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10,002,400 | Two-dimensional ultrasound was employed for qualitative and quantitative studies during cardiac operations in 74 patients. A gas-sterilized phased-array transducer applied directly to the anterior surface of the heart produced high-quality images without a water path or other special manipulations. The techniques employed were successful in demonstrating alterations in cardiac anatomy associated with valve disease and cardiac tumors. Continuous clouds of microbubbles ejected from the left ventricle immediately following cardiopulmonary bypass were detected in 42% of 45 patients studied. Measurement of short-axis area change during systole proved useful for evaluation of intraoperative changes in left ventricular function. In the perioperative period, with the chest closed, the method detected increasing left ventricular mass during transplant rejection and was useful for monitoring changes in left ventricular performance when image quality was sufficient. The capabilities and limitations of this technique for special studies during cardiac operations should be familiar to surgeons with access to the method. | [
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10,002,401 | Endomyocardial fibrosis: early and late results of surgery in 20 patients. | [
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10,002,402 | Twenty patients with endomyocardial fibrosis (EMF), the largest series reported to date, were operated upon between June, 1978, and June, 1980. Eleven were male and nine female, ranging in age from 6 to 23 years (mean 13.3 years). There were seven cases of right ventricular (RVEMF), six of left ventricular (LVEMF), and seven cases of bilateral EMF. All patients underwent endocardiectomy and atrioventricular valve replacement with a xenograft. Four patients had an additional valvular annuloplasty. There were four postoperative deaths (all bilateral EMF): two from low cardiac output and one each from hepatic failure and cerebral malaria. There was one late death from serum hepatitis. The other patients had a relatively difficult postoperative course, but none of the 20 patients atrioventricular block. The longest follow-up of the 15 survivors is 28 months (mean 16.7 months). All patients are symptom free. Three take digitalis and/or diuretics. Ten have been recatheterized from 6 months to 1 year after operation. Intracardiac pressures, the ventricular cineangiogram, liver, and heart size returned to normal in patients with LVEMF; in RVEMF, despite clinical improvement, most of these parameters remained abnormal. Of special interest were (1) our recognitions of an early type of LVEMF and (2) our surgical preservation of a thin juxta-annular rim of fibrosis in the right ventricle to avoid atrioventricular block. Operation is indicated in all patients with LVEMF, despite greater risk. Early intervention is advised in RVEMF to avoid irreversible liver damage and cardiac enlargement. | [
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10,002,403 | Establishment of right ventricle--hypoplastic pulmonary artery continuity without the use of extracorporeal circulation. | [
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10,002,404 | Results of pulmonary resection for metastatic lesions. | [
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10,002,405 | We reviewed the role pulmonary resection for metastatic pulmonary lesions in our institution. Over a 22 year period, 142 patients underwent 153 thoracotomies. The operative mortality was 0.7%. Complete follow-up was obtained on 140 hospital survivors (99.3%). The actuarial 5 year survival rate for carcinoma was 24% (70% confidence limit 0% to 52%) and for sarcoma was 29% (70% confidence limit 0% to 61%). The survival rate to the end of the follow-up for patients with short disease-free intervals (less than 3 months) was 30%; with free intervals of 3 to 30 months, the survival rate was 27%; with long intervals (greater than 30 months), it was 24% (p = 0.8). Six of 29 lobectomy or pneumonectomy specimens has secondary metastases in the regional nodes, but actuarial 5 year survival rates following lobectomy, pneumonectomy, or segmental or wedge excision were not statistically different. Long-term follow-up revealed an overall survival rate of 26%, which was not influenced by tumor histology, disease-free interval, or extent of pulmonary excision. In view of these findings, we continue to advocate conservative excision of pulmonary metastases when the primary tumor is controlled and other organ systems are not involved, regardless of the tumor histology or the disease-free interval. | [
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] |
10,002,406 | Biliary tract problems in pediatric patients. | [
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] |
10,002,407 | Ultrasonography and computed tomography in the evaluation of biliary tract disease. | [
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] |
10,002,408 | Gallstone formation and dissolution. | [
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10,002,409 | Experimental animal endocarditis. | [
