mental disturbance  
class10	3656	it decreased also on the side without the hematoma  
class10	3656	the cbf reduction was always more pronounced in the putamen and thalamus than in the cortex  
class10	3656	on the contrary  the cortex cbf was mostly preserved or even elevated in both groups of patients  
class10	3656	we speculate that cbf reduction in patients with a chronic subdural hematoma occurs initially in central cerebral areas like the basal ganglia and thalamus  and then extends to the entire hemisphere including the cortex as brain compression and displacement progress  
class10	3656	central cerebral area involvement might be more responsible for clinical symptoms than the cortex  
class10	3657	hypertension as a risk factor for epilepsy after aneurysmal subarachnoid hemorrhage and surgery  
class10	3657	a prospective  consecutive series of 307 patients with aneurysmal subarachnoid hemorrhage ranging from grades 1 to v according to the classification of hunt and hess on admission were evaluated to determine the incidence of epilepsy 1 to 3 years  mean  1 4 years  after aneurysmal subarachnoid hemorrhage  sah  and surgery  
class10	3657	sixty three patients had died and one patient was lost to follow up  
class10	3657	twenty nine patients developed epileptic seizures after the sah and surgery  
class10	3657	the mean time from the sah to epileptic seizure varied from 0 days  day of the sah  to 2 years  mean  6 7 months   
class10	3657	the seizures were classified as focal in 9 patients  31   and as generalized in 20 patients  69    
class10	3657	all patients received anticonvulsant medication after more than one seizure  
class10	3657	the risk factors for development of posthemorrhagic postoperative epilepsy were  in order of importance  a history of hypertension  an infarct on late computed tomographic scan  and the duration of coma after the ictus  
class10	3657	of the 85 patients with histories of hypertension  17  20 0   developed epilepsy  
class10	3657	only 12  5 4   of the 222 nonhypertensive patients developed epileptic seizures  
class10	3657	the difference between the groups was significant  p   0 0001   
class10	3657	computed tomographic scans were undertaken in 237 patients 1 to 3 years  mean  1 4 years  after the sah and surgery  
class10	3657	postoperative epilepsy was significantly associated with infarcts visualized on computed tomographic scan  p   0 0005   
class10	3658	changes in intracochlear and intracanalicular nerves after acoustic neurinoma excision confirmed by magnetic resonance imaging  
class10	3658	postoperative magnetic resonance imaging findings related to the vestibulocochlear and facial nerves within the internal auditory canal were analyzed in acoustic neurinomas  
class10	3658	t1  and proton weighted magnetic resonance images showed that the vestibulocochlear nerves distal to the internal auditory meatus increased in signal intensity after surgical intervention  
class10	3658	these nerves were conspicuously enhanced after intravenous administration of gadolinium diethylene triamine pentaacetic acid  
class10	3658	the preserved facial nerves were also markedly enhanced postoperatively  
class10	3658	as a possible cause of these findings  we suggest operative disruption of the blood nerve barrier with ensuing nerve edema  although the operative procedures were carefully carried out using a surgical microscope  
class10	3658	the clinical significance of traumatic disruption of the blood nerve barrier and subsequent nerve edema are discussed from the standpoint of preservation of cochlear nerve function  
class10	3659	fractures of the clivus  classification and clinical features  
class10	3659	fractures of the clival complex were diagnosed in a series of 17 patients admitted to the maryland institute for emergency medical services system and the university of maryland medical system over a 30 month period  
class10	3659	these fractures were divided pathologically into three types based upon their appearance on computed tomography  longitudinal  transverse  and oblique  
class10	3659	the mechanisms of injury were similar in all groups  and the glasgow coma scale scores at admission were comparable  regardless of fracture type  in survivors and nonsurvivors  
class10	3659	longitudinal fractures were associated with severe injury to the central nervous system and with brain stem infarction  and 4 of 6  67   of these patients died  
class10	3659	transverse fractures of the clival complex were found in 6 patients  3 of whom  50   died  
class10	3659	all of these patients had fractures of the petrous ridge  2 of the 3 survivors had multiple cranial nerve deficits  and one patient developed a carotid cavernous fistula  
class10	3659	of the 5 patients with oblique clival fractures  2 survived  40    both of whom had multiple cranial nerve palsies  in addition  one of these patients developed a carotid cavernous fistula  
class10	3659	using the present generation of computed tomographic scanners  fractures of the clival complex can be reliably diagnosed  they are probably more common than previously believed and can be separated into three groups based on the characteristics on computed tomographic scans and clinical findings  
class10	3660	clinicopathological experience with pineocytomas  report of five surgically treated cases  
class10	3660	the clinicopathological experience associated with five cases of pineocytoma is presented  
class10	3660	all patients were treated by surgical removal without postoperative radiotherapy  
class10	3660	in three individuals  2000 cgy was administered to the tumor as a presurgical diagnostic test  with no evidence of response  
class10	3660	all cases demonstrated histological features of pineocytoma  according to the criteria of borit et al   and of the so called  pineocytoma with neuronal differentiation   according to the criteria of rubinstein  
class10	3660	the experience obtained from the present series reveals that these tumors can occur in the initial decades of life  that a cystic appearance and the presence of calcifications are distinctive features of their radiological evaluation  and that they have a good prognosis after surgical removal  even when the histological data indicate local invasion  
class10	3660	the convenience of reserving the term  pineocytoma  for these tumors  and of including the so called  pineocytomas without further differentiation  within the group of pineoblastomas  is suggested in order to achieve a practical clinicopathological assessment of parenchymatous pineal tumors  
class10	3661	concurrent intradural and extradural meningiomas of the cervical spine  
class10	3661	a case of an extradural spinal meningioma presenting with a separate intradural meningioma at the same cord level is reported  
class10	3661	review of the english literature on spinal epidural meningiomas reveals a high incidence of concurrent intradural tumors in patients with epidural meningiomas  
class10	3661	this leads to the conclusion that the intradural space should be evaluated carefully when an epidural meningioma is encountered  
class10	3662	intradural spinal cord tumor presenting as a subarachnoid hemorrhage  magnetic resonance imaging diagnosis  
class10	3662	negative findings on four vessel angiography after a subarachnoid hemorrhage are seen in 5 to 30  of patients  
class10	3662	a previously silent lesion in the spinal canal may be responsible for the ictus in a small percentage of this group  
class10	3662	the etiological factors include tumors and arteriovenous malformations  however  investigations of such lesions have been limited to patients with signs and symptoms of spinal cord or nerve root pathological processes  
class10	3662	this report describes the management of a 56 year old woman with clinical findings typical of an aneurysmal subarachnoid hemorrhage and negative findings on cerebral angiography  in whom magnetic resonance imaging with gadolinium enhancement revealed an intradural extramedullary cervical schwannoma  
class10	3662	for this reason  cervicothoracic magnetic resonance imaging with gadolinium enhancement should be considered as an adjunctive scanning examination in all patients with a subarachnoid hemorrhage and negative findings on angiography  
class10	3663	myelopathy presenting decades after surgery for congenital cervical cutaneous lesions  
class10	3663	we report on two patients in whom cervical myelopathy developed decades after they had undergone surgery for congenital cervical cutaneous lesions  
class10	3663	preoperative magnetic resonance imaging demonstrated dorsal tethering and cavitation of the cervical cord in the area of the previous surgery and was helpful in decision making regarding surgical exploration and in planning for it  
class10	3663	we stress the importance of long term follow up by both clinical examination and magnetic resonance imaging in children who have been operated on for cervical cutaneous masses that may have central connections  
class10	3664	paraplegia after a routine lumbar laminectomy  report of a rare complication and successful management  
class10	3664	arachnoid cysts of the spinal canal are relatively common lesions that may be either intra  or extradural  
class10	3664	these cysts are usually asymptomatic but may produce symptoms by compressing the spinal cord or nerve roots  
class10	3664	we report a case in which an intradural thoracic arachnoid cyst became symptomatic after a routine decompressive lumbar laminectomy for spinal stenosis  
class10	3664	myelography revealed no abnormality  although magnetic resonance imaging and computed tomography after myelography demonstrated a mass within the posterior aspect of the thoracic spinal canal associated with anterior displacement and compression of the spinal cord  
class10	3664	a change in the flow dynamics of the cerebrospinal fluid probably allowed the development of spinal cord compression due to one of the following  expansion of the cyst  decreased cerebrospinal fluid buffer between the cord and the cyst  or epidural venous engorgement  
class10	3664	a concomitant and more cephalad lesion such as an arachnoid cyst should be considered when myelopathic complications arise after lumbar surgery  
class10	3664	magnetic resonance imaging and computed tomography after myelography are useful to demonstrate the additional pathological processes  
class10	3665	pituitary hemorrhage into a rathke s cleft cyst 
class10	3665	this report describes a case of symptomatic pituitary hemorrhage into a rathke s cleft cyst in a 25 year old woman  
class10	3665	the literature on pituitary hemorrhage in nonadenomatous sellar tumors is reviewed  
class10	3666	mechanism of stroke in patients taking aspirin  
class10	3666	during a 1 year period  we prospectively studied the mechanism and severity of stroke in 47 patients sustaining a cerebral infarction while taking aspirin  
class10	3666	the mechanism of stroke was undetermined in 12 patients  26    
class10	3666	in the remaining 35 patients  we identified 39 potential mechanisms  large artery atherosclerosis  19 patients  40    cardioembolism  15 patients  32    and small vessel occlusive disease  5 patients  11    
class10	3666	of 11 patients with carotid atherosclerosis and stroke  9  82   had greater than 90  carotid stenosis or occlusion  of 12 patients with stroke of undetermined mechanism  10  83   had previous stroke  of which 8 were also of undetermined mechanisms  
class10	3666	disability after stroke was moderate or severe in 27 patients  57    
class10	3666	these data suggest that  1  stroke in patients taking aspirin has a variety of etiologies and frequently causes moderate or severe disability   2  patients with carotid disease failing aspirin often have high grade carotid stenosis or occlusion   3  stroke of undetermined mechanism may recur more frequently than other stroke subtypes in patients taking aspirin  
class10	3667	aspiration in bilateral stroke patients  
class10	3667	seventy patients with bilateral strokes underwent neurologic and videofluoroscopic barium swallowing examinations  34  48 6   aspirated  
class10	3667	patients with aspiration were more likely to have posterior circulation strokes  abnormal cough  abnormal gag  and dysphonia  
class10	3667	however  patients likely to aspirate can be identified best by the presence of an abnormal voluntary cough  an abnormal gag reflex  or both  
class10	3667	the prediction of patients at risk for aspiration was not improved by additional clinical information  ie  presence of dysphonia or bilateral neurologic signs   
class10	3668	prolonged confusion following convulsions due to generalized nonconvulsive status epilepticus  
class10	3668	among patients with a prolonged confusional state after convulsive seizure  we diagnosed 8 cases as generalized nonconvulsive status epilepticus  
class10	3668	six had a history of seizures  and 2 had new onset  
class10	3668	the convulsive seizures were generalized in 6 and focal in two  
class10	3668	the postictal confusion lasted up to 36 hours in the most prolonged case  and a delayed response to anticonvulsant medications occurred in all cases  
class10	3668	the clinical symptoms ranged from mild confusion to coma  
class10	3668	psychiatric manifestations or automatisms were rare  
class10	3668	the presumed etiology was due to diverse causes  but a withdrawal state was the most common  
class10	3668	eeg demonstrated continuous or nearly continuous generalized ictal discharges of variable morphology  
class10	3668	these cases call attention to the fact that some prolonged confusional states following convulsive seizures are in fact due to persistent seizure activity that can be diagnosed by eeg  
class10	3669	verbal memory impairment correlates with hippocampal pyramidal cell density  
class10	3669	thirty five patients with medically refractory epilepsy localized to the temporal lobe  18 left  17 right  completed the verbal selective reminding test before surgery  
class10	3669	verbal memory impairments existed before surgery regardless of the lateralization of the seizure focus  but patients with left temporal seizure foci were significantly more impaired  
class10	3669	after surgical removal of the mesial temporal lobe structures  2 blinded observers established volumetric cell densities for hippocampal subfields ca1  ca2  ca3  the hilar area  and the granule cell layer of the area dentata  
class10	3669	statistically significant correlations existed between presurgical memory impairment and cell counts  in ca3 and the hilar area  only  for patients with left temporal seizure foci  
class10	3669	these findings support the hippocampal model of memory and complement prior research documenting the memory impairments present after surgical removal of the mesial temporal structures  
class10	3670	a case control study of alzheimer s disease in australia  
class10	3670	we conducted a case control study of clinically diagnosed alzheimer s disease  ad  on 170 cases aged 52 to 96 years  and 170 controls matched for age  sex and  where possible  the general practice of origin  
class10	3670	trained lay interviewers naive to the hypotheses and to the clinical status of the elderly person carried out risk factor interviews with informants  
class10	3670	significant odds ratios were found for 4 variables  a history of either dementia  probable ad  or down s syndrome in a 1st degree relative  and underactivity as a behavioral trait in both the recent and more distant past  
class10	3670	previously reported or suggested associations not confirmed by this study include head injury  starvation  thyroid disease  analgesic abuse  antacid use  aluminum exposure   alcohol abuse  smoking  and being left handed  
class10	3671	the opposite pupil in herniation  
class10	3671	i serially examined the pupil opposite the one already enlarged from transtentorial herniation in 13 patients  
class10	3671	the main abnormalities  stereotyped in most patients  were an initially diminished light reaction with a 2 5  to 4 mm diameter pupil  followed by slight reduction in size  and then reenlargement to greater than original size  all with preserved roundness  
class10	3671	subsequent deterioration varied among patients  but a transitional oval shape was infrequent and oculomotor function was preserved until both pupils were enlarged and fixed  
class10	3671	once the pupil on the side of a mass enlarges  heralding herniation  subsequent deterioration can be appreciated through changes in reactivity and size of the opposite pupil  
class10	3672	spatiotemporal contrast sensitivity differs in normal aging and parkinson s disease  
class10	3672	we measured contrast sensitivity for static and laterally drifting vertical gratings in 12 young adults  7 normal elderly adults  and 8 patients with parkinson s disease  pd   
class10	3672	we compared static and motion contrast sensitivity for spatial frequencies of 0 25  1  and 4 cycles per degree  cpd   and temporal frequencies of 1  3  and 9 hz  
class10	3672	results show that normal aging leads to a reduction of motion sensitivity for the spatial frequency of 0 25 cpd  
class10	3672	compared with elderly controls  pd patients do not present specific abnormalities in this domain  
class10	3672	however  for spatial frequencies of 1 and 4 cpd and temporal frequencies of 1 and 3 hz  motion sensitivity is worse than static sensitivity in pd patients and not in elderly controls  
class10	3672	these findings suggest a specific deficit of motion perception in pd  and possible dopaminergic involvement in the control of visuospatial behavior  
class10	3673	cytokine accumulations in csf of multiple sclerosis patients  frequent detection of interleukin 1 and tumor necrosis factor but not interleukin 6  
class10	3673	we identified the cytokines interleukin 1 beta  il 1 beta   tumor necrosis factor  tnf   and interleukin 6  il 6  by specific radioimmunoassays in the csf of patients with multiple sclerosis  ms  and other neurologic diseases  ond   
class10	3673	there was a high incidence of detectable il 1 beta in patients with active ms compared with inactive ms or ond patients  
class10	3673	tnf was also more frequently present in active ms than in ond csf  
class10	3673	by contrast  most ms csf did not contain detectable il 6  
class10	3673	there was no correlation between the degree of csf pleocytosis and the level of individual cytokines  suggesting that cytokine accumulations may be derived from cns  and not csf  cells  
class10	3673	as il 1 beta and tnf experimentally induce astrogliosis  demyelination  temperature elevation  lassitude  and sleep  and results raise the possibility that these cytokines may contribute to a variety of manifestations in ms and in other disease states  
class10	3674	catecholaminergic systems in the medulla oblongata in parkinsonian syndromes  a quantitative immunohistochemical study in parkinson s disease  progressive supranuclear palsy  and striatonigral degeneration  
class10	3674	we investigated tyrosine hydroxylase  th  immunoreactive neurons in the medulla oblongata corresponding to the a1 and a2 cell groups in autopsy tissue of patients with parkinson s disease  pd   n   3   progressive supranuclear palsy  psp   n   3   striatonigral degeneration  snd   n   2   and in controls  n   4   
class10	3674	the estimated total number of th positive neurons in the a1 and the a2 regions was normal in pd and psp patients  
class10	3674	the sparing of medullary catecholaminergic cells in pd and psp may be related to their minor degree of melanization and the possibility that intermediate compounds associated with the oxidative catabolism of norepinephrine and epinephrine may be less cytotoxic than those generated by degradation of dopamine  
class10	3674	patients with snd showed a marked loss of th immunoreactive cells in the a1 and the a2 groups  which may contribute to the impairment of vasomotor control characteristic of the disease  
class10	3675	anti gm1 igm antibodies in motor neuron disease and neuropathy  
class10	3675	we found anti gm1 igm antibodies in 23  of 56 patients with motor neuron disease  mnd   in 19  of 69 patients with neuropathy  and in 7  of 107 controls with other neurologic and nonneurologic diseases  
class10	3675	most of these patients had anti gm1 igm antibody titers of 1 80 or less  slightly higher antibody titers  up to 1 640  were found in 3 patients  1 with mnd and 2 with neuropathy  and very high titers  1 20 480  in a patient with mnd and an igm kappa m protein that reacted with gm1  gd1b  and asialo gm1  
class10	3675	six other patients with anti gm1 igm that also bound to gd1b  
class10	3675	reactivity with gd1b did not correlate with anti gm1 titers but was only present in patients with mnd or neuropathy  
class10	3675	anti gm1 igm antibodies may be a normal constituent of the human antibody repertoire but their frequency and  in some cases  their levels are higher in patients with mnd and neuropathy  
class10	3675	the origin and the pathogenetic role of these antibodies in neural impairment remain to be established  
class10	3676	kearns sayre syndrome presenting as renal tubular acidosis  
class10	3676	renal tubular acidosis and tetany were the 1st manifestations of kearns sayre syndrome in a 5 year old child  
class10	3676	subsequently  he developed progressive external ophthalmoplegia  ptosis  retinopathy  heart block  and endocrinopathy  
class10	3676	there was a 7 5 kb deletion of mitochondrial dna documented in muscle  kidney  skin fibroblasts  and leukocytes  providing evidence for a multisystem mitochondrial cytopathy  
class10	3677	antibodies to synthetic peptide  125 148  of the alpha subunit of human nicotinic acetylcholine receptor in sera from patients with myasthenia gravis  
class10	3677	we measured the amount of antibodies to a synthetic peptide that corresponds to the alpha subunit residues lys125 thr148 of human acetylcholine receptor  achr  in myasthenic sera  
class10	3677	we detected anti peptide antibodies in 52   89 171  of the patients with myasthenia gravis  mg   but none in any of the healthy controls  
class10	3677	anti peptide antibodies should provide a valuable immunologic parameter for the clinical evaluation of mg  but no apparent correlation was observed between the titers of anti peptide and anti achr antibodies  
class10	3678	streptococcus bovis meningitis  report of 2 cases  
class10	3678	we describe 2 cases of streptococcus bovis meningitis and review the 9 cases previously reported  
class10	3678	this microorganism is a rare cause of meningitis in which there are no distinctive clinical or laboratory features  
class10	3678	the gram stain of the csf is usually negative  
class10	3678	ten of the 11 cases had some underlying disease or comorbid condition that predisposed to s bovis infection  gastrointestinal disorder  endocarditis  csf leak  polymyalgia rheumatica  and mandibular block  
class10	3678	treatment with high dose penicillin is usually adequate  
class10	3679	a comparison of regulatory cells in spinal fluid and blood in patients with multiple sclerosis and other neurologic diseases  
class10	3679	multiple sclerosis is a disease in which immune abnormalities are present both in the cns and peripheral blood  
class10	3679	whether these changes are primary or secondary to the disease process is not known  
class10	3679	we tested t cell clones derived from activated lymphocytes in the blood and csf of ms patients and controls for their capacity to regulate t cell responses to alloantigens  
class10	3679	a wide spectrum of regulatory functions were observed  ranging from marked enhancement to almost complete suppression  
class10	3679	clones from different patient populations and anatomic sites were equivalent in their regulatory functions with the net effect of clones in each compartment being suppression  
class10	3679	however  certain clones from csf and peripheral blood had the capacity to stimulate autologous t cells  
class10	3679	percentages of such clones in the peripheral blood of ms patients were significantly higher than in controls  while percentages in ms and other neurologic diseases  ond  csf were equivalent  
class10	3679	our data suggest that  1  functional suppressor cells are not lost from the blood or csf or ms and ond patients   2  lymphocytes that have entered the cns in patients with ms and other cns diseases have equivalent regulatory functions   3  ms may be an illness in which peripheral immunologic events are important in perpetuating the disease process  and  4  responses to autologous antigens may also play a role in this perpetuation  
class10	3680	eosinophilia myalgia syndrome  l tryptophan associated neuromyopathy   
class10	3680	histopathologic study of skeletal muscle biopsy in a patient with eosinophilia myalgia syndrome following l tryptophan use showed prominent lymphocytic perineuritis  neuritis  and perimysial fasciitis  
class10	3680	the presence of perineuritis and neuritis provides a histopathologic basis for clinical features of neuropathy in eosinophilia myalgia syndrome and occurred in conjunction with a fasciitis or interstitial myositis that was predominantly perimysial and focally endomysial  
class10	3681	visual disturbance in patients with melanocytoma of the optic disk  
class10	3681	visual disturbance in 11 patients with melanocytoma of the optic disk was analyzed  
class10	3681	goldmann visual field examination showed enlargement of mariotte s blind spot in 7 of 10 patients  70   and visual field defect or depression in 7 patients  70    
class10	3681	in 6 of the 7 patients with visual field defect of depression  86    the portion of visual field damage corresponded with the location of the tumor and retinal nerve fiber bundle defect  
class10	3681	in 1 patient  sudden loss of visual acuity occurred  presumably due to anterior ischemic optic neuropathy induced by melanocytoma  
class10	3682	signs distinguishing spasmus nutans  with and without central nervous system lesions  from infantile nystagmus  
class10	3682	clinical findings as well as eye and head movement recordings were analyzed from 23 patients with spasmus nutans without central nervous system  cns  changes  10 patients with spasmus nutans like disease  head nodding  intermittent nystagmus associated with intracranial anomalies or visual pathway disorders   and 25 patients with infantile nystagmus  
class10	3682	ten diagnostic signs were established to differentiate between the patient groups  
class10	3682	although they were helpful in separating patients with infantile nystagmus from those with spasmus nutans  no difference was found between the patients with spasmus nutans with and without cns lesions  
class10	3682	this study indicates that eye and head movement recordings do not allow differentiation between benign spasmus nutans and spasmus nutans like disease  
class10	3682	the differentiation must be made on the basis of neuroimaging  
class10	3683	late juvenile onset krabbe s disease  
class10	3683	krabbe s disease is an autosomal recessive leukodystrophy characterized by a lack of galactocerebroside beta galactosidase activity  
class10	3683	in contrast to the classic early infantile onset form of krabbe s disease  less recognized  late onset variants exist  
class10	3683	the authors present a case of late juvenile onset krabbe s disease  including the associated magnetic resonance imaging  mri  findings  
class10	3683	most patients with late onset krabbe s disease present with visual loss due to optic atrophy  
class10	3683	associated gait abnormalities and parental consanguinity should increase the clinician s suspicion that a child may have late onset krabbe s disease  
class10	3683	because of the prolonged survival in late onset krabbe s disease  the recent development of bone marrow transplantation for these patient makes diagnosis of this disorder particularly important  
class10	3684	pharmacological versus non pharmacological prophylaxis of recurrent migraine headache  a meta analytic review of clinical trials  
class10	3684	in order to generate information about the relative effectiveness of the most widely used pharmacological and non pharmacological interventions for the prophylaxis of recurrent migraine  i e   propranolol hcl and combined relaxation thermal biofeedback training   meta analysis was used to integrate results from 25 clinical trials evaluating the effectiveness of propranolol and 35 clinical trials evaluating the effectiveness of relaxation biofeedback training  2445 patients  collectively   
class10	3684	meta analysis revealed substantial  but very similar improvements have been obtained with propranolol and with relaxation biofeedback training  
class10	3684	when daily recordings have been used to assess treatment outcome  both propranolol and relaxation biofeedback have yielded a 43  reduction in migraine headache activity in the average patient  
class10	3684	when improvements have been assessed using other outcome measures  e g   physician therapist ratings   improvements observed with each treatment have been about 20  greater  
class10	3684	in both cases  improvements observed with propranolol and relaxation biofeedback have been significantly larger than improvement observed with placebo medication  14  reduction  or in untreated patients  no reduction   
class10	3684	meta analysis thus revealed substantial empirical support for the effectiveness of both propranolol and relaxation biofeedback training  but revealed no support for the contention that the two treatments differ in effectiveness  
class10	3684	these results suggest that greater attention should be paid to determining the relative costs and benefits of widely used pharmacological and non pharmacological treatments  
class10	3685	antinociception and cardiovascular responses produced by electrical stimulation in the nucleus tractus solitarius  nucleus reticularis ventralis  and the caudal medulla  
class10	3685	in experiment 1  quantitative regional comparisons of the antinociceptive and cardiovascular responses produced by electrical stimulation in the caudal medulla  including regions such as the nucleus tractus solitarius  nts   nucleus reticularis ventralis  nrv   nucleus reticularis gigantocellularis  nrgc   nucleus reticularis paragigantocellularis  nrpgc   nucleus raphe obscurus  nro   and medial portions of the lateral reticular nucleus  lrn   were made in the rat  
class10	3685	electrical stimulation in all of these regions resulted in inhibition of the nociceptive tail flick reflex  although the threshold intensity for inhibition was greater for sites in nts compared to many sites ventral to the nts  
class10	3685	antinociception was generally accompanied by an increase in mean arterial blood pressure  with the exception of sites in the nro  where depressor responses were evoked by stimulation  
class10	3685	detailed comparisons between the nts and nrv revealed that greater intensities of electrical stimulation were required to produce antinociception for sites in the nts as compared to the nrv  
class10	3685	there were no significant differences in threshold intensities for antinociception as a function of rostrocaudal subdivisions of the nts  but the lateral subdivision of the nts was significantly more efficacious than the medial subdivision  
class10	3685	this mediolateral difference within nts was primarily due to stimulation in medial sites producing overt movements in some animals  probably due to stimulation of adjacent midline nuclei or pathways  
class10	3685	within the nrv  thresholds for inhibition of the tail flick reflex were greater for sites in the dorsal subdivision as compared to the ventral subdivision  which contains spinopetal projections from the nrm  
class10	3685	the slopes of the lines of recruitment for inhibition of the tail flick reflex at stimulation sites in either the nts or nrv were both very steep  similar to other forms of antinociception  
class10	3685	in experiment 2  the pulse duration of electrical stimulation was varied for sites of stimulation in the lateral nts and nrv to generate strength duration curves  
class10	3685	this experiment confirmed that stimulation sites in the lateral nts required greater current intensities to inhibit the tail flick reflex than sites in the nrv  
class10	3685	however  the chronaxies derived from the strength duration functions for the nts or nrv were both approximately 170 microseconds  indicating that the antinociceptive effects in these regions may not be exclusively due to the stimulation of fibers of passage  
class10	3685	these results are discussed in terms of the role of the nts  nrv  and caudal medulla in the modulation of nociceptive responses and cardiovascular function  
class10	3686	clinical judgments in pain management  
class10	3686	from research reports published over the last 20 years  it appears that moderate to severe uncontrolled pain may be the norm for hospitalized patients despite recent advances in the management of pain  
class10	3686	research on the extent of under management of pain and the factors associated with it is examined and summarized in this paper  
class10	3686	methodological imperfections of the research are identified  
class10	3686	several explanations for pain under management have been proposed and these are reported  
class10	3686	a clinical decision making model is also reviewed and it is suggested that this model could be applied to pain management problems  
class10	3686	further  it is suggested that this model may be very useful in developing educational interventions to improve health practitioners  clinical skills in pain management  
class10	3687	pain relief achieved by transcutaneous electrical nerve stimulation and or vibratory stimulation in a case of painful legs and moving toes  
class10	3687	a patient is described with painful legs and moving toes  
class10	3687	the pain had been occurring for more than 15 years  and a variety of therapies had been attempted with only partial  if any  success  
class10	3687	only morphine had succeeded in relieving the pain  but it had to be discontinued to avoid tolerance and dependence  
class10	3687	we devised a treatment consisting of transcutaneous electrical nerve stimulation  tens   vibratory stimulation  vs   and a combination of the two methods  tens   vs   
class10	3687	tens brought about partial pain relief  but was less effective than vs  dual stimulation  tens   vs  led to complete alleviation of the pain  
class10	3687	four months later  the patient was applying dual stimulation himself at home and was thus able to maintain complete relief with 3 or 4 weekly sessions  
class10	3687	we suggest that dual stimulation results in a large scale recruitment of large diameter afferent fibres and may thus set up a powerful inhibitory control of nociception in our patient  
class10	3688	heritability of symptoms in an experimental model of neuropathic pain  
class10	3688	male and female rats underwent transection and ligation of the sciatic and saphenous nerves  and the development of autonomy was monitored  
class10	3688	the deafferented animals were then interbred  always selecting males and females that expressed relatively high and  alternatively  relatively low levels of autotomy  
class10	3688	offspring were similarly operated and interbred  
class10	3688	by the sixth generation of selective breeding  lines were achieved in which autotomy was consistently high  ha  or consistently low  la   
class10	3688	there was no indication of sex linkage  
class10	3688	thermal and mechanical nocifensive responsiveness co selected with propensity to express autotomy following nerve injury  response thresholds were lower in ha than in la rats  
class10	3688	f1 hybrids formed by crossing homozygous ha and la animals showed low levels of autotomy  similar to la stock  
class10	3688	this indicates recessive inheritance of the autotomy trait  
class10	3688	backcrossing f1 hybrids onto the la line yielded a low autotomy phenotype in almost all cases  backcrossing f1 hybrids onto ha stock yielded about 50  high autotomy and 50  low autotomy  
class10	3688	these ratios are consistent with simple mendelian inheritance of a single gene  
class10	3688	taken together  the data suggest that autotomy is inherited as a single gene autosomal recessive trait  
class10	3689	adrenal medullary implants in the rat spinal cord reduce nociception in a chronic pain model  
class10	3689	previous work in this laboratory has indicated that the transplantation of adrenal medullary tissue into the subarachnoid space of the rat spinal cord can reduce pain sensitivity to acute noxious stimuli  particularly following stimulation by nicotine  
class10	3689	this most likely results from the stimulated release of opioid peptides and catecholamines from the transplanted chromaffin cells  
class10	3689	however  chronic pain models may more closely resemble human clinical pain  and the arthritic rat model has been used for screening potential therapeutic strategies  
class10	3689	the purpose of the present study was to assess the potential for adrenal medullary tissue implanted into the spinal subarachnoid space to alleviate chronic pain  
class10	3689	adrenal medullary tissue was implanted into adjuvant induced arthritic rats  and changes in body weight and vocalization responses were monitored over the 10 week course of the disease  
class10	3689	results indicate that the severe weight reduction normally associated with this inflammatory arthritis was attenuated by adrenal medullary  but not control  implants  
class10	3689	in addition  vocalizations were reduced in animals implanted with adrenal medullary  but not control tissue following nicotine stimulation  
class10	3689	this reduction was blocked by the opiate antagonist  naloxone  and partially attenuated by the alpha adrenergic antagonist  phentolamine  
class10	3689	together  these results suggest that the transplantation of adrenal medullary tissue into the subarachnoid space of the spinal cord may provide a local source of opioid peptides and catecholamines for the reduction of chronic pain  
class10	3690	interactions between substance p  calcitonin gene related peptide  taurine and excitatory amino acids in the spinal cord  
class10	3690	using in vivo microdialysis in the dorsal spinal cord of the rat  we have previously observed increases in glutamate and aspartate during exposure to a noxious stimulus  
class10	3690	the present investigation was designed to determine whether these increases may be mediated by substance p  
class10	3690	infusion of 1 mm of substance p in the dialysis fluid increased the concentrations of glutamate and aspartate  similar to the response seen during noxious stimulation  
class10	3690	in addition  substance p also increased the concentrations of the inhibitory amino acids glycine and taurine  
class10	3690	calcitonin gene related peptide  previously shown to enhance substance p induced biting and scratching behavior  produced no effect on amino acid release by itself but potentiated the apparent release of taurine by substance p  
class10	3690	to assess the importance of substance p induced amino acid release in sensory processing  we examined the influence of taurine and of excitatory amino acid antagonists on the biting and scratching behavior produced by excitatory amino acids and substance p  
class10	3690	taurine selectively inhibited only substance p induced biting and scratching while excitatory amino acid antagonists inhibited only excitatory amino acid induced behavior  
class10	3690	to further explore the ability of taurine to inhibit the substance p induced behavior  3 tests of nociception were then used  
class10	3690	pretreatment with taurine inhibited the nociceptive related writhing behavior produced by an intraperitoneal injection of acetic acid in mice but failed to alter the latency of response in the hot plate or tail flick assay  
class10	3691	thrombocytosis after pneumonia with empyema and other bacterial infections in children  
class10	3691	thrombocytosis is seen in association with many conditions  including infectious diseases  
class10	3691	we studied thrombocytosis after severe bacterial infections  particularly pneumonia with empyema in children  
class10	3691	a systematic survey of the phenomenon was conducted  
class10	3691	twenty seven children admitted for pneumonia with empyema were studied  
class10	3691	thrombocytosis  platelet counts greater than 500 x 10 3  microliters  was present in 92 5   
class10	3691	platelet counts reached their maximum at 15 1     3 7 days  range  7 to 25  and declined to normal after 3 weeks of illness  
class10	3691	compared with a healthy control group  significant thrombocytosis  but of lower incidence  was also noted in children with lobar pneumonia without pleural effusion  bacterial meningitis and osteomyelitis  
class10	3691	platelet functions were examined in seven of the children but no abnormalities were observed  
class10	3691	bone marrow aspiration of three children with pneumonia and empyema showed megakaryocytic hyperplasia  
class10	3691	we found no correlation between thrombocytosis  neutrophilia  fever  the clinical course  complications  prognosis or treatment  
class10	3691	neither thromboembolic nor hemorrhagic phenomena were observed  
class10	3692	central nervous system tuberculosis in children  a review of 30 cases  
class10	3692	the medical records of 30 children with central nervous system tuberculosis  cns tuberculosis  who were treated between march  1976  and february  1989  were reviewed  
class10	3692	all had cranial computerized tomography scans at presentation  
class10	3692	the mean cerebrospinal fluid leukocyte count was 200 mm3  protein 239 mg dl  glucose 25 mg dl and csf serum glucose ratio 21   
class10	3692	mantoux skin tests with 5 tuberculin units were greater than or equal to 10 mm induration in 50   and chest radiographs were positive in 40  of patients  
class10	3692	hydrocephalus was demonstrated by cranial computerized tomography in all 30 patients  100    
class10	3692	cranial computerized tomography scan demonstrating hydrocephalus is a sensitive radiographic nervous system tuberculosis and should be part of the early evaluation of children with suspected central nervous system tuberculosis  
class10	3693	acute pain relief  
class10	3693	pain is a multidimensional psychophysiologic phenomenon  
class10	3693	systematic multidimensional assessment is an essential first component of an effective plan to relieve the pain  
class10	3693	nurses are key to effective pain management because of the close  24 hour a day relationship with the hospitalized patient  
class10	3693	it is the nurse who is most critical to the adequate assessment of pain  to the implementation of the treatment plan  and to the evaluation of efficacy  
class10	3693	nurses should continue to develop a better knowledge base about pain and pain therapies and assessment skills  be assertive in obtaining effective treatment for their patients  and perceive themselves as responsible for pain relief  
class10	3694	chronic pain  
class10	3694	understanding of the etiology of chronic pain is growing rapidly as researchers seek to integrate physiologic and psychosocial mechanisms  
class10	3694	when nurses assess clients with chronic pain  they should make their assessments using both verbal and nonverbal methods and realize that no one instrument is comprehensive enough to be used alone  
class10	3694	the key to successful treatment of these difficult clients lies in the use of a comprehensive approach that takes the client seriously and integrates both physiologic and psychosocial approaches  
class10	3695	pain in children  
class10	3695	the assessment and management of children s pain is a topic that has received a great deal of attention since the late 1970s  
class10	3695	nurse researchers have played a dominant role in all areas of pediatric pain relief and likely will continue to do so  
class10	3695	there are currently a number of pediatric pain assessment instruments developed that are used in selected practice settings  but their use should be extended to document the existence of pediatric pain and its relief  
class10	3695	pharmacologic interventions for pediatric pain relief have been hampered by incorrect beliefs about analgesic risks  prescribing and administrating habits  and a virtual explosion of information in the area of analgesics  
class10	3695	although nurses have traditionally used nonpharmacologic interventions for pain relief  these methods have not been well researched  
class10	3695	continued research efforts in this important area will result in improved diagnosis and management of pediatric pain  
class10	3696	confusion  
class10	3696	the term confusion describes a plethora of possible cognitive deficits and behavioral manifestations  
class10	3696	a subjective assessment of confusion must be followed by an objective systematic evaluation to develop the cognitive behavior profile  
class10	3696	because of age associated physiologic and pathologic changes  elderly patients are at high risk for developing acute confusion  
class10	3696	the management of confusion presents a challenge to nursing  
class10	3696	nursing can play a significant role in the prevention and the early detection of acute confusion  
class10	3696	preventing or identifying confusion early will decrease the physical and psychological stress of the patient as well as decrease the cost of hospitalization by shortening length of stay  
class10	3696	additional research is needed to determine the efficacy of present nursing activities and to identify new approaches for management  
class10	3697	when epilepsy masquerades as heart disease  awareness is key to avoiding misdiagnosis  
class10	3697	autonomic neural impulses that accompany discharges during a seizure can cause a variety of cardiac manifestations  including cardiac arrhythmias  sudden death  anginal chest pain  neurogenic pulmonary edema  and symptoms of pheochromocytoma  
class10	3697	either generalized or focal seizures may generate such signs and symptoms  
class10	3697	a better appreciation of cardiac problems caused by epilepsy is helpful in preventing misdiagnosis  because the clinical picture in such a patient may be confusing  
class10	3698	steroids induce acetylcholine receptors on cultured human muscle  implications for myasthenia gravis  
class10	3698	antibodies to the acetylcholine receptor  achr   which are diagnostic of the human autoimmune disease myasthenia gravis  block achr function and increase the rate of achr degradation leading to impaired neuromuscular transmission  
class10	3698	steroids are frequently used to alleviate symptoms of muscle fatigue and weakness in patients with myasthenia gravis because of their well documented immunosuppressive effects  
class10	3698	we show here that the steroid dexamethasone significantly increases total surface achrs on cultured human muscle exposed to myasthenia gravis sera  
class10	3698	our results suggest that the clinical improvement observed in myasthenic patients treated with steroids is due not only to an effect on the immune system but also to a direct effect on muscle  
class10	3698	we propose that the identification and development of pharmacologic agents that augment receptors and other proteins that are reduced by human genetic or autoimmune disease will have broad therapeutic applications  
class10	3699	controlling stability of a complex movement system  
class10	3699	human movement systems have frequently been treated as one dimensional  single axis  rigid bodies in order to simplify the gathering  analysis  and interpretation of data  
class10	3699	the problem with this approach is that the results of such assumptions often lead to conclusions about the production and control of movement that do not relate to the control demands placed on the central nervous system  
class10	3699	in order to truly understand how the central nervous system plans and produces movements to match environmental demands  we must take into account the many variations available within the body  
class10	3699	the purpose of this article is to examine two movement systems that have the potential to act in multiple spatial dimensions with variable muscle action patterns when performing a stabilizing task  
class10	3699	methods of analyzing how the systems operate under differing task constraints and results of the experiments will be presented  
class10	3699	hypothetical models that have been proposed to explain how complex movement systems operate will also be discussed  
class10	3700	interferon system and natural killer cell activity in myasthenia gravis  
class10	3700	the autoimmune response in myasthenia gravis is well characterized  but little is known about the mechanisms initiating it  
class10	3700	we have studied the interferon system and natural killer cell activity in 25 patients with myasthenia gravis and compared them to 68 healthy subjects and 96 patients with acute viral infections  
class10	3700	forty four per cent of patients had circulating interferon  greater than 16 mu ml   and in a similar proportion their peripheral blood mononuclear cells were in an antiviral state  i e   showed low levels of viral replication when infected by vesicular stomatitis virus  
class10	3700	spontaneous in vitro interferon production by patients  peripheral blood mononuclear cells was also common  greater than 10 mu ml  32 per cent   while the response to the alpha interferon inducer poly i c was lower than expected  possibly reflecting the already high state of activation of the interferon system  
class10	3700	these results were essentially similar to those obtained in patients with viral illnesses and differed significantly from healthy controls  
class10	3700	in many myasthenia gravis patients  16 of 22  73 per cent   a markedly deficient natural killer cell activity was found  with a median cytotoxicity of 6 5 per cent compared to 29 per cent in healthy subjects  p less than 0 005   
class10	3700	thus  many patients with myasthenia gravis have evidence of an activated interferon system and defective natural killer cell activity  suggesting an occult viral infection or reflecting nonspecific stimulation which may nevertheless contribute to the pathogenesis of the autoimmune response  
class10	3701	haemostatic changes in the loin pain and haematuria syndrome  secondary to renal vasospasm  
class10	3701	twenty five patients  seven male  18 female  were diagnosed as having the loin pain and haematuria syndrome  
class10	3701	presenting symptoms were either loin pain alone or pain associated with macroscopic or microscopic haematuria  and were longstanding  having been present for mean of 9 3 years in males  and 10 years in females  
class10	3701	ten patients described symptoms of passing gravel or renal stones but these were only demonstrated radiologically in two patients  
class10	3701	investigation of all patients showed anatomically normal renal tracts  normal renal function  and no significant proteinuria  
class10	3701	phase contrast microscopy during episodes of haematuria revealed dysmorphic red cells in all 10 patients studied  
class10	3701	renal biopsies were performed in 20 patients and showed no glomerular pathology  but arteriolar and arterial hyalinosis was seen in 13 of 20  65 per cent   fibro elastosis in larger vessels in eight of 20  40 per cent  and red blood cells in tubules in 13 of 20  65 per cent  patients  
class10	3701	the histological appearance in vessels was similar to that seen in cyclosporin a nephrotoxicity and would be consistent with the hypothesis that regional vasospasm occurs in the cortical circulation  
class10	3701	haematological studies in 22 patients  when compared with age and sex matched controls  showed the presence of circulating platelet aggregates  elevation of plasma beta thromboglobulin  p less than 0 001   and increased platelet aggregation in response to serotonin and adp  p less than 0 05 and p less than 0 03  respectively   
class10	3701	plasma concentrations of d dimer  p less than 0 02  and c reactive protein  p less than 0 03  were also significantly elevated in the patient group  
class10	3701	there was no deterioration of renal function during a mean observation period of 3 7 years and no patients developed proteinuria  
class10	3701	treatment was largely supportive  seven patients with intractable loin pain underwent surgical denervation with the relief of pain in four  
class10	3702	tropical neuromyelopathies and retroviruses  a review  
class10	3702	debilitating disorders of the nervous system have a relatively high prevalence in the tropics  a geographic region that is often deficient in specialists in the fields of neurology and epidemiology  
class10	3702	during world war ii  attention was called to a possible nutritional origin for most of these diseases  
class10	3702	recently  however  human t lymphotropic virus type i  htlv i   formerly linked only to a rare form of leukemia  adult t cell leukemia   has been associated with a spastic paraplegia observed mostly in tropical areas and referred to as tropical spastic paraparesis  
class10	3702	this entity is also observed in nontropical areas endemic for htlv i  including japan  south america  and the southern united states  
class10	3702	viruses of the htlv family are being associated increasingly with pathology in humans  
class10	3702	the pathogenesis of htlv i associated tropical spastic paraparesis remains to be understood  
class10	3702	however  future research is expected to favor a multidisciplinary approach  with exciting potential insights derived from the fields of neurology  immunology  and infectious diseases  
class10	3702	the aim of this review is to summarize contemporary research related to the viral etiology of this clinical entity  
class10	3703	tamoxifen therapy for painful idiopathic gynecomastia  
class10	3703	we have evaluated the efficacy of the antiestrogen tamoxifen in six men with painful idiopathic gynecomastia  
class10	3703	subjects were given either tamoxifen or placebo for 2 to 4 months and then were given the other agent for an identical period  
class10	3703	breast size was considered to have been reduced only if it had decreased by one or more marshall tanner stages during the treatment period  
class10	3703	pain reduction with tamoxifen therapy was statistically significant for the group  occurring in five of six subjects during tamoxifen treatment and in only one of six during the placebo period  
class10	3703	size reduction with tamoxifen was only marginally significant for the entire group  but occurred in all three subjects who were initially in marshall tanner stage iii and in none of the three subjects who were initially in stage v  
class10	3703	during tamoxifen treatment  there was a significant increase in the serum levels of luteinizing hormone and total estradiol and a marginally significant increment in the total testosterone level  
class10	3704	normeperidine induced seizures in hereditary coproporphyria  
class10	3704	seizures are common in acute exacerbations of hepatic porphyria  even though the etiology is not identified in most cases  
class10	3704	we have reported a case of normeperidine induced seizures in a patient with hereditary coproporphyria  
class10	3704	although meperidine is commonly used for pain control during acute attacks in these patients  this report suggests that meperidine is not a good analgesic choice in porphyria  
class10	3704	normeperidine induced seizures in patients with porphyria may be treated by withdrawal of meperidine therapy and selective use of anticonvulsants  
class10	3705	postural hypotension  pressor effect of octreotide not mediated by norepinephrine  
class10	3705	orthostatic hypotension of the shy drager syndrome is a chronic incapacitating condition characterized by lack of an appropriate increase in the plasma norepinephrine level in response to standing  
class10	3705	recently  the somatostatin analogue octreotide has been reported to induce a pressor response in patients having this syndrome  
class10	3705	we have reported a case of shy drager syndrome in which octreotide was effective  but the rise in blood pressure was not accompanied by an increase in the plasma norepinephrine level  
class10	3705	hence  the pressor effect of octreotide is not mediated by stimulation of the sympathetic nervous system  but probably through splanchnic vasoconstriction  
class10	3706	synchronous hodgkin s disease and myelofibrosis terminating with granulocytic sarcoma and acute megakaryocytic leukemia  
class10	3706	our patient had stage iiiai hodgkin s disease with synchronous myelofibrosis and myeloid metaplasia  
class10	3706	a slowly progressive myeloproliferative disease developed over 9 1 2 years and terminated in a painful osteolytic bone disease  spinal extradural granulocytic sarcoma and acute megakaryocytic leukemia  
class10	3706	it is likely that this was a result of the myeloproliferative disease rather than a late complication from combination chemotherapy  
class10	3706	our case demonstrates the importance of a curative approach to hodgkin s disease even in the face of a coexistent disease with a long or unknown natural history  
class10	3707	persistent segmental cutaneous anesthesia after a brown recluse spider bite  
class10	3707	patients with brown recluse spider bites commonly suffer from pain  muscular aching  and a variety of local dysesthesias during the acute and resolution phases of toxin induced injury  
class10	3707	this is our first well documented observation of persistent cutaneous anesthesia caused by a spider bite  
class10	3707	the anesthetic area conformed to the distribution of a specific nerve  the transverse cervical cutaneous nerve  
class10	3707	the identification of the spider as a brown recluse and the location of the bite over the nerve s usual pathway strongly suggest that the venom was responsible for this complication  
class10	3708	neurologic abnormalities in a patient with human ehrlichiosis  
class10	3708	human ehrlichiosis is a tick borne rickettsial disease characterized by fever  headache  myalgias  anorexia  and occasionally rash  
class10	3708	in our patient  changes in mental status  upper motor neuron signs  cerebrospinal fluid pleocytosis  and increased serum protein levels were found in association with serologically confirmed ehrlichiosis and were most likely due to vasculitis involving the central nervous system  
class10	3708	intraleukocytic inclusions  although observed in our case  have been infrequently found in other reported cases of ehrlichiosis  
class10	3709	stroke in systemic lupus erythematosus  published erratum appears in stroke 1991 mar 22 3  417  
class10	3709	we investigated the clinical and pathologic characteristics of stroke in 234 patients with systemic lupus erythematosus  
class10	3709	thirteen patients  5 6   developed cerebrovascular disease  
class10	3709	cerebral infarction was noted in eight  cerebral hemorrhage in two  and subarachnoid hemorrhage in three  
class10	3709	in seven  54   of these 13 patients  stroke occurred less than or equal to 5 years after systemic lupus erythematosus was diagnosed  
class10	3709	among the predisposing risk factors for stroke  hypertension was the most important  
class10	3709	lupus anticoagulant was detected in three  38   and anticardiolipin antibody in three  43  of seven investigated  of the patients with infarction  
class10	3709	evaluation of the clinical manifestations and autoantibodies indicated that renal involvement and high titers of anti deoxyribonucleic acid antibody were more frequent in the stroke group than in the non stroke group  
class10	3709	autopsy studies on six of the patients with stroke revealed small infarcts and hemorrhages in all  but in no case was true angiitis observed  
class10	3709	libman sacks endocarditis was found in two of the three patients with infarction  
class10	3709	in conclusion  the important contributory factor to the development of stroke in patients with systemic lupus erythematosus is considered to be hypertension mediated by immunologic abnormalities  
class10	3709	antiphospholipid antibodies and libman sacks endocarditis are closely associated with occlusive cerebrovascular disease  
class10	3710	surgical experience with cerebral amyloid angiopathy  
class10	3710	cerebral amyloid angiopathy can present as lobar intracerebral hemorrhage in an elderly person  presumably due to increased fragility of the vessels affected by amyloid deposition  
class10	3710	for this reason  patients presenting with intracerebral hemorrhage and suspected of having cerebral amyloid angiopathy have often been treated nonsurgically  
class10	3710	since 1983 we have evaluated 11 patients with cerebral amyloid angiopathy  nine women and two men  mean age 73 years  who have undergone either intracerebral hematoma evacuation or brain biopsy  
class10	3710	nine of the 11 patients presented with intracerebral hemorrhage  which was unilobar in three patients and multilobar in six and involved the parietal lobes seven times  the frontal lobes four times  the temporal lobes four times  and the occipital lobes twice  
class10	3710	these nine patients underwent hematoma removal  with no cases of abnormal intraoperative bleeding or recurrent hemorrhage  
class10	3710	six patients improved neurologically  and two were unchanged after hematoma evacuation  the remaining patient had a fatal cardiopulmonary arrest during the immediate postoperative period  
class10	3710	during follow up in seven patients  median 11 months  range 1 week to 74 months  none experienced a recurrent intracerebral hemorrhage and four continued to improve  
class10	3710	two of the 11 patients had cerebral amyloid angiopathy diagnosed by brain biopsy as part of an evaluation for dementia  also without surgical complications  
class10	3710	this series suggests that patients with cerebral amyloid angiopathy may safely undergo operative procedures  and patients presenting with intracerebral hemorrhage may show neurologic improvement following evacuation of the hematoma  
class10	3711	remote effect of deep seated vascular brain lesions on cerebral blood flow  
class10	3711	we measured regional cerebral blood flow using the xenon 133 inhalation method  at approximately 1 month after onset  in 60 stroke patients who had no evidence of major carotid artery stenosis or occlusion  
class10	3711	their single lesions  43 infarcts and 17 hematomas  were located in the capsulothalamolenticular region  sparing the cortex  
class10	3711	hemispheric mean cerebral blood flow was reduced on the side of the lesion in 25 patients and on both sides in 20  
class10	3711	regional hypoperfusion was observed in 46 patients  ipsilaterally in 34  bilaterally in 10  and contralaterally in two   
class10	3711	regional hypoperfusion was observed most frequently in the frontal lobe  particularly in the motor and premotor cortices of the prerolandic area  
class10	3711	the 46 patients with regional hypoperfusion were compared with the 14 patients without regional hypoperfusion  considering the size and location of the lesion as well as the functional and analytic motor performances  
class10	3711	as a rule  the lesion was slightly smaller and more posterior and the functional  p less than 0 001  and analytic  p less than 0 05  motor performances were significantly better in the 14 patients without regional hypoperfusion  
class10	3711	since the xenon 133 inhalation method examines cortical blood flow  we can attribute blood flow reductions resulting from deep seated lesions to a functional depression akin to diaschisis  
class10	3711	interpretation of the clinical consequences and pathogenesis of this phenomenon requires further sequential and pathologic studies  
class10	3712	correlation of clinical and computed tomographic findings in stroke patients  
class10	3712	we evaluated the correlation between clinical features and computed tomographic findings in a prospective study of 1 191 consecutive patients with acute cerebrovascular disease seen during 1 year  
class10	3712	in the 386 patients in whom symptoms and signs initially suggested a cerebrovascular disorder  computed tomography revealed a relevant lesion in 154  hemorrhagic in 52  33 8    ischemic in 102  66 2    and a significant nonstroke abnormality in 14  3 1    
class10	3712	among the remaining 805 patients with symptoms and signs suggesting some central nervous system disorder other than stroke  computed tomography revealed a cerebrovascular lesion in 38  4 7    35 of these lesions were ischemic  
class10	3712	the computed tomographic findings was compatible with the final clinical diagnosis in 192  84 2   of the 228 patients with lesions  
class10	3712	in the entire sample of 1 191 patients  a cerebrovascular disorder would have been missed in 38  3 2   without computed tomography  
class10	3712	on the other hand  computed tomography failed to visualize a cerebrovascular lesion in 40 patients in whom such a lesion was clinically obvious  
class10	3712	our results emphasize that both careful neurologic assessment and a policy of early computed tomography are of crucial importance in the diagnosis of stroke and for therapeutic considerations  
class10	3713	effect of emitted power on waveform intensity in transcranial doppler 
class10	3713	this study assesses the problem of transcranial doppler recording failure and seeks to determine the extent to which this can be ameliorated by increased emitted power  
class10	3713	we hypothesized that waveform intensity is directly related to the rate and quality of successful recording and may be compared quantitatively among groups of patients  
class10	3713	among a large group of patients recorded at 800 mw cm2 emitted power  intensity was strongest in white men  weakest in black women  and intermediate in black men and white women  
class10	3713	it declined with age in women of either race  but not in men of either race  
class10	3713	analysis of the effect of emitted power on intensity predicted that significant numbers of waveforms recorded at 800 mw cm2 could not be recorded at the current clinical standards of 100 mw cm2  the difference being most pronounced in elderly black women  
class10	3713	temporal bone window thickness measured in a series of adult cadaver skulls was least in white men  greatest in black women  and intermediate in black men and white women  
class10	3713	the findings of this study support the hypothesis that temporal bone window thickness is an important determinant of recording difficulty and suggest that increased emitted power can significantly increase successful recording  particularly in black and elderly patients  
class10	3713	increased power alone  however  cannot completely solve the recording problem within safe limits  
class10	3714	moderate hypothermia after cardiac arrest of 17 minutes in dogs  effect on cerebral and cardiac outcome  
class10	3714	moderate hypothermia  30 degrees c  induced before circulatory arrest is known to improve neurologic outcome  
class10	3714	we explored  for the first time in a reproducible dog outcome model  moderate hypothermia induced during reperfusion after cardiac arrest  resuscitation   
class10	3714	in three groups of six dogs each  n   18   normothermic ventricular fibrillation cardiac arrest  no blood flow  of 17 minutes was reversed by cardiopulmonary bypass  normothermic in control group i  37 5 degrees c  and hypothermic to 3 hours in groups ii  32 degrees c  and iii  28 degrees c   
class10	3714	defibrillation was achieved in less than or equal to 5 minutes and partial bypass was continued to 4 hours  controlled ventilation to 20 hours  and intensive care to 96 hours  
class10	3714	all 18 dogs survived  
class10	3714	electroencephalographic activity returned significantly earlier in groups ii and iii  
class10	3714	mean     sd best neurologic deficit between 48 and 96 hours was 44     8  in group i  38     12  in group ii  and 35     7  in group iii  differences not significant   
class10	3714	best overall performance category 2  good outcome  between 48 and 96 hours was achieved in none of the six dogs in group i and in four of the 12 dogs in the combined hypothermic groups ii and iii  difference not significant   
class10	3714	mean     sd brain total histologic damage score was 130     22 in group i  93     28 in group ii  p   0 05   and 80     26 in group iii  p   0 03   
class10	3714	gross myocardial damage was greater in groups ii and iii than in group i  numerically higher overall and significantly higher in group iii for the right ventricle alone  p   0 02   
class10	3714	moderate hypothermia after prolonged cardiac arrest may or may not improve cerebral outcome slightly and can worsen myocardial damage  
class10	3715	progressing cerebral infarction in relation to plasma glucose in gerbils  
class10	3715	we studied neurologic morbidity and its evolution during hyperglycemia induced immediately after permanent unilateral common carotid artery ligation in mongolian gerbils  
class10	3715	a total of 60 animals were divided into five groups  one experiencing severe hyperglycemia for 1 hour after the onset of ischemia  brief hyperglycemia group  n   13   a normoglycemic control group for the brief hyperglycemia group  n   12   a group with severe hyperglycemia for 4 hours after the onset of ischemia  prolonged hyperglycemia group  n   11   a normoglycemic control group for the prolonged hyperglycemia group  n   13   and a hyperosmolar normoglycemic control group for the prolonged hyperglycemia group  n   11   
class10	3715	neurologic morbidity and mortality were higher in the two hyperglycemic groups than in the three normoglycemic control groups  
class10	3715	the neurologic deficit progressed according to the duration of severe hyperglycemia  
class10	3715	in the three normoglycemic control groups neurologic status stabilized 120 minutes after the onset of ischemia  in the brief hyperglycemia group stabilization occurred at 210 minutes  and in the prolonged hyperglycemia group neurologic deficit progressed for approximately 360 minutes  coinciding with the death of all but one gerbil  in which the neurologic deficit remained stable until death 23 hours after ischemia  
class10	3715	we suggest that hyperglycemia is another cause of progressing cerebral infarction  
class10	3716	embolic stroke after smoking  crack  cocaine  
class10	3716	a 39 year old woman had an embolic upper division middle cerebral artery branch occlusion 3 hours after smoking the free base of cocaine   crack    
class10	3716	radionuclide ventriculography demonstrated cardiomyopathy  and echocardiography documented a left atrial thrombus  
class10	3716	this case demonstrates that embolism is one mechanism of ischemic stroke after cocaine use  and that cardiomyopathy  possibly cocaine induced  may be the source of embolus  
class10	3716	a cardiac source of embolus should be sought in patients with cocaine associated cerebral infarction  
class10	3717	progress report of the stroke prevention in atrial fibrillation study  
class10	3717	the stroke prevention in atrial fibrillation study recently found and reported  spaf investigators  n engl j med  1990 322 863 868  a beneficial effect of both warfarin and aspirin compared with placebo in the primary prevention of ischemic stroke and systemic embolism in patients with nonvalvular atrial fibrillation  
class10	3717	among warfarin eligible patients  the event rates were 1 6  yr for those receiving active antithrombotic therapy  warfarin or aspirin  and 8 3  yr for those receiving placebo  p less than 0 00005   risk reduction 81   95  confidence interval 56 91   
class10	3717	ironically  we did not find a beneficial effect of aspirin in warfarin ineligible patients  
class10	3717	on the basis of these results  the study has been reshaped to directly compare these two antithrombotic agents  
class10	3717	insight into the apparent aspirin unresponsiveness noted in some patients also is being sought  
class10	3717	interpretation of the preliminary results and the reshaping of the study have been made more complex by the continued blinding of the investigators to certain portions of the data  
class10	3717	presented is an account of the study from its inception through its recent redesign  
class10	3718	growth factor expression after stroke  
class10	3718	fibroblast growth factors are polypeptides with potent trophic effects on central nervous system cells  
class10	3718	both acidic and basic forms of fibroblast growth factor are found in the mammalian brain  
class10	3718	we have examined the expression of these factors after focal brain injury or stroke  
class10	3718	after infarction of the lateral cerebral cortex in the mature rat brain  we found a twofold to threefold increase during the first 3 weeks after stroke in levels of fibroblast growth factors in tissue surrounding infarcts  
class10	3718	this increase persisted for at least 2 months and appeared mainly to be due to increased levels of basic  but not acidic  fibroblast growth factor  
class10	3718	because of its gliotrophic  angiogenic  and neuronotrophic properties  basic fibroblast growth factor may play an important role in the cascade of cellular reactions that contributes to wound healing and functional recovery after stroke  
class10	3719	genetics of cerebrovascular disease  
class10	3719	stroke is a complex disease  with both genetic and environmental factors having a role in its pathogenesis  
class10	3719	a review of past studies shows some evidence of genetic influences in the development of stroke  
class10	3719	this is supported by studies of cardiovascular disease  which indicate major genetic influences at several levels including the development of risk factors  
class10	3719	new approaches to phenotypic classifications  patient ascertainment  and genetic analysis will stimulate research into the role of genetics in cerebrovascular disease  
class10	3720	molecular biology of atherothrombotic brain infarction  
class10	3720	because reduced high density lipoproteins may contribute to atherothrombotic brain infarction  we performed molecular biologic and metabolic studies to characterize high density lipoprotein metabolism with respect to its role in reverse cholesterol transport  to clone the high density lipoprotein receptor  and to determine gene polymorphism for apolipoprotein a i  the major protein of high density lipoprotein  because altered structure may impair reverse cholesterol transport  
class10	3720	for high density lipoprotein metabolism measurements  high density lipoprotein 3 was isolated  purified  and labeled with iodine 125  
class10	3720	the radiolabeled high density lipoprotein 3 was reinjected  and daily blood samples were taken for 10 days  
class10	3720	synthesis rates and fractional catabolic rates were determined from the specific activities and daily decrements  
class10	3720	preliminary data indicate that stroke prone individuals  fractional catabolic rates for high density lipoprotein 3 are twice those of normal individuals  
class10	3720	also  the conversion of high density lipoprotein 3 to high density lipoprotein 2 is reduced in these individuals  suggesting that high density lipoprotein may be abnormally processed in individuals prone to atherothrombic brain infarctions  
class10	3720	we surveyed more than 100 patients with carotid stenosis using a 2 2 kb probe for the apolipoprotein a i gene  
class10	3720	a subset of these patients displays polymorphism with restriction enzymes saci or psti  
class10	3720	these preliminary findings suggest that gene polymorphism for apolipoprotein a i may provide a molecular clue of atherothrombic brain infarction  
class10	3721	modification of stroke susceptibility by genotype dependent maternal influences  
class10	3721	the influence of the prenatal and postnatal maternal environment on stroke susceptibility was evaluated by reciprocally crossing the spontaneously hypertensive  shr  and the dahl salt sensitive  ss jr  inbred rat strains to produce reciprocal f1 hybrids that were nurtured  respectively  during prenatal and postnatal life by shr or ss jr mothers  
class10	3721	following placement on a high salt diet containing 8  nacl at 35 days of age  f1 rats reared by shr mothers had shorter survival times and were more likely to die with cerebral hemorrhage than f1s reared by ss jrs  
class10	3721	across reciprocal f1 female groups  enhanced susceptibility to stroke was associated with greater elevations of systolic blood pressure  but this association was not seen across reciprocal f1 male groups  
class10	3721	there was also an association between blood pressure and stroke within each f1 gender subgroup  rats eventually suffering strokes developed higher blood pressure after placement on the high salt diet than rats that did not suffer stroke  
class10	3721	lower day 35 body weights  before exposure to the high salt diet  were associated with greater likelihood of stroke both across the reciprocal f1 groups  and within three of the four f1 gender subgroups  
class10	3721	the differences in stroke susceptibility between the reciprocal f1 groupings may be due to systematic differences in the prenatal and or postnatal environments of shr and ss jr mothers and may be mediated by variations in the nutritive capacity of the two inbred mothers  
class10	3722	pharmacology of recovery after stroke  
class10	3722	laboratory research during the past decade has begun to provide insights into the neurobiologic basis of functional recovery after brain injury  
class10	3722	it is clear that drugs influencing specific neurotransmitters also can influence the recovery process  
class10	3722	some of these drugs may be beneficial  but others may be detrimental  
class10	3722	some of the difficulties in interpreting the results of these behavioral studies are reviewed  and potential mechanisms of drug effects are discussed  
class10	3722	these types of studies are leading to an increased awareness of the potentially harmful effects of some drugs often given to stroke patients  
class10	3722	pharmacotherapy designed to enhance functional recovery after stroke may be possible in the future  
class10	3723	multilevel transneuronal degeneration after brain damage  behavioral events and effects of anticonvulsant gamma aminobutyric acid related drugs  
class10	3723	recent morphologic and behavioral studies of the effects of gamma aminobutyric acid agents on transsynaptic degeneration after cortical and striatal damage are reviewed and discussed  
class10	3723	following unilateral lesions of the anteromedial cortex  mild atrophy appears in the ipsilateral striatum and substantia nigra pars reticulata  
class10	3723	long term diazepam administration greatly enhances this degeneration  extends the degeneration into the thalamus  and severely disrupts recovery from somatosensory asymmetries  
class10	3723	following unilateral excitotoxic lesions of the striatum  progressive degeneration of neurons occurs in the substantia nigra pars reticulata and efferent targets in the thalamus  
class10	3723	this degeneration can be prevented by chronic infusion of muscimol  a gamma aminobutyric acid agonist  
class10	3723	unexpectedly  this treatment did not facilitate recovery from somatosensory asymmetries  
class10	3723	recovery in muscimol treated animals was impaired relative to saline treated controls  
class10	3723	thus  gamma aminobutyric acid agonists either may enhance or prevent neural atrophy secondary to brain damage  but the behavioral outcome appears to depend importantly on the excitatory and inhibitory characteristics of the affected networks  
class10	3724	influence of amphetamine treatment on somatosensory function of the normal and infarcted rat brain  
class10	3724	the consequences of acute amphetamine administration on the metabolic responsiveness of the cerebral cortex to physiologic activation were studied in normal and infarcted rats  
class10	3724	treated rats received a 4 mg kg intravenous injection of d amphetamine 1 hour before unilateral vibrissae stimulation and 2 deoxyglucose study  
class10	3724	in nontreated normal rats  metabolic activation was restricted to the major relay stations of the vibrissae barrel circuit  
class10	3724	in amphetamine treated rats  stimulation induced increased glucose utilization was widespread  including ipsilateral and contralateral cortical regions outside the barrel field circuit  
class10	3724	for example  an 84  increase in glucose utilization above control was seen in cortical areas anterior to the barrel field region  
class10	3724	increased glucose utilization induced by stimulation was severely depressed in nontreated rats that had undergone infarction of the left cortical barrel field 2 weeks previously  
class10	3724	vibrissae stimulation failed to increase glucose utilization significantly in cortical areas remote from the infarct  
class10	3724	in contrast  bilateral increases in glucose utilization were observed within cortical regions of treated infarcted rats  
class10	3724	for example  a 50  increase in glucose utilization was detected in cortical areas bordering the infarct  
class10	3724	thus  in the normal and infarcted rat  amphetamine appears to promote alternate circuit activation  a pharmacologic property that may be advantageous for recovery after injury  
class10	3725	effects of mk 801 on recovery from sensorimotor cortex lesions  
class10	3725	histologic evidence suggests that drugs acting as noncompetitive antagonists at the n methyl d aspartate receptor can have beneficial or pathologic effects on central nervous system neurons  
class10	3725	in the present experiments we examined the effects of mk 801 on recovery of behavioral function after unilateral lesions in the rat somatic sensorimotor cortex  
class10	3725	in the first experiment  rats with unilateral sensorimotor cortex lesions were given either mk 801  1 mg kg  or saline 12 16 hours after surgery  
class10	3725	additional injections were given on postoperative days 2  4  and 6  
class10	3725	behavioral tests measured somatosensory asymmetries  i e   bilateral tactile stimulation tests  and forelimb placing  
class10	3725	after creation of sensorimotor cortex lesions  rats showed an ipsilateral somatosensory bias and an impairment in placing the contralateral forelimb  
class10	3725	rats treated with mk 801 recovered slightly faster than saline treated animals as measured by a bilateral tactile stimulation test  p less than 0 05   
class10	3725	in contrast  there was no significant difference between the groups in the recovery of forelimb placing  
class10	3725	in a second experiment  rats with sensorimotor cortex lesions were treated with a single injection of mk 801 after behavioral recovery  
class10	3725	twenty hours after the mk 801 injection  rats with sensorimotor cortex lesions showed a reinstatement of the placing deficits  
class10	3725	the impairment endured for at least 7 days after injection  
class10	3725	these behavioral data support the idea that mk 801 can have either beneficial or detrimental effects when administered after brain damage  
class10	3726	ionic channels  cholinergic mechanisms  and recovery of sensorimotor function after neocortical infarcts in rats  
class10	3726	unilateral photochemical infarcts were produced in the hind limb sensorimotor neocortex of 243 rats by intravenous injection of the fluorescein derivative rose bengal and focal illumination of the intact skull surface  
class10	3726	facial contact stimuli governed the degree and recovery rate of contralateral tactile proprioceptive forelimb placing reactions  
class10	3726	contralateral forelimb placing recovered  whereas hind limb placing was resistant to recovery  
class10	3726	infarcted rats displayed marked recovery of spontaneous limb usage  beam traversing   
class10	3726	however  deficits in isolated tactile proprioceptive hind limb placing reactions endured  
class10	3726	posttreatment with the class iv calcium antagonist flunarizine after neocortical infarction protected sensorimotor function in a dose dependent manner  
class10	3726	this protective effect may be due to the peculiar ionic channel blocking profile of flunarizine  
class10	3726	scopolamine hydrobromide reinstated contralateral placing errors in infarcted rats at a dosage that did not affect neurologically intact rats  
class10	3726	the cognitive enhancer sabeluzole  a novel benzothiazol derivative  dose dependently blocked the anticholinergic induced deterioration of a sensorimotor deficit in rats  
class10	3727	magnetic resonance imaging demonstrates that electric stimulation of cerebellar fastigial nucleus reduces cerebral infarction in rats  
class10	3727	we sought to determine whether high spatial resolution magnetic resonance imaging is useful for noninvasive quantitation of the ischemic infarct produced by occlusion of the middle cerebral artery and for detection of reduced infarct volume elicited by electric stimulation of the cerebellar fastigial nucleus  
class10	3727	male rats of the spontaneously hypertensive strain were anesthetized  the middle cerebral artery was occluded  and the fastigial nucleus was stimulated for 1 hour  
class10	3727	twenty four hours later  rats were reanesthetized and t1  and t2 weighted images were obtained  
class10	3727	rats were killed and the volume and distribution of the lesion was established by histopathology  
class10	3727	magnetic resonance imaging estimates of the lesion volume were 271     41 0 mm3  middle cerebral artery  n   5  and 148     8 4 mm3  middle cerebral artery   fastigial nucleus stimulation  n   6  45  reduction  p less than 0 05   
class10	3727	histopathological analysis revealed a lesion of 229 8     15 4 mm3 involving somatosensory cortex  lateral caudate putamen  and lateral hippocampus  
class10	3727	fastigial nucleus stimulation resulted in a 36  reduction in infarct volume to 146 0     10 3 mm3  
class10	3727	the retrieved zone was largely in the cortex dorsal and ventral to the lesion and mostly posterior to the lesion  
class10	3727	the estimates of lesion volume by magnetic resonance imaging and histopathology did not differ and were highly correlated  r   0 90  p less than 0 001   
class10	3727	this study confirms our previous finding that fastigial nucleus stimulation reduces the volume of a focal ischemic infarct and demonstrates that magnetic resonance imaging not only accurately estimates the volume of the lesion but also can detect changes as small as 50 100 mm3  
class10	3728	symptomatic carotid endarterectomy trials  
class10	3728	the possible benefit of carotid endarterectomy in stroke prevention is being evaluated in three major clinical trials  
class10	3728	to date  the european carotid surgery trial has randomized 2 200 patients  30  of whom have a carotid stenosis of greater than 70  appropriate to their symptoms  
class10	3728	the north american symptomatic carotid endarterectomy trial has randomized 1 000 patients  of whom more than half have this severity of appropriate stenosis  
class10	3728	quality control and the evaluation of outcome events in this trial is achieved by a three tier review  including review by medical and surgical adjudicators who are blinded to the treatment arm of each patient  
class10	3728	baseline characteristics of the patients eligible but not randomized are similar to those of patients who have been randomized  
class10	3728	two percent of the patients randomized to the surgical arm have declined surgery and crossed over to the medical arm  and 3  have elected surgery after randomization to the medical arm  
class10	3728	both of these studies  as well as a veterans administration trial  are continuing to randomize patients  
class10	3729	the pathophysiology of anoxic injury in central nervous system white matter  
class10	3729	white matter of the mammalian brain is susceptible to anoxic injury  but little is known about the pathophysiology of this process  
class10	3729	we studied the mechanisms of anoxic injury in white matter using the isolated rat optic nerve  a typical central nervous system white matter tract  
class10	3729	optic nerve function  measured as the area under the compound action potential  rapidly failed when exposed to anoxia  
class10	3729	postanoxic recovery was variable  depending on duration of the anoxic insult  after a standard 60 minute period of anoxia  the compound action potential recovered to 28 5  of control  
class10	3729	irreversible anoxic injury was critically dependent on extracellular ca2   maintaining the tissue in zero  ca2   solution throughout the anoxic period resulted in 100  compound action potential recovery  
class10	3729	increasing perfusate  ca2   during anoxia from zero to 4 mm resulted in progressively less recovery  
class10	3729	anoxic damage to the optic nerve appears to depend on the gradual accumulation  over tens of minutes  of ca2  in a cytoplasmic compartment  
class10	3729	the inorganic ca2  channel blockers mn2   1 mm   co2   1 mm   or la3   0 1 mm  had no effect on recovery of the compound action potential after anoxia  only mg2   10 mm  significantly improved recovery  
class10	3729	treatment with the dihydropyridine ca2  channel blockers nifedipine  1 10 microm  or nimodipine  1 40 microm  also had no effect on recovery from anoxia  
class10	3729	thus  ca2  influx during anoxia does not occur via conventional ca2  channels  
class10	3729	preliminary evidence suggests that this ca2  influx may occur via other cation channels that are imperfectly selective for ca2  or via the na    ca2  exchanger  
class10	3730	putative neuroexcitation in cerebral ischemia and brain injury  
class10	3730	involvement of neuroexcitatory mechanisms in cerebral ischemia and brain injury was explored in experimental models of repetitive forebrain ischemia by temporary occlusion of carotid arteries in gerbils and cryogenic injury to the cerebral cortex in rats and gerbils  
class10	3730	our observations in these models revealed a pattern of injury that involved some anatomic structures outside the areas of direct ischemic or traumatic insult  
class10	3730	such foci of injury revealed conspicuously abnormal uptake of 45ca associated with slight or moderate neuronal alteration  whereas severely injured areas showed no 45ca uptake  
class10	3730	electron microscopic observations revealed a characteristic presence of calcium in swollen dendrites  closely resembling pictures obtained in neuroexcitatory conditions such as epileptic seizures  
class10	3730	abnormal uptake of 45ca was associated with apparent blood brain barrier changes characterized by intracytoplasmic uptake of extravasated albumin into the neurons  
class10	3730	protein synthesis assayed by in vivo  3h leucine incorporation was reduced in regions showing calcium accumulation  
class10	3730	our observations suggest that neuroexcitation may play an important role in development of secondary and chronic changes after ischemic or traumatic brain insults  
class10	3731	platelet activating factor  a putative mediator in central nervous system injury  
class10	3731	platelet activating factor  1 o hexadecyl 2 acetyl sn glycero 3 phosphorylcholine  is a potent lipid autacoid produced by many cell types  
class10	3731	platelet activating factor is produced by cerebellar granule cells in culture and has been extracted from brain tissue  
class10	3731	multiple platelet activating factor receptors have been demonstrated in brain tissue  
class10	3731	activation of platelet activating factor receptors in transformed neuronal cell lines involved increases in intracellular calcium  
class10	3731	platelet activating factor has potent actions on cerebral vessels and cerebral metabolism when administered in vivo  but may not have direct effects on brain microvessels  
class10	3731	excessive platelet activating factor production in pathological states of the nervous system such as neurotrauma and stroke has been shown in only a few models  e g   spinal cord ischemia and reperfusion or focal repercussion brain injury   
class10	3731	in multiple studies using highly specific and potent platelet activating factor antagonists  reversal or prevention of key consequences of brain injury such as hypoperfusion following ischemia  reperfusion and edema  inflammatory cell accumulation  neurologic motor deficits  and neuronal salvage were demonstrated  
class10	3731	this review provides and analyzes evidence in support of the role that platelet activating factor might have in modulation of brain function and pathophysiological processes in brain ischemia and trauma  
class10	3732	bacteremia in an ambulatory setting  improved outcome in children treated with antibiotics  
class10	3732	we undertook a study of 414 bacteremic patients  167 with haemophilus influenzae and 247 with streptococcus pneumoniae bacteremia  to evaluate their clinical presentation  laboratory and clinical results  and subsequent outcomes  
class10	3732	patients with h influenzae bacteremia were more likely to have soft tissue foci  poorer clinical appearance at presentation  and be at higher risk for subsequent serious focal infections  persistent bacteremia  and subsequent hospital admissions than patients with s pneumoniae  
class10	3732	patients with h influenzae bacteremia had a 21 1 fold increase in risk of meningitis  95  confidence interval  ci  of 3 8 to 78 0  compared with those with s pneumoniae  
class10	3732	the odds ratio for initial lumbar puncture was 5 25  95  ci  1 1 23 6    
class10	3732	ambulatory patients treated with antibiotics at presentation were less likely to develop new serious soft tissue infections  persistent bacteremia  or to require subsequent hospital admissions than untreated patients  
class10	3732	the effect of treatment was greater for patients with s pneumoniae than those with h influenzae  
class10	3732	careful follow up and reevaluation of patients with presumptive bacteremia is essential because treated and untreated patients can still develop serious soft tissue infections  
class10	3733	physical features of prader willi syndrome in neonates  
class10	3733	a retrospective study of 16 patients was undertaken to identify physical features that may typify neonates with prader willi syndrome  
class10	3733	several features known to be typical of prader willi syndrome in early infancy were confirmed  including hypotonia and genital hypoplasia  
class10	3733	a number of features that have not previously been emphasized as characterizing prader willi syndrome were also identified  most notably abnormal cry and  in males  signs of genital hypoplasia but with an apparently normal phallus  
class10	3733	other features included disproportionately large head circumference  disproportionately large anterior fontanelle  mild micrognathia  mild anomalies of the gingivae or alveolar ridges  and changes in the appearance of the skin  
class10	3733	appreciation of these features may assist the pediatrician in recognizing the child with prader willi syndrome during the neonatal period  before the appearance of better known findings of later onset  such as obesity and acromicria  
class10	3734	replication patterns of the fragile x in heterozygous carriers  analysis by a brdurd antibody method  
class10	3734	the replication status of the fragile x chromosomes was studied in short term cultures of lymphocytes from six female heterozygous carriers  
class10	3734	the fragile x was induced by adding 0 1 microm fluorodeoxyuridine during the last 24 h of culturing  
class10	3734	the replication status of the x chromosomes was studied using a bromodeoxyuridine  brdurd  antibody method  
class10	3734	brdurd was added  1  at a final concentration of 0 2 micrograms ml during the early s phase of chromosome replication  16 10 h before harvest    2  at 0 2 microgram ml during the late s phase  the last 6 h of culturing    3  at 20 micrograms ml during the early s phase  and  4  at 20 micrograms ml during the late s phase  
class10	3734	brdurd that was incorporated into replicating chromosomes was detected by using a nuclease and brdurd monoclonal antibody  
class10	3734	the frequency of the fragile x was reduced by brdurd treatment  
class10	3734	the degree of reduction was more severe in the 20 micrograms ml than in the 0 2 microgram ml series and was more severe with late s than with early s treatment  
class10	3734	of the early  and late replicating fragile x chromosomes  those which were actively replicating during a brdurd treatment were more reduced than the others  
class10	3734	thus  the average rate of early and late s treatment with 0 2 microgram brdurd ml was assumed to be the closest reflection of the situation in vivo  
class10	3734	there was no correlation between the average rate of the early replicating  active fragile x and the intelligence of the heterozygous carriers studied  
class10	3735	serum aldolase isozyme levels in patients with cerebrovascular diseases  
class10	3735	a subunit specific radioimmunoassay was developed for the quantification of human aldolase a  b  and c  
class10	3735	the method used was a double antibody radioimmunoassay using radioiodinated purified aldolase a  b  or c subunits as the ligand  specific chicken antibodies to aldolase isozymes and rabbit antibodies to chicken igg  
class10	3735	the iodogen method was used for iodination of the purified isozyme subunits in this study  
class10	3735	human brain tissue contained similar concentrations of aldolase a and aldolase c  and a smaller amount of aldolase b  which was the main isozyme of liver tissue  
class10	3735	levels of serum aldolase a were greater than 203 ng ml  the upper limit of normal  in six of 24 patients with cerebral infarction and in 11 of 31 patients with cerebral hemorrhage  
class10	3735	nine of 24 patients with cerebral infarction and 16 of 31 patients with cerebral hemorrhage had serum aldolase c levels greater than 4 1 ng ml  the upper limit in normal sera  
class10	3735	these data suggest that serum aldolase c may be a more specific and sensitive marker of cerebrovascular diseases than aldolase a  
class10	3735	we also demonstrated that serial measurement of serum aldolase c in patients with cerebrovascular diseases might be useful in estimating prognosis  since serially increasing serum aldolase c levels during the course of these diseases were correlated with a high mortality rate  
class10	3736	the  stuck twin  phenomenon  ultrasonographic findings  pregnancy outcome  and management with serial amniocenteses  
class10	3736	thirteen consecutive twin pregnancies affected by the  stuck twin  phenomenon were reviewed to determine the potential benefit of serial amniocenteses  
class10	3736	the fetal survival rate for the eight pregnancies that underwent serial amniocenteses was 69   11 of 16 fetuses   
class10	3736	this is significantly improved compared with a fetal survival rate of 20  among the five preceding pregnancies managed without serial amniocenteses at the same institution  p   0 01   
class10	3736	it is also markedly improved compared with a combined fetal survival rate of 16  among 48 previously reported pregnancies with the stuck twin phenomenon managed without serial amniocenteses  p less than 0 0001   
class10	3736	survival correlated with the absence of concomitant pregnancy complications  i e   maternal hypertension or intractable labor  and with the absence of severe fetal structural abnormalities  
class10	3736	procedural complications occurred in three of eight pregnancies  37 5   managed with serial amniocenteses and was attributed as a cause of fetal death in one case  
class10	3736	two of 11 survivors  18   had complications after serial amniocenteses including brain infarction and renal tubular necrosis  
class10	3736	serial amniocenteses may significantly improve the survival rate of twin gestations affected by the stuck twin phenomenon but may be associated with complications among survivors  
class10	3737	pregnancy in a patient with treated wilson s disease  a case report  
class10	3737	pregnancy should have a successful outcome in a patient with treated wilson s disease if complications are excluded before conception  
class10	3737	chelating treatment must be maintained  although there is some concern about its teratogenicity  
class10	3737	we describe the course of pregnancy in a patient followed up in our department  
class10	3738	prenatal diagnosis of fetal intracranial calcifications  
class10	3738	a case is presented wherein fetal intracranial calcifications as a result of intrauterine cytomegalovirus infection were visualized by computed tomography and magnetic resonance imaging at 36 weeks  gestation  
class10	3738	diagnosis of in utero cytomegalovirus infection was made by isolation of the virus from amniotic fluid  
class10	3738	no symptomatic abnormality has been noted in the neonatal period except periventricular calcifications  
class10	3739	practical aspects of pulsatile gonadotropin releasing hormone administration  
class10	3739	pulsatile administration of gonadotropin releasing hormone represents a major advance in the treatment of anovulation in women who fail to ovulate with clomiphene citrate and is an alternative for many women who currently receive human menopausal gonadotropin  
class10	3739	four issues must be addressed before administering pulsatile gonadotropin releasing hormone   1  safety   2  efficacy   3  convenience  and  4  cost  
class10	3739	each of these issues will be affected by the three major decisions a physician makes with gonadotropin releasing hormone therapy   1  patient selection   2  route of administration  and  3  dose of gonadotropin releasing hormone  
class10	3739	the ideal candidate for gonadotropin releasing hormone therapy is a patient with an absence of endogenous pulsatile gonadotropin releasing hormone  as seen in hypothalamic amenorrhea  
class10	3739	although women with polycystic ovarian disease can be treated with pulsatile gonadotropin releasing hormone  a decreased ovulation rate should be expected  
class10	3739	the route of administration  intravenous or subcutaneous  and the degree of monitoring can be tailored by the physician to fit each patient s needs  
class10	3739	pulsatile gonadotropin releasing hormone therapy is a safe  effective  convenient  and economical alternative to human menopausal gonadotropin for ovulation induction in women resistant to clomiphene  
class10	3740	orbital intramuscular schwannoma  
class10	3740	in an 8 year old girl with asymptomatic proptosis  computed tomographic scans showed a large medial orbital mass that contoured the globe anteriorly  bowed the optic nerve laterally  and extended posteriorly to the orbital apex  
class10	3740	t1 weighted coronal magnetic resonance images showed the mass to be a diffusely enlarged medial rectus muscle  
class10	3740	histopathologic examination of a medial rectus muscle biopsy specimen disclosed a multinodular  intramuscular schwannoma  separating and infiltrating normal skeletal muscle fibers  
class10	3740	the intramuscular location and multinodular configuration of this tumor  together with its occurrence in a child  distinguish it from previous orbital schwannomas  
class10	3741	south american blastomycosis  ophthalmic and oculomotor nerve lesions  
class10	3741	a case of south american blastomycosis began with an oropharyngeal lesion which was followed by a granulomatous uveitis  
class10	3741	the patient was treated with amphotericin b and showed a clinical regression  
class10	3741	four months later  he developed a right 3rd cranial nerve palsy  aggravating the clinical aspect with a severe generalized involvement of the central nervous system and death  
class10	3741	necropsy showed blastomycotic meningoencephalitis  
class10	3742	attenuation of suxamethonium myalgias  effect of midazolam and vecuronium  
class10	3742	we studied the incidence of fasciculations and postoperative myalgias in 100 female outpatients who had laparoscopy under thiopentone  n2o  isoflurane anaesthesia  
class10	3742	four groups of 20 patients each were pretreated with saline  group 1   tubocurarine 0 05 mg kg  group 2   vecuronium 0 006 mg kg  group 3   or midazolam 0 025 mg kg  group 4   followed by suxamethonium 1 5 mg kg  
class10	3742	group 5 received only vecuronium 0 1 mg kg as relaxant  no suxamethonium   
class10	3742	fasciculations were graded  and postoperative myalgias rated on the first and third postoperative days  
class10	3742	in groups 1 5 the incidence of fasciculations was 95  15  25  95 and 0   the incidence of myalgias on the first day after operation was 70  45  65  75 and 60   and on the third day after operation 20  5  20  20  and 5   respectively  
class10	3742	we conclude that pretreatment with vecuronium  but not midazolam  decreases the incidence of fasciculations after suxamethonium  p less than 0 05  and that in this patient population  postoperative myalgias appear to be unrelated to the use of suxamethonium  
class10	3743	spinal catheter anaesthesia for caesarean section in a patient with spina bifida  
class10	3743	a patient with grossly deformed vertebral anatomy  scheduled for elective caesarean section  expressed her wish to stay fully awake during the procedure  
class10	3743	epidural anaesthesia was considered to be impracticable  while dural puncture appeared possible only at thoracic level  
class10	3743	spinal anaesthesia using a subarachnoid catheter placed at t7 8 was employed successfully  
class10	3744	the woolley and roe case  a reassessment  
class10	3744	in 1953  two patients  cecil roe and albert woolley  sued their anaesthetist for alleged negligence because they had developed painful spastic paraparesis after spinal anaesthesia  
class10	3744	the court found that phenol  which was used to sterilise the outside of the ampoules of local anaesthetic  had percolated the glass through invisible cracks  contaminating the solution  but that the anaesthetist could not have been aware of this risk  
class10	3744	the case was important  despite the fact that judgement was in favour of the anaesthetist  because of the fears that it generated over the incidence of paralysis after spinal anaesthesia  
class10	3744	the  invisible crack  theory has been the subject of much scepticism  
class10	3744	new information has been obtained  and the case re examined objectively  
class10	3744	the most probable source of contamination  which led to paralysis in the two patients  and in a third who received spinal anaesthesia on the same day  has been identified  
class10	3744	a similar explanation may lie behind a number of other episodes of paralysis associated with spinal anaesthesia  
class10	3745	autonomic dysfunction and guillain barre syndrome  the use of esmolol in its management  
class10	3745	a 17 year old girl with guillain barre syndrome and autonomic dysfunction was treated successfully with esmolol  
class10	3745	esmolol may be an appropriate drug for the rapid assessment and control of tachyarrhythmias in critically ill patients  
class10	3746	loss of consciousness after emergence from anaesthesia  a case of suspected micturition syncope  
class10	3746	a case of postanaesthesia micturition syncope with respiratory arrest is described  
class10	3746	if syncope occurs  the temporary myocardial ischaemia and cerebral hypoperfusion may increase anaesthetic risk in the marginally compensated patient  
class10	3746	the loss of airway protection during the syncopal period is also a cause of concern  
class10	3746	we recommend the use of an indwelling bladder catheter during any prolonged surgical procedure  
class10	3747	an evaluation of a 30 gauge needle for spinal anaesthesia for caesarean section  
class10	3747	a 30 gauge spinal needle was evaluated for caesarean section  using a combined epidural spinal technique  in 50 mothers  
class10	3747	spinal anaesthesia failed in six mothers and was inadequate in another six  
class10	3747	general anaesthesia was required on one occasion  
class10	3747	a 25  overall failure rate suggests that a 30 gauge needle is not a practical proposition for routine clinical practice  
class10	3748	intrathecal anaesthesia for day care surgery  a retrospective study of 160 cases using 25  and 26 gauge spinal needles  
class10	3748	the records of 160 day care surgical patients who received intrathecal anaesthesia were reviewed  
class10	3748	no major complications were recorded  
class10	3748	the incidence of postspinal headache after puncture with a 25 gauge spinal needle was nearly four times more frequent compared to a 26 gauge needle  
class10	3748	the occurrence of postspinal headache in patients over the age of 45 years was significantly less frequent  p less than 0 05  than in younger patients  
class10	3748	intrathecal anaesthesia was acceptable to 91  of outpatients in this group  
class10	3749	relief of injection pain in adults  emla cream for 5 minutes before venepuncture  
class10	3749	the effectiveness of skin anaesthesia after 5 minutes  topical application of a lignocaine prilocaine cream was evaluated  
class10	3749	one hundred and twenty patients estimated the pain of antecubital venepuncture both on a linear scale and verbally after use of the cream for either 5 or 60 minutes  a placebo cream or no treatment  
class10	3749	reported pain was significantly less after only 5 minutes of the lignocaine prilocaine cream  p   0 002   
class10	3749	the cream can be used to relieve the pain of all routine injections  
class10	3750	resistance to atracurium induced neuromuscular blockade in patients with intractable seizure disorders treated with anticonvulsants  
class10	3750	previous studies have demonstrated that  with the exception of atracurium  resistance to the neuromuscular blocking effects of various muscle relaxants develops in patients receiving anticonvulsant therapy  
class10	3750	we studied the effects of 0 5 mg kg iv atracurium in 53 neurosurgical patients  21 nonepileptic patients receiving no anticonvulsant therapy  med   0   14 epileptic patients treated with carbamazepine for years  med   1   and 18 epileptic patients treated with carbamazepine plus either phenytoin or valproic acid for years  med   2   
class10	3750	the evoked compound electromyogram of the adductor pollicis brevis was recorded  and results were analyzed using analysis of covariance  with weight and age as covariables  
class10	3750	the onset time was not significantly different among the three groups  
class10	3750	times for recovery of baseline and train of four responses to stimuli were significantly shorter in the med   1 and med   2 groups than in control patients  med   0   
class10	3750	the recovery index  time between 25  and 75  recovery of baseline electromyogram values  was progressively shorter in the three groups  med   0  8 02 min  med   1  5 93 min  med   2  1 96 min  p less than 0 001   
class10	3750	this study demonstrates that atracurium  when used on epileptic patients requiring long term  that is  years of  anticonvulsant therapy  has a shorter duration of action than when used in nonepileptic patients  
class10	3751	infection during chronic epidural catheterization  diagnosis and treatment  
class10	3751	a potentially serious complication of long term epidural catheterization in cancer patients is infection  
class10	3751	the early signs of infection were studied in 350 patients in whom long term epidural catheters were inserted  
class10	3751	three areas of the catheter track were found to be involved  exit site and superficial catheter track infection  and epidural space infection  
class10	3751	the authors identified the early signs of infection in each area and the progress of the infection from the deep track to include the epidural space in four of these patients  
class10	3751	all 19 patients who developed deep track or epidural infections were successfully treated with antibiotics and catheter removal  
class10	3751	none of the patients required surgery for spinal cord decompression  
class10	3751	catheters were replaced in 15 of the 19 treated patients who requested them after treatment with no recurrent infections  
class10	3751	it was concluded that use of long term epidural catheterization is associated with a definable epidural infection rate  
class10	3751	the use of epidural opioid analgesia is an effective and safe means of obtaining pain relief for terminally ill patients when patients are monitored for possible infection and receive prompt treatment when the diagnosis is established  
class10	3752	differential effect of oncotic pressure on cerebral and extracerebral water content during cardiopulmonary bypass in rabbits  
class10	3752	to study the effect of oncotic pressure on brain water content during cardiopulmonary bypass  cpb   14 anesthetized new zealand white rabbits underwent 60 min of nonpulsatile cpb at normothermia  
class10	3752	animals were grouped according to the composition of the circuit priming fluid  
class10	3752	group 1 animals  n   7  received a priming fluid  6 5  hydroxyethyl starch in 0 72 n nacl  323     13 mosm kg  mean     sd   that maintained normal colloid oncotic pressure  cop  during cpb  19 0     1 5 mmhg   
class10	3752	group 2 animals  n   7  received a priming fluid  0 9 n nacl  324     23 mosm kg  that led to a hypooncotic state  cop   6 2     1 2 mmhg   
class10	3752	blood chemistries and hemodynamics were recorded every 15 min during cpb  
class10	3752	animals were given additional priming fluid and sodium bicarbonate during cpb to maintain a circuit flow of 85 ml kg 1 min 1 and arterial ph greater than 7 35  
class10	3752	there were no significant differences between groups 1 and 2 with respect to temperature  central venous pressure  mean arterial pressure  pao2  paco2  plasma sodium concentration  or osmolality at any time during cpb  although osmolality increased in both groups  
class10	3752	after 60 min of bypass  animals were killed and organ water contents were determined by wet dry weight ratios  
class10	3752	a separate group of nine similarly prepared and anesthetized animals that did not undergo cannulation or cpb also underwent measurement of plasma chemistries and tissue water contents and served as nonbypass controls  group 3   
class10	3752	brain and kidney water contents were unaffected by oncotic pressure  whereas duodenum and skeletal muscle had significantly greater water content  p   0 003 and p   0 008  respectively  after hypooncotic cpb  
class10	3753	buffered versus plain lidocaine as a local anesthetic for simple laceration repair  
class10	3753	study objective  buffered lidocaine was compared with plain lidocaine as a local anesthetic for simple lacerations  
class10	3753	design  randomized  double blind  prospective clinical trial  
class10	3753	setting  urban emergency department  
class10	3753	type of participants  ninety one adult patients with simple linear lacerations were enrolled  
class10	3753	patients with allergy to lidocaine and patients with an abnormal mental status were excluded  
class10	3753	interventions  each wound edge was anesthetized with either plain or buffered lidocaine using a randomized  double blind protocol  
class10	3753	the pain of infiltration was measured with a previously validated visual analog pain scale  
class10	3753	measurements and main results  analysis of pooled data and paired data  using patients as their own controls  revealed that infiltrating buffered lidocaine was significantly less painful than plain lidocaine  p    03 and p    02  respectively   
class10	3753	there was no significant difference in the anesthetic effectiveness of the two agents during suturing  
class10	3753	conclusion  buffered lidocaine is preferable to plain lidocaine as a local anesthetic agent for the repair of simple lacerations  
class10	3754	neurologic complications of cocaine abuse  
class10	3754	the neurologic complications of cocaine toxicity are responsible for a major portion of the morbidity and mortality associated with cocaine  
class10	3754	most of the complications appear to be related to the hyperadrenergic state induced by cocaine and may be treated symptomatically  
class10	3754	diazepam is the most effective drug for cocaine induced seizures  
class10	3755	occipital condyle fracture presenting as retropharyngeal hematoma  
class10	3755	reported is the case of a 30 year old male motorcycle accident victim who was found on plain cervical spine radiography to have prevertebral soft tissue swelling  
class10	3755	although subsequent computed tomography demonstrated no cervical spine fracture  it did reveal a fracture of one occipital condyle  
class10	3755	the mechanism  diagnosis  and treatment of occipital condyle fractures are reviewed  as is the ligamentous and fascial anatomy of the cervicocranium  
class10	3755	dissection of fracture hematoma inferiorly along vertically oriented tissue planes is hypothesized as the pathogenesis of our patient s retropharyngeal hematoma  
class10	3755	in addition to being a sign of potential cervical spine injury  post traumatic prevertebral soft tissue swelling may also indicate occipital condyle fracture  
class10	3755	to avoid overlooking such fractures  computed tomography undertaken to investigate upper cervical spine prevertebral soft tissue swelling should always include slices up to the level of the basal skull so as to visualize the condyles  
class10	3756	erythromycin failure with subsequent pasteurella multocida meningitis and septic arthritis in a cat bite victim  
class10	3756	we report the case of a 75 year old woman who developed pasteurella multocida meningitis and septic arthritis while being treated for a cat bite wound infection with erythromycin  
class10	3756	review of the literature revealed that erythromycin has poor in vitro activity against this bacterium and has been associated with serious clinical failures  
class10	3756	we recommend that erythromycin not be prescribed for empiric therapy of established animal bite infections  
class10	3756	suggestions for optimal empiric therapy of animal bite infections and the differential diagnosis of severe cat bite associated sepsis are discussed  
class10	3757	distinguishable types of dyspnea in patients with shortness of breath  
class10	3757	dyspnea frequently accompanies a variety of cardiopulmonary abnormalities  
class10	3757	although dyspnea is often considered a single sensation  alternatively it may encompass multiple sensations that are not well explained by a single physiologic mechanism  
class10	3757	to investigate whether breathlessness experienced by patients represents more than one sensation  we studied 53 patients with one of the following seven conditions  pulmonary vascular disease  neuromuscular and chest wall disease  congestive heart failure  pregnancy  interstitial lung disease  asthma  and chronic obstructive pulmonary disease  
class10	3757	patients were asked to choose descriptions of their sensation s  of breathlessness from a dyspnea questionnaire listing 19 descriptors  
class10	3757	cluster analysis was used to identify natural groupings among the chosen descriptors  
class10	3757	we found that patients could distinguish different sensations of breathlessness  
class10	3757	in addition  we found an association between certain groups of descriptors and specific conditions producing dyspnea  
class10	3757	these findings concur with those in an earlier study in normal volunteers in whom dyspnea was induced by various stimuli  
class10	3757	we conclude that different types of dyspnea exist in patients with a variety of cardiopulmonary abnormalities  
class10	3757	furthermore  different mechanisms may mediate these various sensations  
class10	3758	carotid endarterectomy for elderly patients  predicting complications 
class10	3758	objective  to determine whether the complication or death rate from carotid endarterectomy can be predicted from hospital and physician structural variables  such as the hospital s teaching status or the number of endarterectomies done by the surgeon per year  
class10	3758	design  survey of medical records  
class10	3758	after controlling for the severity of the patient s condition on the basis of data in the medical record at the time of the endarterectomy  regression analyses were used to predict the postoperative stroke  heart attack  and 30 day death rate as a function of patient  physician  and hospital characteristics  
class10	3758	setting  three geographic areas  states or large parts of states  average population  3 million  in the united states  
class10	3758	patients  random sample of 1302 patients 65 years of age or older having carotid endarterectomy in 1981  
class10	3758	intervention  carotid endarterectomy  
class10	3758	measurements and main results  of 1302 patients  11 3  had a postoperative stroke or heart attack or died within 30 days of the operation  
class10	3758	patient age  race  income  and gender  physician volume  board certification status  and age  and hospital size  for profit status  ownership  and teaching status were not significantly related to the postoperative complication or death rate  
class10	3758	if the surgeon was a graduate of a foreign  but not a western european or canadian  medical school  however  the average complication or death rate rose from 10 4  to 19 6   p less than 0 05   
class10	3758	conclusions  the effectiveness of carotid endarterectomy depends heavily on its complication rate  
class10	3758	because complications after surgery cannot  in general  be predicted from structural variables  referring physicians cannot rely solely on the surgeon s experience and qualifications when recommending a carotid endarterectomy  
class10	3758	the surgeon s and the hospital s actual postoperative complication and death rate should be considered  
class10	3759	emergence of recreational drug abuse as a major risk factor for stroke in young adults 
class10	3759	objective  to investigate the clinical and epidemiologic relations between recreational drug abuse and stroke in young persons  
class10	3759	design  a case control study based on medical records  
class10	3759	setting  san francisco general hospital  a 400 bed municipal hospital  
class10	3759	patients  consecutive sample of 214 patients aged 15 to 44 years  admitted between 1979 and 1988 with a diagnosis of ischemic or hemorrhagic stroke  
class10	3759	an equal number of control patients admitted with diagnoses of status asthmaticus  acute appendicitis  or acute cholecystitis were matched to stroke patients by age  sex  and year of hospitalization  
class10	3759	measurements and main results  seventy three patients with stroke  34   were drug abusers compared with 18  8   of the controls  
class10	3759	in 47 patients with stroke  temporal proximity of drug administration  n   34  or infectious endocarditis  n   13  suggested a direct association between drug abuse and stroke  
class10	3759	after controlling for other identifiable stroke risk factors  the estimated relative risk for stroke among drug abusers compared with that among non drug abusers was 6 5  95  ci  3 1 to 13 6   and this increased to 49 4  ci  6 4 to 379 0  for those patients whose symptoms began within 6 hours of drug administration  
class10	3759	among patients less than 35 years of age  drug abuse was the most commonly identified potential predisposing condition  47    and it was the only condition with a significantly elevated relative risk for stroke  11 7  ci  3 2 to 42 5   
class10	3759	further  a substantial rise in the proportion of drug related strokes was observed in the last 3 years of the study  31  in 1986 to 1988  compared with 15  in 1979 to 1985  p   0 008   
class10	3759	cocaine  especially recently  was the drug used most frequently in drug related strokes  
class10	3759	conclusion  in an urban population such as ours  recreational drug abuse appears to be a prominent and growing risk factor for strokes in young adults  
class10	3760	improving outcomes of analgesic treatment  is education enough  
class10	3760	frequent undertreatment of analgesic responsive acute pain and chronic cancer pain persists  despite intensive efforts to provide clinicians with information about analgesics  
class10	3760	a set of background factors must be addressed in interventions to improve pain treatment  traditional patterns of clinician and patient interaction on the ward  quality assurance  and drug regulatory practices do not support prompt recognition and treatment of pain  
class10	3760	possible interventions to modify these patterns of daily practice include monitoring and displaying patient pain ratings routinely  making available educational tools to assist optimal drug ordering  encouraging patients to communicate about unrelieved pain  reviewing quality assurance of pain treatment regimens  increasing behavioral research into analgesic prescribing  and selectively modifying narcotics regulatory practices  
class10	3761	clarifying confusion  the confusion assessment method  a new method for detection of delirium 
class10	3761	objective  to develop and validate a new standardized confusion assessment method  cam  that enables nonpsychiatric clinicians to detect delirium quickly in high risk settings  
class10	3761	design  prospective validation study  
class10	3761	setting  conducted in general medicine wards and in an outpatient geriatric assessment center at yale university  site 1  and in general medicine wards at the university of chicago  site 2   
class10	3761	patients  the study included 56 subjects  ranging in age from 65 to 98 years  
class10	3761	at site 1  10 patients with and 20 without delirium participated  at site 2  16 patients with and 10 without delirium participated  
class10	3761	measurements and main results  an expert panel developed the cam through a consensus building process  
class10	3761	the cam instrument  which can be completed in less than 5 minutes  consists of nine operationalized criteria from the diagnostic and statistical manual of mental disorders  dsm iii r   
class10	3761	an a priori hypothesis was established for the diagnostic value of four criteria  acute onset and fluctuating course  inattention  disorganized thinking  and altered level of consciousness  
class10	3761	the cam algorithm for diagnosis of delirium required the presence of both the first and the second criteria and of either the third or the fourth criterion  
class10	3761	at both sites  the diagnoses made by the cam were concurrently validated against the diagnoses made by psychiatrists  
class10	3761	at sites 1 and 2 values for sensitivity were 100  and 94   respectively  values for specificity were 95  and 90   values for positive predictive accuracy were 91  and 94   and values for negative predictive accuracy were 100  and 90   
class10	3761	the cam algorithm had the highest predictive accuracy for all possible combinations of the nine features of delirium  
class10	3761	the cam was shown to have convergent agreement with four other mental status tests  including the mini mental state examination  
class10	3761	the interobserver reliability of the cam was high  kappa   0 81   1 0   
class10	3761	conclusions  the cam is sensitive  specific  reliable  and easy to use for identification of delirium  
class10	3762	stroke in pediatric acquired immunodeficiency syndrome  
class10	3762	in a 4 1 2 year period  4 of 68 children in a longitudinal study of neurological complications of human immunodeficiency virus  hiv  infection had clinical and or neuroradiological evidence of stroke  yielding a clinical incidence of stroke in this population of 1 3  per year  
class10	3762	during this period  32 subjects died  and permission for autopsy was granted in 18 of the patients  including 3 of 4 who had clinical evidence of stroke  
class10	3762	the prevalence of cerebrovascular pathological features in our consecutive autopsy series was higher than the clinical incidence  
class10	3762	at autopsy cerebrovascular disease was documented in 6  24   of 25 children with hiv infection  including all 3 children who had clinical evidence of stroke  
class10	3762	four patients had intracerebral hemorrhages  6 patients had nonhemorrhagic infarcts  and 3 had both  
class10	3762	hemorrhage was catastrophic in 1 child and clinically silent in 3 children  all of whom had immune thrombocytopenia  
class10	3762	one child had an arteriopathy that affected meningocerebral arteries  
class10	3762	in another child  the arteries of the circle of willis were aneurysmally dilated  
class10	3762	two children had coexisting cardiomyopathy and subacute necrotizing encephalomyelopathy with vascular proliferation  
class10	3762	these results suggest that stroke should be considered when children with hiv infection develop focal neurological signs  
class10	3763	myasthenic thymus and thymoma are selectively enriched in acetylcholine receptor reactive t cells  
class10	3763	we compared t cell proliferative responses to acetylcholine receptor  achr  and to purified protein derivative  ppd   of tuberculin  of hyperplastic thymus  thymoma  and blood cells from patients with myasthenia gravis  mg   
class10	3763	hyperplastic mg thymus cells gave significantly higher and more consistent responses to achr than parallel cultures of autologous blood cells  whereas responses to ppd showed an opposite trend  
class10	3763	thus there was a preferential localization of achr reactive t cells in the hyperplastic mg thymus  
class10	3763	furthermore  there was a strong correlation between blood and thymus cell responses to ppd  but not to achr   arguing that the hyperplastic mg thymus contains a sample of sensitized peripheral t cells  
class10	3763	by contrast  both achr  and ppd responsive t cells were almost undetectable in thymus from nonmyasthenic patients  which is evidently much less receptive to circulating t cells  
class10	3763	cells from mg thymomas showed the highest stimulations by achr but did not consistently react to ppd  
class10	3763	however  the uninvolved thymus adjacent to these thymomas behaved almost identically to the hyperplastic samples described above  
class10	3763	our interpretation is that achr specific t cells are initially sensitized in the mg thymoma but are selectively trapped in the hyperplastic thymus after being primed elsewhere  
class10	3764	auras and subclinical seizures  characteristics and prognostic significance  
class10	3764	the characteristics and prognostic significance of subclinical seizures and independent auras were studied in 40 patients with partial epilepsy who had long term electroencephalographic  eeg  monitoring with intracranial electrodes  
class10	3764	focal  restricted subclinical seizures were noted in 23 patients  and 11 patients experienced auras that were accompanied by ictal eeg discharges  
class10	3764	auras and subclinical seizures usually were identical in eeg appearance  but were distributed differently among patients  
class10	3764	the subclinical seizures and auras usually had the same origin as complex partial seizures  but did not always reliably indicate complex partial seizure origin  
class10	3764	subclinical seizures and auras were of favorable prognostic significance for patients undergoing temporal lobectomy  
class10	3764	a majority  greater than 80   of individuals with subclinical seizures and auras were free of complex partial seizures after surgery  whereas a minority  29   of patients without subclinical seizures and auras became free of complex partial seizures  
class10	3765	increased mepp frequency as an early sign of experimental immune mediated motoneuron disease  
class10	3765	intracellular recordings of miniature end plate potentials were performed in extensor digitorum longus muscles from guinea pigs with experimental immune mediated motoneuron destruction  
class10	3765	in the early stages of the disease  the miniature end plate potential frequency was elevated compared to that in control and normal animals  
class10	3765	the amplitude and time course of the miniature end plate potentials as well as the resting potential of the muscle fibers were not altered  which implies integrity of the postjunctional membrane  
class10	3765	the increase in frequency of miniature end plate potential reflects an increase of basal acetylcholine release and documents dysfunction of the presynaptic terminal of the neuromuscular junction  
class10	3765	the increased frequency was associated with high levels of antimotoneuronal igg in the blood and the presence of igg at motor end plates  
class10	3765	these data suggest that the presynaptic terminal of the neuromuscular junction may be involved in the immune attack in animal models of motoneuron degeneration  
class10	3766	anoxic injury of mammalian central white matter  decreased susceptibility in myelin deficient optic nerve  
class10	3766	the rat optic nerve  a typical central nervous system white matter tract  rapidly loses excitability when it is exposed to anoxia and is irreversibly damaged by prolonged anoxia  
class10	3766	neonatal optic nerve is extremely resistant to anoxia induced dysfunction and injury  the adult pattern of response to anoxia appears between 10 and 20 days postnatal  that is  during the period of oligodendroglial proliferation and myelination  
class10	3766	to test the hypothesis that myelination  or associated events  confer anoxic susceptibility on developing white matter  we analyzed the effects of anoxia on the myelin deficient  md  strain of rat  
class10	3766	acutely isolated optic nerves from 19  to 21 day old md rats and control optic nerves from unaffected male littermates were maintained in vitro at 37 degrees c  and exposed to a standard 60 minute period of anoxia  
class10	3766	the supramaximal compound action potential was recorded and amplitude of the compound action potential  expressed as   of amplitude before anoxic exposure  was determined  
class10	3766	the compound action potential was nearly abolished within 3 to 6 minutes after onset of anoxia in control optic nerves  while optic nerves from md rats displayed a slower decrease in compound action potential amplitude during anoxia  with a distinct action potential present even after 60 minutes of anoxia  
class10	3766	optic nerves from md rats showed significantly greater recovery of compound action potential  71     25   than did control optic nerves  33     21   p less than 0 02  after 60 minutes of anoxia  
class10	3766	these findings support the hypothesis that myelination  or changes associated with it  may be important in the development of anoxic susceptibility in central white matter  
class10	3767	substantia nigra  a site of action of muscle relaxant drugs  
class10	3767	sites of action of centrally active muscle relaxant drugs are not well defined  
class10	3767	clinical experience with such drugs suggests that the spinal cord may be one of the important regions from which pathologically increased muscle tone may be relieved  
class10	3767	supraspinal centers that may also be involved in the expression of muscle relaxant action have not yet been defined  
class10	3767	we report here that microinjections of therapeutically relevant muscle relaxants into the midbrain tegmentum of genetically spastic rats decrease muscle tone  
class10	3767	the substantia nigra is the region from which midazolam  baclofen  and tizanidine  drugs used clinically in the treatment of spasticity   or gamma vinyl gaba      2 amino 7 phosphonoheptanoate  and  d pro2 d phe7 d trp9  substance p  experimental drugs active in animal models of spasticity   reduce muscle tone in genetically spastic rats and hoffmann reflexes in normal rats  
class10	3767	the effects of muscle relaxant drugs are topographically restricted to the substantia nigra pars reticulata and are receptor specific  
class10	3767	these observations disclose a previously unknown function of the substantia nigra in mediating muscle relaxation  
class10	3768	polyneuropathy  ophthalmoplegia  leukoencephalopathy  and intestinal pseudo obstruction  polip syndrome  
class10	3768	we describe 5 individuals  from three separate families  with a progressive neurological disorder characterized by sensorimotor peripheral polyneuropathy  cranial neuropathies  external ophthalmoplegia  deafness   and the syndrome of chronic intestinal pseudo obstruction  
class10	3768	magnetic resonance imaging showed widespread abnormality of the cerebral and cerebellar white matter in the 2 patients studied  
class10	3768	autopsy examination in 3 revealed widespread endoneurial fibrosis and demyelination in the peripheral nervous system  possibly secondary to axonal atrophy  and poorly defined changes in cerebral white matter  leukoencephalopathy   
class10	3768	the cranial nerves and spinal roots were less severely involved and the neurons in the brainstem and spinal cord were intact  
class10	3768	the fatal gastrointestinal dysmotility was due to a severe visceral neuropathy  
class10	3768	we suggest that these patients manifested a hereditary disorder with distinctive clinical  radiological  and neuropathological features  and propose the acronym polip to emphasize the distinctive tetrad of polyneuropathy  ophthalmoplegia  leukoencephalopathy  and intestinal pseudo obstruction  
class10	3769	major histocompatibility complex antigen expression in the affected tissues in amyotrophic lateral sclerosis  
class10	3769	monoclonal antibody immunocytochemistry was used to examine spinal cord and muscle in amyotrophic lateral sclerosis for changes that would indicate ongoing or potential immune activity  
class10	3769	increased expression of class i and ii major histocompatibility complex  mhc  antigens was seen in the affected areas of spinal cord  
class10	3769	new mhc expression was concentrated in phagocytes  particularly in degenerating white matter in which they were dispersed in the tissue and also packed around blood vessels  
class10	3769	mhc antigen was not revealed in motor neurons or skeletal muscle fibers  
class10	3769	an anti pan t cell monoclonal revealed small numbers of t cells in degenerating white matter  
class10	3769	similar changes have been seen in other neurodegenerative disorders  
class10	3769	they suggest a potential for  secondary  cell mediated activity in the affected areas rather than an ongoing mhc restricted t cell response  
class10	3769	vessel associated phagocytes may be a source of antigen to peripheral lymphoid tissue  stimulating production of the autoantibodies that have been described  
class10	3770	igm deposits at nodes of ranvier in a patient with amyotrophic lateral sclerosis  anti gm1 antibodies  and multifocal motor conduction block  
class10	3770	we studied a patient with amyotrophic lateral sclerosis  multifocal motor conduction block  and igm anti gm1 antibodies  
class10	3770	a sural nerve biopsy demonstrated deposits of igm at nodes of ranvier by direct immunofluorescence  
class10	3770	the deposits were granular and located in the nodal gap between adjacent myelin internodes  and in some instances  they extended along the surface of the paranodal myelin sheath  
class10	3770	when injected into rat sciatic nerve  the serum igm bound to the nodes of ranvier  and the binding activity was removed by preincubation with gm1  
class10	3770	these observations suggest that anti gm1 antibodies may have caused motor dysfunction by binding to the nodal and paranodal regions of peripheral nerve  
class10	3771	spinal cord compression with paraplegia in xanthomatosis due to normocholesterolemic sitosterolemia  
class10	3771	a 48 year old woman with a 30 year history of tendinous xanthomatosis developed paraplegia  
class10	3771	the magnetic resonance image revealed extramedullary tumors  
class10	3771	the analysis of her sera and tumors revealed increased amount of plant sterols  especially sitosterol  and the diagnosis of sitosterolemia was made  
class10	3771	this is the first reported case of a patient with sitosterolemia who had the neurological complication of spinal cord compression due to extramedullary sitosterolemic xanthomas  
class10	3772	ichthyosis  mental retardation  and asymptomatic spasticity  a new neurocutaneous syndrome with normal fatty alcohol nad  oxidoreductase activity  
class10	3772	a number of inherited disorders of cornification have been related to abnormal lipid metabolism  
class10	3772	in the recessively inherited sjogren larsson syndrome  defined by the triad of ichthyosis  mental retardation  and spasticity  fatty alcohol nad  oxidoreductase deficiency has recently been reported  
class10	3772	these patients accumulate fatty alcohol in the plasma and cultured fibroblasts  
class10	3772	a 19 year old woman with ichthyosis  mental retardation  and mild spasticity is described in whom fatty alcohol metabolism was normal  as determined by plasma octadecanol level and fibroblast fatty alcohol nad  oxidoreductase activity  
class10	3772	ultrastructural studies on skin from the patient revealed morphologically abnormal epidermal lamellar bodies  not unlike those seen in neutral lipid storage disease with ichthyosis  
class10	3772	we postulate that this patient has a novel neurocutaneous syndrome that may be secondary to abnormal lipid metabolism  
class10	3773	ischaemic brain lesions diagnosed at birth in preterm infants  clinical events and developmental outcome  
class10	3773	in 232 newborn babies of less than 32 weeks  gestational age ultrasound brain scans were carried out shortly after birth  daily for the first week of life  and at least twice weekly thereafter  
class10	3773	periventricular echogenicity associated with or progressing to periventricular leukomalacia  ischaemic brain lesions  was present in nine babies within two hours of birth  early onset   30 other babies subsequently developed similar lesions  late onset   
class10	3773	babies with early onset lesions were more likely to have a history of intrauterine growth retardation and to have recurrent apnoea in the first few hours after birth  
class10	3773	by contrast  late onset lesions were associated with hyaline membrane disease  
class10	3773	in later childhood four of six survivors with early onset periventricular leukomalacia  and seven of 14 survivors with late onset periventricular leukomalacia  had various disabilities including spastic diplegia  impaired vision  squints  sensorineural hearing loss  and developmental delay  
class10	3773	in a third of the children with disabilities ischaemic brain lesions were noted within two hours of birth  raising the possibility that some of this damage had taken place before or during birth  
class10	3774	area of lateral ventricles measured on cranial ultrasonography in preterm infants  association with outcome  
class10	3774	the association between measurements of lateral ventricle area  determined by serial ultrasound scans  and outcome was studied in 70 preterm neonates of 33 weeks  gestation or less  
class10	3774	the study group was subdivided into four groups according to cranial ultrasonographic findings at 2 weeks postnatal age  group a  n   15  had isolated periventricular intraventricular haemorrhage  group b  n   20  had periventricular intraventricular haemorrhage and dilated ventricles  group c  n   24  had periventricular intraventricular haemorrhage and periventricular leukomalacia with or without dilated ventricles  and group d  n   11  had isolated periventricular leukomalacia  
class10	3774	eighty seven preterm infants with no evidence of intracranial disease and good neurodevelopmental outcomes at 2 years formed the control group  
class10	3774	a poor outcome was observed in infants in group b  c  and d  particularly in those who had persistent dilated ventricles at 6 weeks postnatal age and extensive periventricular leukomalacia  
class10	3774	there was no difference in outcome between group a and controls  
class10	3774	during the first six weeks of life ventricular area growth velocities were significantly higher in groups b  c  d  compared with normal controls and group a  
class10	3774	we suggest that persistent ventricular dilatation at this early stage carries a bad prognosis  which is the result of atrophy of the brain  
class10	3775	skin conductance and arousal in the newborn  
class10	3775	we measured skin conductance continuously from the sole of a foot in babies of different conceptional ages before  during  and for 10 minutes after a  heel prick  carried out for routine blood sampling  
class10	3775	we studied 82 healthy babies whose gestational and postnatal ages ranged from 25 42 weeks  and 1 73 days  
class10	3775	the median skin conductance level  preheel prick  in babies of 40 43 weeks  conceptional age was 0 6 micros  microsiemens  and differed significantly between awake babies  1 2 micros  and those who were asleep  0 5 micros   
class10	3775	in contrast babies less than 40 weeks had a significantly lower median skin conductive level  0 3 micros  which was identical in awake and asleep babies  
class10	3775	in response to the heel prick all babies became aroused and skin conductance rose sharply and immediately in 21 out of 22  95   babies 40 43 weeks  conceptional age  and in seven out of 23  30   babies 36 39 weeks  
class10	3775	the median rise at one minute in babies of 40 43 weeks was significantly higher than those 36 39 weeks  2 7 micros compared with 0 5 micros   
class10	3775	no babies less than 36 weeks had a change in their skin conductance after the heel prick  
class10	3775	these results are consistent with the notion that  emotional sweating  is a function of maturity and does not develop until 36 weeks  conceptional age  
class10	3776	the acutely affected abdomen in paraplegic spinal cord injury patients  
class10	3776	the records of 145 paraplegic or quadriplegic patients were reviewed to identify those factors useful in the correct diagnosis of the acute abdomen in this population  
class10	3776	twenty one patients had 22 episodes of acute or subacute abdominal problems  
class10	3776	presenting complaints  physical findings  and laboratory results were useful in various ways  
class10	3776	however appropriate radiographic studies led to the correct diagnosis in 77  of patients  
class10	3776	although paraplegic and quadriplegic patients are predisposed to a distinct constellation of medical problems  including urinary tract infection and calculi  they also may present with other abdominal conditions that cause significant morbidity and mortality if not promptly recognized  
class10	3777	does carotid restenosis predict an increased risk of late symptoms  stroke  or death  
class10	3777	the identification of carotid restenosis as an unexpected late complication of carotid endarterectomy has prompted concerns regarding its importance as a source of new cerebral symptoms  stroke  and death  
class10	3777	to investigate these concerns  we analyzed a consecutive series of 507 patients undergoing 566 carotid endarterectomies  each documented as technically satisfactory  
class10	3777	post operative duplex doppler examination data at 3 days  1  3  6  12 months  and annually thereafter in 484 arteries  85 5   permitted classification of these arteries according to the most severe degree of postoperative stenosis  normal  n   306   1  to 19   n   89   20  to 50   n   40   more than 50   n   49  including 8 occluded   
class10	3777	the incidence of more than 50  restenosis was 14 5  in female and 7 7  in male patients  p   0 003   
class10	3777	life table analyses to 10 years revealed a significantly greater life expectancy among those with restenosis  p   0 05   
class10	3777	stroke was also less likely in patients with restenosis  although this difference did not reach statistical significance  
class10	3777	when survival and stroke were both endpoints  the likelihood of patients with more than 50  restenosis remaining alive and stroke free was also greater than the less than 20  stenotic group  p   0 03   
class10	3777	thus patients with carotid restenosis were less likely than patients with normal postoperative scans to have late symptoms  stroke  or early death  
class10	3778	choreoathetosis after deep hypothermia without circulatory arrest 
class10	3778	in 8 of 758 patients undergoing an intracardiac operation under cardiopulmonary bypass and hypothermia  choreoathetosis developed 3 to 7 days postoperatively  
class10	3778	before the onset of choreoathetosis  varying degrees of neurological dysfunction were noted  
class10	3778	electroencephalography and neuroimaging failed to detect any responsible functional or structural changes  
class10	3778	six patients are alive 1 to 3 years postoperatively  and their condition is improving  
class10	3778	two patients died of aspiration or sepsis  
class10	3778	all patients were grouped based on factors identified as being possibly causative  depth of hypothermia  cooling time  flow rate  and repeated hypothermia  
class10	3778	the incidence of choreoathetosis was significantly different in group a  rectal temperature greater than 25 degrees c  compared with group b  rectal temperature less than or equal to 25 degrees c   0 295 versus 8 463  p   0 02   
class10	3778	based on cooling time  the incidence of choreoathetosis was significantly different in group b1  cooling time less than 1 hour  compared with group b2  cooling time greater than or equal to 1 hour   1 220 versus 7 243  p   0 05   
class10	3778	based on flow rate during cooling  group b2 was further divided into the low flow group  less than 1 500 ml min 1 m 2  and the high flow group  greater than or equal to 1 500 ml min 1 m 2   
class10	3778	although not significant  the incidence of choreoathetosis was higher in the high flow group  6 153 versus 1 90  p   0 22   
class10	3778	in group b patients having reoperation  the incidence of choreoathetosis was higher than in patients operated on for the first time  5 54 versus 3 409  p less than or equal to 0 0001   
class10	3779	vagal schwannoma  
class10	3779	a patient with a benign encapsulated intrathoracic vagal schwannoma is presented and the literature is reviewed  
class10	3779	the right paratracheal tumor was identified incidentally on a chest film and excised using a right thoracotomy  
class10	3779	although rare  vagal schwannomas should be considered for any mediastinal mass along the vagus nerves especially when the paratracheal tumor produces minimal or no respiratory symptoms suggesting a slow growing  encapsulated process  
class10	3780	role of perfusion pressure and flow in major organ dysfunction after cardiopulmonary bypass  
class10	3780	the role of perfusion pressure and flow during cardiopulmonary bypass with moderate hypothermia and hemodilution in the development of new postoperative renal or clinically apparent cerebral dysfunction was examined in 504 adults  
class10	3780	cardiopulmonary bypass flow was targeted at greater than 40 ml kg 1 min 1 and pressure at greater than 50 mm hg  
class10	3780	flows and pressures less than target occurred in 21 6  and 97 1  of patients  respectively  
class10	3780	fifteen patients  3 0   suffered new renal and 13  2 6   new central nervous system dysfunction  
class10	3780	low pressure or flow during cardiopulmonary bypass  expressed in absolute values or in intensity duration units  were not predictors of either adverse outcome  
class10	3780	multivariate analysis identified use of postoperative intraaortic balloon counterpulsation  p less than 10  6   excessive blood loss in the icu  p less than 10  4   need for vasopressors before cardiopulmonary bypass  p less than 10  4   postoperative myocardial infarction  p less than 10  3   emergency reoperation  p less than 0 002   excessive postoperative transfusion  p less than 0 02   and chronic renal disease  p less than 0 03  as independent predictors of postoperative renal dysfunction  
class10	3780	independent predictors of postoperative central nervous system dysfunction were cardiopulmonary resuscitation in the intensive care unit  p less than 10  6   intracardiac thrombus or valve calcification  p less than 0 02   and chronic renal disease  p less than 0 03   
class10	3780	age greater than 65 years  40 7  of patients  did not predict either outcome  
class10	3780	we conclude that failure of the native circulation during periods other than cardiopulmonary bypass rather than the flows and pressures considered here is the major cause of renal and clinically apparent central nervous system dysfunction after cardiac operations  
class10	3781	misdiagnosis in patients with amyotrophic lateral sclerosis  
class10	3781	to confirm our impression that a high percentage of patients with amyotrophic lateral sclerosis are initially misdiagnosed  we reviewed records of 33 patients with a definitive diagnosis of amyotrophic lateral sclerosis seen over 10 years  
class10	3781	fourteen patients  43   were initially misdiagnosed  
class10	3781	mean time to correct diagnosis was significantly greater for the misdiagnosed group  16 0     9 3 months  than for the rest of the patients  7 6     4 1 months   
class10	3781	two of three patients with an initial symptom of dyspnea were misdiagnosed  
class10	3781	three patients underwent laminectomies because of misdiagnosis  
class10	3781	age  stage of disease  and unusual presenting symptoms were not identified as causes of misdiagnosis  
class10	3781	most likely causes were physicians  failure to consider the diagnosis and lack of familiarity with the common clinical presentations of amyotrophic lateral sclerosis  
class10	3781	earlier diagnosis of amyotrophic lateral sclerosis may help prevent medical mismanagement and may benefit patients both medically and psychologically  
class10	3782	syncope and presyncope associated with probable adverse drug reactions  
class10	3782	the purpose of this study was to determine whether syncope and presyncope were associated with drug therapy in 70 patients referred to a tertiary care ambulatory clinic  
class10	3782	drug use information was obtained  validated  and classified by its potential to cause syncope and presyncope  
class10	3782	utilizing a standardized adverse drug reaction algorithm  nine  13   of the 70 patients were rated as having probable drug induced syncope and presyncope events  
class10	3782	overall  12 medications were implicated  
class10	3782	patients with probable adverse drug reactions were older  and taking more medications  or taking an antihypertensive  
class10	3782	seven of the nine patients with probable adverse drug reactions were previously classified as having syncope of unknown origin after their initial clinic evaluation  
class10	3782	syncope and presyncope are commonly associated with adverse drug reactions  especially in the elderly and those taking multiple medications  
class10	3783	epidemiologic features of asymptomatic cerebral infarction in patients with nonvalvular atrial fibrillation  
class10	3783	we performed unenhanced computed tomographic scans on 141 asymptomatic patients with nonvalvular atrial fibrillation  
class10	3783	thirty six patients  26   had hypodense areas consistent with cerebral infarction  
class10	3783	the majority of these were small deep infarcts  seen in 29 patients  21    but 13 patients  9   had cortical or large deep infarctions  
class10	3783	twelve patients had more than one infarct on computed tomographic scan  
class10	3783	increasing age and increased left atrial diameter were the only clinical features associated with asymptomatic infarction  
class10	3783	patients older than 65 years with a left atrial diameter greater than 5 0 cm  n   23  had a 52  prevalence of asymptomatic infarction  
class10	3783	patients younger than 65 years with a left atrial diameter less than 5 0 cm  n   38  had an 11  prevalence of silent infarction  
class10	3783	patients with only one of these risk factors  n   72  had a 24  prevalence of silent infarction  
class10	3783	infarction was more common in those with chronic  34   as opposed to intermittent  22   nonvalvular atrial fibrillation  but this difference was not significant  
class10	3783	hypertension  diabetes  duration of atrial fibrillation  congestive heart failure  history of myocardial infarction  and echocardiographic evidence of left ventricular dysfunction were not associated with asymptomatic infarction  
class10	3783	a history of hypertension was present in only 35  of our patients with small deep asymptomatic infarction  similar to the percentage in patients without stroke  
class10	3783	asymptomatic cerebral infarction is common in nonvalvular atrial fibrillation  
class10	3783	the association with enlarged left atria and the lack of correlation with major cerebrovascular risk factors suggests a cardioembolic mechanism  
class10	3783	further study is needed to determine the functional and prognostic significance of these strokes  
class10	3784	acute autonomic neuropathy  two cases and a clinical review  
class10	3784	acute autonomic neuropathy is an uncommon syndrome  usually affecting healthy young people  
class10	3784	presentation is often dramatic and initial misdiagnosis is common  
class10	3784	we describe two young women with acute autonomic neuropathy who presented with gastrointestinal involvement heralding widespread dysautonomia and review 26 additional cases of acute autonomic neuropathy from the english language literature  
class10	3784	acute autonomic neuropathy can be primarily cholinergic without orthostatic hypotension  26   or pandysautonomic  74   involving sympathetic adrenergic functions  
class10	3784	onset has been temporally related to viral syndromes in 20  of cases  with autonomic deficits usually evolving over 1 to 3 weeks  
class10	3784	gastroparesis  69   and syncope  12   are frequent presenting complaints  
class10	3784	spinal fluid protein levels are often  75   elevated in pandysautonomic subtypes  
class10	3784	prolonged and incomplete recovery is the rule  60    with persistent gastroparesis and orthostatic hypotension  
class10	3784	other specific diseases that occasionally mimic acute autonomic neuropathy include botulism  porphyria  amyloidosis  and paracarcinomatous neuropathies  
class10	3784	acute autonomic neuropathy shares several clinical features with acute idiopathic polyneuropathy  guillain barre syndrome   suggesting an immune mediated pathogenesis  
class10	3785	recurrent meningitis in a patient with congenital deficiency of the c9 component of complement  first case of c9 deficiency in europe  
class10	3785	we describe the first cases  to our knowledge  of c9 deficiency in europe that were detected in a swiss family  of which two members  one with a complete deficiency and the other with approximately half normal c9 levels  experienced bacterial meningitis  
class10	3785	the index patient  a 56 year old white man with a history of purulent meningitis at the age of 23 years  presented with an acute meningococcal meningitis  
class10	3785	no impairment of cellular immunity or immunoglobulin deficiency could be found  
class10	3785	complement assays showed a complete deficiency of the c9 component  while the other individual component levels were normal and the hemolytic activity  measured using the ch50 assay  was only slightly reduced  
class10	3785	a family study revealed complete c9 deficiency in the patient s healthy brother and half normal c9 concentrations in his sister  his son  who also had experienced an episode of bacterial meningitis   and his niece  consistent with an inherited c9 deficiency  
class10	3785	this first case of recurrent meningitis in a white patient with complete c9 deficiency suggests that this complement defect may also be a risk factor for bacterial  especially neisserial  infections  
class10	3786	gilles de la tourette syndrome is not linked to d2 dopamine receptor  
class10	3786	gilles de la tourette syndrome has an important genetic component  the pathophysiology of this disorder may involve the dopamine system  
class10	3786	we tested a d2 dopamine receptor  locus drd2  recognized by probe hd2g1  for genetic linkage with gilles de la tourette syndrome  
class10	3786	using a genetic linkage map of the region of drd2 on the long arm of chromosome 11 and restriction fragment length polymorphism data from a total of four markers  drd2 itself  d11s84  d11s29  and pbgd   we were able to exclude linkage of this candidate gene and gilles de la tourette syndrome in two extended kindreds segregating for gilles de la tourette syndrome  
class10	3786	this rules out causation of gilles de la tourette syndrome by mutation in drd2 in the kindreds studied under the genetic assumptions we employed  use of the map and multipoint linkage analyses also allowed us to exclude a gilles de la tourette syndrome susceptibility locus from a larger genetic region  
class10	3787	quantitative evaluation of sway as an indicator of functional balance in post traumatic brain injury  
class10	3787	the test of sway  using different conditions of stance with measurements of the average radial deviation of the center of pressure and its path length of sway per unit of time  has been shown to be a useful clinical tool in determining balance problems in traumatic brain injury  tbi  patients  
class10	3787	normative values were established to determine if an individual patient s sway values fell within the normal range  mean     2sd   
class10	3787	the tests have shown good test retest reliability for tbi patients  
class10	3787	in addition  it has been shown that the sensitivity of the test is sufficient to identify changes in patients  performances as their clinical conditions change  
class10	3787	it has been demonstrated that the different stance conditions of the battery of tests become progressively more difficult to perform  from comfortable stance  eyes open and eyes closed  through narrow stance  eyes open and eyes closed  to tandem stance with right or left foot forward  eyes open and eyes closed   
class10	3787	by using these subtests  it is easy to distinguish between the performances of able bodied patients and tbi patients with very mild balance problems  
class10	3787	the validity of the measure has been documented by correlating the sway performance with clinical functional performance tests  
class10	3787	the test performance also correlates with the patient s own assessment of his or her gait difficulties  
class10	3787	the limited data available suggest that the test of sway relates difficulties in static balance to the frequency of falls  
class10	3787	finally  subtests permit identification of specific problems in maintaining balance as a basis for therapeutic intervention  
class10	3788	asymptomatic ulnar neuropathy in carpal tunnel syndrome  
class10	3788	quantitative assessment of the vibration threshold of the second and fifth fingertips at 125hz was performed on 28 affected limbs of 17 patients with carpal tunnel syndrome  cts  together with a median and ulnar sensory nerve conduction velocity  sncv  study  
class10	3788	twenty six limbs of 26 age matched healthy subjects were used as controls  
class10	3788	both the vibration threshold elevation of the second finger and the delay of median sncv were significant in cts patients as compared with controls  p less than  001   
class10	3788	although the ulnar sncvs of all affected limbs were within the normal range  ten affected limbs  36   were found to have a concomitant vibration threshold elevation of the fifth finger  and eight of those limbs were found to be exposed to chronic occupational mechanical stimulation at the wrist  
class10	3788	these findings appear to support the presence of subclinical traumatic damage to the ulnar nerve at the wrist  
class10	3788	in summary  digital vibration measurement can elucidate subclinical ulnar neuropathy in cts which cannot be detected by sncv studies  
class10	3789	postoperative complications in patients with disabling psychiatric illnesses or intellectual handicaps  a case controlled  retrospective analysis  
class10	3789	the purpose of this study was to quantitate the operative risk and costs encountered in the surgical treatment of institutionalized patients  
class10	3789	operative complications and duration of hospitalization for 200 institutionalized patients were compared with those in a control group of patients matched for age  sex  and type of operation drawn from the general hospital population  
class10	3789	postoperative complications occurred in 53  26 5   of the patients in the study group compared with 15  7 5   of the patients in the control group  
class10	3789	elective laparotomy was followed by a complication in 48  of institutionalized patients compared with 11 6  of matched controls  
class10	3789	emergency celiotomy carried a 75  complication rate in the study group  
class10	3789	atelectasis and pneumonia accounted for 50  of the postoperative complications and occurred with greatest frequency following intra abdominal procedures  
class10	3789	the median hospital stay for all institutionalized patients was 3 days more than for matched controls  
class10	3789	a strategy for postoperative treatment is presented  with particular emphasis on prevention of pulmonary complications  
class10	3790	the influence of hyperglycemia and diabetes mellitus on immediate and 3 month morbidity and mortality after acute stroke  
class10	3790	fasting serum glucose  glycosylated hemoglobin  and fructosamine concentrations were determined in 304 consecutive subjects admitted with acute stroke  within 48 hours of ictus  
class10	3790	based on the medical history and these results  subjects were divided into known diabetics  newly diagnosed diabetics  subjects with stress hyperglycemia  and nondiabetics  
class10	3790	the type of stroke was classified as lacunar infarct  cerebral infarct  or intracerebral hemorrhage  based on clinical examination by a neurologist and computed tomographic brain scan and or autopsy  
class10	3790	immediate and 3 month outcomes were examined in relation to  1  fasting glucose  glycosylated hemoglobin  and fructosamine levels by stroke subtypes  and  2  glucose tolerance categories by stroke subtypes  
class10	3790	a high fasting glucose level was associated with an increased mortality  but this was observed only among patients with intracerebral hemorrhage  
class10	3790	patients with stress hyperglycemia  but not diabetics  had increased mortality  
class10	3790	in spite of having similar glucose concentrations to those patients with stress hyperglycemia  diabetics did not have a worse outcome compared with nondiabetics  
class10	3790	it is concluded that the association between glucose concentration and outcome is a reflection of stress relating to stroke severity  rather than a direct harmful effect of glucose on damaged neurons  
class10	3791	screening for early dementia using memory complaints from patients and relatives  
class10	3791	this study examined whether the subjective impression of memory function might differentiate healthy elderly subjects from patients with memory complaints  and whether memory complaints differed between patients with and without a dementing illness  
class10	3791	both self assessment and relatives  responses on a new memory questionnaire differentiated patient groups from control subjects  
class10	3791	the relatives  form measuring deterioration in memory function over time identified dementing individuals from those with non dementing causes for their memory complaints  
class10	3791	factor analysis indicated that patients  memory complaints correlated with depression rather than objective memory performance  while relatives  ratings correlated with objective memory scores  not depression  
class10	3791	stepwise discriminant function analyses showed that objective memory testing greatly improved specificity but not sensitivity of the subjective memory questionnaire alone  
class10	3792	cerebrospinal fluid as a reflector of central cholinergic and amino acid neurotransmitter activity in cerebellar ataxia  
class10	3792	cerebrospinal fluid  csf  amino acid neurotransmitters  related compounds  and their precursors  choline levels  and acetylcholinesterase activity were measured in the csf of patients with cerebellar ataxia during a randomized  double blind  crossover  placebo controlled clinical trial of physostigmine salicylate  
class10	3792	the csf gamma aminobutyric acid  methionine  and choline levels  adjusted for age  were significantly lower in patients with cerebellar ataxia compared with controls  
class10	3792	physostigmine selectively reduced the level of csf isoleucine and elevated the levels of phosphoethanolamine  
class10	3792	no change occurred in csf acetylcholinesterase activity and in the levels of plasma amino compounds in patients with cerebellar ataxia when compared with controls  
class10	3792	median ataxia scores did not statistically differ between placebo and physostigmine nor did functional improvement occur in any of the patients  
class10	3793	asthma and eczema in children born to women with migraine  
class10	3793	migraine and asthma have been reported to occur in the same person more commonly than would be expected if they are independent  
class10	3793	the large collaborative perinatal project provided an opportunity to see if children born to women with migraine or with the group of disorders characterized by asthma and or allergies were more likely to manifest asthma or eczema in the first 7 years of life  
class10	3793	among children whose mothers had neither migraine nor asthma allergies  3 2  had asthma  
class10	3793	of children whose mothers had migraine  but not asthma allergies  more than 6  had asthma  
class10	3793	the risk of asthma among children born to women who had both migraine and asthma allergies was greater than the risk associated with each maternal disease  
class10	3793	the risk of eczema in children was not appreciably influenced by the mother s propensity to migraine or asthma allergies  
class10	3793	the results of this first study of migraine in one generation and asthma in the next lead to the conclusion that the two disorders are probably related  
class10	3794	temporoparietal cortex in aphasia  evidence from positron emission tomography  
class10	3794	forty four aphasic patients were examined with  f18  fluorodeoxyglucose positron emission tomography in a resting state to determine whether consistent glucose metabolic abnormalities were present  
class10	3794	ninety seven percent of subjects showed metabolic abnormalities in the angular gyrus  89  in the supramarginal gyrus  and 87  in the lateral and transverse superior temporal gyrus  
class10	3794	pearson product moment correlations were calculated between regional metabolic measures and performance on the western aphasia battery  
class10	3794	no significant correlations were found between the western aphasia battery scores and right hemisphere metabolic measures  
class10	3794	most left hemisphere regions correlated with more than one score from the western aphasia battery  
class10	3794	temporal but not frontal regions had significant correlations to the comprehension score  
class10	3794	the left temporoparietal region was consistently affected in these subjects  suggesting that common features in the aphasias were caused by left temporoparietal dysfunction  while behavioral differences resulted from  1  the extent of temporoparietal changes  and  2  dysfunction elsewhere in the brain  particularly the left frontal and subcortical areas  
class10	3795	nontropical pyomyositis as a cause of subacute  multifocal myalgia in the acquired immunodeficiency syndrome  
class10	3795	we report a case of nontropical pyomyositis in a patient with acquired immunodeficiency syndrome and disseminated mycobacterium avium infection  in which severe myalgia was the presenting symptom over several weeks  
class10	3795	multifocal muscle lesions were identified by gallium scanning and magnetic resonance imaging techniques  
class10	3795	the epidemiology  possible pathogenesis  clinical features  diagnostic imaging  and therapy are reviewed  
class10	3795	early suspicion of nontropical pyomyositis in severely immunocompromised patients with  cryptic  myalgia is recommended  
class10	3796	neurodevelopmental outcome of children with evidence of periventricular leukomalacia on late mri  
class10	3796	fifteen children  8 months of age or older  from a neonatal follow up program underwent magnetic resonance imaging and neurologic  cognitive  and language evaluations  
class10	3796	magnetic resonance imaging findings in all children included increased white matter signal on t2 weighted images and ventricular enlargement adjacent to regions of abnormal white matter  
class10	3796	the extent of degree of abnormal white matter signal and the degree of sulcal prominence were variable  
class10	3796	twelve children had cerebral palsy  5 children  4 of whom had cerebral palsy  manifested significant sensory impairments  
class10	3796	the median score on cognitive testing was 89  only 2 children exhibited severe to profound cognitive disability  
class10	3796	cognitive scores were stable on retesting  
class10	3796	the degree of motor disability was correlated with the extent of white matter signal abnormality  however  cognitive outcome was not related to the extent and degree of white matter signal abnormality or to the degree of sulcal prominence  
class10	3796	despite the association of a major handicapping condition and periventricular leukomalacia  cognitive and language functioning may be relatively spared  
class10	3797	rett syndrome  cerebellar pathology  
class10	3797	the cerebellar pathology at autopsy of 5 patients with rett syndrome is described  
class10	3797	the patients ranged in age from 7 30 years  
class10	3797	all had markedly reduced brain weights with proportionately small cerebella  
class10	3797	microscopic examination revealed loss of purkinje cells  atrophy  astrocytic gliosis of the molecular and granular cell layers  and gliosis and loss of myelin in the white matter  
class10	3797	cortical atrophy occurred focally along the folia and was often more marked in the tips of the folia  
class10	3797	the 2 oldest patients had been treated with phenytoin which may have contributed to the morphologic changes  
class10	3797	atrophy and gliosis increased with age or in patients without phenytoin treatment  the youngest patient demonstrated only minor microscopic changes  
class10	3797	in addition to the generalized alterations  1 patient had several adjacent folia with severe atrophy  
class10	3797	the results indicate that cerebellar changes in rett syndrome consist of general hypoplasia with the addition of atrophy beginning in childhood and progressing over many years  
class10	3798	recurrent lateral rectus palsy in childhood  
class10	3798	five patients with recurrent  lateral rectus palsy in childhood  examined at the university of iowa hospitals over a period of 22 years  are reported  
class10	3798	during the same period  131 abducens nerve palsy patients  younger than 18 years of age  were evaluated  
class10	3798	eighteen similar patients  most single case reports  are reviewed from the literature  
class10	3798	all reported patients  including our own  shared the following features  spontaneous recovery within 6 months in the majority of patients  ipsilateral recurrence  and painless palsy  
class10	3798	there is female and left sided preponderance  
class10	3798	etiology is undetermined  
class10	3798	hypotheses include viral etiology  neurovascular compression by aberrant artery  and migraine  
class10	3799	ultrasonography and magnetic resonance imaging in leigh disease  
class10	3799	an infant with leigh disease  who was the younger sister of a similarly affected infant  had been examined before the onset of the disease  
class10	3799	ultrasonography revealed hyperechoic lesions in the putamen and caudate nucleus during the preclinical stage  
class10	3799	at onset  these changes extended into the cerebral cortex and medulla  
class10	3799	these lesions were also detected by t2 weighted magnetic resonance imaging  mri  as areas of increased signal intensity  
class10	3799	her brother demonstrated the same ultrasonographic results  cranial computed tomography disclosed low density areas in the basal ganglia which were detected as hyperechoic lesions by ultrasonography  
class10	3799	these findings suggest that ultrasonography is useful in detecting early intracranial lesions in leigh disease  
class10	3800	rett syndrome  findings suggesting axonopathy and mitochondrial abnormalities  
class10	3800	we report the histopathologic findings of 3 sural nerve biopsies and 1 muscle biopsy from 3 patients with rett syndrome  
class10	3800	the 3 sural nerve biopsies demonstrated a few ultrastructural abnormalities  including the presence of many pi granules and mitochondrial changes in the cytoplasm of schwann cells  occasional bands of bungner and onion bulb formations  and mitochondrial alterations in myelinated axons  
class10	3800	morphometric analysis disclosed reduction in the number of large myelinated fibers with normal densities in comparison to those of an age matched normal control  
class10	3800	light microscopic examination of the biopsied muscle from a 6 year old patient with rett syndrome revealed the existence of many small  dark  angulated fibers with nadh tr staining  
class10	3800	ultrastructural investigation of the muscle confirmed the presence of the dumbbell shaped mitochondria  
class10	3800	peripheral nerve involvement and the possibility of mitochondrial abnormalities in rett syndrome were suggested by the results  
class10	3801	west syndrome associated with hyperlexia  
class10	3801	two patients are reported with west syndrome associated with hyperlexia  
class10	3801	they had peculiar linguistic and psychosocial development and autistic behavior  yet began to read japanese and chinese characters  numbers  roman alphabet letters  and trademark letters at 3 years of age  
class10	3801	neuropsychologic  electroencephalographic  and radiologic studies were performed at 11 years of age in patient 1 and at 10 years of age in patient 2  
class10	3801	although they were able to read fluently with correct intonation  their comprehension was significantly impaired  
class10	3801	the neuropsychologic evaluation of both patients demonstrated selective  excellent ability in auditory memory in contrast to impairment of associational abilities  visual retention  and visual constructional abilities  
class10	3801	these findings suggest that the functions in the nondominant hemisphere were also impaired  
class10	3801	although children with west syndrome frequently have associated mental retardation  patients with west syndrome associated with hyperlexia have never been reported  
class10	3801	a neuropsychologic investigation of epileptic children with mental retardation is necessary for the detection of hyperlexia  
class10	3802	flow cytometric dna content of adenoid cystic carcinoma of submandibular gland  correlation of histologic features and prognosis  
class10	3802	flow cytometric analysis of nuclear dna content was performed in 26 adenoid cystic carcinomas of the submandibular gland using archived  paraffin embedded tissues  
class10	3802	the dna content was compared with multiple histologic parameters and clinical course  
class10	3802	ten carcinomas  38   were aneuploid and 16  62   diploid  
class10	3802	aneuploid carcinomas demonstrated a higher frequency of solid cytoarchitecture  lymph node metastases  and advanced clinical stage  as compared with diploid carcinomas  
class10	3802	other histologic features predicting aggressive clinical behavior also correlated with abnormal dna content and included invasion of nerves larger than 0 25 mm and intravascular extension  
class10	3802	our data suggest that dna content analysis can be an effective objective parameter in the clinicopathologic assessment of adenoid cystic carcinoma  
class10	3803	the use of obstetric analgesia in sweden 1983 1986 
class10	3803	the use of obstetric analgesia was investigated in a swedish population based prospective study of 335 207 births  which represents almost all women who had vaginal deliveries in sweden between 1983 and 1986  
class10	3803	lumbar epidural analgesia  eda  was used in 16   paracervical block  pcb  in 12   pethidine or morphine in 49  and pudendal block in 62   
class10	3803	all four types of analgesia were much more commonly used by nulliparae than multiparae  
class10	3803	variables such as maternal age  smoking  nationality  relationship with the infant s father and gestational age had only moderate influence on the rates of different types of analgesia  
class10	3803	eda and pcb were more frequently used in larger than in smaller hospitals and in the daytime than at night  
class10	3803	no such differences were found for pethidine or morphine  or pudendal block  which were administered routinely by midwives  
class10	3804	choroid plexus cysts and chromosomal defects 
class10	3804	during a 4 year period  83 pregnant women with fetal choroid plexus cysts were investigated in our unit  
class10	3804	abnormal karyotypes were found in 20 fetuses  including trisomy 18  n   16   trisomy 13  n   1   triploidy  n   1  and translocation down s syndrome  n   2   
class10	3804	all fetuses with chromosomal defects had structural malformations in addition to the choroid plexus cysts  
class10	3805	neurologic complications in chronic renal failure  a retrospective study  
class10	3805	we have retrospectively examined 324 patients with chronic renal failure and evaluated the probable underlying causes of neurologic complications  laboratory data and therapeutic interventions  
class10	3805	the common neurologic problems in our patients were alterations in consciousness  40 7   and convulsions  35 1    
class10	3805	when bun concentration was above 135 mg dl and creatinine clearance was below 8 m min 1 73 m2  alteration of consciousness was observed and when bun concentration was 200 mg dl and creatinine clearance was below 7 m min 1 73 m2  abnormal convulsives appeared  
class10	3805	changes in deep tendon reflexes and pathologic reflexes were associated with hypertension  
class10	3805	all of the patients with cortical atrophy using computerized cranial tomography aluminum hydroxide at least for 18 months  and six of them had hemodialysis  
class10	3805	fourteen patients who underwent dialysis developed convulsions and were thought to have disequilibrium syndrome  
class10	3805	these findings are consistent with the suggestion that the metabolic and biochemical derangements associated with crf may be particularly detrimental to the still developing cns of the child  
class10	3806	evaluation and treatment of mental disorders in patients with aids  
class10	3806	mental symptoms are common in patients with aids  
class10	3806	optimal management involves the identification and treatment of underlying mental disorders rather than symptomatic treatment alone  
class10	3806	organic mental disorders are very frequent in aids  particularly with seriously ill patients who are medical inpatients  
class10	3806	there is a high priori probability that such common symptoms as agitation  irritability  and insomnia will be caused by an organic mental disorder  
class10	3806	psychopharmacology in the patient with aids requires considerable caution  
class10	3806	lower doses and careful surveillance for subtle neuropsychiatric side effects are necessary  
class10	3806	routine medical contact with a compassionate physician may be of inestimable value to the patient in coping with the fear and dread that surround the illness  
class10	3807	schindler disease  the molecular lesion in the alpha n acetylgalactosaminidase gene that causes an infantile neuroaxonal dystrophy  
class10	3807	schindler disease is a recently recognized infantile neuroaxonal dystrophy resulting from the deficient activity of the lysosomal hydrolase  alpha n acetylgalctosaminidase  alpha galnac   
class10	3807	the recent isolation and expression of the full length cdna encoding alpha galnac facilitated the identification of the molecular lesions in the affected brothers from family d  the first cases described with this autosomal recessive disease  
class10	3807	southern and northern hybridization analyses of dna and rna from the affected homozygotes revealed a grossly normal alpha galnac gene structure and normal transcript sizes and amounts  
class10	3807	therefore  the alpha galnac transcript from an affected homozygote was reverse transcribed  amplified by the polymerase chain reaction  pcr   and sequenced  
class10	3807	a single g to a transition at nucleotide 973 was detected in multiple subclones containing the pcr products  
class10	3807	this point mutation resulted in a glutamic acid to lysine substitution in residue 325  e325k  of the alpha galnac polypeptide  
class10	3807	the base substitution was confirmed by dot blot hybridization analyses of pcr amplified genomic dna from family members with allele specific oligonucleotides  
class10	3807	furthermore  transient expression of an alpha galnac construct containing the e325k mutation resulted in the expression of an immunoreactive polypeptide which had no detectable alpha galnac activity  
class10	3808	effect of normal msafp screening on maternal age for genetic amniocentesis  
class10	3808	routine maternal serum alpha fetoprotein  msafp  screening for neural tube defects is considered by many to be standard obstetrical care  and recently many have encouraged this test to screen for trisomy 21  down s syndrome   
class10	3808	we questioned whether  after a normal msafp screen  the risk of trisomy 21 decreases enough to warrant modifying the recommended age for genetic amniocentesis for down s syndrome  
class10	3808	a logistic regression was developed which  using reported values for sensitivity and specificity for msafp detection of trisomy 21 and assuming a constant threshold risk in opting for amniocentesis  indicates that genetic amniocentesis for trisomy 21 may be deferred in some women who have a normal msafp screening  
class10	3808	sensitivity analysis of varying thresholds for a normal msafp demonstrates that a 37 year old woman with a median msafp level has the same risk for trisomy 21 as an unscreened women who is 4 5 years younger  
class10	3808	an abnormal msafp is useful in screening for neural tube defects and possibly for trisomy 21  
class10	3808	a normal msafp may allow for delaying the potentially risky amniocentesis in otherwise low risk pregnancies  
class10	3809	acupuncture and chronic pain  a criteria based meta analysis  
class10	3809	a literature search revealed 51 controlled clinical studies on the effectiveness of acupuncture in chronic pain  
class10	3809	these studies were reviewed using a list of 18 predefined methodological criteria  
class10	3809	a maximum of 100 points for study design could be earned in four main categories   a  comparability of prognosis   b  adequate intervention   c  adequate effect measurement and  d  data presentation  
class10	3809	the quality of even the better studies proved to be mediocre  
class10	3809	no study earned more than 62  of the maximum score  
class10	3809	the results from the better studies  greater than or equal to 50  of the maximum score  are highly contradictory  
class10	3809	the efficacy of acupuncture in the treatment of chronic pain remains doubtful  
class10	3810	the role of carotid screening before coronary artery bypass  
class10	3810	five hundred thirty nine patients with no symptoms of cerebral ischemia undergoing coronary artery bypass were preoperatively evaluated for presence of carotid stenosis by noninvasive methods  duplex scanning and ocular pneumoplethysmography gee   
class10	3810	overall prevalence of carotid stenosis greater than 75  was higher  8 7   than that generally reported  
class10	3810	age greater than 60 years was significantly related to presence of carotid stenosis greater than 75   11 3  vs 3 8   p   0 003   
class10	3810	risk factors such as hypercholesterolemia  hypertension  diabetes mellitus  and smoking were not predictive for carotid stenosis  postoperative stroke  or death  
class10	3810	carotid stenosis greater than 75   odds ratio 9 87  p less than 0 005  and coronary artery bypass redo  odds ratio 5 26  p less than 0 05  were both independent predictors of stroke risk  
class10	3810	patients were divided into four groups  group 1  minimal or mild degree of carotid stenosis  less than 50    not submitted to prophylactic carotid endarterectomy  432 patients  80 1    group 2  moderate degree of stenosis  50  to 75    no prophylactic carotid endarterectomy  60 patients  11 2    group 3  severe carotid stenosis   greater than 75    submitted to prophylactic carotid endarterectomy  19 patients  3 5    group 4  severe carotid stenosis  greater than 75   no prophylactic carotid endarterectomy  28 patients  5 2    
class10	3810	patients in group 4 had significantly higher stroke rate  14 3   compared to the other three groups  1 1    p   0 0019   
class10	3810	the finding of carotid stenosis greater than 75  in patients over 60 years of age was associated with occurrence of stroke in 15  of cases  
class10	3810	carotid screening is helpful to determine patients at increased risk of stroke and should be performed in patients greater than 60 years  
class10	3811	a single cholesterol measurement underestimates the risk of coronary heart disease  an empirical example from the lipid research clinics mortality follow up study  
class10	3811	in prospective epidemiologic studies of coronary heart disease  a single measurement of cholesterol is made to assess its relationship to the risk of coronary disease  
class10	3811	statistical theory states that if this measurement is subject to within individual variability  the strength of the relationship will be underestimated  
class10	3811	this is empirically shown for the example of plasma cholesterol  
class10	3811	for the lipid research clinics follow up study population  comprising 2170 white men over 30 years of age   the age adjusted coronary heart disease mortality regression coefficient increases from  453 to  496 if the average of two cholesterol measurements is used instead of a single measurement  
class10	3811	since the correlation between the two repeated cholesterol measurements is  815  an increase in the regression coefficient up to  556 would be expected if the true cholesterol values were available  
class10	3811	thus  epidemiologic studies have substantially underestimated the strength of the relationship between cholesterol levels and the risk of coronary disease by calculating the relationship on the basis of a single cholesterol determination  
class10	3812	acute syphilitic posterior placoid chorioretinitis  
class10	3812	six patients with evidence of secondary syphilis presented with visual loss in both eyes caused by large  placoid  yellowish lesions with faded centers at the level of the pigment epithelium in the macula and juxtapapillary areas  
class10	3812	all eyes had vitreitis  
class10	3812	all of the lesions showed a similar fluorescein angiographic pattern of early hypofluorescence and late staining  
class10	3812	five patients had mucocutaneous lesions typical of secondary syphilis  
class10	3812	all five patients treated with antibiotics had prompt improvement in visual function and resolution of the fundus lesions  
class10	3812	the ophthalmoscopic and angiographic appearance of these posterior fundus lesions was sufficiently characteristic to suggest a diagnosis of secondary syphilis  
class10	3812	modification of the host response to syphilis by human immune deficiency virus  hiv  infection may be partly responsible for this peculiar fundus picture  
class10	3812	three of the four patients tested positive for hiv  
class10	3813	repetitive strain injuries  how to deal with  the epidemic of the 1990s   
class10	3813	occupational trends  especially the mushrooming of computer use in the united states  have brought with them a virtual epidemic of repetitive strain injury of the upper limb  
class10	3813	what can you as a primary care physician do to stem the tide  in this article  the authors fill you in on treatment of the most common injuries as well as remark on the ramifications for business and industry  
class10	3814	treating systemic fungal infections in aids patients  prolonging life against the odds  
class10	3814	fungal infections have become one of the major causes of death among immunocompromised patients  particularly patients with aids  
class10	3814	accurate and quick diagnosis is difficult  therefore  empirical therapy is often necessary  
class10	3814	this scenario is complicated by the fact that most antifungal agents are toxic at the doses used or relatively ineffective against deep seated mycoses  
class10	3814	because the population of aids patients is increasing  physicians will be faced more often with the management of systemic fungal infections  
class10	3814	despite the current bleak prognosis for these patients  several new antigen detection tests are being developed and triazole agents are proving to be effective and less toxic than their predecessors  
class10	3814	many cases of systemic mycoses do result in mortality  but appropriate treatment can both prolong life and improve its quality  
class10	3815	rigid fixation of internal orbital fractures  
class10	3815	when large portions of the internal orbit are destroyed  two to four walls   standard bone grafting techniques for immediate and late orbital reconstruction may not yield predictable eye position  
class10	3815	critical bone support is most often deficient inferomedially  
class10	3815	ct analysis of orbital volume in cases where eye position was unsatisfactory reveals that displacement of bone grafts is one mechanism of the unsatisfactory result  
class10	3815	other mechanisms include undercorrection and bone graft resorption  
class10	3815	in order to minimize postoperative bone graft displacement  titanium implants were used to span large defects in the internal orbit to provide a platform for bone graft support  
class10	3815	twenty six implants were placed in immediate and 12 were placed in late orbital reconstructions  
class10	3815	more reliable bone graft position resulted  
class10	3815	two late infections have occurred resulting in implant removal in a 3 year period  
class10	3816	early cerebral infarction  gadopentetate dimeglumine enhancement 
class10	3816	gadopentetate dimeglumine was administered prospectively to 50 patients who presented for magnetic resonance  mr  imaging within 2 weeks after a cortical cerebral infarction  
class10	3816	twenty two patients  44   were imaged within 3 days after clinical ictus  
class10	3816	abnormalities detected with gadopentetate dimeglumine enhancement were observed in 46  92   of 50 patients  
class10	3816	classic parenchymal enhancement was a late finding  observed in all patients  17 of 17  imaged at 7 14 days after infarction  
class10	3816	before this time  three additional phases of contrast material related abnormalities were observed  
class10	3816	enhancement of vessels supplying the infarct   intravascular enhancement sign   was the earliest finding  seen in 17  77   of 22 infarcts aged 1 3 days  
class10	3816	from day 2 to day 6  abnormal enhancement of meninges adjacent to the infarct was frequently noted   meningeal enhancement sign    
class10	3816	finally  a transition phase that combined intravascular or meningeal enhancement with early parenchymal enhancement was seen from day 3 to day 6  
class10	3816	gadopentetate dimeglumine enhanced mr imaging in early stroke reveals evidence of vascular engorgement and sluggish flow  which precede the development of classic parenchymal enhancement  
class10	3817	embolization with particles in thoracic intramedullary arteriovenous malformations  long term angiographic and clinical results  
class10	3817	to evaluate the long term results of endovascular treatment with particles in the management of thoracic intramedullary arteriovenous malformations  avms   the authors retrospectively reviewed the angiographic and clinical findings in 35 patients  
class10	3817	follow up was 1 15 years  mean  6 years  in 28 patients and 6 10 months  mean  7 months  in seven  
class10	3817	a total of 158 embolization procedures were performed in 35 patients  
class10	3817	revascularization occurred frequently  necessitating multiple endovascular sessions  
class10	3817	long term clinical evaluation showed clinical improvement  compared with the initial status before treatment  in 63  of the patients  
class10	3817	clinical aggravation due to embolization was observed in seven patients  20   after 12 of the 158 endovascular sessions  8    
class10	3817	these results are better than those reported after surgery and indicate that embolization with particles is an efficient and safe tool in the treatment of thoracic intramedullary avms  
class10	3818	graves orbitopathy  correlation of ct and clinical findings  
class10	3818	the clinical and high resolution computed tomographic  ct  findings in 71 patients  142 orbits  with graves orbitopathy and 20 healthy patients  40 orbits  were retrospectively reviewed  
class10	3818	the orbits with orbitopathy were subgrouped at clinical examination into those with  n   18  and those without  n   124  optic neuropathy  
class10	3818	mean extraocular muscle diameters and the calculated muscle diameter index were significantly increased in all orbits with ophthalmopathy  particularly in those with optic neuropathy  
class10	3818	graves orbitopathy affected the superior muscle group  63 4   more than the medial  61 3   or inferior  57   recti  
class10	3818	the most common pattern of muscle involvement involved all five measured extraocular muscles  
class10	3818	solitary muscle involvement most frequently involved the superior muscle group  6 3    
class10	3818	significant enlargements of the retrobulbar optic nerve sheath and superior ophthalmic vein were noted only in orbits with optic neuropathy  
class10	3818	anterior displacement of the lacrimal gland at ct correlated with clinical palpability and occurred more frequently in patients with optic neuropathy  
class10	3818	severe apical crowding was the most sensitive indication of optic neuropathy at ct  
class10	3819	neuromuscular diseases  evaluation with high frequency sonography  
class10	3819	forty four patients with clinically suspected neuromuscular disease and 12 healthy volunteers underwent high frequency ultrasound examination of the rectus femoris  vastus medialis  vastus lateralis  and biceps brachii muscles  and the number of perimysial septa was determined  
class10	3819	these numbers and muscle soft tissue ratios of the lower extremity were compared  
class10	3819	findings were correlated with results of muscle biopsy in all patients with suspected disease  
class10	3819	using the number of perimysial septa in the lower extremity  the authors found significant differences between the muscles of healthy volunteers and those of patients with duchenne muscular dystrophies  other muscular dystrophies  and spinal muscular atrophies  the receiver operating characteristic curve showed that an average of 12 perimysial septa within 1 cm of muscle is the ideal cutoff value to differentiate subjects without morphologic changes from those with pathologic findings  
class10	3819	the authors conclude that this measurement is useful for differentiation of neuromuscular diseases and may be a noninvasive  reproducible means with which to evaluate disease progression  
class10	3820	emergency portosystemic shunt in patients with variceal bleeding  
class10	3820	thirty five patients for whom emergency sclerotherapy or conservative treatment  or both  failed to arrest variceal bleeding  or who had early rebleeding and required emergency portosystemic shunts  epss  were studied  
class10	3820	epss permanently controlled the variceal bleeding in all but one patient  
class10	3820	in this patient  the shunt was patent as demonstrated by angiography  
class10	3820	esophageal varices disappeared in 18 patients and were reduced in 14  
class10	3820	three patients died before the endoscopic examination could be performed  
class10	3820	the causes of death were hepatic failure in two and bleeding ulcerations of the gastric fundus in the other patient  
class10	3820	one patient was classified in child s category b and two in child s category c  
class10	3820	thirty two patients submitted to epss and were discharged alive  
class10	3820	twelve of these patients subsequently died  at an average of 11 2 months after undergoing the shunt procedure  
class10	3820	four of 12 patients died of hepatic failure  two patients died of hepatomas  two  other neoplasia  three  hemorrhaging duodenal ulcers  and one patient  renal failure  
class10	3820	analysis of actuarial survival rates showed that the five year survival rate was 43 per cent  
class10	3820	the long term survival rates were fewer for patients with child s category c than for those with combined child s categories a and b  five year survival rates were 21 versus 55 per cent  p less than 0 05   
class10	3820	during the follow up period  none of the patients had variceal bleeding  
class10	3820	chronic encephalopathy developed in six  which was mild in three  moderate in one instance and severe in two  
class10	3820	it developed soon after epss  with onset in the first month after discharge in three  
class10	3820	thus  when conservative treatment fails to arrest variceal bleeding  epss should be performed to guarantee definitive control of hemorrhage and prolong the survival period  
class10	3821	vancomycin pharmacokinetics in hydrocephalic shunt prophylaxis and relationship to ventricular volume  
class10	3821	vancomycin pharmacokinetics were determined in 25 patients receiving ventriculoperitoneal shunts for hydrocephalus  
class10	3821	computed tomography scan derived ventricular brain ratio as an expression of hydrocephalus varied between 9 3  and 15 4   12 9      1 7    
class10	3821	one hour prior to surgery each patient received 1 g of vancomycin infused intravenously over 60 minutes  
class10	3821	samples of cerebrospinal fluid and venous blood were obtained 1 hour later and vancomycin levels assayed by fluorescence polarization immunoassay  
class10	3821	there were 11 females and 14 males  with a mean age of 44 5     10 3 years and a mean weight of 72 0     11 4 kg  
class10	3821	all had normal renal function  
class10	3821	levels of vancomycin in the cerebrospinal fluid at 1 hour ranged from 0 1 to 1 5 micrograms ml  0 9     0 3   
class10	3821	weight did not affect these values  p greater than 0 1   
class10	3821	simultaneous blood vancomycin levels varied between 9 1 and 38 7 micrograms ml  22 3     8 3   
class10	3821	ventricular volume  expressed as the ventricular brain ratio  did not correlate with cerebrospinal fluid vancomycin levels  p greater than 0 5   
class10	3821	there was no significant increase in concentrations of vancomycin in csf as cerebrospinal fluid protein concentration increased  nor when blood vancomycin concentration was greater than 20 mg dl  therapeutic range   p greater than 0 1   
class10	3821	no patient had evidence of infection at 6 months follow up  
class10	3821	these results indicate minimal cerebrospinal fluid penetrance of vancomycin when administered systemically 1 hour prior to shunt surgery  
class10	3821	in addition concentrations of vancomycin in cerebrospinal fluid bear no relationship to weight  ventricular volume  meningeal inflammation  or blood levels in the therapeutic range  
class10	3821	the minimum inhibitory concentration of vancomycin for staphylococci is 1 5 to 3 1  and as bactericidal levels of 5 to 8 minimum inhibitory concentration are needed to kill organisms  a combination of both systemic and intraventricular vancomycin may be needed to ensure adequate cerebrospinal fluid and tissue concentration of antibiotic during shunt prophylaxis  
class10	3822	cerebral blood flow velocities in the anterior cerebral arteries and basilar artery in hydrocephalus before and after treatment  
class10	3822	we studied pourcelot s index  pi   which shows cerebral vascular resistance  in the anterior cerebral arteries and basilar artery  and the pi ratio  pourcelot s index in the anterior cerebral artery pourcelot s index in the basilar artery  in 11 measurements of hydrocephalus  
class10	3822	the mean values of pi in the anterior cerebral artery  basilar artery  and the pi ratio before treatment were significantly higher than those after treatment and those in normal infants  
class10	3822	before treatment  the mean pi in the anterior cerebral arteries was significantly higher than the mean pi in the basilar artery  
class10	3822	all pi ratios increased to 1 00 or more  
class10	3822	after treatment and in normal infants  the mean pi in the anterior cerebral arteries was significantly lower than the mean pi in the basilar artery  
class10	3822	all pi ratios decreased to less than 1 00  
class10	3822	we believe that the pi ratio is useful to evaluate the need or effect of treatment in hydrocephalus  
class10	3823	brain stem tuberculoma in adult patients  diagnosis and treatment  
class10	3823	a consecutive series of six adult patients ranging in age from 29 to 53 years is presented  
class10	3823	the clinical and radiological features in each patient are described  
class10	3823	attention is drawn to the features demonstrated on computed axial tomography  
class10	3823	in only one patient  the first encountered  was surgical excision undertaken and histological verification obtained  
class10	3823	one patient died before any form of treatment could be instituted  
class10	3823	the remaining four patients were treated with antituberculous chemotherapy alone and their progress monitored by sequential computed tomography  
class10	3823	the excellent response and good outcome in this conservatively treated group are documented  
class10	3824	cerebral hemodynamics in patients with normal pressure hydrocephalus  correlation between cerebral circulation time and dementia  
class10	3824	regional cerebral blood flow and regional cerebral circulation time were measured in 13 demented patients with chronic hydrocephalus  mostly normal pressure hydrocephalus  
class10	3824	the average hemispheric  frontal  and temporal cerebral blood flows were significantly reduced  
class10	3824	the average regional cerebral circulation time values were significantly prolonged in the frontal  temporal  and thalamic regions  most markedly in the frontal white matter  where periventricular lucency was observed on computed tomography  
class10	3824	clinical improvement was obtained in all patients after operation  
class10	3824	while postoperative regional cerebral blood flow values did not change compared with preoperative ones  postoperative regional cerebral circulation time values were significantly reduced in all the regions measured  and most markedly in the frontal white matter  
class10	3824	the present results suggest that microcirculation in the frontal lobe is closely correlated with dementia in association with pressure exerted on the nerve fibers in the frontal white matter in patients with normal pressure hydrocephalus  
class10	3825	aqueductal  pencil  glioma presenting as neurogenic pulmonary edema  a case report  
class10	3825	a case of neurogenic pulmonary edema due to hydrocephalus  without initial neurological deficit  is described  
class10	3825	computed tomography demonstrated a ring enhancing lesion in the tectum of the mesencephalon obstructing the aqueduct of sylvius  
class10	3825	the lesion  on autopsy  was a rare mesencephalic glioma described in the literature as a  pencil glioma  of the aqueduct  
class10	3826	metoprolol for aggressive behavior in persons with mental retardation  
class10	3826	persons with mental retardation sometimes exhibit behaviors that are difficult to control  
class10	3826	use of neuroleptic medications may be limited by side effects or ineffectiveness  
class10	3826	beta blockers such as propranolol and metoprolol have been shown to decrease aggressive and impulsive behaviors in some patients with mental retardation  
class10	3827	concomitant neurocysticercosis and brucellosis  
class10	3827	a young mexican woman had headache and left arm weakness develop shortly after immigrating to the united states  
class10	3827	a solitary cerebral cysticercus was found at surgery  but  instead of the expected finding of clear fluid  the cyst contained pus from which brucella melitensis was cultured  
class10	3827	although the patient had no signs or symptoms suggestive of brucellosis  agglutination studies revealed igm and igg antibodies consistent with active brucellosis  
class10	3827	clinicians should be alert to the possibility of multiple infections in immigrants from countries where parasites and bacteria that are uncommon in the united states are endemic  
class10	3828	the deja vu experience  remembrance of things past  
class10	3828	the deja vu experience is a common phenomenon  occurring in pathological as well as nonpathological conditions  
class10	3828	it has been defined as any subjectively inappropriate impression of familiarity of a present experience with an undefined past  
class10	3828	the authors discuss the epidemiologic data  clinical features  and etiology of the phenomenon of deja vu  
class10	3828	they also review the different hypotheses on the psychopathogenesis of the deja vu experience and introduce an explanation based on the hologram as a mnestic model  
class10	3829	brainstem auditory evoked response and subcortical abnormalities in autism  
class10	3829	previous studies of the neurobiology of autism that have used the brainstem auditory evoked response have given contradictory results  
class10	3829	the authors of this study considered two supplementary aspects  they added an ipsilateral masking procedure  and they compared the results for every subject to the values  corrected for age and sex  of a large number of normal children  
class10	3829	twenty autistic  according to dsm iii r criteria  and 13 mentally retarded  nonverbal iq less than 75  subjects were assessed  
class10	3829	eighty percent of the autistic subjects had abnormal interpeak latencies  compared to 15  of the mentally retarded subjects  
class10	3829	the i v and iii v prolonged interpeak latency values were seen only in the autistic subjects  
class10	3829	the ipsilateral masking procedure doubled the rate of detection of higher brainstem abnormalities in the autistic children  
class10	3830	the ucla university of utah epidemiologic survey of autism  the etiologic role of rare diseases  
class10	3830	twelve rare diseases known to cause cns pathology were found in 26  11   of 233 autistic probands identified during a recent epidemiologic survey of utah  
class10	3830	these 26 probands had significantly lower mean iqs than the remaining patients  43 versus 60  but similar sex distribution and prevalence of abnormal eegs and seizures  
class10	3830	the rarity and diversity of these 12 diseases make it highly unlikely that they randomly occurred with autism  
class10	3830	their presence in this epidemiologic survey is the most compelling evidence to date to support the hypothesis that different diseases producing different types of cns pathology can play an etiologic role in autism  
class10	3831	pharmacologic treatment of noncognitive behavioral disturbances in elderly demented patients  
class10	3831	fifty nine elderly residents of long term care facilities who had dsm iii diagnoses of dementia were studied in an 8 week randomized  double blind comparison trial of haloperidol  oxazepam  and diphenhydramine to test the efficacy of these agents in the treatment of clinically significant behavioral disturbances in patients with dementia  
class10	3831	all three agents demonstrated modest but significant efficacy as measured by clinician ratings of agitated behavior and activities of daily living  
class10	3831	the absolute magnitude of improvement was greater for haloperidol and diphenhydramine than for oxazepam  but differences among groups did not approach statistical significance  
class10	3831	frequencies of acute adverse events during the trial were similar across the drug treatment groups  
class10	3831	although these drugs may differ in terms of long term safety and efficacy  they appear to be equivalent for short term management of agitated behavior in severely demented patients  
class10	3832	steroid anabolic drugs and arterial complications in an athlete  a case history  
class10	3832	serious side effects and complications have been attributed to anabolic and androgenic steroids when used for medical reasons or when taken in sports in hopes of increasing strength and  hence  performance  
class10	3832	the author presents a case of an athlete who experienced two metachronous arterial complications after taking these drugs  a cerebrovascular accident caused by a carotid artery thrombus that partially embolized to the brain and  later  a severe ischemic episode in a lower limb caused by a diffused distal arterial thrombosis  
class10	3832	this patient represents the first reported case of vascular events in an otherwise healthy athlete taking androgens to increase his skeletal muscle mass  
class10	3833	type i hypersensitivity to rubber  
class10	3833	seven patients with type i hypersensitivity reactions to rubber are reported  
class10	3833	radioallergosorbent testing with crude latex antigen was positive in 6 7 patients  
class10	3833	five patients had coexisting spina bifida  and all had undergone surgery before the development of rubber allergy  
class10	3833	rubber allergy is a new phenomenon that should be in the differential diagnosis of idiopathic anaphylaxis and urticaria  
class10	3834	cystocerebral syndrome  acute urinary retention presenting as confusion in elderly patients  
class10	3834	the diagnosis of acute mental status changes in the elderly patient is often very difficult  
class10	3834	many causes are possible  and there is often little history obtainable  
class10	3834	the physical examination occasionally provides the essential clues needed to discover the source of the sudden deterioration  
class10	3834	we have recently evaluated four episodes of acute delirium in three elderly patients who presented with no readily apparent cause for these changes  
class10	3834	on further evaluation  the patients were found to have marked bladder distention associated with acute urinary retention  
class10	3834	none of these patients complained of discomfort  and none had any awareness or recollection of their deterioration  
class10	3834	each patient had rapid resolution of symptoms on bladder decompression  
class10	3834	to our knowledge  this  cystocerebral syndrome  has not been previously described  and we suggest that it be considered in the evaluation of acute confusional states in elderly men  
class10	3835	rapid eye movement sleep deprivation as a probe in elderly subjects  
class10	3835	the effects of a 2 night rapid eye movement  rem  sleep deprivation  rsd  procedure on electroencephalographic sleep and mood were examined in 15 healthy elderly control subjects  14 elderly patients with endogenous depression  and 15 patients with primary degenerative dementia  
class10	3835	compared with control subjects  both patient groups maintained a higher amount of rem sleep time and rem activity during rsd  
class10	3835	unexpectedly  depressed patients showed little rebound in visually scored or automated rem sleep measures following rsd  and they showed stability of rem activity temporal distribution from baseline to recovery conditions  
class10	3835	this contrasted with the rebound in rem sleep activity seen in control subjects  and the more modest increase in demented patients  
class10	3835	the rsd was fairly specific  with some impact on delta sleep during the procedure but not during recovery sleep  
class10	3835	mood ratings were unaffected by rsd  
class10	3835	these findings demonstrated a greater plasticity of rem sleep regulation in the healthy elderly control subjects and suggested a higher rem  pressure  with a  ceiling effect  in depressed patients  
class10	3835	patients with dementia appeared to have an impaired capacity to respond to the challenge of rsd  
class10	3836	altered waveform of plasma nocturnal melatonin secretion in premenstrual depression  
class10	3836	the nocturnal secretion of plasma melatonin was determined under dim to dark conditions in eight patients with prospectively confirmed premenstrual syndrome and in eight age  and menstrual cycle phase matched normal control subjects  
class10	3836	plasma samples for melatonin were collected every 30 minutes from 6 pm to 9 am during the early follicular  late follicular  midluteal and late luteal phases of the menstrual cycle  
class10	3836	compared with normal controls  patients with premenstrual syndrome had an earlier  phase advanced  offset of melatonin secretion  which contributed to a shorter secretion duration and a decreased area under the curve  
class10	3836	no statistically significant differences were found between women with premenstrual syndrome and normal controls for melatonin onset or peak concentration  or for estradiol or progesterone levels  
class10	3836	the data demonstrate that women with premenstrual syndrome have chronobiological abnormalities of melatonin secretion  
class10	3836	the fact that these patients respond to treatments that affect circadian physiology  such as sleep deprivation and phototherapy  suggests that circadian abnormalities may contribute to the pathogenesis of premenstrual syndrome  
class10	3837	a study of immunoglobulin g in the cerebrospinal fluid of 1007 patients with suspected neurological disease using isoelectric focusing and the log igg index  a comparison and diagnostic applications  
class10	3837	cerebrospinal fluid and serum immunoglobulin g from 1007 patients with suspected neurological disease were analysed by 2 methods  isoelectric focusing for the detection of oligoclonal banding  and quantitative measurement of igg and albumin for the formulation of a log igg index  
class10	3837	a comparison of the 2 methods in the detection of local synthesis of igg showed that isoelectric focusing not only gave a much higher yield overall  with 282 patients showing local synthesis versus 225 for the log igg index  but also a higher specificity  with a false positive rate of 0  versus 3 5   
class10	3837	in addition  of the 282 patients positive by isoelectric focusing only 163  58   were positive by the log igg index  
class10	3837	of the 1007 patients studied  206 had multiple sclerosis  ms   and isoelectric focusing showed local synthesis in 95  of clinically definite cases  with a 90  detection rate overall  
class10	3837	the log igg index was positive in only 67  of clinically definite cases  with an overall 59  detection rate  
class10	3837	thus with the exceptions noted above  local synthesis of igg as defined by isoelectric focusing is confined to demyelinating  inflammatory  infectious and postinfectious disorders  
class10	3837	our results compare very favourably with the published sensitivities of magnetic resonance imaging in the detection of abnormalities in multiple sclerosis  and better than those for evoked potentials  
class10	3837	where both these investigations are readily available isoelectric focusing provides a useful adjunct  
class10	3837	for the majority of physicians and neurologists who do not have ready access to magnetic resonance imaging  isoelectric focusing is an excellent alternative  
class10	3837	we would also recommend that it become the standard for the measurement of igg abnormalities in the cerebrospinal fluid and that the use of quantitative data be abandoned for routine purposes  
class10	3838	congenital myasthenia associated with facial malformations in iraqi and iranian jews  a new genetic syndrome  
class10	3838	fourteen jewish patients from 10 families of either iraqi or iranian origin with congenital myasthenia had associated facial malformations which included an elongated face  mandibular prognathism with class iii malocclusion and a high arched palate  
class10	3838	other common features were muscle weakness restricted predominantly to ptosis  weakness of facial and masticatory muscles  and fatigable speech  mild and nonprogressive course  response to cholinesterase inhibitors  absence of antibodies to acetylcholine receptor  decremental response on repetitive stimulation at 3 hz but no repetitive compound muscle action potential in response to a single nerve stimulus  
class10	3838	this newly recognized form of congenital myasthenia with distinctive ethnic clustering and associated facial malformations is transmitted as an autosomal recessive disorder  
class10	3838	the facial abnormalities may be secondary to the neuromuscular defect or may be primary and unrelated  
class10	3838	further studies are needed to elucidate the defect in neuromuscular transmission responsible for the pathogenesis of this syndrome  
class10	3839	myelopathy associated with human t cell lymphotropic virus type i  htlv i  in natal  south africa  a clinical and investigative study in 24 patients  
class10	3839	unexplained spastic myelopathy in black  zulu  patients  similar to that seen in the tropics  has previously been described from natal  south africa  
class10	3839	following reports linking the human t cell lymphotropic virus type i  htlv i  to spastic myelopathy  we undertook a prospective and retrospective search for htlv i antibodies in 36 patients who were labelled as having unexplained myelopathy  24  66   were positive and htlv i was isolated from 4 out of the 6 patients whose peripheral blood lymphocytes were cultured  
class10	3839	eighteen  75   gave a short history  less than 6 months   
class10	3839	there was a female preponderance  71    spinothalamic dysfunction was common  55   and as many as half were severely disabled  50  wheelchair bound   
class10	3839	routine laboratory studies showed no specific trends apart from hypergammaglobulinaemia and csf pleocytosis  greater than 5 cells microliter in 66  of patients   
class10	3839	the total csf protein was raised  greater than 0 4 g l  in 45  of patients  
class10	3839	the igg index was greater than 0 7 in 15 of 19 patients  
class10	3839	conventional myelography did not show any specific abnormalities  
class10	3839	computer assisted myelography was undertaken in 22 patients  3 showed arachnoiditis and 2 spinal cord atrophy  
class10	3839	periventricular lucencies were seen in 1 of 10 patients who had computed tomography of the head  
class10	3839	nerve conduction studies demonstrated abnormalities in 46  of the patients indicating that subclinical peripheral nerve dysfunction was common  
class10	3839	visual evoked responses were abnormal in only 1 patient but brainstem auditory evoked response studies showed some abnormality in 42  of the patients  
class10	3839	the finding of htlv i antibodies in a significant number  and the isolation of htlv i from the blood in 6 of our black patients with noncompressive myelopathy  represents a substantial clinical advance  
class10	3839	future studies should define more clearly the role of the virus in this disorder  
class10	3840	heterogeneity in progressive aphasia due to focal cortical atrophy  a clinical and pet study  
class10	3840	six patients with a slowly progressive aphasic disorder due to degenerative cortical disease are reported  
class10	3840	the length of history varied from 18 months to 6 years  
class10	3840	in 5 patients  there was a naming deficit  associated in 4 of these with some abnormalities in comprehension  
class10	3840	one patient had a progressive history of reduced speech output  which was associated with an orofacial dyspraxia  
class10	3840	all patients were studied neuropsychologically  and in addition regional cerebral metabolism was measured using position emission tomography  
class10	3840	a localized left hemisphere deficit was found in all patients except 1  who had the longest history and the most profound clinical deficit  and who also had right hemisphere hypometabolism  
class10	3840	the major brunt of the deficit was in the anterior portion of the left temporal lobe in all but 1 case  the patient with poor speech output who had a more severe left posterior frontal deficit  
class10	3840	these findings suggest that in progressive aphasia due to focal cortical atrophy there is heterogeneity in the clinical presentation and anatomical site of the deficit  with possible implications for the underlying aetiology  
class10	3841	developmental dysmnesia in a poor reader  
class10	3841	a 22 yr old subject with moderate developmental dyslexia experienced poor memory from an early age  
class10	3841	in spite of normal intelligence he had great difficulty in learning historical and geographical names  mathematical formulae  poems and songs  and verbal series such as the letters of the alphabet and the months of the year  
class10	3841	his recognition of familiar faces was also faulty at times  
class10	3841	a battery of memory tests confirmed a moderate deficit of verbal as well as visual memory  whereas spatial memory was preserved  
class10	3841	other cognitive functions were intact  except for a mild reading disability  
class10	3841	no evidence of brain pathology was provided by his history  neurological examination and ct scanning  
class10	3842	familial paroxysmal kinesigenic ataxia and continuous myokymia  
class10	3842	a large family with paroxysmal ataxia and continuous myokymic discharges is described  
class10	3842	the disorder is of autosomal dominant inheritance  
class10	3842	during attacks coordination of movements and balance are disturbed  often a postural tremor of the head and the hands and fine twitching in some of the facial and hand muscles are present  
class10	3842	the attacks usually last a few minutes and may occur several times per day  
class10	3842	they first appear in childhood and tend to abate after early adulthood  
class10	3842	the attacks are frequently precipitated by kinesigenic stimuli similar to those in paroxysmal kinesigenic choreoathetosis  
class10	3842	their occurrence can be reduced or prevented by carbonic anhydrase inhibitors  
class10	3842	between attacks a slight postural tremor and ataxia was found in a few of the elderly affected members  
class10	3842	fine rippling myokymia was obvious in a few and could be detected on close inspection in about half of the adults  
class10	3842	electromyography  emg  showed myokymic discharges in all affected members  
class10	3842	the characteristics and reactivity of this myokymic activity suggest multiple impulse generation in the peripheral nerves  
class10	3843	the comportmental learning disabilities of early frontal lobe damage  
class10	3843	two adult patients are described who suffered bilateral prefrontal damage early in life and who subsequently came to psychiatric attention because of severely aberrant behaviour  
class10	3843	a battery of developmental psychology paradigms  not previously used to assess neurologically impaired individuals  showed that social and moral development of these 2 patients was arrested at an immature stage  
class10	3843	in comparison with other types of brain damage which disrupt cognitive development  frontal damage acquired early in life appears to provide the neurological substrate for a special type of learning disability in the realms of insight  foresight  social judgement  empathy  and complex reasoning  
class10	3844	cerebral blood flow in progressive aphasia without dementia  case report  using 133xenon inhalation  technetium 99m hexamethylpropyleneamine oxime and single photon emission computerized tomography  
class10	3844	we report a case of progressive aphasia without clinical signs of intellectual or behavioral impairment  satisfying mesulam s clinical criteria of primary progressive aphasia  as 4 yrs of extensive psychometric testing and radiological imaging  comprising ct and mri  failed to detect evidence of relevant involvement outside the left perisylvian regions  
class10	3844	cranial ct was normal but mri showed multiple bilateral lesions in the deep white matter  
class10	3844	cerebral blood flow  cbf  studies by single photon emission computerized tomography  however  showed an initial frontotemporal focus of hypoperfusion that progressively extended to include most of the ipsilateral hemisphere and the contralateral frontal lobe  
class10	3844	this suggests that cbf imaging may yet be the most sensitive technique in revealing subclinical injury in the degenerative brain diseases of focal onset  
class10	3845	the anatomical basis of the caecocentral scotoma  new observations and a review  
class10	3845	it is shown that the  papillomacular bundle  of optic nerve fibres  although a concept discussed frequently in the clinical literature  lacks a clear anatomical definition  
class10	3845	it is suggested that the explanation for this is that the  bundle  was originally described in autopsy studies of toxic amblyopia  not normal anatomy  
class10	3845	the optic nerve fibre projection and vascular architecture of the caecocentral region of the retina is described  
class10	3845	these anatomical features are discussed in relation to a number of possible anatomical explanations for the fact that a caecocentral scotoma is the characteristic field defect found in toxic amblyopia  
class10	3845	we have been unable to identify a distinct anatomical feature which might explain this vulnerability but suggest that the problem has not as yet been clearly addressed by anatomists  
class10	3846	the distribution of muscle weakness in upper motoneuron lesions affecting the lower limb  
class10	3846	to determine the distribution of weakness in the lower limb after upper motoneuron lesions the strength of 8 muscle groups was measured  
class10	3846	four groups of patients were studied  22 control subjects  16 patients with unilateral leg paresis  4 patients with severe unilateral paralysis and 5 patients with paraparesis  
class10	3846	in the testing posture  seated   patients with cerebral upper motoneuron lesions showed no selective loss of power in flexors or extensors on the contralateral side  
class10	3846	gravitational torques were included in the measurements  
class10	3846	however  proximal muscles  acting at hip and knee  were significantly less severely affected than more distal muscles  acting at ankle and hallux   
class10	3846	at any particular joint  physiological flexors and extensors were affected equally in both the hemiparetic and paraparetic subjects  
class10	3846	as in the upper limb  colebatch and gandevia  1989   the strength of muscles on the clinically unaffected side was reduced compared with control subjects  although no muscle groups were especially affected  
class10	3847	innervation territories for touch and pain afferents of single fascicles of the human ulnar nerve  mapping through intraneural microrecording and microstimulation  
class10	3847	the peripheral distribution of the fibre content of individual ulnar nerve fascicles supplying skin and muscles of the hand in human volunteers was indirectly mapped by tracing the fields of projected sensation evoked by intraneural electrical microstimulation  inms  and by tracing receptive fields delineated through intraneural recording of afferent impulse activity elicited by natural stimulation of end organs  
class10	3847	moderate intensity suprathreshold inms  delivered in cutaneous fascicles  induced nonpainful sensations projecting to stereotyped and coherent areas of skin  the fascicular projected fields  fpfs   
class10	3847	fascicular receptive fields  frfs  were mapped during microneurographic recording by determining the area of skin which  when activated by light tactile stimuli  elicited afferent neural discharges recorded intraneurally  
class10	3847	it was found that at a given electrode position in a skin nerve fascicle  moderate intensity inms induced nonpainful sensations projecting to a cutaneous field  fpf  that coincides with the frf  while high intensity inms induced painful sensations projecting within the cutaneous field of nonpainful sensations  
class10	3847	pain induced by inms in muscle nerve fascicles was projected to the muscles innervated by that fascicle and  in most instances  to areas beyond the muscular receptive field  
class10	3847	the study demonstrates that individual ulnar nerve fascicles  at wrist levels  subserve well defined cutaneous territories in the hand  and that the area of skin covered by the sum of all ulnar fascicular receptive or projected fields matches the maximal possible cutaneous distribution of the ulnar nerve  
class10	3847	insights of practical relevance regarding clinical expression of fascicular nerve injuries are also brought up by this study  
class10	3848	volume conduction of the parietal n20 potential to the prerolandic frontal area  
class10	3848	somatosensory evoked potentials were recorded from the frontal and parietal areas in patients with various lesions in the central nervous system on stimulation of the median nerve  
class10	3848	five representative cases who showed a selective loss of the positive potential from the frontal area are reported  
class10	3848	in each case  the parietal n20 potential was relatively well preserved  and the midposition between the frontal and central areas  fc area  showed a negative potential following p14  
class10	3848	the peak of this negative potential was synchronous with that of the parietal n20 potential  
class10	3848	this negativity on the fc area is considered to be a volume conducted potential from the parietal n20 to the prerolandic frontal area  
class10	3848	such an anterior volume conduction of the parietal n20 would not be explained by the concept of a tangentially oriented dipole generated in the posterior bank of the central sulcus  
class10	3848	instead  for the generator of the parietal n20 potential  a radically oriented dipole generated mainly in the parietal area is postulated  
class10	3849	selective spatial attention in patients with visual extinction  
class10	3849	the present study was designed to verify the attentional performance of patients with parietal lesions in the experimental condition in which they had to pay attention to 3 spatial positions located on the left  on the right and directly above the fixation stimulus  experiment 1  and to only 1 of the 3 spatial positions at a time  experiment 2   
class10	3849	twelve patients  6 subjects with right parietal lesions and 6 subjects without neurological deficits  participated in the experiment  
class10	3849	the results of experiment 1 showed that in patients with right parietal lesions the speed and accuracy of response to horizontally aligned stimuli increased gradually from right to left  whereas the control group showed only the effect due to the different retinal eccentricities of the 3 stimuli  that is  responses to central stimuli were faster and more accurate than responses to left and right stimuli  
class10	3849	the results of experiment 2 showed that both the neurological and control groups were faster to respond to central than to left and right stimuli  and that the neurological group was faster to respond to right than left stimuli  whereas no difference in rts between two visual fields was obtained in the control group  
class10	3849	furthermore  when the patients had to respond to 3 spatial locations aligned horizontally  experiment 1   the speed and accuracy of response to the right stimulus were the same as when they had to focus attention on it  experiment 2   
class10	3849	these results showed that the focus of attention in patients with visual extinction is on the rightmost stimulus and that the increased attention to the right is accompanied by a decreased attention to the left  
class10	3850	osseointegration of titanium implants in total hip arthroplasty  
class10	3850	osseointegration is defined as direct contact on the light microscopic level between living bone tissue and the implant  
class10	3850	using titanium screw dental implants in the jaw  a lasting interface under loaded conditions extending over a 20 year follow up period has been demonstrated  
class10	3850	this demonstration brings up the question whether a similar interface can be achieved in total hip arthroplasty  tha  between living bone and a titanium alloy implant under necessitated conditions of immediate loading  
class10	3850	two series of cases are reported  
class10	3850	the first series used a femoral  press fit  titanium alloy component and the second used a press fit titanium acetabular component and redesigned femoral  press fit  titanium alloy component  
class10	3850	both demonstrated a high percentage of good to excellent results  
class10	3850	roentgenograms showed that the geometrical changes in the redesigned femoral component gave early indications of a better fixation with loading in valgus  less subsidence  and less evidence of distal stress transfer  
class10	3850	a two and one half year postoperative anatomic specimen study confirmed osseointegration to the press fit titanium alloy femoral component  
class10	3850	multiple areas of contact between bone and metal without fibrous interposition were seen  
class10	3850	examination by electron microscopy supported the light microscopic findings  
class10	3850	these findings support further use of smooth  press fit titanium components in thas without the need for porous coating  mesh  or other surface modifications  
class10	3851	intraoperative dexamethasone irrigation in lumbar microdiskectomy  
class10	3851	in 45 lumbar hemilaminectomy microdiskectomy patients  a control group of 23 patients had the standard operative procedure  
class10	3851	the remaining 22 patients were treated with intraoperative irrigation of long acting dexamethasone before incision closure  
class10	3851	age  weight  gender ratio  mean postoperative hospital stay  mean in hospital narcotics usage  and incidence of perioperative complications among the two groups were compared  
class10	3851	age and gender ratios were comparable  although the control group was significantly heavier in body weight than the steroid irrigated group  
class10	3851	the steroid irrigated group had a significant reduction in hospitalization and a marked reduction in narcotics usage compared with the control group  
class10	3851	postoperative fever occurred in one patient in the steroid group  
class10	3851	the control group had three postoperative complications  
class10	3851	these preliminary observations suggest that dexamethasone irrigation during lumbar diskectomy is a safe and effective adjunct to surgical management  
class10	3852	continuous removal of middle molecules by hemofiltration in patients with acute liver failure  
class10	3852	in patients with acute liver failure and hepatic coma  an increase in the abnormal  middle molecules  seen on the chromatograms of the sera is suspected of playing an etiologic role in the coma  
class10	3852	a pilot study of continuous hemofiltration using a high performance membrane was conducted in 16 such patients in an attempt to decrease the serum levels of the middle molecules  
class10	3852	the procedure was used alternately with plasma exchange  
class10	3852	high performance liquid chromatography showed a notable removal of the substances in the filtrates and a sequential removal from the serum by hemofiltration  
class10	3852	eight  50   of the 16 patients had amelioration in level of consciousness and were weaned successfully from hemofiltration  
class10	3852	although only three of the 16 patients survived the acute illness  13 others lived an average of 15 days and five patients survived greater than 3 wk  
class10	3852	while the continuous removal of middle molecules from the serum may not reverse liver failure  this procedure used in conjunction with plasma exchange may provide a means of life support  e g   for patients awaiting a liver transplant  
class10	3853	a limited diagnostic investigation for obstructive sleep apnea syndrome  oximetry and static charge sensitive bed  
class10	3853	a simplified sleep apnea investigation consisting of combined oximetry and respiration movement monitoring was compared with conventional polysomnography  
class10	3853	these two types of recordings were performed simultaneously during one night in 77 patients with suspected obstructive sleep apnea syndrome  osas   
class10	3853	a static charge sensitive bed  scsb  was used in the simplified recording because it provides a comfortable and reliable means of recording respiration movements  
class10	3853	periods of obstructive apneas gave a diamond shaped periodic respiration movement pattern in the scsb  usually accompanied by repetitive oxygen desaturations  
class10	3853	the average number of desaturations greater than or equal to 4 percent per sleeping hour was termed the oxygen desaturation index  odi  and compared with the apnea index  ai   
class10	3853	in the whole population they were well correlated  p less than 0 0001  r2   0 41   but in individual cases there were considerable discrepancies  
class10	3853	patients with periodic respiration movements less than 18 percent of total sleeping time and odi less than 2 never had ai greater than or equal to 5  whereas patients with periodic respiration greater than 45 percent and odi greater than 6 always had ai greater than or equal to 5  
class10	3853	fifty one of the 77 patients fulfilled these criteria  
class10	3853	a bradycardia response to apneas was absent in 29 percent of patients with ai greater than or equal to 5  
class10	3853	a combination of respiration movement and oximetry recording thus seems to give sufficient information to confirm or negate a diagnosis of osas in a majority of patients with clinical symptoms  
class10	3853	in borderline patients  further investigations should be performed  
class10	3854	systemic hypertension in sleep apnea syndrome  relationship with sleep architecture and breathing abnormalities  
class10	3854	to examine the possible relationship between systemic ht and sas we compared 21 hypertensive  ht   and 29 normotensive  ht   patients for morphologic characteristics  sleep disturbances and respiratory events monitored during a full night polysomnography  
class10	3854	there was no significant difference between ht  and ht  patients with respect to age  weight  bmi  sleep stage distribution and disorganization  apnea hypopnea index  number of episodes per hour of sleep  and duration  minutes per hour of sleep  nor o2 saturation indices  mean nocturnal and minimum o2 saturation  
class10	3854	we conclude therefore that ht in sas patients is not directly related to morphologic characteristics  sleep disturbances and breathing abnormalities  
class10	3855	clinical dysautonomia in patients with bronchial asthma  study with seven autonomic function tests  
class10	3855	fifty asthmatic patients and 20 healthy control subjects  carefully age  and sex matched  were subjected to seven standardized tests to evaluate their autonomic status  
class10	3855	due care was taken to remove factors which could interfere with results  
class10	3855	of the tests concerned with the parasympathetic system  the intravenous atropine test  p greater than 0 10  and heart rate response to standing  p greater than 0 01  which measured the basal parasympathetic tone  did not show a significant difference  
class10	3855	tests requiring stimulation of the parasympathetic system  ie  deep breathing test  p less than 0 001   valsalva maneuver  p less than 0 001   and carotid sinus massage  p less than 0 001  showed significantly heightened response  
class10	3855	postural fall of blood pressure  p greater than 0 10  and sustained hand grip test  p greater than 0 10   chiefly concerned with the sympathetic system  did not show a significant difference  
class10	3855	of the 50 asthmatic patients  nine were atopic and 41 nonatopic  
class10	3855	when the results were compared in the two groups separately  we found that there was no alteration in the measurements except the intravenous atropine test which showed heightened response with atopic subjects  p less than 0 05   
class10	3855	these results suggest that hyperresponsiveness of the parasympathetic system is an important factor in producing bronchial spasm in asthmatic patients  and atopic and nonatopic subjects do not differ much in their autonomic status  
class10	3856	maxillofacial surgery and nasal cpap  a comparison of treatment for obstructive sleep apnea syndrome 
class10	3856	nasal continuous positive airway pressure  cpap  is the primary therapy for obstructive sleep apnea syndrome  osas   
class10	3856	recent reports have indicated  however  that there is a small but significant number of failures related to patient compliance  
class10	3856	primary surgical treatment  which has been uvulopalatopharyngoplasty  uppp   has declined because of poor results  
class10	3856	a reviewed of uppp failures has shown that while uppp eliminated palatal obstruction  it failed to eliminate base of tongue obstruction  
class10	3856	maxillofacial surgery has been reported as treatment of osas by correcting base of tongue obstruction  
class10	3856	thirty patients with severe osas were evaluated to compare nasal cpap and maxillofacial surgery  
class10	3856	the goal was to determine if our surgical protocol was as effective as nasal cpap  
class10	3856	all patients initially underwent baseline diagnostic polysomnography to document osas  
class10	3856	a nasal cpap study was performed to determine the appropriate positive end expiratory pressure  
class10	3856	the patients in this study were using nasal cpap  but they found it unacceptable as long term treatment and elected surgery  
class10	3856	maxillofacial surgery consisted of maxillary  mandibular  and hyoid advancement  
class10	3856	polysomnography was performed six months following surgery and compared with the night 2 cpap results  
class10	3856	the parameters included in the investigation were the respiratory disturbance index  rdi   lowest sao2  number of sao2 falls below 90 percent  total sleep time  tst   rem sleep percent  stage 3 4 sleep percent  and wake after sleep onset  
class10	3856	the mean rdi before treatment was 72 0  sd 25 7   
class10	3856	after completing therapy  the rdi from surgery and cpap was 8 8  sd 6 0  and 8 6  sd 4 1   respectively  
class10	3856	the mean low sao2 prior to treatment was 61 0  sd 13 5   and the cpap results and postsurgical results were 86 2  sd 5 5  and 86 1  sd 4 2   respectively  
class10	3856	an analysis of variance was used to examine the results  and there was no statistical difference between nasal cpap and surgery for all respiratory variables  
class10	3857	lack of change in neurochemical markers during the postepileptic phase of intrahippocampal tetanus toxin syndrome in rats  
class10	3857	the chronic epileptic syndrome induced by injecting tetanus toxin into rat hippocampus causes functional changes that essentially are permanent  outlasting the period of active seizures by at least 1 year  
class10	3857	these long term changes have been characterized by an impaired performance on a range of behavioral tasks  which in turn have been associated with a physiologic depression of hippocampal evoked responses but not with any discernible histopathology  
class10	3857	in the present study  we examined the hippocampi of rats in the postseizure phase of the tetanus toxin model and observed no significant changes in the concentration of neurochemical markers for six neurotransmitters  
class10	3857	therefore  the long term reduction in hippocampal excitability cannot be attributed to any major loss of afferents or hippocampal neurons using aspartate  acetylcholine  gamma aminobutyric acid  gaba   glutamate  norepinephrine  ne   or serotonin as their transmitters  
class10	3858	some endorphin derivatives and hydrocortisone prevent eeg limbic seizures induced by corticotropin releasing factor in rabbits  
class10	3858	corticotropin releasing factor  crf  injected into the cerebral ventricles of small mammals induces eeg limbic seizures  behavioral excitability  stereotyped behavior  and tardive enhancement of hippocampal theta voltage and frequency  
class10	3858	because we addressed this phenomenon when we explained the pathogenesis of infantile spasms in children  we wished to study the interference exerted by some gamma endorphin fragments on eeg epileptiform and behavioral symptoms induced by crf in the rabbit  
class10	3858	animals were implanted intracerebroventricularly  i c v   with semichronic cortical and hippocampal electrodes  together with a cannula into the left lateral ventricle  
class10	3858	when some gamma endorphin derivatives  dt gamma e  de gamma e  were injected intravenously  i v   for 4 days  or hydrocortisone once   they prevented the eeg ictal seizures induced in the hippocampus of rabbits by crf injected i c v  
class10	3858	hydrocortisone and de gamma e also prevented the appearance of scattered spiking and partially prevented tardive enhancement of theta voltage in the hippocampal eeg  
class10	3858	finally  de gamma e also prevented stereotyped behavior and excitability induced by crf  
class10	3858	these results confirm the regulatory role exerted by crf in limbic structure excitability and suggest that the above peptides may be involved in a regulatory feedback mechanism of crf metabolism or activity  
class10	3858	the possibility that these peptides may also have interesting antiepileptogenic properties should be considered  
class10	3859	neonatal monosodium glutamate abolishes corticotropin releasing factor induced epileptogenic activity in rats  
class10	3859	intracerebroventricular  i c v   injection of rat corticotropin releasing factor  rcrf  at doses of 5 20 micrograms in rats induces epileptogenic activity characterized by pacemaker like spikes localized in the hippocampal leads  
class10	3859	such an effect was still present in rats neonatally treated with saline but was absent in those neonatally treated with monosodium glutamate  msg   a treatment that caused marked changes in the concentration of several brain neurotransmitters and neuropeptides in hypothalamic nuclei where crf is highly concentrated and is believed to induce endocrinologic and behavioral effects  
class10	3859	the present results suggest the rcrf induced spiking activity is mediated by activation of neuronal pathways sensitive to msg neurotoxic effect  
class10	3860	triiodothyronine and brain excitability  
class10	3860	we investigated mechanisms involved in thyroid hormone action on brain excitability  
class10	3860	the effect of acute exposure of triiodothyronine  t3  to rat hippocampal slices in vitro was studied  
class10	3860	no significant changes could be detected in prevolley  field excitatory postsynaptic potentials  fepsp  and population spike amplitude  while there was a minor  nonsignificant trend toward shortening of the population spike latency time  
class10	3860	t3 had no effect on penicillin induced epileptiform activity  
class10	3860	there was  however  an active accumulation of radioactively labeled t3 in the slices  
class10	3860	a rat cervaux isole preparation was used to determine focal seizure thresholds in the visual cortex  and no acute  2 4 h  effects were demonstrated  
class10	3860	no significant acute effects of t3 on brain excitability in the hippocampus and visual cortex was observed  despite an active accumulation of t3  
class10	3860	thus  the effect of t3 on brain excitability most likely is due to delayed effects  
class10	3861	epidemiology of epilepsy in guaymi indians from bocas del toro province  republic of panama  
class10	3861	this cross sectional study was conducted to describe the epidemiology of epilepsy in guaymi indians residing in changuinola  a small town on panama s caribbean coast near costa rica  
class10	3861	we randomly selected households and attempted to enroll all residents aged less than or equal to 1 year  337 eligible subjects agreed to participate  93  response rate   
class10	3861	we administered a standard neurologic disease screening examination to all subjects and  if any abnormality was found  we administered a standard neurologic evaluation  
class10	3861	we detected 19 cases of active epilepsy  the mean age at onset was 12 years  and generalized tonic clonic seizures were the most common diagnosis  10 of 19  53    
class10	3861	the prevalence of active epilepsy among caribbean coastal guaymi  57 1000  is considerably greater than that in lower class panama city populations  22 1000  or in other parts of the world  
class10	3861	to identify risk factors for epilepsy  we collected epidemiologic data and serum  for cysticercus antibody  from subjects with active epilepsy and from 44 age sex matched controls  
class10	3861	significantly more cases  47   than controls  6   had other family members with epilepsy  relative risk  rr   14   44  of cases and 13  of controls reported a history of febrile seizures during childhood  rr   6   
class10	3862	electrocorticographic confirmation of focal positron emission tomographic abnormalities in children with intractable epilepsy  
class10	3862	the relationship between focal disturbances of glucose utilization demonstrated by positron emission tomography  pet  and electrophysiologic abnormalities defined by intraoperative electrocorticography  ecog  was studied in eight children  aged 13 months to 12 years  who underwent cortical resection because of intractable seizures  
class10	3862	none of the children had pure temporal lobe epilepsy  
class10	3862	computed tomography  ct  and or magnetic resonance imaging  mri  were normal in four of the eight children  
class10	3862	the scalp electroencephalogram  eeg  showed lateralized interictal epileptiform abnormalities in all eight and lateralized ictal onset in five of eight  
class10	3862	in seven children  interictal pet showed focal hypometabolism  the eighth child had focal  ictal hypermetabolism  
class10	3862	ecog at the time of surgery showed epileptiform spiking  slowing  and or suppression of normal background activity that in every case corresponded to the focus on pet scan  
class10	3862	the ecog findings support the notion that in children with epilepsy focal metabolic abnormalities on pet correspond to electrophysiologically abnormal areas of cortex  which are presumably also the epileptogenic regions  
class10	3862	such areas can appear normal on anatomic imaging studies  ct and mri   
class10	3862	when ictal scalp eeg data are ambiguous or contradictory  pet provides a less invasive means than chronic grid or depth electrode recording for evaluating whether a localized epileptogenic area exists  
class10	3863	lateralized effects of subclinical epileptiform eeg discharges on scholastic performance in children  
class10	3863	the interaction between lateralization of subclinical epileptiform discharges and cognitive tasks was investigated in 21 children  12 girls and 9 boys  mean age 10 6 years   
class10	3863	seventeen had a diagnosis of epilepsy  partial or secondarily generalized   
class10	3863	testing was by reading  arithmetic  and intelligence subtests during continuous telemetric eeg and video monitoring  
class10	3863	children with left sided discharges had significantly lower reading performance than children with right sided discharges  
class10	3863	during reading  epileptiform discharges occurred relatively less frequently and with a shorter total duration over the left hemisphere than the right  
class10	3863	this supports the view that cognitive tasks suppress epileptiform discharges when they activate a region of the brain within the epileptogenic zone  
class10	3863	discharges from other epileptogenic zones not directly activated by the tasks are increased  however  
class10	3864	topographic comparative study of magnetic resonance imaging and electroencephalography in 34 children with tuberous sclerosis  
class10	3864	a series of 34 children with confirmed tuberous sclerosis  ts  were studied prospectively by both eeg and magnetic resonance imaging  mri  at ages ranging from 5 months to 18 years  
class10	3864	size and topography of the cortical tubers were analyzed on axial and coronal views  in t2 sequences  and the large tubers greater than 10 mm were studied  
class10	3864	in addition  eeg follow up data were reviewed retrospectively  
class10	3864	twenty six patients  76   had both mri large cortical tubers and eeg foci  3 had normal eeg  2 had normal mri  and the remaining 3 had only small tubers  
class10	3864	the number of large tubers was significantly related to eeg foci  
class10	3864	a topographic mri eeg correspondence was observed for at least one tuber in 25 of the 26 patients  and correspondence was complete in 10 patients  
class10	3864	large cortical tubers without corresponding eeg foci were observed in 11 patients  these tubers mainly involved the frontal regions and were found before the patients were 2 years old  
class10	3864	eeg foci without corresponding tubers were observed in 4 patients  
class10	3864	in addition  secondary bilateral synchrony was preferentially observed in patients with frontal lesions and after the age of 2 years  
class10	3864	these data confirm that the cortical tubers are epileptogenic and that their expression may be influenced by regional cortical maturation  
class10	3865	landau kleffner syndrome  a clinical and eeg study of five cases  
class10	3865	in five children with normal initial psychomotor development  a landau kleffner syndrome appeared at age 3 7 years  
class10	3865	no neuroanatomic lesions were noted  
class10	3865	aphasia and hyperkinesia were isolated in three patients and associated with global regression of higher cortical functions in one patient  
class10	3865	massive intellectual deterioration and psychotic behavior were associated with transient aphasia in one patient  
class10	3865	the epilepsy  focal motor and generalized tonic clonic seizures  subclinical eeg focal seizures during sleep  and atypical absences  always regressed spontaneously or with antiepileptic drug  aed  treatment  
class10	3865	the eeg in waking patients showed focal and generalized spike wave discharges on a normal background rhythm  
class10	3865	discharge topography and pattern changed frequently  
class10	3865	during sleep  discharges always increased  
class10	3865	at some time during syndrome development  all patients had bilateral spike waves for greater than 85  of the sleep period  while at other times the discharges were discontinuous or continuous but focal or unilaterally hemispheric  
class10	3865	discharge topography and abundance changed from night to night  
class10	3865	the abnormal eeg and the impaired higher functions developed and regressed together  but not with strict temporal correlation  
class10	3865	our own experience suggests that the landau kleffner syndrome and epilepsy with continuous spike wave activity in slow wave sleep cannot be clearly differentiated  
class10	3865	they may be different points on the spectrum of a single syndrome  
class10	3866	landau kleffner syndrome  a pharmacologic study of five cases  
class10	3866	five children with landau kleffner syndrome  epilepsy  acquired aphasia  and continuous spike wave discharges during sleep   were treated with antiepileptic drugs  aeds   sleep modifying drugs  and corticosteroids  
class10	3866	the pharmacologic profiles differed from those observed in focal epilepsies  resembling instead those of certain generalized epilepsies  such as west or lennox gastaut syndromes  
class10	3866	phenobarbital  pb   carbamazepine  cbz   and phenytoin  pht  were ineffective or worsened the eeg and neuropsychological symptoms  whereas valproate  vpa   ethosuximide  esm   and benzodiazepines were partially or transiently efficacious  
class10	3866	dextroamphetamine produced a dramatic but transient improvement in waking and sleep eeg in one of two children  aphasia did not change  
class10	3866	corticosteroid treatment resulted in improved speech  suppression of seizures  and normalization of the eeg in three of three children  
class10	3866	our own experience and data from the literature suggest that corticosteroids should be given in high doses as soon as the diagnosis is firmly established and should be continued in maintenance dose for several months or years to avoid escape  
class10	3866	early diagnosis  before mutism or global deterioration develops  appears to be essential for effective therapy with minimal neuropsychological sequelae  
class10	3867	cerebral glucose utilization during sleep in landau kleffner syndrome  a pet study  
class10	3867	three right handed male children  aged 5  6  and 11 years  with signs  symptoms and or history of the syndrome of acquired aphasia epilepsy  landau kleffner syndrome  were studied during drug induced  electroencephalographically  eeg  monitored sleep by positron emission tomography  pet  and the  18f fluorodeoxyglucose  fdg  method  
class10	3867	our data demonstrate that in landau kleffner syndrome  cerebral glucose utilization is not normal during sleep  
class10	3867	the metabolic pattern varied between the children but the metabolic disturbances always predominated over the temporal lobes  
class10	3867	they were right sided  left sided  or bilateral  
class10	3867	in the two first patients  eeg recordings showed continuous spike and wave discharges during sleep and a right greater than left asymmetry was observed in temporal areas  
class10	3867	in patient 1  the asymmetry was associated with a relative increase of glucose utilization of the right posterior temporal region  
class10	3867	in patient 2  the glucose utilization was relatively decreased in the left anterotemporal and left perisylvian regions  
class10	3867	in patient 3  the sleep eeg showed no discharge and no significant asymmetry was observed  however  glucose utilization of both temporal lobes was decreased  
class10	3867	lower metabolic rates in subcortical structures than in cortex were also noted in the three children  
class10	3867	this metabolic pattern may be related to the maturation of the central nervous system  cns   
class10	3868	gastrointestinal motor dysfunction in acquired selective cholinergic dysautonomia associated with infectious mononucleosis  
class10	3868	this report documents the disturbance in gastrointestinal motor function in a patient with selective cholinergic dysautonomia that occurred following acute infectious mononucleosis  
class10	3868	apart from the gut  other organs affected included the pupils  sweat glands  lacrimal and salivary glands  and urinary bladder  
class10	3868	autonomic function tests showed the preservation of sympathetic adrenergic functions in contrast to the generalized involvement of postganglionic parasympathetic and sympathetic cholinergic nerves  including denervation hypersensitivity of the pupil and urinary bladder to exogenous cholinergic agonists  
class10	3868	cardiac and abdominal vagal responses were abnormal  
class10	3868	colon myenteric plexus ganglion cells were normal by morphological and immunohistochemical studies  suggesting that the selective cholinergic dysautonomia was the most likely pathophysiologic process responsible for the observed motility disorder  
class10	3868	this study documents the occurrence of selective cholinergic dysautonomia following a viral illness  the importance of the extrinsic neural control on the motor function of the gastrointestinal tract  and the usefulness of combined motility and autonomic function testing in the evaluation of patients with symptoms suggestive of gut dysmotility  
class10	3869	silent cerebrovascular disease in the elderly  correlation with ambulatory pressure  
class10	3869	does the average daily blood pressure correlate with hypertensive cerebrovascular disease better than the casual pressure  as has been reported in other target organ involvement  we investigated the associations of two abnormal findings on brain magnetic resonance imaging suggestive of a vascular etiology  low intense foci  lacunae   and periventricular hyperintense lesions on t1  and t2 weighted images  with both office and average daily blood pressure values in a population of 73 healthy normotensive and hypertensive elderly individuals  70     6 years old   
class10	3869	lacunae were detected in 34 subjects  47    the number per subject ranged from 0 to 19 and was significantly correlated with advancing age  
class10	3869	furthermore  these changes were supposedly related to the average of noninvasive ambulatory  24 hour and during awake and asleep periods  pressure recordings but not to office pressures  
class10	3869	the grade of periventricular hyperintensity was also significantly associated with advancing age and the average of ambulatory systolic pressure recordings  particularly during sleep  but not with office blood pressure  
class10	3869	in comparisons of normotensive   office hypertensive   and hypertensive subgroups  abnormalities on magnetic resonance imaging were appropriate to the level of the 24 hour blood pressure measurements but not to that of clinic pressure  
class10	3869	in hypertensive patients  the presence of electrocardiographic evidence of left ventricular hypertrophy was also associated with greater abnormalities on magnetic resonance imaging  
class10	3869	we conclude that ambulatory blood pressure monitoring is superior to casual pressure measurements in predicting latent cerebrovascular disease  which is unexpectedly common in apparently healthy elderly subjects  
class10	3870	effect of age on the efficacy of blood pressure treatment strategies  
class10	3870	to study whether the proportion of excess cardiovascular events attributable to various levels of systolic blood pressure varies with age  we calculated the population attributable risk of all cause mortality  fatal and nonfatal cardiovascular events  stroke  coronary heart disease  angina  congestive heart failure  and peripheral vascular disease   and stroke incidence due to systolic blood pressure in men and women 45 years of age or older in the united states during 1980  
class10	3870	our estimates are based on us census counts  blood pressure prevalence distributions from the second national health and nutrition examination survey  and the annual risk of cardiovascular complications during 18 years of follow up in the framingham cohort  
class10	3870	we then determined the impact of age on the relative efficacy of mass treatment and case finding strategies in preventing systolic blood pressure related events  
class10	3870	at 45 54 years of age  only 30 40  of systolic blood pressure related excess events occur in hypertensive individuals  systolic blood pressure greater than or equal to 160 mm hg   
class10	3870	with increasing age  however  the percentage of systolic blood pressure related events that occur in hypertensive individuals rose substantially  in the older age group  greater than or equal to 75 years   65 70  of fatal and nonfatal cardiovascular disease events occur in hypertensive persons  
class10	3870	the pattern is similar for men and women  
class10	3870	the potential impact of a mass treatment strategy designed to shift the distribution of blood pressure downward by a small amount is greater in younger than in older groups  whereas an opposite trend is seen for a high risk  hypertensive case finding and treatment approach  
class10	3871	glucocorticoid induced muscle atrophy prevention by exercise in fast twitch fibers  
class10	3871	exercise has been shown to be effective in preventing glucocorticoid induced atrophy in muscles containing high proportions of type ii or fast twitch fibers  
class10	3871	this investigation was undertaken to further evaluate this response in type iia and iib fibers  determined by histochemical staining for myofibrillar adenosinetriphosphatase with alkaline and acid preincubation  
class10	3871	steroid  cortisol acetate  ca   100 mg kg body wt  and exercise  running 90 min day  29 m min  treatments were initiated simultaneously for 11 consecutive days in female rats  
class10	3871	fiber distribution and area measurements were performed in a deep and superficial region of plantaris muscle  
class10	3871	the exercise regimen spared approximately 40  of the ca induced plantaris muscle atrophy  
class10	3871	in the deep region  the fiber population  which contained approximately 13  type i  slow twitch   24  type iia  and 63  iib fibers  was not affected by either treatment  
class10	3871	in the superficial section  which consisted solely of type ii fibers  the proportion of type iia fibers was higher  27 vs  
class10	3871	9   p less than 0 01  in the steroid  than in the vehicle treated groups  
class10	3871	within each region  type iia fibers were less susceptible to atrophy than type iib fibers  and within each fiber type  the deep region had less atrophy than the superficial region  
class10	3871	type i fibers were unchanged by steroid treatment  
class10	3871	for type iia fibers  exercise prevented 100  of the atrophy in the deep region and 50  in the superficial region  
class10	3871	for type iib fibers  the activity spared 67 and 40  of the atrophy in these same regions  respectively  
class10	3871	these results show that glucocorticoids are capable of changing the myosin phenotype  
class10	3872	failed acromioplasty for impingement syndrome  
class10	3872	we evaluated 67 shoulders in 65 patients who had pain and dysfunction for more than two years after an initial acromioplasty for impingement syndrome without a rotator cuff tear  
class10	3872	in addition to a thorough history  physical examination  local anaesthesia injection and any other necessary investigations all patients had arthroscopic evaluation of the shoulder  
class10	3872	in 27 shoulders there had been diagnostic errors  and in 28 operative errors  only in 12 had the diagnosis and the operative procedure both been correct  
class10	3872	subsequent operative intervention in patients not receiving worker s compensation benefit had a 75  success rate  whereas in those receiving such benefits the success rate was only 46   
class10	3873	effect of the topical anesthetic emla on the efficacy of pulsed dye laser treatment of port wine stains  
class10	3873	emla cream  eutectic mixture of local anesthetics  is a new topical anesthetic composed of 25 mg lidocaine and 25 mg prilocaine in an oil in water emulsion cream  
class10	3873	it has been found to be very effective for local anesthesia prior to venepuncture  minor surgical procedures  and pulsed dye laser  pdl  therapy for port wine stains  pws  in children  
class10	3873	however  since emla may cause vasoconstriction of cutaneous vessels  we tried to determine whether pretreatment with emla decreases the efficacy of subsequent pdl treatment  
class10	3873	we report eight patients between the ages of 4 and 32 years with pws who received two test site treatments prior to pdl treatment  
class10	3873	one site was pretreated with emla cream under occlusion for 60 minutes and then left unoccluded for 15 minutes prior to pdl test treatment  
class10	3873	the other site  in the same area of the pws and patient s body  was not pretreated with emla  
class10	3873	the test sites were compared 6 8 weeks later to determine whether emla decreased the degree of lightening of the pws compared to the non emla treated site  
class10	3873	we conclude that emla is an effective topical anesthetic for pdl treatment of pws and does not adversely affect the efficacy of the treatment  
class10	3874	disturbance in daily sleep wake patterns in patients with cognitive impairment and decreased daily activity  
class10	3874	the sleep wake patterns of 121 chronically ill  mentally and physically handicapped patients were visually monitored hourly for 14 consecutive days  
class10	3874	four types of sleep wake patterns were found  
class10	3874	in order to investigate how cognitive and physical functions correlated with sleep disorders  patients were classified based on a scale of mental function and the grading of daily activity  
class10	3874	the percent of total sleep hours and the sleep rating  showing disturbances in sleep wake pattern  were evaluated  
class10	3874	we found a high degree of individuality in sleep wake patterns  
class10	3874	sleep disturbance was associated with daily activity as well as with cognitive impairment  
class10	3874	this monitoring system provides medical personnel with valuable information for clinical management  
class10	3875	what practicing physicians in north carolina rate as their most challenging geriatric medicine concerns  
class10	3875	we recently surveyed a random sample of 500 physicians in family practice  general practice  and internal medicine in north carolina  to discover their most challenging geriatric concerns  
class10	3875	using a three stage survey technique  respondents were asked to answer two open ended questions about the most challenging geriatric problems they face and what specific geriatric content areas would attract their participation in an educational program  
class10	3875	they were then asked to rank 34 topics on which they would like more information  
class10	3875	a total of 242 responses were received for a 55  response rate  63 of the 500 were undeliverable   
class10	3875	responses indicated that physicians are more concerned with management than diagnosis and revealed considerable evidence of empathy and concern  
class10	3875	the top three topics had to do with the management of dementia  multiple problems  and depression  
class10	3875	approximately 25  of physicians consider problems of financing health care as among the most challenging problems  
class10	3876	delirium  masquerades and misdiagnosis in elderly inpatients  
class10	3876	delirium is an organic mental disorder defined as transient  fluctuating global dysfunction of cognition  
class10	3876	it is common in elderly medical inpatients  yet its varied presentation is often missed or misdiagnosed  
class10	3877	primary intratemporal tumours of the facial nerve  diagnosis and treatment  
class10	3877	benign primary tumours of the facial nerve are uncommon  
class10	3877	a slowly progressive facial palsy should be considered the result of a nerve tumour until proven otherwise  
class10	3877	improvements in diagnostic imaging techniques of the temporal bone have increased the possibility of a correct pre operative diagnosis but facial nerve tumours remain a frequently ignored or misdiagnosed entity as a consequence of their subtle and protean clinical manifestations  
class10	3877	a series of 12 cases of primary facial nerve tumours is presented  
class10	3877	the clinical features  diagnostic modalities and treatment are discussed in relation to a review of the literature  
class10	3878	parapharyngeal abscess and torticollis  
class10	3878	the combination of a parapharyngeal abscess and torticollis in an adult  due to a spastic contraction of the sterno cleido mastoid muscle is an extremely rare condition  
class10	3878	we have recently been exposed to such case  in which it was very difficult to make the diagnosis and where ct of the neck gave us the answers without any difficulty  
class10	3878	the indication for ct at an early stage in unexplained neck infections is stressed  
class10	3879	outcome of pregnancies experienced during residency  
class10	3879	to investigate potential adverse effects of residency training on pregnancy outcome  a cohort study was conducted among 45 university affiliated residency programs  
class10	3879	outcomes of the first pregnancy experienced during residency were compared between 92 female residents and 144 spouses of male residents  
class10	3879	despite long hours  sleep deprivation  and an increase in perceived stress  the female residents were as likely to give birth to a live  full term newborn as the spouses of male residents  
class10	3879	for white cohort members  an increased risk of premature labor without delivery was identified  rr   12 3  95  confidence interval 2 4 61 6   
class10	3879	no significant differences were found in prematurity  spontaneous and therapeutic abortions  or presence of congenital abnormalities in the infants  
class10	3879	method of delivery and use of anesthetics and of other medications were similar in both groups  
class10	3879	pregnancy outcomes between the two groups were similar  however  the increased risk for premature labor among female residents is a cause for concern and should be further investigated  
class10	3880	immunopathology and viral reactivation  a general theory of schizophrenia  
class10	3880	a theory is proposed that explains a broad range of clinical manifestations in schizophrenia  
class10	3880	it is a heuristic device for organizing research in the neuroimmunology and virology of schizophrenia  
class10	3880	this approach is different from other immune and viral theories of schizophrenia and defines testable hypotheses for further theory refinement or rejection  
class10	3880	defective alpha interferon  aifn  regulation resulting in excessive effect is postulated to cause schizophrenia  
class10	3880	the role of aifn in the regulation of development and its induction within the brain by the reactivation of viruses that are commonly present in the normal central nervous system  cns  are the primary pathophysiological mechanisms  
class10	3880	biological properties of aifn include neural excitation  opiate and adrenocorticotropic hormone activity  and inhibition of cellular proliferation and differentiation  
class10	3880	psychosis results from in situ viral stimulation of aifn production in the cns of a vulnerable host having defective regulation of either sensitivity or production  
class10	3880	negative symptoms result from aifn effects on cns development and the behavioral toxicity of aifn  
class10	3880	biological developmental abnormalities  gender differences in severity  and decline in psychotic symptoms with age are discussed in the context of the theory  
class10	3880	research strategies and specific testable hypotheses are presented  
class10	3881	multiple muscle enzyme release with psychiatric illness  
class10	3881	associations  p less than  001  between serum concentrations of lactate dehydrogenase  ldh  and glutamic oxaloacetic transaminase  sgot  were observed in physically well patients with mania  n   100  r    70   depression  n   138  r    51   chronic schizophrenia  n   85  r    68   and schizoaffective or atypical psychosis  n   39  r    52  discharged from 1978 through 1981  
class10	3881	in contrast  there was a negligible association between these enzymes in 90 nonpsychiatric inpatient control subjects  
class10	3881	patients with mania  229 0     106 1 iu l  showed significantly  t   3 16  p less than  002  two tailed  higher lactate dehydrogenase  ldh  levels than control subjects  191     41 7 iu l  and a 14  incidence of abnormally high serum ldh levels vs  
class10	3881	1  among control subjects  
class10	3881	results were unchanged when patients taking neuroleptics were excluded  
class10	3881	these results indicate that psychiatric illness  especially mania  induces release of ldh and sgot  occasionally to unusually high levels  
class10	3881	this is similar to previous reports of muscle creatine phosphokinase release in psychiatric patients  
class10	3881	presumably  these enzymes are released from skeletal muscle in association with agitation  with muscle tension  or with blood stasis and local tissue hypoxia consequent to hypoactivity  
class10	3882	infarction in the territory of the medial branch of the posterior inferior cerebellar artery  
class10	3882	we report 10 cases of cerebellar infarction in the territory of the medial branch of the posterior inferior cerebellar artery  mpica   
class10	3882	axial sections on mri through the middle of the medulla and the cerebellum showed the infarction as a triangular area with a dorsal base and a ventral apex directed towards the fourth ventricle  
class10	3882	the infarct also involved the lateral and dorsal medulla when the mpica supplied all or part of these regions  
class10	3882	three clinical patterns were observed  1  pseudolabyrinthine signs with or without dysmetria and ataxia when the medulla was spared  marked axial lateropulsion was present in most cases  2  complete or incomplete wallenberg s syndrome  when the medulla was involved  3  silent infarction  
class10	3882	these syndromes are precisely those previously attributed to pica occlusion without distinction of the branch involved  
class10	3882	no alteration of consciousness was recorded and spontaneous recovery was the rule  
class10	3882	cerebellar infarction in the distribution of the mpica can be regarded as a benign condition with a good prognosis  
class10	3883	transcranial electrical motor evoked potentials as a prognostic indicator for motor recovery in stroke patients  
class10	3883	transcranial electrical motor evoked potentials  mep  were examined in 33 patients within three days after stroke  
class10	3883	normal values for mep and motor central conduction time  cct  were obtained in 46 healthy controls whose meps were evaluated during slight voluntary muscle contraction and at rest  
class10	3883	two months later 23 patients were re examined clinically and electrophysiologically  
class10	3883	motor function change was correlated with mep results  
class10	3883	two months after stroke the patients with normal or prolonged cct had an improved motor function compared with those with absent cct  
class10	3883	mep may be a valuable prognostic indicator in the acute stage of paralytic stroke for recovery of motor function  
class10	3884	parkinsonian tremor loses its alternating aspect during non rem sleep and is inhibited by rem sleep  
class10	3884	non rem sleep transforms the waking alternating parkinsonian tremor into subclinical repetitive muscle contractions whose amplitude and duration decrease as non rem sleep progresses from stages i to iv  
class10	3884	during rem sleep parkinsonian tremor disappears while the isolated muscle events increase significantly  
class10	3885	the effects of cyproheptadine on locomotion and on spasticity in patients with spinal cord injuries  
class10	3885	the effects of cyproheptadine  a serotonergic antagonist  were studied in seven patients with spastic paresis of spinal origin  
class10	3885	six patients were included in a double blind crossover trial  maximal dose 24 mg day   
class10	3885	the patients were evaluated on both their spasticity and locomotor function  
class10	3885	four of the patients also participated in an open trial in which cyproheptadine was administered for a minimum of six months at optimal dose  
class10	3885	patients walked on a treadmill at full weight bearing when possible  or with 40  of their body weight externally supported  as required  by an overhead harness system  
class10	3885	cyproheptadine considerably decreased the sustained ankle clonus and episodes of spontaneous spasms observed in all the patients who previously presented these manifestations of spasticity  
class10	3885	two patients who required body weight support  bws  during locomotion could walk at full weight bearing during cyproheptadine therapy  
class10	3885	a more normal timing of emg patterns in these patients during cyproheptadine therapy was associated with temporal distance changes and marked improvement of joint angular displacement  
class10	3885	in contrast  the other patients showed marginal changes in the emg and the kinematic pattern but eventually managed to walk at a higher speed  
class10	3885	these preliminary results suggest that cyproheptadine can reduce spasticity and enhance locomotor function in spinal cord injured patients  
class10	3886	motor unit discharge characteristics and short term synchrony in paraplegic humans  
class10	3886	frequency of firing and regularity of discharge of human motor units  and short term synchrony between pairs of motor units  have been assessed in extensor digitorum communis  edc  and tibialis anterior  ta  muscles in control subjects and in clinically complete paraplegic subjects  
class10	3886	the discharge pattern of ta motor units in paraplegia ranged from extremely regular to very irregular for different motor units whereas in the control population  and in edc of both groups  there was a narrow  but intermediate  range of regularity  
class10	3886	there was little difference in the incidence and degree of short term synchrony  sts  in edc between paraplegic and normal subjects  
class10	3886	in contrast  virtually no sts of motor units was observed in the ta muscles of the paraplegic group whereas control subjects exhibited approximately the same amount of sts in their ta and edc muscles  
class10	3886	it is concluded that the extra burden placed on arm muscles in paraplegia does not change the amount of synchronisation between motor units  
class10	3886	furthermore  section of the spinal cord does not increase sts as predicted from lesions of the reticulospinal tract in cats  
class10	3886	this may reflect the coincidental removal of supraspinal synchronising inputs of motoneurons or the reorganisation of synaptic inputs in chronic paraplegia  
class10	3887	magnetic and electrical stimulation of cervical motor roots  technique  site and mechanisms of excitation  
class10	3887	cervical motor roots and the brachial plexus were excited transcutaneously with magnetic  magstim  and electrical stimulation  elstim  applied dorsally over the spine and over the supraclavicular fossa  erb s point   
class10	3887	the compound muscle action potentials  cmaps  from the abductor digiti minimi  adm  and the biceps muscles  biceps  could be evoked with either stimulating technique in all 52 subjects tested  
class10	3887	with magstim over the spinous process c7  greater cmaps were obtained from adm  p less than or equal to 0 0001  paired t test  and biceps  p less than or equal to 0 005  when the inducing current in the coil as viewed from behind was clockwise for the right arm and vice versa  
class10	3887	elstim with the cathode over c7 t1 and the anode directed cranially provided greater cmaps from the adm  p less than or equal to 0 0001  and smaller cmaps from the biceps  p less than or equal to 0 01  than with the inverse polarity  
class10	3887	magstim of the cervical roots provided cmaps which were smaller from adm  p less than or equal to 0 0001   and greater from biceps  p less than or equal to 0 0001   than elstim  cathode c7 t1   whereas latencies did not differ significantly  p less than or equal to 0 3   
class10	3887	when comparing elstim and magstim applied over erb s point  the former yielded greater cmaps and 0 5 ms longer latencies from both the adm and biceps  p less than or equal to 0 001   
class10	3887	from these data and additional studies in four patients  including direct intraoperative root stimulation in one of them  it is concluded that elstim and magstim over the spine excite the motor roots at a similar site  that is  within a few cm outside the intervertebral foramina  
class10	3888	eosinophilic meningitis  cause of a chronic pain syndrome  
class10	3888	three tourists developed eosinophilic meningitis after visiting the fijian islands  
class10	3888	two had a severe and long lasting illness with chronic intractable pain  
class10	3888	in one patient electrophysiological studies and mri scan of the brain were abnormal and provided evidence of both radicular and cerebral parenchymal involvement by the most likely causative agent  angiostrongylus cantonensis  
class10	3889	rigid spine syndrome with respiratory failure  
class10	3889	the pathogenesis and therapy of respiratory failure in the rigid spine syndrome are discussed in two cases who improved with respiratory assistance  
class10	3889	in both cases  the partial pressures of oxygen and carbon dioxide were reversed in arterial blood gas analysis and  vc was less than 30   
class10	3889	remission from respiratory failure has been obtained by the use of a ventilator during the night  
class10	3889	the cause of the respiratory failure in both cases was severe restrictive respiratory dysfunction due to extreme flattening of the chest and fixation of the thorax during respiration as a result of contracture of costovertebral joints  
class10	3889	all the previously reported cases of the rigid spine syndrome with respiratory failure died  
class10	3889	appropriate use of the ventilator can improve the prognosis  
class10	3890	learning a unimanual motor skill by partial commissurotomy patients  
class10	3890	a series of motor tests on four chinese partial commissurotomy patients is reported  
class10	3890	the single stage commissurotomy in all four patients included the anterior commissures and two thirds or four fifths section of the corpus callosum with sparing of the splenium  
class10	3890	there was no demonstrable ability to transfer hand posture in these patients  
class10	3890	this was the major evidence for functional deconnexion  
class10	3890	a newly learned task of one hand knotting revealed right hand impairment in all four patients  
class10	3890	there was no dyspraxia in the right hand for over learned object handling tasks in these patients  
class10	3890	it is suggested that there might be right hemisphere specialisation for the initial acquisition of unimanual object handling skills and that the spared callosal fibres in the splenium alone are insufficient to mediate task control under these conditions  
class10	3890	this is supported by the finding that one of these patients  who was the only one who had a right parietal lesion  was unable to perform the newly learned task with either hand  
class10	3891	involvement of the central nervous system in chronic inflammatory demyelinating polyneuropathy  a clinical  electrophysiological and magnetic resonance imaging study  
class10	3891	in a consecutive series of 30 patients with chronic inflammatory demyelinating polyneuropathy  cidp  minor clinical evidence of cns involvement was found in five  
class10	3891	cranial magnetic resonance imaging  mri  was performed in 28 and revealed abnormalities consistent with demyelination in nine patients aged less than 50 years and abnormalities in five aged 50 years or over  
class10	3891	measurements of central motor conduction time  cmct  were obtained in 18 and showed unilateral or bilateral abnormalities in six  
class10	3891	it is concluded that subclinical evidence of central nervous system  cns  involvement is common  at least in patients with cidp in the united kingdom  but that clinically evident signs of cns disease are infrequent  
class10	3891	the association of a multiple sclerosis like syndrome with cidp is rare  
class10	3892	hip pain in late pregnancy  
class10	3892	hip pain in late pregnancy is quite common  and its etiology is rarely established unless acute demineralization occurs  
class10	3892	we measured the bone mineral content of both hips in 26 women within 48 hours of delivery  
class10	3892	twelve of 36 densities  33   were decreased in a group with severe pain when compared to 12 of 120 decreased densities  10   in the remaining patients  p less than  05   
class10	3892	those data suggest that severe hip pain may be related to a decrease in bone mineral content  
class10	3893	non vesicular release of glutamate from glial cells by reversed electrogenic glutamate uptake  
class10	3893	glutamate uptake into nerve and glial cells usually functions to keep the extracellular glutamate concentration low in the central nervous system  
class10	3893	but one component of glutamate release from neurons is calcium independent  suggesting a non vesicular release that may be due to a reversal of glutamate uptake  
class10	3893	the activity of the electrogenic glutamate uptake carrier can be monitored by measuring the membrane current it produces  and uptake is activated by intracellular potassium ions  
class10	3893	here we report that raising the potassium concentration around glial cells evokes an outward current component produced by reversed glutamate uptake  
class10	3893	this current is activated by intracellular glutamate and sodium  inhibited by extracellular glutamate and sodium  and increased by membrane depolarization  
class10	3893	these results demonstrate a non vesicular mechanism for the release of glutamate from glial cells and neurons  
class10	3893	this mechanism may contribute to the neurotoxic rise in extracellular glutamate concentration during brain anoxia  
class10	3894	long term potentiation of electrotonic coupling at mixed synapses  
class10	3894	long term potentiation of chemical synapses is closely related to memory and learning  
class10	3894	studies of this process have concentrated on chemically mediated excitatory synapses  
class10	3894	by contrast  activity dependent modification of gap junctions  which also widely exist in higher structures such as hippocampus and neocortex  has not been described  
class10	3894	here we report that at mixed synapses between sensory afferents and an identified reticulospinal neuron  the electrotonic coupling potential can be potentiated  as well as the chemically mediated excitatory postsynaptic potential  for a prolonged time period using a stimulation paradigm like that which produces long term potentiation in hippocampus  
class10	3894	the effect on coupling is due to an increase in gap junctional conductance  
class10	3894	our data indicate that the potentiation of both synaptic components requires an increase in intracellular calcium  involves activation of nmda  n methyl d aspartate  receptors  and is specific to the tetanized pathway  
class10	3895	indications for thymectomy in myasthenia gravis  
class10	3895	fifty six board certified neurologists with interest and expertise in myasthenia completed a survey of indications for thymectomy in myasthenia gravis  
class10	3895	thymectomy was advocated for virtually all patients with thymoma  for a variable subset of patients with generalized myasthenia without thymoma  and occasionally for selected patients with disabling ocular myasthenia  
class10	3896	phenotypic heterogeneity of spinal muscular atrophy mapping to chromosome 5q11 2 13 3  sma 5q   
class10	3896	we made phenotypic analysis of 14 families with spinal muscular atrophy  sma  linking to chromosome 5q11 2 13 3  sma 5q   and 2 that may not map to this locus  to assess clinical symptoms among sma families known to result from mutation at the identical gene locus  
class10	3896	although the current number of families is still small  the correlation of clinical phenotype and molecular genotype supports 2 observations  
class10	3896	first  sma mutations at the 5q locus present with a broad continuum of clinical abnormalities  and 2nd  the single clearly unlinked family presents with an unusual phenotype characterized by relatively late onset and early death  
class10	3896	thus  there are as yet no unambiguous cases of typical sma families that are clearly unlinked to the locus at 5q ie  no clear cases of nonallelic heterogeneity  
class10	3896	analysis of sma 5q families supports the view that  with certain exceptions  there is little phenotypic intrafamilial variability  
class10	3896	when families were ranked by severity of disease there was a strong correlation with age of onset  
class10	3896	onset within the 1st few months was associated with early death  but not in all cases  
class10	3896	with rare exception  onset after 1 year of age was associated with less severe disease and greater longevity  
class10	3897	routine and quantitative eeg analysis in gilles de la tourette s syndrome  
class10	3897	gilles de la tourette s syndrome  gdlt  is a neurobehavioral disorder  with a reportedly high frequency of eeg abnormalities  
class10	3897	we performed eegs on 48 consecutive patients with gdlt  and frequency analysis in 26 patients  17 males   and compared the results with those from age  and sex matched normal controls  
class10	3897	routine 18 channel eeg revealed minimal diffuse nonspecific slowing in only 3 of 48 patients  6   and in 2 of 26 controls  7 7    
class10	3897	the frequency analysis of the eeg of the 26 gdlt patients and their normal controls showed similar brain activity  
class10	3897	we conclude that no significant differences exist between the eeg activity in gdlt patients as compared with that in sex  and age matched controls in routine as well as in quantitative eeg  
class10	3898	internuclear ophthalmoplegia in the chiari type ii malformation  
class10	3898	we describe 3 cases of chiari type ii malformation presenting with bilateral internuclear ophthalmoplegia  ino   
class10	3898	although prominent  the ino was not an isolated sign in any of the patients  superimposed abduction paresis was present in 2  and deficits in smooth pursuit  optokinetic nystagmus  and vestibulo ocular responses were present in 3  
class10	3898	two had hydrocephalus  1 was clinically unchanged without therapy after 5 years  the other did not improve with shunting  
class10	3898	findings in our 3 patients  along with the 4 previously reported  confirm that ino is 1 manifestation of widespread brainstem or cerebellar dysfunction  
class10	3898	its origin is probably multifactorial  related to hydrocephalus  vascular compromise  direct neuronal distortion  or congenital neural malformation  
class10	3899	sensory visual testing in idiopathic intracranial hypertension  measures sensitive to change  
class10	3899	management decisions in idiopathic intracranial hypertension  iih  pseudotumor cerebri  are based on the presence and change of visual loss  
class10	3899	to study this change  we evaluated tests of sensory visual function over time  
class10	3899	we used the results of the right eye of 19 patients whose clinical status improved  decrease in papilledema grade   and compared the outcome measures of the initial and final examinations  
class10	3899	contrast sensitivity testing showed significant improvement in the middle and high spatial frequency targets  
class10	3899	snellen acuity and color tests did not change significantly over the same period  
class10	3899	both goldmann and automated visual field grade significantly improved from the initial to the final visit  while the presence of a defect on confrontation visual fields did not  
class10	3899	numerical analyses of automated perimetry thresholds also showed significant improvement  
class10	3899	generalized loss  most pronounced on the nasal side of the visual field  was present on the initial examination  
class10	3899	generalized improvement followed  least in the central and inferior paracentral areas  
class10	3899	patients with iih should be followed with contrast sensitivity testing and perimetry using a disease specific strategy  
class10	3900	deteriorating ischemic stroke  risk factors and prognosis  
class10	3900	to determine a risk profile of deterioration in cerebral infarction of less than 8 hours  duration  we studied prospectively a series of clinical and radiologic data in 98 patients  
class10	3900	we evaluated the canadian neurological scale score and barthel index during a follow up period of 3 months  
class10	3900	there was deterioration in the 1st 48 hours in 40 8  of the patients  
class10	3900	high systolic blood pressure  elevated blood sugar concentration at admission  and carotid territory involvement were independently related with deterioration in the logistic regression analysis  
class10	3900	death occurred in 35  of the patients with deteriorating infarcts and in 8 6  of those with stable infarcts  
class10	3900	at the end of the study  functional capacity was lower in those with deteriorating infarcts  but the 2 groups improved in parallel from the 4th day onward  
class10	3901	infantile cns spongy degeneration  14 cases  clinical update  
class10	3901	we studied 14 arab infants with infantile spongy degeneration  13 of whom were products of consanguineous marriages  
class10	3901	they presented in infancy with macrocephaly  poor visual behavior or blindness  and axial hypotonia with appendicular spasticity  
class10	3901	brain ct and mri showed diffuse symmetric leukoencephalopathy  even before neurologic symptoms  
class10	3901	there were relatively normal eegs  
class10	3901	the visual evoked responses  p100  were either absent or delayed early in the course  
class10	3901	the brainstem auditory evoked responses showed milder abnormalities  with loss of later components before the earlier ones  
class10	3901	deficient aspartoacylase activity in cultured fibroblasts or brain biopsy confirmed the diagnosis in all patients  
class10	3902	dominantly inherited apathy  central hypoventilation  and parkinson s syndrome  clinical  biochemical  and neuropathologic studies of 2 new cases  
class10	3902	we describe 2 new patients from a family in which 10 persons in 3 successive generations had a dominant neuropsychiatric disorder characterized by apathy  central hypoventilation  and parkinsonism  
class10	3902	neuropathologically  both patients showed severe neuronal loss and reactive gliosis in the substantia nigra  
class10	3902	neurochemical studies showed a marked depletion of dopamine in substantia nigra  putamen  and caudate nucleus  as well as reduction in serotonin content in the substantia nigra  
class10	3902	glutamate contents were low in frontal cortex and thalamus  and gamma aminobutyric acid  gaba  contents were low in thalamus and substantia nigra of both patients  
class10	3902	in addition  phosphoethanolamine contents were reduced in all brain regions of both patients  especially in the substantia nigra  
class10	3902	one patient with severe symptoms had low levels of homovanillic acid  5 hydroxyindoleacetic acid  and gaba in his csf repeatedly for 3 years before death  aged 58   while the 2nd patient died  aged 51  of an unrelated cause before developing any symptoms of the familial disorder  
class10	3902	because brain deficiencies of multiple neurotransmitters appear to be involved  this disorder is unlikely to respond to treatment  however  neurochemical studies of csf may make presymptomatic diagnosis feasible  
class10	3903	sensorineural hearing loss  a reversible effect of valproic acid  
class10	3903	we report 2 patients over the age of 70 who  while on valproate  vpa  for complex partial seizures  developed sensorineural hearing loss  
class10	3903	following discontinuation of vpa for nonaudiologic reasons  the patients reported improved hearing which was confirmed by audiometry  
class10	3903	these findings represent vpa induced sensorineural hearing loss  possibly in preexisting presbycusis  
class10	3904	large cystic optic glioma  
class10	3904	a 5 1 2 year old boy developed a huge cyst in his chiasmal glioma 4 years after radiation therapy  
class10	3904	the cyst produced obtundation but was successfully treated  
class10	3905	study of verbal description in neuropathic pain  
class10	3905	the aim of this paper is to study the quality of verbal description and its diagnostic value in neuropathic pain  
class10	3905	the verbal description of pain as assessed by a french adjective list questionnaire  qdsa  is compared between a group of 100 patients with neuropathic pain and a mixed group of 97 chronic benign and cancer non neuropathic pain patients  
class10	3905	seventeen descriptors of the 61 qdsa descriptors have a significant intergroup frequency difference  
class10	3905	by principal component analysis and varimax rotation of the intercorrelation matrix of descriptors in the neuropathic group  
class10	3905	7 factors accounting for 66 0  of the total variance are derived  
class10	3905	six factors reflect purely sensory or affective aspects of the pain experience  
class10	3905	seven descriptors from the discriminant analysis function correctly assign 77  of neuropathic pain patients and 81  of the non neuropathic pain patients  
class10	3905	in a second neuropathic pain group of 32 patients  the discriminant function coefficient permits correct diagnostic categorization in 66  of the cases  
class10	3905	implications for clinical practice and trials are discussed  
class10	3906	quantification of biomedical findings of chronic pain patients  development of an index of pathology  
class10	3906	difficulties in assessing and quantifying the biomedical signs and symptoms that may be related to patients  reports of pain are well recognized  
class10	3906	although there appears to be some consensus among physicians as to the potential utility of examination and diagnostic tests frequently used to evaluate chronic pain patients  little attention has been paid to the reliability of interpreting the results of these procedures  
class10	3906	moreover  the integration of biomedical findings to form a general index of pathology associated with chronic pain has been a difficult problem to solve because not all biomedical procedures used to evaluate pain patients are necessarily relevant or indicated for a specific patient  
class10	3906	two studies are presented that were designed to evaluate the reliability of 23 biomedical procedures commonly used to evaluate chronic pain patients and to determine if findings on these procedures can effectively be combined to form a reliable index of physical pathology  
class10	3906	the results of study 1 suggest that 17 of the 23 procedures can be applied in clinical setting with acceptable levels of reliability  
class10	3906	study 2 provides evidence that an innovative weighted scoring approach  based on current medical consensus  can be used to produce a reliable  general index of pathology that is independent of the number of procedures used to evaluate patients  
class10	3906	the utility of this quantification approach to biomedical findings for clinical and research purposes is discussed  
class10	3907	is emotional disturbance a precipitator or a consequence of chronic pain  
class10	3907	the present study examined the relationship between psychological factors and pain in order to assess the contribution of emotional disturbance to the perpetuation of pain  
class10	3907	a group of 163 chronic pain suffers in multiple settings was compared with 81 control subjects on measures of personal history antecedent to pain onset  as well as on measures of current emotional disturbance  
class10	3907	in addition  these psychological variables were examined for their associations with subjectively rated pain intensity  
class10	3907	overall  pain was found to be related to more current depression and less current life satisfaction  but was not associated with most of the personal history variables examined  
class10	3907	these results suggests that emotional disturbance in pain patients is more likely to be a consequence than a cause of chronic pain  
class10	3907	the dangers of routinely ascribing intractable pain to psychological causation are discussed in the light of these findings  
class10	3908	epidural haematoma requiring surgical decompression following repeated cervical epidural steroid injections for chronic pain  
class10	3908	we report a case of epidural haematoma following a steroid injection into the cervical epidural space  
class10	3908	the complication occurred on the seventh such injection over a 2 year period for chronic spinal pain  
class10	3908	surgical decompression over the seventh cervical and the upper 3 thoracic vertebrae was required to alleviate the symptoms of paralysis and anaesthesia  
class10	3908	the patient subsequently required skin grafting to the surgical site and two trans urethral resections of the prostate gland during his 6 week hospital admission  
class10	3908	he made a full recovery  
class10	3909	quantitative evaluation of hypnotically suggested hyperaesthesia and analgesia by painful laser stimulation  
class10	3909	the ability to reduce both clinically and experimentally induced pain by hypnotic suggestion of analgesia is well known  
class10	3909	however  the nature of hypnotic analgesia still remains uncertain  
class10	3909	attempts to demonstrate and identify specific psychophysiological mechanisms have  so far  been unsatisfactory  
class10	3909	methodological problems in inducing pain and monitoring physiological responses may be the reason for this lack of success  
class10	3909	in the present study  we have attempted to eliminate some of these methodological problems  
class10	3909	the sensory and pain thresholds to laser stimulation were determined  and the laser evoked brain potentials were measured for 8 highly hypnotically susceptible subjects in 3 conditions   1  waking state   2  suggestion of hyperaesthesia   3  suggestion of analgesia  
class10	3909	the thresholds were reduced during induced hyperaesthesia and increased during analgesia  
class10	3909	during hyperaesthesia sensations could be evoked by laser intensities which were below intensities that could be perceived in the awake state  
class10	3909	the amplitude of the evoked brain potentials increased during hyperaesthesia and decreased during analgesia  
class10	3909	the latency of the potential remained constant  
class10	3909	the perception of pain during hypnosis can change very fast  indicating that slow endogenous mechanisms may play only a minor role in suggested hyperaesthesia analgesia  
class10	3910	cytoreductive hepatic surgery for neuroendocrine tumors  
class10	3910	we retrospectively reviewed 37 patients who underwent hepatic resection between 1970 and 1989 to evaluate the role of cytoreductive hepatic surgery in patients with metastatic neuroendocrine tumors  carcinoid  24  islet cell  13   
class10	3910	seventeen resections were curative  no gross residual tumor   nine patients had symptomatic endocrinopathies and seven patients had symptoms caused by the primary tumor  
class10	3910	eight of nine patients with symptomatic endorcrinopathies obtained complete relief of symptoms  five are alive with no evidence of disease at 2 to 82 months  mean  26 months   
class10	3910	six of seven patients with symptoms caused by the primary tumor obtained complete relief  five are alive with no evidence of disease at 5 to 28 months  mean  14 months   
class10	3910	one symptom free patient underwent curative hepatic resection 5 years after abdominoperineal resection for a rectal carcinoid  
class10	3910	twenty resections were palliative  gross residual tumor   16 patients had symptomatic endocrinopathies and 4 patients had symptoms caused by the primary tumor  
class10	3910	eight of 16 patients with symptomatic endocrinopathies obtained complete relief  five are alive at 2 to 30 months  mean  11 months   with a mean duration of complete relief of 6 months  3 to 12 months   
class10	3910	all four patients who underwent resection for symptoms caused by the primary tumor obtained complete relief  two are alive and symptom free at 10 and 101 months  
class10	3910	our experience suggests that curative surgery should be considered in all patients with completely resectable metastatic disease and that palliative surgery  despite the short duration of complete relief  should be considered in selected patients because it delays and may reduce the subsequent need for medical therapy  
class10	3911	pharyngeal shape and dimensions in healthy subjects  snorers  and patients with obstructive sleep apnoea  
class10	3911	to characterise the relation between pharyngeal anatomy and sleep related disordered breathing  17 men with complaints of snoring were studied by all night polysomnography  
class10	3911	ten of them had obstructive sleep apnoea  mean  sd  apnoea hypopnoea index 56 3  41 7   age 52  10  years  body mass index 31 4  5 3  kg m2   whereas seven were simple snorers  apnoea hypopnoea index 6 7  4 6   age 40  17  years  body mass index 25 9  4 3  kg m2   
class10	3911	the pharynx was studied by magnetic resonance imaging in all patients and in a group of eight healthy subjects  age 27  6  years  body mass index 21 8  2 2  kg m2  both significantly lower than in the patients  p less than 0 05   
class10	3911	on the midsagittal section and six transverse sections equally spaced between the nasopharynx and the hypopharynx several anatomical measurements were performed  
class10	3911	results showed that there was no difference between groups in most magnetic resonance imaging measurements  but that on transverse sections the pharyngeal cross section had an elliptic shape with the long axis oriented in the coronal plane in normal subjects  whereas in apnoeic and snoring patients the pharynx was circular or had an elliptic shape but with the long axis oriented in the sagittal plane  
class10	3911	it is suggested that the change in pharyngeal cross sectional shape  secondary to a reduction in pharyngeal transverse diameter  may be related to the risk of developing sleep related disordered breathing  
class10	3912	role of serum prolactin determination in evaluation of impotent patient  
class10	3912	hyperprolactinemia is a recognized cause of impotence  
class10	3912	the discovery of elevated prolactin levels in impotent men is very important since pharmacotherapy in this instance is highly successful  
class10	3912	we review our experience with prolactin determinations in impotent men  and a population is defined that may benefit from routine prolactin determination  
class10	3912	in our experience  the predominant symptom associated with hyperprolactinemia in men is loss of libido  
class10	3913	retrograde transurethral balloon dilation of prostate  innovative management of abacterial chronic prostatitis and prostatodynia  
class10	3913	retrograde transurethral balloon dilatation  rtbd  of the prostate recently has been suggested as alternative therapy for patients with benign prostatic hyperplasia  bph   
class10	3913	seven patients with documented functional urinary outlet obstruction at the level of the bladder neck or prostatic urethra underwent rtbd of prostate  
class10	3913	each patient had a classic diagnosis of abacterial chronic prostatitis or prostatodynia based on history  physical examination  and localization cultures  
class10	3913	prior to rtbd of prostate  patients underwent cystoscopy  voiding cystourethrogram  urodynamic and uroflow studies  
class10	3913	rtbd of prostate was done as an outpatient procedure requiring intravenous sedation or general anesthesia  
class10	3913	dilation was performed with a 25 mm urethroplasty balloon catheter inflated at 3 5 atm of pressure for twenty minutes  
class10	3913	improvement in voiding symptomatology was noted in all patients and graded numerically  0 10 scale   with ten indicating normal voiding  
class10	3913	follow up to date ranges from one to five months  
class10	3913	this technique may have promise as a treatment option in patients with abacterial chronic prostatitis and prostatodynia  
class10	3914	protecting the vasculature  an eye toward the future  
class10	3914	although calcium antagonists were originally developed for use in the management of patients with angina pectoris  they are now used in the management of other cardiovascular disorders  including hypertension  
class10	3914	more recently  the calcium antagonists have been under investigation for their potential protective role in atherosclerosis  
class10	3914	coupled with these new possibilities for therapeutic use are the development of new  long acting  tissue specific calcium antagonists  
class10	3914	amlodipine belongs to this group  and although it is a dihydropyridine based calcium antagonist  its pharmacologic profile differs from that of other dihydropyridine based calcium antagonists  
class10	3914	differences include  different ph optimum for receptor binding  different rates of association and dissociation  and differences in allosteric interaction with the diltiazem and verapamil binding sites  
class10	3914	amlodipine  when given orally to rabbits receiving a high cholesterol diet  reduces atheroma formation  
class10	3914	evidence of its ability to protect the vasculature is provided by its ability to significantly increase  p less than 0 001  survival in stroke prone hypertensive rats  
class10	3915	anisocoria in the pigmentary dispersion syndrome 
class10	3915	we studied four patients with anisocoria and the pigmentary dispersion syndrome  
class10	3915	in all patients  the larger pupil was on the side of the greater iris transillumination  
class10	3915	the amount of anisocoria was between 0 5 and 1 5 mm and was the same in both the light and dark  
class10	3915	there was no blepharoptosis  and all pupils dilated normally with cocaine  
class10	3915	all of the patients were young men with myopia  and one patient had increased intraocular pressure  
class10	3916	laser placement in noncontact nd yag cyclophotocoagulation  
class10	3916	we treated 40 eyes of 40 patients by using noncontact transscleral nd yag cyclophotocoagulation to determine whether treatment 1 5 or 3 0 mm posterior to the corneoscleral lumbus was preferable  
class10	3916	patients were randomly assigned to one of the treatment groups  and all other variables  including power  number  and distribution of laser applications  were kept constant  
class10	3916	six months postoperatively  those treated 1 5 mm posterior to the corneoscleral limbus had a lower intraocular pressure  p    0047  than those treated 3 0 mm from the corneoscleral limbus  
class10	3916	the 1 5 mm group also required fewer retreatment  p    017  and had a slightly lower occurrence of visual acuity loss after this procedure  
class10	3916	we believe it may be advantageous to locate the laser application approximately 1 5 mm posterior to the corneoscleral limbus  rather than further posteriorly  when performing noncontact transscleral nd yag cyclophotocoagulation  
class10	3917	antinociceptive interaction between opioids and medetomidine  systemic additivity and spinal synergy  
class10	3917	the antinociceptive interaction on the tail flick  tf  and hot plate  hp  tests between opioid analgesics and medetomidine after intravenous  iv  or intrathecal administration were examined by isobolographic analysis  
class10	3917	male sprague dawley rats received fixed ratios of medetomidine to morphine  fentanyl  and meperidine of 1 10 and 1 30  10 1  and 1 3  respectively  by iv administration or 10 1  3 1 and 10 1  and 1 3 by intrathecal administration  respectively  
class10	3917	data were expressed as the percentage maximal possible effect   mpe   
class10	3917	the a50  dose producing 50  mpe  for each drug or drug combination was determined from the dose response curve  
class10	3917	isobolographic analysis revealed that the effect of medetomidine combined with fentanyl  morphine  or meperidine was additive after iv administration  
class10	3917	the intrathecal administration of combinations of medetomidine with the opioids produced a synergistic antinociceptive effect in the tf but not hp test  
class10	3917	these data confirmed that the interaction between medetomidine and opioids in producing antinociception may be additive or synergistic  depending on the route of administration  drug ratio administered  and level of processing of the nociceptive input  i e   spinal vs  
class10	3917	supraspinal   
class10	3917	moreover  these results were consistent with a spinal role for alpha 2 adrenoceptors in mediating antinociception  
class10	3917	the authors suggest that the interaction between the opioid and alpha 2 adrenergic receptors occurs within the spinal cord  
class10	3918	calcium antagonists in the management of patients with aneurysmal subarachnoid hemorrhage  a review  
class10	3918	cerebral arterial vasospasm and infarction is the leading cause of death and disability among patients who reach a major medical center after aneurysmal subarachnoid hemorrhage  sah   
class10	3918	recent evidence suggests that two calcium antagonists  nimodipine or nicardipine  may be useful in preventing this important complication of sah  
class10	3918	this paper reviews the current status of these two calcium antagonists in the management of sah  
class10	3919	sudden blindness after thermocoagulation of the trigeminal ganglion  
class10	3919	sudden blindness during percutaneous thermocoagulation of the gasserian ganglion occurred in a 72 year old woman with trigeminal neuralgia  
class10	3919	considered a safe procedure  we highlight the possibility of this serious complication which was probably due to direct damage of the optic nerve  
class10	3920	short stature  mental retardation  and hypoparathyroidism  a new syndrome  
class10	3920	eight children  four boys and four girls  with extreme failure to thrive  dysmorphic features  developmental delay  hypoparathyroidism  and abnormal skeletal survey were studied  
class10	3920	they were the products of seven consanguinous marriages  two of the patients being brothers  
class10	3920	in the remaining six families  a further four children had affected siblings who had died in infancy  
class10	3920	when assessed the children were aged 0 47 12 8 years  sd scores were less than  2 for height  weight  and head circumference in all patients  
class10	3920	the children had identical facies with deep set eyes  depressed nasal bridge with beaked nose  long philtrum  thin upper lip  micrognathia  and large floppy earlobes  
class10	3920	they were all developmentally retarded  
class10	3920	the following abnormalities were found on investigation  hypocalcaemia in all  of whom six of seven had hypoparathyroidism   medullary stenosis and other skeletal survey defects in seven of the eight children  and reduced numbers of t cell subsets in four of four tested  
class10	3920	we believe that these children represent a new  as yet undescribed genetically determined syndrome  
class10	3921	survey of adolescents with severe intellectual handicap  
class10	3921	a diagnostic survey was undertaken of children aged 11 to 19 years in tameside with severe learning difficulties  intelligence quotient less than or equal to 50   
class10	3921	eighty two children were identified and their medical records reviewed  
class10	3921	a specific diagnosis for the retardation was documented in 25  30   of the children  18 of whom had down s syndrome  
class10	3921	a probable aetiology or a disorder of unknown aetiology had been identified in a further 21  26   children  
class10	3921	to confirm the existing diagnosis  identify new diagnoses  and offer genetic counselling  the parents of 63 children were offered detailed reassessment of their child  
class10	3921	fifty three children were reviewed  and a specific disorder identified in 25 out of 31 previously undiagnosed children  
class10	3921	the most frequent diagnoses made were fragile x syndrome and rett s syndrome  
class10	3921	on completion of the survey  61 of the 82 children  74   had a specific diagnosis or probable aetiology identified  12  15   had associated disorders such as cerebral palsy  and in only nine of the 82 children  11   were there no clues at all to the cause of their retardation  
class10	3922	continuous papaveretum infusion for the control of pain in painful sickling crisis  
class10	3922	we describe our experience of using continuous papaveretum infusions to control pain in 24 children admitted on 45 occasions with painful sickling crisis  
class10	3922	the children were aged from 1 7 to 14 3 years  
class10	3922	infusion duration ranged from one to nine days  median three days   total dose from 0 3 to 21 mg kg  median 2 4 mg kg   with a pronounced tendency for dosage to increase with increasing age  
class10	3922	no respiratory depression was observed  
class10	3922	one infusion was discontinued because of cerebral toxicity  
class10	3923	benign intracranial hypertension after ciprofloxacin administration  
class10	3923	many drugs  including antibiotics  have been implicated in the aetiology of benign intracranial hypertension  
class10	3923	we report the development of benign intracranial hypertension after the use of ciprofloxacin in a teenager with cystic fibrosis  
class10	3924	endocrine function and morphological findings in patients with disorders of the hypothalamo pituitary area  a study with magnetic resonance  
class10	3924	evaluation of the sellar area was performed with magnetic resonance imaging in 101 patients  age range 0 8 27 years  with hypopituitarism  isolated diabetes insipidus  hypogonadotrophic hypogonadism  and central precocious puberty  
class10	3924	the hypopituitary patients  n   70  included multiple pituitary deficiency  n   23   pituitary deficiency with diabetes insipidus  n   5   and isolated growth hormone deficiency  n   42   
class10	3924	the patients with multiple pituitary deficiency showed pathological morphological findings in all cases  with stalk and posterior lobe always involved  
class10	3924	the group with associated diabetes insipidus had abnormal stalk in four of five cases and posterior lobe not visible in all cases  
class10	3924	only five of 42  12   patients with isolated growth hormone deficiency had abnormalities of the sellar area  
class10	3924	in two out of four patients with isolated diabetes insipidus posterior lobe was not seen  
class10	3924	all patients with hypogonadotrophic hypogonadism  three with kallmann s syndrome  one prader willi syndrome  and two idiopathic hypogonadism  appeared normal  
class10	3924	in precocious puberty  n   21  the three patients with onset of symptoms before age 2 years exhibited a hypothalamic hamartoma  whereas in the others with onset of puberty between age 2 and 7 the magnetic resonance image was normal in 17 of 18 patients  
class10	3924	the probability of finding a pathological magnetic resonance image was considerably high in our patients with multiple pituitary deficiency  isolated diabetes insipidus  and precocious puberty with very early onset of symptoms  
class10	3924	on the contrary  purely functional abnormality is suggested in most patients with isolated growth hormone deficiency  hypogonadotrophic hypogonadism  and precocious puberty with later onset of symptoms  
class10	3925	central nervous system vasculitis after chickenpox  cause or coincidence  
class10	3925	a 7 5 year old boy  known to have a seizure disorder  presented with an infarct in the left middle cerebral artery territory  10 weeks after severe chickenpox  
class10	3925	immunofluorescent antibody titre to the varicella zoster virus in the cerebrospinal fluid was 1 32  
class10	3925	cerebral angiography showed evidence of focal vasculitis  
class10	3925	he presented again seven months later with an acute exacerbation of seizures  
class10	3925	magnetic resonance imaging of the brain showed an old posterior extension of the infarct  but a repeated angiography demonstrated an improvement in the vasculitic process  
class10	3925	cerebrospinal fluid antibody titre was again 1 32  
class10	3925	although this may have been an unfortunate coincidence  a possible association between chickenpox and vasculitis  similar to that reported with herpes zoster  and with potentially significant clinical implications  should be considered  
class10	3925	as a definite proof can be obtained only by a brain biopsy  however  which is generally not indicated in such cases  only additional clinical reports can lead to delineation of this association as a definite entity  
class10	3926	pneumocephalus secondary to a high pressure water injury to the nose  
class10	3926	we report a case of pneumocephalus following a water jet injury to the nose incurred during a water skiing fall  
class10	3926	pneumocephalus due to this type of injury has not been previously reported  to our knowledge  
class10	3926	since this unusual injury may be associated with serious complications  it must be promptly recognized and treated  
class10	3927	quantitative assessment of extradural bupivacaine analgesia  
class10	3927	bupivacaine  0 5   20 ml was administered extradurally to six healthy volunteers  
class10	3927	it was found that simultaneous application of 10 needles to the skin could evoke pain when analgesia was obtained to one needle stimulation  
class10	3927	in addition  a laser beam was used as a quantitative technique to activate simultaneously many cutaneous nociceptors  
class10	3927	for 7 h  thresholds  sensory and pain  and pain evoked brain potentials  amplitude and latency  to laser stimulation were monitored and used for quantitative assessment of onset  efficacy and duration of analgesia at various dermatomes  c7  t8  t10  t12  l1  l3  s1   
class10	3927	the onset time of analgesia was shortest and conduction delay longest at the dermatome related to the site of injection  l3   
class10	3927	full analgesia was obtained at l1  l3 and s1  although the peak efficacy at s1 was delayed for 120 180 min after injection  
class10	3927	a minor effect was found at dermatome c7 approximately 60 min after injection  
class10	3928	onset phase of spinal bupivacaine analgesia assessed quantitatively by laser stimulation  
class10	3928	analgesia was assessed quantitatively at various dermatomes  c7  t8  t10  t12  l1  l3  s1  for the first 30 min after subarachnoid administration of 0 5  bupivacaine 3 5 ml  
class10	3928	stimulation with 10 needles and laser stimulation could evoke pain in dermatomes with adequate analgesia to single needle stimulation  
class10	3928	analgesia was assessed by thresholds  sensory and pain  and by pain related brain potentials  amplitude and latency  to laser stimulation  
class10	3928	little analgesia was found at t10  but it increased gradually towards caudal segments  
class10	3928	the dermatome related to the site of the injection  l3  was not blocked to a greater extent than the surrounding dermatomes  
class10	3928	conduction time  the latency of the evoked brain potential  was increased relatively more from the s1 dermatome compared with l1  
class10	3929	are myotonias and periodic paralyses associated with susceptibility to malignant hyperthermia  
class10	3929	excised muscles from patients with myotonia or periodic paralysis were subjected to the in vitro contracture test for susceptibility to malignant hyperthermia  mh   
class10	3929	in a group of 44 patients  this standard test gave four positive  10 equivocal and 30 negative results  
class10	3929	the results for 27 control muscles from normal subjects were negative  
class10	3929	when the test was performed with less than normal concentrations of contracture triggering substances  caffeine less than or equal to 2 mmol litre 1  less than or equal to 2  halothane   70  of the muscles from the patients and only 15  of the controls responded with small contractures  less than 0 2 g   
class10	3929	these results should not be taken to indicate that the patients have the genetic trait for mh  
class10	3929	the positive and equivocal test results  in addition to the slight contractures  may be accounted for by the electrical after activity in the cases of pure myotonia  and by increased resting myoplasmic  ca2   in myotonic dystrophy  
class10	3929	this shows that the in vitro contracture test lacks specificity  
class10	3930	7th nerve palsy after extradural blood patch  
class10	3930	we describe a patient who developed a 7th cranial nerve palsy following an extradural blood patch  full recovery followed  
class10	3930	the likely aetiology is discussed  
class10	3931	bladder function in the mentally retarded  
class10	3931	a group of 21 mentally retarded patients with severe  long standing urinary symptoms underwent urodynamical investigation  
class10	3931	the most common abnormalities were detrusor areflexia and detrusor hyper reflexia  
class10	3931	of 11 patients treated surgically  10 derived marked benefit  
class10	3931	drugs were successful in reducing micturition problems in 3 6 patients  
class10	3931	severely retarded patients with spastic quadriplegia are difficult to investigate and if this is associated with detrusor hyper reflexia it is impossible to treat them in any way  
class10	3931	severely retarded patients with detrusor areflexia and infrequent voiding can benefit from bladder outlet surgery  
class10	3931	patients with moderate  especially mild  retardation can be investigated and treated in the same way as non retarded people  
class10	3932	lens opacity as a predictor of visual field impairment due to cataract  
class10	3932	the contribution of cataract to the decrease of visual field in patients with glaucoma is difficult to ascertain  
class10	3932	to attempt to quantitate the change in visual field due to cataract  we examined 27 eyes of 26 patients before and after cataract extraction  
class10	3932	the examination consisted of measurement of best refraction with visual acuity  visual field testing with the pupil dilated  measurement of lens opacity  determination of the intraocular pressure  and evaluation of the character of the cataract before surgery and of the posterior capsule after surgery  
class10	3932	the results reaffirmed the detrimental effect that cataract may have on the visual field but also showed that the heterogeneity of cataracts limits the usefulness of the lens opacity meter in quantitating the extent of visual field loss due to cataract  
class10	3933	choroid plexus tumors in the breast cancer sarcoma syndrome  
class10	3933	choroid plexus neoplasms are rare epithelial tumors of the central nervous system  
class10	3933	a carcinoma of the choroid plexus occurred in a child from a family with the breast cancer sarcoma syndrome  li fraumeni or sbla syndrome   an inherited condition characterized by the development of diverse neoplasms  sarcoma  breast cancer  brain tumors  leukemia  adrenal cortical carcinoma  and others   
class10	3933	choroid plexus carcinomas were identified in two kindreds previously reported with the syndrome  
class10	3933	the literature contains reports of choroid plexus neoplasms occurring in families and in individuals with multiple primary tumors  
class10	3933	choroid plexus neoplasm may be a manifestation of the inherited proclivity to tumor development in the breast cancer sarcoma syndrome  
class10	3934	codeine increases pain thresholds to copper vapor laser stimuli in extensive but not poor metabolizers of sparteine  
class10	3934	the analgesic efficacy and kinetics of a single oral dose of 75 mg codeine was investigated in 12 extensive metabolizers and 12 poor metabolizers of sparteine in a double blind  placebo controlled crossover study  
class10	3934	the cosegregation of the o demethylation of codeine to morphine with the sparteine oxidation polymorphism was confirmed  
class10	3934	hence morphine could not be detected in the plasma of any of the poor metabolizers  whereas detectable morphine plasma levels were found in 10 of 12 extensive metabolizers  
class10	3934	pain thresholds to laser stimuli were determined before drug intake and 90  150  and 210 minutes after drug intake  
class10	3934	codeine significantly increased the pricking pain thresholds in the extensive metabolizers  p less than 0 05   whereas there were no significant changes in the poor metabolizers  
class10	3934	no change in pain thresholds occurred with placebo in any of the two phenotypes  
class10	3934	in the extensive metabolizers there was a significant positive correlation between the increase in pain threshold and plasma concentration of codeine  
class10	3934	the study supports the hypothesis that morphine formation is essential for achievement of analgesia during codeine treatment  
class10	3935	effects of a multidisciplinary management program on neurologically impaired patients with dysphagia  
class10	3935	dysphagia is a major problem in patients with neurologic disorders  
class10	3935	aspiration pneumonia and impaired nutritional status are consequences of dysphagia that result in high morbidity and mortality rates  
class10	3935	assessment and treatment of the dysphagic patient by a multidisciplinary team have been advocated but to date the effects of such an approach have not been demonstrated quantitatively  
class10	3935	this prospective study was conducted to determine if a dysphagia program would improve patients  caloric intake and body weight  decrease the instances of aspiration pneumonia  or improve patients  feeding ability  
class10	3935	patients were referred from a 26 bed neurology neurosurgery unit  
class10	3935	a time series design was utilized  
class10	3935	the control group consisted of 15 patients  mean age   46 1 years   managed according to the existing ward routine  
class10	3935	subsequently  nursing staff attended a dysphagia training program  
class10	3935	following this  the treated group of 16 patients   mean age   49 3 years  was assessed by the dysphagia team  using bedside and videofluoroscopic examinations to determine the specific swallowing disorder  
class10	3935	an individualized treatment program was designed for each patient  
class10	3935	the groups were compared on the basis of deviation from their baseline weight  deviation from ideal energy intake  and the incidence of aspiration pneumonia  
class10	3935	statistical analysis revealed that the groups were comparable in age  number of days on the study  and glasgow coma scale score  and that a significant weight gain and increase in caloric intake occurred in the treated group  
class10	3935	no incidence of aspiration pneumonia was reported in either group  
class10	3935	we speculate that this may have been influenced by the meticulousness of the care delivered in an acute unit as well as greater attention to prevention given in both groups  
class10	3936	changes in thermal and mechanical pain thresholds in hand amputees  a clinical and physiological long term follow up  
class10	3936	in a previous study  allodynia to cold and vibratory stimuli was found in the finger stumps of 24 patients with amputations  control values being obtained from fingers of the intact contralateral hand  
class10	3936	when treated with regional intravenous guanethidine block  rgb   some of the patients only had short lasting relief of symptoms  whereas others experienced a more long lasting beneficial effect  
class10	3936	in the present long term follow up study the patients were re examined 6 years after the rgb treatment  
class10	3936	the aim was to investigate whether the earlier symptoms and signs persisted  and whether there were any differences in these respects  between patients with long lasting  group 1  and short lasting relief of symptoms after rgb  group 2   
class10	3936	all 24 patients were asked to answer a questionnaire concerning their clinical symptoms  
class10	3936	in addition  14 of them visited the laboratory for determination of thermal and vibration induced pain thresholds  
class10	3936	comparisons were made with values obtained at the first examination before rgb treatment and with values from 14 healthy subjects tested in a similar way on 2 occasions with an interval of 8 years  
class10	3936	twenty of 23 patients reported that cold exposure still evoked stump pain  
class10	3936	however  the threshold measurements showed that with time the patients had become more tolerant to thermal stimuli not only in the injured but also in the uninjured hand  
class10	3936	a rise in pain threshold was also observed when vibration induced pain was tested in the injured hand  
class10	3936	there was no significant difference between groups 1 and 2  
class10	3936	similar changes in pain thresholds with time were not observed in the group of healthy control subjects  
class10	3937	recurrent pain  illness intrusiveness  and quality of life in end stage renal disease  
class10	3937	repeated episodes of headache and muscle cramp were hypothesized to contribute to increased patient perceptions of illness intrusiveness and to compromised quality of life  
class10	3937	standard measures of pain  illness intrusiveness  and quality of life were obtained on 2 occasions  each 6 weeks apart  from 100 end stage renal disease patients  
class10	3937	the impact of recurrent muscle cramps on perceptions of illness intrusiveness was conditional upon the occurrence of headache symptoms  
class10	3937	perceptions of illness intrusiveness were significantly higher when both muscle cramp and headache symptoms occurred during one or more assessment intervals as compared to when muscle cramps or headaches  only  occurred  
class10	3937	illness related concerns and general feelings of pessimism were also significantly higher among patients who experienced recurrent episodes of muscle cramp  
class10	3937	although no direct relations were observed between pain and other quality of life indicators  previous research has documented a relation between illness intrusiveness and quality of life  
class10	3937	recurrent pain problems  thus  appear to contribute to increased illness intrusiveness and to reduced quality of life in end stage renal disease patients  
class10	3938	health locus of control  gender differences and adjustment to persistent pain  
class10	3938	locus of control  loc  beliefs  long thought important in adjustment to persistent pain  were studied among 160 subjects  67 males and 93 females  referred to a comprehensive pain rehabilitation program  
class10	3938	the subscale structure of the multidimensional health locus of control  mhlc  was factorially replicated in our sample  
class10	3938	three unique mhlc profile clusters were identified for both males and females  
class10	3938	among men  cluster assignment was related to age only  
class10	3938	the younger male patients reported a stronger internal attributional style  
class10	3938	older male patients relied more heavily on both chance and powerful other factors  
class10	3938	among women  cluster assignment was related to the use of coping strategies  
class10	3938	for example  patients with high internal scores only  reflecting a strong internal orientation towards self management of health care needs  were more likely to utilize information seeking  self blame  and threat minimization coping strategies than patients with high scores on both the internal and powerful other factors  
class10	3938	it appears that the presence of both internal and powerful other health attributional styles is associated with less frequent use of cognitive self management techniques  
class10	3938	in understanding the loc scores it is important to rely on pattern analysis of scores  
class10	3938	implications for clinical treatment are discussed  
class10	3939	neonatal facial and cry responses to invasive and non invasive procedures  
class10	3939	evaluation of pain in neonates is difficult due to their limited means of communication  
class10	3939	the aim was to determine whether behavioural reactions of cry and facial activity provoked by an invasive procedure could be discriminated from responses to non invasive tactile events  
class10	3939	thirty six healthy full term infants  mean age 2 2 h  received 3 procedures in counterbalanced order  intramuscular injection  application of triple dye to the umbilical stub  and rubbing thigh with alcohol  
class10	3939	significant effects of procedure were found for total face activity and latency to face movement  
class10	3939	a cluster of facial actions comprised of brow bulging  eyes squeezed shut  deepening of the naso labial furrow and open mouth was associated most frequently with the invasive procedure  
class10	3939	comparisons between the 2 non invasive procedures showed more facial activity to thigh swabbing and least to application of triple dye to the umbilical cord  
class10	3939	acoustic analysis of cry showed statistically significant differences across procedures only for latency to cry and cry duration for the group as a whole  
class10	3939	however  babies who cried to two procedures showed higher pitch and greater intensity to the injection  
class10	3939	there were no significant differences in melody  dysphonation  or jitter  
class10	3939	methodological difficulties for investigators in this area were examined  including criteria for the selection of cries for analysis  and the logical and statistical challenges of contrasting cries induced by different conditions when some babies do not always cry  
class10	3939	it was concluded that facial expression  in combination with short latency to onset of cry and long duration of first cry cycle typifies reaction to acute invasive procedures  
class10	3940	treatment of reflex sympathetic dystrophy with topical capsaicin  case report  
class10	3940	a 31 year old woman with intractable reflex sympathetic dystrophy experienced nearly complete  though temporary  resolution of pain following 3 weeks of topical capsaicin  
class10	3940	we propose that capsaicin may be a useful treatment for reflex sympathetic dystrophy  either by depleting substance p from primary afferent neurons that mediate allodynia  or by modulating sympathetic efferent activity  
class10	3941	receptor changes in the spinal cord of sheep associated with exposure to chronic pain  
class10	3941	there is evidence that post injury hypersensitivity is partly due to changes in the central nervous system  
class10	3941	sheep with foot rot were used to investigate the effect of chronic pain on some receptors thought to be involved in spinal nociceptive processing systems  alpha 2 adrenoceptor and mu and delta opioid receptors   
class10	3941	saturation binding studies showed a variable distribution of  3h  clonidine  alpha 2 adrenoceptor agonist  in the spinal cord of normal sheep  
class10	3941	the number of receptors  bmax  present in areas thought to be involved in nociceptive processing  laminae i and ii and lamina x  increased to 131  and 169  of control sheep values respectively in animals exposed to chronic pain  
class10	3941	the affinity of the receptors  kd   however  remained unchanged at approximately 2 nm  
class10	3941	there was less  3h dago  mu opioid agonist  and  3h dpdpe  delta opioid agonist  binding in the sheep spinal cord  
class10	3941	both opioid receptor types being mainly located in the superficial dorsal horn  
class10	3941	the  3h dpdpe binding was unchanged in the sheep with foot rot  whilst the number  bmax   but not the affinity  of the  3h dago binding sites increased in laminae i and ii in lame animals to 130  of the control sheep values  
class10	3941	hence  in animals in chronic pain  the number of alpha 2 adrenoceptors and mu opioid receptors increased mainly in areas of the sheep spinal cord associated with nociception  
class10	3942	characterization of descending inhibition and facilitation from the nuclei reticularis gigantocellularis and gigantocellularis pars alpha in the rat  
class10	3942	descending influences on the spinal nociceptive tail flick  tf  reflex produced by focal electrical stimulation and glutamate microinjection in the nuclei reticularis gigantocellularis  ngc  and gigantocellularis pars alpha  ngc alpha  were examined and characterized in rats lightly anesthetized with pentobarbital  
class10	3942	both inhibition and facilitation of the tf reflex were produced by electrical stimulation at identical sites in the ngc ngc alpha  glutamate microinjection only inhibited the tf reflex  
class10	3942	the chronaxie of stimulation for inhibition of the tf reflex was 169     28 microseconds  
class10	3942	inhibition of the tf reflex by stimulation was produced throughout the ngc and ngc alpha  intensities of stimulation for inhibition were least in the ventral ngc and in the ngc alpha  
class10	3942	at threshold intensities of stimulation  inhibition of the tf reflex did not outlast the period of stimulation  
class10	3942	facilitation of the tf reflex was produced at many of the same sites at which stimulation inhibited the tf reflex  but always at lesser intensities of stimulation  mean  10 microa vs  
class10	3942	43 microa for inhibition  n   25   
class10	3942	stimulation in the ngc ngc alpha at threshold intensities for facilitation or inhibition of the tf reflex did not significantly affect blood pressure  
class10	3942	strength duration characterization of electrical stimulation and microinjection of glutamate into identical sites in the ngc and ngc alpha suggest that descending inhibition of the tf reflex results from activation of cell bodies in the ngc and ngc alpha  
class10	3943	transcranial electrical stimulation with high frequency intermittent current  limoge s  potentiates opiate induced analgesia  blind studies  
class10	3943	transcutaneous cranial electrical stimulation  tces  with high frequency  166 khz  intermittent current  100 hz  limoge current  has been used for several years in cardiac  thoracic  abdominal  urological and micro surgery  
class10	3943	the main benefits are a reduced requirement for analgesic drugs  especially opiates  and a long lasting postoperative analgesia  
class10	3943	we have confirmed these clinical observations in rats using the tail flick latency  tfl  test to measure pain threshold  
class10	3943	tces was not found to modify the pain threshold in drug free rats  but it potentiated morphine induced analgesia  systemic injection   
class10	3943	to obtain a maximal effect  the stimulation must be initiated 3 h before the drug injection and be maintained throughout the duration of its pharmacological action  
class10	3943	tces potentitation was found to depend on the dose of the drug  the intensity of the current and the polarity of electrodes  
class10	3943	these findings were confirmed by blind tests of the efficiency of tces on several opiate analgesic drugs currently used in human surgery  morphine  fentanyl  alfentanil and dextromoramide   
class10	3943	the analgesic effect of these 4 opiates  tfl as   of baseline without or with tces  were respectively  174   306   176   336   160   215   and 267   392   
class10	3943	the results were obtained not only after systemic opiate treatment  but also after intracerebroventricular injection of morphine  10 micrograms  analgesic effect 152   207  with tces  suggesting that tces potentiation of opiate induced analgesia is centrally mediated  
class10	3944	induction  blockade and restoration of a persistent hypersensitive state  
class10	3944	a new model of chronic hypersensitivity was developed in the rat by daily intraplantar administration of either prostaglandin e2 dopamine or isoprenaline  for a period of 2 weeks  
class10	3944	like other hyperalgesic mediators  dibutyryl camp  when applied to the paws  caused an acute effect but did not produce persistent hypersensitivity  
class10	3944	the persistent hypersensitive state was not affected by a typical non steroidal anti inflammatory drug  indomethacin   was temporarily inhibited by a centrally acting analgesic  morphine   was partially inhibited by a protein synthesis inhibitor  cycloheximide  and abolished by a single dose of peripherally acting analgesics such as dipyrone or n methyl morphine  
class10	3944	once the residual hypersensitivity had been abolished with dipyrone or n methyl morphine  a small dose of prostaglandin e2  dopamine or interleukin 1 beta  which in normal animals causes a mild and short lived effect  restored the persistent hypersensitive state  
class10	3944	this ability to restore the persistent effect was not observed with intraplantar administration of dibutyryl camp  
class10	3944	our results suggest the existence of a peripheral trace of inflammatory pain  a phenomenon which may be associated with stimulation of neuronal adenylate cyclase and protein synthesis  
class10	3944	this concept may explain part of the puzzle of chronic inflammatory pain and lead to the development of new analgesics  
class10	3945	the influence of warning signal timing and cognitive preparation on the aversiveness of electric shock  
class10	3945	many medical and dental procedures are noxious  
class10	3945	finding an optimal way of warning patients concerning the aversive procedures could help them to cope better  
class10	3945	a model for the effective use of a warning signal in coping with pain posited that a person needs enough time to be able to react and should possess the skills necessary to utilize the time effectively  
class10	3945	it was felt that a very short warning period  e g   5 sec  could not be long enough  while a 180 sec warning period would in and of itself become aversive  
class10	3945	reactions to electric shock were obtained from 36 paid  volunteer subjects who were each tested on a within subject  counterbalanced order at 4 different warning periods  5  30  60  and 180 sec  
class10	3945	the subjects were divided into 3 groups   1  the experimental group was provided with a pretested self instructional booklet to learn a variety of pain control techniques   2  the placebo group was provided with a self instructional booklet on citizenship   3  the control group waited quietly for 13 min  
class10	3945	no significant results were obtained for the different pain coping conditions  
class10	3945	significant differences  however  were obtained for the various warning periods  
class10	3945	maximum skin resistance changes  higher ratings of pain and of anxiety were obtained for the 60 and 180 compared to the 5 and 30 sec warning periods  
class10	3945	maximum heart rate was obtained for the 30 sec warning  
class10	3945	results were discussed in terms of the psychological meaning of the various measures as well as their clinical implications  
class10	3946	efficacy of methylphenidate among mentally retarded children with attention deficit hyperactivity disorder  
class10	3946	twelve children with iq scores of 50 to 74  educable mental retardation  who met rigorous diagnostic criteria for attention deficit hyperactivity disorder participated in a double blind crossover study of the efficacy of two doses of methylphenidate compared with placebo  
class10	3946	dependent measures included behavioral ratings  classroom work output  laboratory measures of attention and learning  and direct observations of social behavior  
class10	3946	improvement with medication on the conners hyperactivity index was observed in 75  of subjects  
class10	3946	significant increases in work output  on task behavior  and attentional skills were associated with methylphenidate  
class10	3946	however  gains in measures of attention were not associated with improvement in learning  as measured by a paired associate learning task  
class10	3946	additionally  no significant increases in appropriate social interactions during free play were associated with methylphenidate  
class10	3946	the results suggest that mentally retarded children with attention deficit hyperactivity disorder respond to methylphenidate at similar rates and in similar domains to that of the nonretarded population  
class10	3947	quantifying language development from birth to 3 years using the early language milestone scale  
class10	3947	a point scoring technique for the early language milestone scale is described  
class10	3947	normative data based on the original 1982 cross sectional sample and validation data based on a separate longitudinal sample are presented  
class10	3947	mean early language milestone scale point scores  standard deviations  and percentile equivalents for raw point scores are presented for all ages from birth to 36 months  
class10	3947	correlations between point scores on the early language milestone scale and scores on other standardized developmental tests such as the stanford binet intelligence scale  the peabody picture vocabulary test  and the illinois test of psycholinguistic abilities are presented  
class10	3947	the clinical and research advantages of this point scoring technique are presented and compared with the original pass fail scoring method  
class10	3948	unilateral hydrocephalus in adults  
class10	3948	the authors report 14 cases of unilateral hydrocephalus in adults  
class10	3948	headache was the most common presenting symptom  
class10	3948	unilateral hydrocephalus was documented in each patient with computed tomography scans  magnetic resonance imaging was also used in seven patients in the latter part of the series  
class10	3948	unilateral hydrocephalus was caused by tumor  seven patients   venous angioma  one patient   ependymal cyst  one patient   postinflammatory gliosis  one patient   and was idiopathic in four patients  
class10	3948	the primary surgical treatment was craniotomy with fenestration of the septum pellucidum  which relieved symptoms in eight of nine patients for whom long term follow up data were available  
class10	3949	cerebrospinal fluid endothelin 1 and endothelin 3 levels in normal and neurosurgical patients  a clinical study and literature review  
class10	3949	endothelins are a family of structurally related  potent  long lasting vasoconstrictor peptides  
class10	3949	there are no established normal human levels of endothelin 1 or endothelin 3 in the cerebrospinal fluid  
class10	3949	we measured cerebrospinal fluid endothelin 1 and endothelin 3 levels in five groups of patients  normal controls  patients with subarachnoid hemorrhage and cerebral vasospasm  patients with severe head injuries  patients undergoing temporal lobectomy for intractable epilepsy  and a patient with a gunshot injury to the thoracic spine  
class10	3949	endothelin 3 levels were significantly elevated in patients with subarachnoid hemorrhage and may participate in cerebral vasospasm and subsequent neurologic deterioration  
class10	3950	familial trigeminal neuralgia and charcot marie tooth neuropathy  report of two families and review  
class10	3950	typical trigeminal neuralgia has occasionally occurred in multiple members of the same family over several generations  
class10	3950	the clinical features of such cases  including the increased incidence in females  and the absence of other apparent hereditary  neurologic  metabolic  or structural abnormalities were identical to those of sporadic cases  
class10	3950	more rarely  familial trigeminal neuralgia has been described in the setting of hereditary peripheral neuropathy  especially charcot marie tooth disease  
class10	3950	we describe patients from two different families with charcot marie tooth disease and medically intractable trigeminal neuralgia  
class10	3950	both patients were successfully treated by percutaneous retrogasserian glycerol rhizolysis  
class10	3950	the occurrence of cranial nerve symptoms in patients with demyelinating peripheral neuropathies is discussed in light of the current hypotheses regarding the etiology of trigeminal neuralgia  
class10	3951	reversal of chronic hepatic encephalopathy by colonic exclusion  poor correlation with blood gaba levels  
class10	3951	previous studies have suggested that the inhibitory neurotransmitter gamma aminobutyric acid  gaba  is a key factor in the syndrome of portasystemic encephalopathy  
class10	3951	we report the case of a patient with medically intractable portasytemic encephalopathy after portacaval shunt who had marked clinical improvement after creation of an end ileostomy  
class10	3951	plasma gaba and serum ammonia levels were measured before and after ileostomy  
class10	3951	although the clinical syndrome and the eeg improved markedly after the ileostomy  the plasma gaba levels remained markedly elevated  
class10	3951	preoperative and postoperative gaba levels were 865 and 633 pmol ml  respectively  nl   100 180 pmol ml   
class10	3951	our findings confirm previous reports of the efficacy of colonic exclusion in patients with intractable portasystemic encephalopathy  
class10	3951	however  our results conflict with the hypothesis that gaba itself is the key mediator of the syndrome  
class10	3952	surgical correction of the snapping iliopsoas tendon  
class10	3952	eighteen patients with 20 symptomatic hips underwent lengthening of the iliopsoas tendon for persistent painful snapping of this  internal  variety of snapping hip  
class10	3952	we referred to the pathologic  painful snapping of the iliopsoas in the deep anterior groin as the  internal  snapping hip  
class10	3952	this is in contrast to the more common and better known  external  snapping that involves the greater trochanter and its overlying soft tissues  
class10	3952	the results of our iliopsoas lengthening procedure are presented here  
class10	3952	lengthening of the iliopsoas tendon was accomplished by step cutting of the tendinous portion of the iliopsoas  
class10	3952	the pathoanatomy of this poorly understood symptom complex was described in 1984 paper from this institution and is reviewed here  
class10	3952	iliopsoas bursography demonstrated a sudden jerking movement of the iliopsoas tendon between the anterior inferior iliac spine and iliopectineal eminence  synchronous with the patient s pain and often accompanied by an audible snap  
class10	3952	the average preoperative duration of symptoms was 2 9 years  and the average length of postoperative followup was 25 months  
class10	3952	all patients  except one  had a marked reduction in the frequency of snapping after tendon lengthening  and 14 of 20 hips had no snapping postoperatively  
class10	3952	of the six patients who had recurrence of snapping  all but one stated that this occurred much less frequently and was much less painful compared to the preoperative state  
class10	3952	two hips required reoperation  
class10	3952	postoperatively  only three patients complained of subjective weakness  and most patients were unlimited in physical activity with return to activities such as competitive football  pole vaulting  and long distance running  
class10	3953	anteromedial tibial tubercle transfer without bone graft  
class10	3953	we followed 30 patients for more than 2 years after anteromedial tibial tubercle transfer for persistent patellofemoral pain associated with patellar articular degeneration  
class10	3953	twelve of these patients were followed more than 5 years  
class10	3953	we report 93  good and excellent results subjectively and 89  good and excellent results objectively  
class10	3953	the quality of improvement was sustained in all 12 of the patients who were evaluated again after more than 5 years from surgery  
class10	3953	when examined separately  75  of those patients with advanced patellar arthrosis achieved a good result  none of these patients achieved an excellent result  
class10	3953	postoperative continuous passive motion has markedly reduced the incidence of stiffness  
class10	3953	serious complications such as compartment syndrome  infection  and skin slough were avoided completely in 51 consecutive cases  
class10	3953	patellofemoral contact pressure studies in five cadaver knees have shown that anteromedial tibial tubercle transfer can provide substantial reduction of patellofemoral contact stress while helping to balance medial and lateral facet pressures  
class10	3953	this surgical procedure is mechanically and clinically successful for alleviating intractable pain related to patellar malalignment and articular degeneration  
class10	3953	this procedure enables the majority of appropriately selected patients with malalignment and patellar articular degeneration to resume increased levels of activity with substantially diminished pain  
class10	3954	arterial abnormalities of the hand in athletes  
class10	3954	vascular lesions of the hand may be seen in athletes exposed to repetitive blunt trauma  
class10	3954	thirteen athletes seen from 1983 to 1988 experienced symptoms related to hand ischemia  
class10	3954	nine were professional baseball catchers  
class10	3954	the majority of patients complained of chronic symptoms  including cold hypersensitivity  four patients   finger numbness  one   finger coolness  three   and finger blanching  three   
class10	3954	two patients had acute symptoms with sudden posttraumatic hand ischemia with finger and palmar pain  
class10	3954	diagnosis was established by history and physical examination and confirmed by noninvasive testing  
class10	3954	testing included use of doppler examination and cold tolerance examination with thermistors  
class10	3954	two athletes required angiographic evaluation because of severe ischemia and continuous pain  
class10	3954	all patients in this group were managed nonoperatively  
class10	3954	those with chronic complaints were counseled regarding cold avoidance and instructed to increase their glove padding  
class10	3954	the two patients with acute symptoms required vasodilator  papaverine chloride  infusion  followed by intravenous heparin and dextran  
class10	3954	all baseball catchers returned to their sport with dissipation of symptoms  
class10	3955	community hospital carotid endarterectomy in patients over age 75  
class10	3955	we compared the prevalence of stroke and death in 133 patients aged 75 and older in whom 170 carotid endarterectomies were performed with that in 501 patients less than age 75 in whom 640 carotid endarterectomies were performed  
class10	3955	there were three strokes  2   in patients aged 75 and older and nine strokes  1   in younger patients  p   0 7   
class10	3955	there were 8 deaths  5   in patients aged 75 and older and 14 deaths  2   in younger patients  p   0 1   
class10	3955	after controlling for the possible confounding effects of diabetes  prior stroke  history of angina  prior carotid artery disease  previous vascular surgery  history of myocardial infarction  preoperative hypertension requiring medication  and female gender  a logistic regression model showed that patients aged 75 and older were no more likely to have a stroke or death than patients under age 75  
class10	3955	we conclude that age alone is not a contraindication to the safe performance of carotid endarterectomy in the community hospital  
class10	3956	alkalinisation of prilocaine for intravenous regional anaesthesia  suitability for clinical use  
class10	3956	eighty unpremedicated patients undergoing day case hand surgery under intravenous regional anaesthesia were randomly allocated to receive  in a double blind study  either 40 ml 0 75  prilocaine hydrochloride  with 5 ml 8 4  sodium bicarbonate or 5 ml 0 9  saline  
class10	3956	the alkalinised group had significantly less pain on injection  p   0 0045   during surgery  p   0 0074  and 5 minutes after the tourniquet was deflated  p   0 0027   
class10	3956	the time elapsed between insertion of the block and commencement of surgery was not affected  
class10	3957	ph adjustment and discomfort caused by the intradermal injection of lignocaine  published erratum appears in anaesthesia 1991 mar 46 3  242  
class10	3957	one hundred adult day case patients who required intravenous access had cannulae inserted using local anaesthesia with 1  lignocaine  1  lignocaine with adrenaline or the corresponding ph adjusted solutions  
class10	3957	the local anaesthetic solutions were modified by the addition of 1 ml 8 4  sodium bicarbonate to 10 ml lignocaine  
class10	3957	pain scores at different stages of cannulation were noted and showed a significant reduction after use of ph adjusted solutions  p less than 0 02 for the plain lignocaine  and less than 0 001 for the lignocaine with adrenaline   
class10	3957	modification of the ph of lignocaine solutions by the addition of sodium bicarbonate is a simple method significantly to reduce the discomfort caused by the infiltration of the local anaesthetic  
class10	3958	nasal and oral flow volume loops in normal subjects and patients with obstructive sleep apnea  
class10	3958	because flow volume loops  fvls  are clinically useful in evaluating upper airway  ua  obstruction and the fact that patency of the nasopharyngeal ventilatory pathway is important to the prevention of obstructive sleep apnea  osa   the present study examined the role of nasal compared with oral fvls in evaluating patients with osa  
class10	3958	fourteen obese male patients 56     3 yr of age with a mean apnea plus hypopnea index  ahi  of 51     9 h were studied along with 14 nonobese  healthy  age  and sex matched control subjects whose mean ahi was 6     1 h  
class10	3958	nasal and oral fvls obtained in the normal subjects indicated the nose behaved like a variable resistor  with flow limitation during inspiration but not during expiration  
class10	3958	in the patient group  flow limitation was observed during expiration as well as inspiration indicating nondistensibility of the nasopharyngeal ventilatory pathway in the patients compared to the control subjects  
class10	3958	a change in body position from upright to supine in the osa group was associated with small reductions in expiratory but not inspiratory flow rates  
class10	3958	the area under the nasal supine flow volume loop  fvlanasup  was found to be highly correlated with awake resting pao2  r   0 80  and paco2  r    0 83  in the patient group  
class10	3958	in addition  multiple linear regression analysis revealed that pao2 and the area under the nasal fvls independently contributed to the prediction of ahi with a multiple r of 0 89  
class10	3958	these results suggest that limitations to ventilation via the nasopharynx may significantly influence both gas exchange and the frequency of sleep disordered breathing in patients with osa  
class10	3959	the south karelia air pollution study  the effects of malodorous sulfur compounds from pulp mills on respiratory and other symptoms  
class10	3959	the paper mills in south karelia  the southeast part of finland  are responsible for releasing a substantial amount of malodorous sulfur compounds such as hydrogen sulfide  h2s   methyl mercaptan  ch3sh   and methyl sulfides   ch3 2s and  ch3 2s2   into ambient air  
class10	3959	in the most polluted residential area the annual mean concentrations of hydrogen sulfide and methyl mercaptan are estimated to be 8 and 2 to 5 micrograms m3 and the highest daily average concentration 100 and 50 micrograms m3  
class10	3959	the annual mean and highest daily concentrations of sulfur dioxide  so2  are very low  
class10	3959	we studied the effects of malodorous sulfur compounds on eye  nasal and respiratory symptoms  and headache in adults  
class10	3959	a cross sectional self administered questionnaire was distributed in february 1987 and responded to by 488 adults living in a severely  n   198   a moderately  n   204   and a nonpolluted community  n   86   
class10	3959	this included questions about occurrence of the symptoms of interest during the previous 4 wk and 12 months and individual  behavioral  and other environmental determinants of the symptoms  
class10	3959	the response rate was 83   
class10	3959	the odds ratios  or  for symptoms experienced often or constantly in severely versus nonpolluted and moderately versus nonpolluted communities were estimated in logistic regression analysis controlling potential confounders  
class10	3959	the odds ratios for eye  moderate exposure or 11 70  cl95  2 33 to 58 65  severe exposure or 11 78  cl95  2 35 to 59 09  and nasal symptoms  or 2 01  cl95  0 97 to 4 15  or 2 19  cl95  1 06 to 4 55  and cough  or 1 89  cl95  0 61 to 5 86  or 3 06  cl95  1 02 to 9 29  during the previous 12 months were increased  with a dose response pattern  
class10	3960	brain microemboli during cardiac surgery or aortography 
class10	3960	we have observed many focal dilatations or very small aneurysms in terminal arterioles and capillaries of 4 of 5 patients and 6 dogs who had recently undergone cardiopulmonary bypass  
class10	3960	a smaller number of sausagelike dilatations distended medium sized arterioles  
class10	3960	two other patients had a small number of the same microvascular changes following proximal aortography  
class10	3960	thirty four patients and 6 dogs not undergoing cardiopulmonary bypass had none  
class10	3960	 a 35th patient who had not undergone cardiopulmonary bypass or aortography showed a small number of dilatations  mediastinal air was a suggested source   some of the dilatations exhibited various forms of birefringence  
class10	3960	because most of the dilatations appear empty  we speculate that they are the sites of gas bubbles or fat emboli that have been removed by the solvents used in processing  
class10	3960	these microvascular events  occurring only in conjunction with major arterial interventions  may be the anatomical correlate of the neurological deficits or moderate to severe intellectual dysfunction seen in at least 24  of patients after cardiac surgical procedures assisted by cardiopulmonary bypass  
class10	3961	synaptic transmission in human neocortex removed for treatment of intractable epilepsy in children  
class10	3961	synaptic transmission to pyramidal cells was studied in slices of neocortex resected from infants and children  n   10  age 8 months to 13 years  undergoing surgical treatment for intractable epilepsy  
class10	3961	most specimens were from the least abnormal area of the resection  
class10	3961	stable intracellular recordings could be obtained for up to 8 hours  
class10	3961	most of the recorded neurons had electrophysiological characteristics similar to those of regular firing pyramidal cells and were in layers iii to v  which was confirmed by intracellular staining with lucifer yellow  
class10	3961	local extracellular stimulation evoked a sequence of excitatory and inhibitory postsynaptic potentials  
class10	3961	after application of the gamma aminobutyric acid antagonist  bicuculline  10 30 microm   extracellular stimulation induced large excitatory postsynaptic potentials and epileptiform bursts  
class10	3961	spontaneous bursts occasionally occurred in bicuculline  
class10	3961	this effect of bicuculline was observed in all the tissue samples  even those from infant patients  n   4  age 8 16 months   
class10	3961	kynurenic acid depressed or abolished both spontaneous and stimulation induced bursts  
class10	3961	the competitive antagonist for n methyl d aspartate receptors  dl 2 amino 5 phosphonopentanoic acid decreased the duration of bicuculline induced bursts  
class10	3961	these data provide evidence that  similar to rat and cat neocortex  excitatory and inhibitory amino acids are important transmitters to pyramidal cells in immature human neocortex  
class10	3962	treatment of spasticity with botulinum toxin  a double blind study  
class10	3962	we studied the effect of botulinum a toxin on spasticity of the leg adductors in 9 patients who were either chair bound or bed bound with chronic stable multiple sclerosis  
class10	3962	we injected botulinum toxin  400 mouse units  or placebo into the adductor muscles in a randomized  crossover  double blind design  
class10	3962	two physicians  who were unaware of the treatment order  used an objective rating scale and independently assessed the patients  interobserver correlation was excellent  r   0 93 0 81   
class10	3962	we found that botulinum toxin produced a significant reduction in spasticity  p   0 009  and a significant improvement in the ease of nursing care  p   0 009   
class10	3962	there were no adverse effects during this short term trial  
class10	3962	this is the first demonstration of the beneficial effect of botulinum toxin on focal spastic muscle contractions  
class10	3963	peripheral neuropathy associated with eosinophilia myalgia syndrome  
class10	3963	in 1989  the centers for disease control recognized the existence of an epidemic illness characterized by myalgia and eosinophilia in individuals taking preparations containing l tryptophan  
class10	3963	we evaluated 3 patients with eosinophilia myalgia syndrome who presented with subacute progressive neuropathies  
class10	3963	the neuropathies were predominantly motor and maximal in the lower extremities  
class10	3963	two patients were confined to a wheelchair and one was ventilator dependent and bedridden  
class10	3963	sensory loss predominantly involved small fiber modalities  
class10	3963	electrophysiological studies showed multifocal marked conduction slowing and conduction block indicating segmental demyelination  with associated axonal degeneration that was accentuated distally  
class10	3963	examination of sural nerve biopsy specimens demonstrated axonal degeneration in all 3 patients and perivascular infiltrates in 2  
class10	3963	levels of quinolinic acid  a neurotoxic metabolite of l tryptophan  were elevated in the cerebrospinal fluid in the 2 patients in whom it was measured  
class10	3963	the cause of the neuropathy is unknown but may include immune mechanisms or toxicity of eosinophils  l tryptophan  its metabolic products  or contaminants within l tryptophan preparations  
class10	3964	adult phosphorylase b kinase deficiency  
class10	3964	phosphorylase b kinase deficiency affecting muscle has been observed infrequently in children with weakness and hepatomegaly  and in 2 adults with cramps on exertion  
class10	3964	we observed 2 additional adults with phosphorylase b kinase deficiency  patient 1  aged 58  had progressive  predominantly distal weakness since age 46 but no cramps on exertion  patient 2  aged 26  had cramps on exertion since age 6 but no weakness  
class10	3964	lactate production on ischemic exercise was impaired only in patient 1  
class10	3964	the serum creatine kinase level was elevated in both  
class10	3964	muscle specimens showed focal glycogen excess in both  and a necrotizing myopathy and mild denervation atrophy in patient 1  
class10	3964	muscle phosphorylase b kinase activity was 0 5  and 8 9  of the lowest control value in patients 1 and 2  respectively  erythrocyte phosphorylase b kinase activity was normal in both  liver phosphorylase b kinase activity  measured in patient 1  was also normal  
class10	3964	other glycolytic enzymes in muscle were preserved in both  
class10	3965	nmda antagonists potentiate antiparkinsonian actions of l dopa in monoamine depleted rats  
class10	3965	systemically administered n methyl d aspartate  nmda  antagonists  mk 801     5 methyl 10 11 dihydro 5h dibenzo a d cyclohepten 5 10 imine maleate  and cpp  3       2 carboxypiperazin 4 yl  propyl 1 phosphonate   potentiate the ability of l dopa  l 3 4 dihydroxyphenylalanine  to reverse akinesia and to alleviate muscular rigidity in monoamine depleted rats  
class10	3965	on the basis of these findings  it is proposed that nmda antagonists may be beneficial as adjunctive treatment in the therapy of parkinson s disease  
class10	3965	cpp locally injected into the subthalamic nucleus  entopeduncular nucleus  the rat homologue of the internal pallidal segment  or substantia nigra pars reticulata of monoamine depleted rats stimulates locomotor activity and alleviates rigidity  whereas local microinjection of cpp into the neostriatum is ineffective  
class10	3965	these results make it unlikely that the neostriatum is the site of the antiparkinsonian action of nmda antagonists in monoamine depleted rats  whereas the subthalamic nucleus  internal pallidal segment  and substantia nigra pars reticulata appear to be important for the effects of nmda antagonists  
class10	3966	cerebrospinal fluid neopterin in human immunodeficiency virus type 1 infection  
class10	3966	we evaluated cerebrospinal fluid  csf  concentrations of neopterin  a putative marker of activated macrophages  in 97 subjects infected with human immunodeficiency virus type 1 who had a spectrum of neurological complications  
class10	3966	the highest csf neopterin concentrations occurred in those with neurological opportunistic infections  primary central nervous systems lymphoma  and acquired immunodeficiency syndrome  aids  dementia complex  
class10	3966	in general  the csf concentration of neopterin was independent of csf cell count and blood brain barrier disruption to albumin  
class10	3966	in the patients with aids dementia complex  csf neopterin concentrations correlated with severity of disease and decreased in conjunction with clinical improvement following treatment with zidovudine  
class10	3966	these results suggest that csf neopterin  although not disease specific  may be useful as a surrogate marker for the presence of aids dementia complex and its response to antiviral therapy  
class10	3967	alpha 1 antichymotrypsin as a possible biochemical marker for alzheimer type dementia  
class10	3967	we measured serum alpha 1 antichymotrypsin levels in 38 patients with alzheimer type dementia  89 control subjects  2 subjects with down s syndrome  20 with vascular dementia  18 with parkinson s disease  14 with spinocerebellar degeneration  15 with cerebrovascular disease without dementia  and 14 with duchenne muscular dystrophy  
class10	3967	cerebrospinal fluid  csf  levels of alpha 1 antichymotrypsin were also measured in 15 patients with alzheimer type dementia  26 control subjects  6 with vascular dementia  7 with cerebrovascular disorder  and 11 with degenerative disorders  
class10	3967	in control subjects  there were no age related changes or sex differences  
class10	3967	serum and csf levels were significantly and specifically higher in patients with alzheimer type dementia than in other subjects  serum  p less than 0 001  csf  p less than 0 05   
class10	3967	serum levels of alpha 1 antichymotrypsin were significantly elevated in the early stage of alzheimer type dementia  whereas there was no definite correlation between serum levels and the degree of dementia  
class10	3967	csf levels of alpha 1 antichymotrypsin tended to parallel the severity of dementia  
class10	3967	serum levels were not correlated with csf levels  
class10	3967	these data indicate that serum and csf levels of alpha 1 antichymotrypsin might be independently upregulated in alzheimer type dementia  
class10	3967	we concluded that the measurement of serum levels of alpha 1 antichymotrypsin could be useful as a screening marker for alzheimer type dementia  
class10	3967	in addition  csf levels also could be a useful marker for alzheimer type dementia  because they might reflect the state of dementia  
class10	3968	failure of nine month phenobarbital administration to reverse amygdaloid kindled seizure susceptibility in cats  
class10	3968	upon completion of left amygdaloid kindling  4 cats underwent long term phenobarbital administration during the subsequent 5  to 9 month rest period  
class10	3968	plasma phenobarbital levels were maintained above 15 to 20 micrograms ml and were restimulated following plasma phenobarbital washout  
class10	3968	three cats served as nonmedicated controls  
class10	3968	all 7 cats were subjected to repeated 6 hour sleep monitoring for observation of interictal discharges  which were observed most often in the immediate postictal period  
class10	3968	their frequency decreased gradually throughout the experiment in both the medicated and control animals  but they never completely disappeared except from the contralateral amygdala in 1 medicated animal  
class10	3968	upon primary site restimulation  all of the medicated animals responded with a generalized convulsion once the afterdischarge was induced  
class10	3968	when these animals underwent secondary site amygdaloid kindling  3 showed a positive transfer effect  
class10	3968	the findings suggest that although phenobarbital is a potent anticonvulsant  it has little effect on the acquired seizure susceptibility of previously amygdaloid kindled cats  
class10	3969	aggravation of myasthenia gravis by erythromycin  
class10	3969	erythromycin is not currently recognized as causing clinical aggravation of myasthenia gravis  
class10	3969	we report the case of a patient who experienced exacerbations of myasthenia gravis subsequent to each of several doses of intravenous erythromycin  
class10	3969	we suggest that erythromycin can cause clinical worsening in patients with disease of the neuromuscular junction  
class10	3970	familial creutzfeldt jakob disease without periodic eeg activity  
class10	3970	four members of a kindred with creutzfeldt jakob disease are reported  in whom myoclonus did not develop and in whom serial electroencephalograms performed late in their illness failed to show periodic sharp wave complexes  
class10	3970	otherwise  the patients  disease duration  clinical features  and neuropathological findings were similar to those described in sporadic cases of creutzfeldt jakob disease  
class10	3970	our findings and those reported by others suggest that periodic electroencephalographic activity may be rare in familial forms of creutzfeldt jakob disease  as it is in other slow transmissible encephalopathies  
class10	3971	fetal homotransplants  ventral mesencephalon and adrenal tissue  to the striatum of parkinsonian subjects  
class10	3971	fetal ventral mesencephalon and fetal adrenal tissue grafted to the caudate nucleus of four and three parkinsonian patients  respectively  have been shown to be an alternative treatment for the amelioration of the signs of the disease  
class10	3971	the ventral mesencephalon patients had a significant amelioration of rigidity  bradykinesia  postural imbalance  gait disturbance  and facial expression  
class10	3971	three of these four patients have returned to work  
class10	3971	the fatal adrenal group only showed amelioration of rigidity and bradykinesia  
class10	3971	though these patients are now able to perform their basic daily living activities  and one of them has renewed her household tasks  the other two have not yet been able to return to work  
class10	3971	the differences observed between the ventral mesencephalon  and the fetal adrenal transplanted patients may be related to the heterogeneity of their disease and or the type of graft implanted  
class10	3971	however encouraging our results may be  this experimental procedure obviously requires further studies  and should not be practiced outside of highly qualified clinical research centers  
class10	3972	autologous transplantation of adrenal medulla in parkinson s disease  18 month results  
class10	3972	eighteen of 19 patients who underwent autologous adrenal medullary transplantation to the right caudate nucleus have been followed up for 18 months  
class10	3972	during the course of this study  a statistically significant improvement was noted in percent  on  time  percent  on  time without dyskinesia  activity of daily living  adl  scores during the  on  stages  and adl  motor  and schwab england scores during the  off  stages  
class10	3972	benefits tended to be maximal at 6 months and to gradually lessen thereafter  although statistically significant improvement in comparison with baseline was still present at 18 months for adl  motor  and hoehn yahr scores during the  off  stages  
class10	3972	almost all parameters had deteriorated by 18 months compared with 12 months  including those remaining significantly improved in comparison with baseline  
class10	3972	these patterns were similar for each of the three participating centers  
class10	3972	complications were largely restricted to the perioperative period  
class10	3973	white matter hyperintensities in dementia of alzheimer s type and in healthy subjects without cerebrovascular risk factors  a magnetic resonance imaging study  
class10	3973	t2 weighted  0 5 t  magnetic resonance images were used to study the prevalence of subcortical white matter hyperintensities  wmhis  in 22 patients with dementia of alzheimer s type  dat   20 age matched older healthy control subjects  and 10 younger healthy control subjects  
class10	3973	exclusionary criteria for all groups included cerebrovascular risk factors  
class10	3973	all subjects had hachinski ischemic index scores of less than 2 and computed tomographic scans showing no infarct  
class10	3973	the wmhis were classified as periventricular wmhis or deep wmhis and graded 0 through 3  0 indicated absent  and 3  severe   
class10	3973	for the group with dat and older control subjects  periventricular wmhis and deep wmhis were graded 2 or 3 in fewer than 17  and 27  of subjects  respectively  whereas in the younger control subjects  all ratings were grade 1 or less  
class10	3973	serum cholesterol and systolic blood pressure values  although within the normal range  were elevated significantly in older control subjects when compared with those in younger control subjects  
class10	3973	no significant differences in wmhi ratings  blood pressure  cholesterol  or triglyceride levels were found between patients with dat and age matched control subjects  
class10	3973	systolic blood pressure levels correlated with the severity of periventricular wmhis only in older control subjects  
class10	3973	age correlated with periventricular wmhis and deep wmhis within both the older control subjects and the patients with dat  
class10	3973	there was no significant correlation between wmhis and the severity of dementia in the group with dat  
class10	3973	these results suggest that  in subjects screened for cerebrovascular risk factors  wmhis are rare and occur with identical frequency in patients with dat as in age matched healthy control subjects  
class10	3974	clinical and positron emission tomographic studies in the  extrapyramidal syndrome  of dementia of the alzheimer type  
class10	3974	extrapyramidal signs  particularly rigidity and tremor  have been reported in a proportion of patients with dementia of the alzheimer type  
class10	3974	to test the hypothesis that these extrapyramidal signs are similar clinically and neurochemically to the extrapyramidal signs of parkinson s disease  a group of 20 patients satisfying clinical criteria for probable alzheimer s disease were studied and assessed clinically for the presence of rigidity  tremor  and bradykinesia  
class10	3974	in those patients with extrapyramidal signs  qualitative differences were observed between the signs in these patients and in subjects with parkinson s disease  
class10	3974	fifteen of 20 patients underwent fluoro 18 dopa scans  which showed no significant difference in fluoro 18 dopa uptake into the caudate and putamen between normal subjects and the rigid and nonrigid patients with alzheimer s disease  in contrast to the marked reduction in fluoro 18 dopa uptake into the putamen that is observed in parkinson s disease  
class10	3974	this provides clinical and in vivo neurochemical support for the hypothesis that extranigral factors may be involved in the pathogenesis of rigidity in alzheimer s disease  
class10	3975	acquired childhood aphasia  outcome 1 year after onset  
class10	3975	the effects of the variables age at onset  cause  severity and bilaterality of lesion  and type of aphasia on course and outcome were investigated in a group of 28 aphasic children  
class10	3975	analysis of spontaneous speech and tests of auditory verbal comprehension were used to determine the presence of aphasia  
class10	3975	the severity of the cerebral lesion was assessed using a rating scale for computed tomographic scans  
class10	3975	most of the children had not recovered completely 1 year after onset  
class10	3975	recovery was significantly different according to etiological categories  
class10	3975	complete recovery was seen in the majority of traumatic cases  
class10	3976	primary progressive aphasia  longitudinal course  neuropsychological profile  and language features  
class10	3976	four patients with the clinical syndrome of primary progressive aphasia and a nonfluent aphasia profile were followed up over a period of 3 to 5 years  
class10	3976	extensive neuropsychological data for three patients revealed a progressive  quantitative decline of language with relative stability of memory  visuospatial skills  and reasoning  
class10	3976	comportment and most activities of daily living were preserved even when speech was unintelligible  
class10	3976	although several aphasia types may be associated with primary progressive aphasia  a nonfluent aphasia profile and phonemic paraphasic errors are most useful in differentiating it from the much more common clinical syndrome   probable alzheimer s disease   the clinicopathological correlates of probable alzheimer s disease differ from those associated with primary progressive aphasia  
class10	3976	therefore  the clinical distinction between the two syndromes may be important for predicting the underlying pathophysiologic changes during the life of the patient  
class10	3977	plasticity in the aging brain  reversibility of anatomic  metabolic  and cognitive deficits in normal pressure hydrocephalus following shunt surgery  
class10	3977	the course of idiopathic normal pressure hydrocephalus was studied in a 78 year old woman with a 4 year history of progressive dementia who underwent neuropsychologic testing  quantitative x ray computed tomography  magnetic resonance imaging  and positron emission tomography with fludeoxyglucose f 18 to measure rates of regional cerebral glucose utilization  
class10	3977	preshunt cognitive testing demonstrated progressive deterioration during 2 years  and positron emission tomography showed significant reductions in regional cerebral glucose utilization of 34  to 49  as compared with age  and sex matched control subjects in frontal  temporal  parietal  and whole brain regions  
class10	3977	periodic testing  carried out during a 2 year period after shunt surgery  showed steady improvement in clinical status  
class10	3977	parallel to the clinical changes  there was a significant reversal in neuropsychologic test scores with increased brain volume and increased regional cerebral glucose utilization in several brain regions  
class10	3977	these results documented the considerable potential for recovery of compromised brain function in older subjects even after 4 years of progressive brain disease  
class10	3978	effects of physostigmine on spatial attention in patients with progressive supranuclear palsy  
class10	3978	we tested patients with progressive supranuclear palsy and control subjects on a task of visuopatial attention  
class10	3978	targets preceded by cues on the same side were termed validly cued  and those on the opposite side  invalidly cued  
class10	3978	for all subjects  validly cued targets were responded to faster than those that were invalidly cued  
class10	3978	the difference between reaction times for invalidly and validly cued targets  which is hypothesized to measure attentional movement  was significantly increased for the patients  
class10	3978	the performance of the controls on certain neuropsychological tests was correlated with their attentional ability  
class10	3978	these correlations were altered by progressive supranuclear palsy  
class10	3978	physostigmine treatment of the patients induced a speeding of responses to invalidly cued targets as a function of the duration of the disease  
class10	3978	these studies show defects in cognition and attention in patients with progressive supranuclear palsy and demonstrate that physostigmine reduces some of the abnormal visual attentional performance  
class10	3979	cumulative aids incidence and altered mortality from bacterial infections  
class10	3979	to determine whether populations with high cumulative incidence of acquired immunodeficiency syndrome  aids  experienced increased deaths from sepsis  central nervous system abscess  or endocarditis  new jersey aids patients were grouped according to their age  sex  race  and residence specific cumulative incidence of aids since the onset of the aids epidemic  
class10	3979	between 1980 and 1986  among 25 44 year olds in the highest cumulative incidence group for aids  sepsis mortality increased from 3 3 to 15 2 deaths 100 000 year  an increase of 11 9 deaths 100 000 year  95  confidence interval  6 9  17 0  deaths 100 000 year   mortality from central nervous system abscesses increased from zero to 1 7  0 1  3 2  deaths 100 000 year  and mortality from endocarditis increased from 0 8 deaths 100 000 year to 2 4 deaths 100 000 year  an increase of 1 6   0 5  3 7  deaths 100 000 year  
class10	3979	age matched new jersey patient populations with low cumulative incidence of aids did not sustain a similar increase  
class10	3979	the hiv disease associated increase in sepsis mortality among young populations represents a new component of the substantial increase in u s  
class10	3979	sepsis mortality that occurred over the last two decades  but was previously limited to older populations  
class10	3980	safety  stability  and effectiveness of immunoadsorption under membrane plasmapheresis treatment for myasthenia gravis  
class10	3980	nine patients  five women and four men  average age 50 4 years  with refractory myasthenia gravis  mg  underwent thymectomy and were then treated with immunoadsorption under membrane plasmaphersis  iap   
class10	3980	thymic histology showed hyperplasia in nine patients  
class10	3980	an immunoadsorption column  asahi  med  co  was made with tryptophan  
class10	3980	a plasouto 1 000  asahi  med  co  was used as the machine  
class10	3980	the plasma separator was a first filter  asahi  med  co   and immunoadsorption columns were used for plasma perfusion  
class10	3980	iap treatment was performed three times weekly for a total of six times  after which iap was done every 3 weeks  
class10	3980	the removal rate of anti ach r titer was 54     12   igg  iga  and igm levels improved in nine of nine patients after iap treatment  and improvement of gait disturbances were seen in two of two  
class10	3980	muscle strength improved in all nine patients  whereas speech disturbances improved in two of three  
class10	3980	eye ptosis improved in nine of nine patients  
class10	3980	subjective improvement was reported by nine of nine patients  and none had severe side effects with iap  
class10	3980	in conclusion  iap is a safe  stable  effective  and clinically useful treatment  
class10	3980	for mg  
class10	3981	an extracorporeal perfusion system to bridge pediatric liver transplant candidates  
class10	3981	an extracorporeal liver perfusion system was designed to maintain cadaver livers in an oxygenated  normothermic state for bridging procedures for hepatic transplantation  
class10	3981	nonpulsatile high flow and pulsatile low flow blood are supplied to the portal venous  pv  and hepatic arterial  ha  circulations  
class10	3981	controlled low blood flow  5 10 cc kg  patient  min  is exchanged between the high flow extracorporeal perfusion circuit  1 cc g  liver  min  and the patient  
class10	3981	the system was evaluated in perfusions of fresh  excised pig livers  n   5   
class10	3981	the average oxygen consumption was 9     3 microliters g min  and bile production averaged 4 7 microliters g hr  
class10	3981	perfusion pressures and flows were normal in both the ha and pv circulations for about 4 hr  
class10	3981	pressures then gradually rose  especially in the ha circulation  causing flow to decrease  with subsequent mottling and discoloration of the liver  
class10	3981	red blood cell  platelet  and white blood cell counts fell continuously  
class10	3981	maintenance of liver function was assessed by clearance of an 80 mg taurocholic acid challenge  
class10	3981	an average of 56  of injected acid was cleared from the perfused livers  n   5  in the first half hour  compared with 90  and 25  for the in situ  n   3  and unperfused  n   3  control livers  respectively  
class10	3981	the system consistently maintained livers in a moderately well functioning state through the first 4 hr of perfusion  
class10	3981	adequate support of animals with induced hepatic failure must now be demonstrated  
class10	3982	aids for visual impairment  
class10	3982	this article provides only a flavour of the type and range of aids available to the visually impaired person  
class10	3982	many other aids for leisure  learning  and daily living are illustrated in the rnib equipment and games catalogue  
class10	3983	gallbladder surgery following cholecystlithotripsy  suggested guidelines for treatment 
class10	3983	twenty three of 229 symptomatic patients undergoing cholecystlithotripsy underwent surgical intervention  22 of the patients had cholecystectomy performed  five also undergoing choledochotomy  and one patient had a cholecystostomy  
class10	3983	of these 23 patients  five were lithotripsy failures  five developed acute pancreatitis  one had acute cholecystitis  and one had cholangitis  
class10	3983	one patient had her gallbladder removed incidentally at the time of surgery for a bleeding gastric ulcer  
class10	3983	ten patients underwent surgery for recurrent biliary pain  probably related to fragment passage via the cystic duct  
class10	3983	we suggest that up to 16 of these 23 patients did not necessarily require cholecystectomy  i e  
class10	3983	five patients with pancreatitis  one patient with cholangitis and ten patients with recurrent biliary colic  
class10	3983	conservative and or endoscopic management may be successful in the first instance to allow further treatment with lithotripsy in the majority of patients  
class10	3983	if  however  the expertise to perform endoscopic sphincterotomy is not available or the patient declines further lithotripsy  then resort to surgery may be necessary  
class10	3983	we propose that it is the responsibility of the management team in charge of the lithotripsy unit to inform both the patient and the referring clinicians of the possible side effects and outcome of treatment in an attempt to avoid unnecessary surgical procedures  
class10	3984	cerebrospinal norepinephrine concentrations and the duration of epidural analgesia 
class10	3984	this study was performed to determine whether the addition of norepinephrine to local anaesthetics prolongs epidural analgesia in man  
class10	3984	in addition  cerebrospinal fluid norepinephrine  ne  concentrations were measured  
class10	3984	in the first part of the study  epidural catheters were inserted in 14 patients before herniotomy  
class10	3984	mepivacaine  1 5 per cent  0 35 ml kg 1   was administered and norepinephrine  5 micrograms ml 1  was added in seven patients  
class10	3984	the duration of anaesthesia was prolonged from 54     11 min to 83     12 min  p less than 0 05  and csf ne concentrations increased from 68     12 pg ml 1 to 336     85 pg ml 1 in the ne group  p less than 0 01   
class10	3984	in the second part  eight patients with herpetic neuralgia received epidural analgesia at the fourth to eighth thoracic interspace  using bupivacaine 0 25 per cent  with and without ne  
class10	3984	the csf ne concentrations in this group were greater than in the surgical patients before operation and increased from 254     58 to 406     58 pg ml 1 30 min after administration of bupivacaine with ne  
class10	3984	the duration of pain relief was prolonged with ne  
class10	3984	these results suggest that adding ne to local anaesthetics prolongs epidural analgesia  
class10	3984	moreover  ne concentrations in surgical patients increased to levels similar to those found in patients suffering from herpetic analgesia  
class10	3984	this suggests that the increase of csf ne in chronic pain states has an antinociceptive effect  
class10	3985	crico tracheal disruption and common carotid artery occlusion  a case of blunt trauma  
class10	3985	a case of blunt trauma to the neck is presented  
class10	3985	while driving an all terrain vehicle  atv   a 20 yr old male was struck across the anterior neck by a cord suspended between two poles  
class10	3985	initial findings were suggestive of an isolated laryngeal injury  48 hours later  however  a dense left hemiplegia became manifest  
class10	3985	a ct scan demonstrated a large right frontoparietal cerebral infarct  and an angiogram confirmed occlusion of the right common carotid artery  
class10	3985	intractable cerebral oedema developed  and the patient died five days after the initial insult  
class10	3985	such injuries should alert the clinician to the possibility of major vascular injury  and if suspected  angiography is warranted  
class10	3986	from disease to delirium  managing the declining elderly patient  
class10	3986	many geriatric patients have concurrent physical and psychiatric illnesses  but at times it may be difficult to determine which is primary  
class10	3986	delirium  a transient syndrome that presents with psychiatric symptoms  is usually the manifestation of an organic disorder and  if undetected and untreated  can be fatal  
class10	3986	clinicians  therefore  must learn to recognize the syndrome  search diligently for the underlying etiology  and treat accordingly  
class10	3987	evidence for motor neuropathy and reduced filling of the rectum in chronic intractable constipation  
class10	3987	subtotal colectomy with ileorectal anastomosis is now frequently offered to patients with slow transit constipation who have severe symptoms and no response to more conventional medical treatment  
class10	3987	if this operation is to be successful  the underlying problem should be delay in the progress of contents through the colon but no mechanical or functional obstruction in the small bowel or rectum  
class10	3987	we have used a recently described technique of prolonged ambulant manometry and electromyography to investigate anorectal function in these patients  
class10	3987	pressure data were collected using a 2 mm diameter intrarectal probe carrying microtransducers  and external anal sphincter activity was assessed by a pair of silver silver chloride surface electrodes  
class10	3987	fourteen control subjects and eight patients with colonic inertia were studied  
class10	3987	sampling reflexes  indicative of rectal filling  occurred at mean  sem  rates of 7 4  2 0  hour in controls but were significantly reduced in patients  2 4  0 3  hour  p less than 0 01   
class10	3987	recurrent rectal motor complexes were seen to occur in both groups at intervals of 76  1 8  minutes in controls and 64 9  7 2  minutes in patients  p less than 0 1   and with amplitudes of 42 4  2 1  mmhg and 9 2  0 7  mmhg  p less than 0 001   respectively  
class10	3987	external sphincter electromyographic spike activity did not differ between groups  
class10	3987	our results support the concept of reduced transit of faeces to the rectum from the colon over a 24 hour period in slow transit constipation and suggest that a motor neuropathy may also be present in the rectum  
class10	3988	phenotypic and functional characterization of t cells from patients with myasthenia gravis  
class10	3988	a study of cell surface phenotypes of pbl of myasthenia gravis  mg  patients showed that their t cells had a significantly higher percentage of 4b4  t cells  the helper inducer subset  than age  and sex matched controls  
class10	3988	the pbl of mg patients proliferated significantly higher than those of normal subjects  ns  in response to the purified alpha chain of the acetylcholine receptor  achr   
class10	3988	anti achr antibody was present in sera of 88  of mg and none of the ns  
class10	3988	the pbl b cells from mg only  when cultured with autologous t cells and stimulated with either pokeweed mitogen  69    or achr alpha chain  38    secreted antibody to achr alpha chain  whereas t and b cells alone secreted no antibody  
class10	3988	t cells from pbl of mg patients were more readily cloned than t cells of ns  by limiting dilution  in the presence of recombinant il 2 and in the absence of achr alpha chain  
class10	3988	about 50  of t cell clones from mg patients  compared to none from ns  proliferated to achr alpha chain  
class10	3988	this response was hla dr restricted  
class10	3988	mg t cell clones did not display significant cytotoxic activity  as compared to control t cell clones  
class10	3988	our results indicate that in mg  4b4  regulatory t cells play their role in the pathogenesis of mg  not by cytotoxicity  but more likely by their ability to stimulate specific antibody production by b cells  
class10	3989	causes of death in the elderly and their changing pattern in hisayama  a japanese community  results from a long term and autopsy based study  
class10	3989	the causes of death for the elderly were prospectively studied in hisayama  japan  a rural community  
class10	3989	we compared 1 621 subjects  aged 40 years or over  recruited in 1961  and 2 053 subjects recruited in 1974  
class10	3989	each cohort was studied in a follow up that lasted 10 years  they had autopsy rates of 82 1  and 86 1  during each 10 year period  respectively  
class10	3989	the most common causes of death for those aged 70 years or over were cerebrovascular disease  malignant neoplasms  and pneumonia  
class10	3989	deaths due to cerebrovascular disease tended to decrease in the recent cohort  but the proportion of decline was more prominent in cases aged 40 to 69 years  
class10	3989	there was a sex difference in the changing pattern of mortality from heart diseases including ischemic heart disease  
class10	3989	deaths by both heart diseases and ischemic heart disease increased in the more recent cohort of aged women  whereas they decreased in the aged men  
class10	3989	pneumonia was an important cause of death for the elderly in both cohorts  
class10	3989	deaths due to  senility  were rare  being only 1  of the deceased aged 70 or over  
class10	3989	with prolonged lifespan  especially for women  the impact of atherosclerosis and its related disorders on the recent japanese aged population appears to have increased  
class10	3990	sphenoid sinusitis  a cause of debilitating headache  
class10	3990	we present a case of sphenoid sinusitis resulting in a debilitating headache refractory to both oral and intramuscular analgesics  
class10	3990	despite an aggressive evaluation in the emergency department  the correct diagnosis and appropriate treatment were delayed  
class10	3990	recognition of sphenoid sinusitis  the complications associated with it  and the need for aggressive management are addressed  
class10	3991	blepharospasm oromandibular dystonia associated with a left cerebellopontine angle meningioma  
class10	3991	blepharospasm oromandibular dystonia is characterized by the presence of spasms of the orbicularis oculi  blepharospasm  and of the lower facial or oromandibular muscles  
class10	3991	a patient with this syndrome is presented in which a left cerebellopontine angle meningioma appeared to act as a triggering mechanism for the development of this disorder  
class10	3991	on the basis of this report  we recommend that physicians search for this tumor in patients with this disorder  
class10	3992	reliability of death certificate diagnoses  
class10	3992	consistency between death certificates and clinical records from 5 general hospitals in kuwait was studied for 470 deaths with the following underlying or associated causes  hypertensive  hyp   ischaemic heart diseases  ihd   cerebrovascular diseases  cvd  and diabetes mellitus  dm   
class10	3992	direct causes were not considered since they are of little interest analytically  
class10	3992	only deaths with definite or most probable ascertainment were included  
class10	3992	one cardiologist  who was provided with the who criteria and relevant documents on death certification  independently reviewed the records  
class10	3992	to test the reviewer s bias and the reliability of his judgement  an adjudication process was effected by having one senior cardiologist re review a random subsample of 140 records  
class10	3992	the two reviewers showed good agreement  
class10	3992	specific diagnoses criteria for deciding the underlying cause of death in multiple morbid conditions by the reviewer were followed  
class10	3992	due to possible reviewer bias  we aimed at measuring the difference between initial certifiers and the reviewer rather than measuring the diagnostic accuracy of initial certifiers in reference to the reviewer  
class10	3992	the agreement index kappa showed poor agreement between original and revised certificates  
class10	3992	the original certificates under estimated cvd as an underlying cause of death by 69 2   dm by 60   ihd by 33 5  and hyp by 31 8  in our sample  
class10	3992	associated causes were also consistently under estimated by initial certifiers as compared with the reviewer  
class10	3992	this bias calls for basing mortality statistics in kuwait on hospital death committees  reports rather than on initial certifier death certificates  use of multiple causes of death instead of one underlying cause and adequate training of the medical profession on the value and process of death certification  
class10	3993	sensitivity of effect variables in rheumatoid arthritis  a meta analysis of 130 placebo controlled nsaid trials  published erratum appears in j clin epidemiol 1991 44 6  613  
class10	3993	in a meta analysis of placebo controlled nsaid trials  the sensitivity of the effect variables was calculated as the correlation coefficient and as the difference between drug and placebo  divided by the placebo group standard deviation  
class10	3993	the patient s global evaluation was the most sensitive variable overall  
class10	3993	pain was more sensitive than ritchie s index  
class10	3993	several variables may be omitted from clinical trials  especially if two active drugs are being compared  
class10	3993	for example  the best maximum estimate for the difference in esr between nsaids and placebo was 1 0 mm hr  95  confidence interval  1 5 to 3 4 mm hr   and for joint size 0 44    1 0 to 1 9    corresponding to a quarter of a millimeter for each of the 10 joints usually measured  
class10	3993	it is suggested to record only the patient s global evaluation  pain  and morning stiffness  
class10	3994	examination by logistic regression modelling of the variables which increase the relative risk of elderly women falling compared to elderly men  
class10	3994	in a community based  prospective study to determine risk factors for falls  465 women and 296 men 70 years and over were followed for 1 year and 507 falls were documented  
class10	3994	a greater proportion of women  32 7   than men  23 0   experienced at least one fall in which there was no or minimal external contribution  
class10	3994	using unconditional logistic regression models we investigated the effect of physical and sociological variables on the sex difference in fall rate  
class10	3994	controlling for the variables age  use of psychotropic drugs  inability to rise from a chair without using arms  going outdoors less than daily and living alone decreased the relative risk of women falling compared to men from 2 02  95  ci  1 40 2 92  to 1 55  95  ci 1 04 2 31   
class10	3994	some of the increased risk of falling associated with being a women was able to be explained and is potentially correctable  
class10	3994	but even after controlling for the physical and social variables which we had assessed  women compared to men still had a significantly increased relative risk of falling  
class10	3995	restricted dose and duration of corticosteroid treatment in patients with polymyalgia rheumatica and temporal arteritis  
class10	3995	to analyze whether corticosteroids in low doses during limited time periods could be safely used in the treatment of patients with polymyalgia rheumatica  pmr  or temporal arteritis  ta  the records of 91 patients diagnosed between 1980 and 1987 were reviewed  
class10	3995	the mean initial prednisolone dose was in patients with pmr 18 mg day and the mean duration of treatment was 17 months  
class10	3995	in patients with ta the mean initial dose was 31 mg day and the mean duration of treatment 16 months  and in all the corticosteroid treatment was terminated within 24 months  
class10	3995	patients with coexisting ta and pmr demanded longer treatment compared to patients with either ta or pmr and thus 18 91 patients were treated for more than 2 years  
class10	3995	no visual or neurological complications occurred after treatment with corticosteroids had been initiated  
class10	3995	our study indicates that most patients with pmr or ta can be treated safely with an initial prednisolone dose of 10 mg given twice daily  
class10	3995	with few exceptions corticosteroid treatment can be terminated within 24 months  
class10	3996	psychological stress and the fibrositis fibromyalgia syndrome  
class10	3996	the relationship of stress and social support to the fibrositis fibromyalgia syndrome  fs  was investigated by administration of 4 questionnaire instruments to 28 patients with fs  20 patients with rheumatoid arthritis  ra  and 28 pain free normal controls  
class10	3996	fs showed higher levels of stress as measured by daily  hassles  than did ra or controls  
class10	3996	however  on a measure of major life stress  they reported lower levels  
class10	3996	no differences were found between groups with regard to daily  uplifts  or social support  
class10	3996	correlations between those measures of stress and social support with their scores on the arthritis impact measurement scale showed that the hassles scale was significantly related to the aims psychological component  
class10	3997	diagnostic criteria for neuropsychiatric systemic lupus erythematosus  the results of a consensus meeting  the ad hoc neuropsychiatric lupus workshop group  
class10	3997	definitions and classifications proposed for the neuropsychiatric complications of systemic lupus erythematosus  np sle  indicate a wide range of approaches taken by different researchers and clinicians  
class10	3997	a meeting of investigators was convened to begin a consensus process for standardizing its classification  
class10	3997	we found that the level of agreement among raters on the importance of elements to the diagnosis of np sle increased significantly as indicated by an intraclass correlation coefficient of 0 05 before the conference to 0 60 after the conference  
class10	3997	the results of such studies can be used to generate and test the utility of diagnostic criteria for np sle in multicenter trials  
class10	3998	severe cerebral and systemic necrotizing vasculitis developing during pregnancy in a case of systemic lupus erythematosus  
class10	3998	we describe a fatal case of systemic lupus erythematosus  sle  developing cerebral and systemic necrotizing vasculitis during pregnancy  
class10	3998	the patient was discovered to have sle at 14 weeks  gestation  
class10	3998	although the symptoms disappeared without treatment with corticosteroid in the 2nd trimester  she presented with meningoencephalitis due to vasculitis in the 3rd trimester  
class10	3998	polyarteritis nodosa  pan  like necrotizing vasculitis of the small muscular arteries and arterioles  with acute and healing lesions in the leptomeninges  brain parenchyma and visceral organs was observed at postpartum autopsy  
class10	3998	pan like vasculitis in the central nervous system is quite rare in sle  
class10	3998	this case is also suggestive in terms of the influence of pregnancy on the activity of sle  