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10,002,410 | The results of studies performed with animal models of experimental infective endocarditis have provided valuable information about the pathophysiology, natural history, and treatment of this infection. The Freedman rabbit model of experimental infective endocarditis is relatively simple to perform, is reproducible, and with minor modifications has become the standard model for the study of experimental endocarditis. The following are the major advantages of the Freedman model: (1) its relatively low cost and simplicity permit the study of large numbers of animals required for statistical analysis of results; (2) the model enables accurate control of the timing of the onset of infection, the administration of antimicrobial agents, and the duration of infection and treatment before the animal is killed; and (3) the experimental infection in rabbits histologically resembles the pathologic changes that occur in this infection in humans. This model has some disadvantages: (1) the artificially induced trauma to rabbit cardiac valves is different pathophysiologically from the conditions that predispose humans to infective endocarditis; (2) a larger inoculum of bacteria is required to produce infections in rabbits than that which causes human endocarditis; and (3) the rabbit model is a more severe, acute form of infection than human infective endocarditis, and survival of untreated animals for longer than 2 weeks is unusual. One should exercise considerable caution in extrapolating the results obtained from animal experimental infective endocarditis to human infection. | [
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10,002,411 | The clinical manifestations of infective endocarditis. | [
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10,002,412 | Frequently, the presence of endocarditis is disguised. The emphasis of this description of the clinical manifestations of endocarditis is on the various modes of presentation, rather than on individual symptoms and signs. Endocarditis can manifest with cardiac, pulmonary, ophthalmic, central nervous system, renal, orthopedic, phthisic, and peripheral vascular disorders. The following clinical data are most useful in helping to establish a diagnosis of endocarditis: a history of fever, anorexia, weight loss, and back pain; a search for petechiae; splenomegaly; and daily examination, especially cardiac auscultation and funduscopic examination, of those patients in whom incomplete evidence exists at admission. The most helpful laboratory tests include those revealing anemia, increased erythrocyte sedimentation rate, abnormalities in the urine compatible with nephritis, or embolization. In patients who have not received antimicrobial therapy just before the diagnostic workup, one set of three blood cultures is sufficient to isolate the offending microorganism in about 95% of cases. | [
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10,002,413 | Primary adrenocortical nodular dysplasia as a cause of Cushing's syndrome in infants and children. | [
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10,002,414 | Two patients with Cushing's syndrome due to primary adrenocortical nodular dysplasia (PAND) are described. Both patients, an infant and a 14-year-old boy at the time of diagnosis, were treated by total bilateral adrenalectomy. On gross inspection, the adrenal glands of the infant did not appear to be abnormal but those of the older patient showed numerous dark nodules. Microscopically, the adrenal glands of each patient manifested multiple micronodules with internodular atrophy. The extreme internodular atrophy suggest that primary adrenocortical nodular dysplasia is a non-ACTH-dependent condition. Since the disorder appears to involve primarily the cortex of both adrenals, adrenalectomy followed by steroid replacement is the recommended treatment. | [
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10,002,415 | University of Vienna Medical School. | [
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10,002,416 | Recognition and management of depression in the elderly. | [
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10,002,417 | Depression is probably the most common psychiatric disorder of the elderly. Societal stereotypes and atypical clinical features are contributing factors to inadequate diagnosis and treatment. Somatic complaints without an obvious mood defect and a syndrome of pseudodementia are commonly encountered. Treatment strategies rest firmly on a comprehensive evaluation that considers the biological, psychologic, and social factors involved. Psychotherapy is a valuable tool in some elderly persons. When antidepressant agents are used, it should be recognized that lower than usual dosage may be effective and that the elderly person is particularly sensitive to the autonomic side effects of these chemical agents. Electroconvulsive therapy remains a helpful and sometimes lifesaving resource when other methods have failed. | [
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10,002,418 | Hyperfunctioning supernumerary parathyroid glands. An occasional cause of hyperparathyroidism. | [
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10,002,419 | It has become increasingly appreciated that, although rare, a supernumerary (fifth) parathyroid gland may be a cause of excess parathyroid hormone production. This review reports 15 patients, each of whom had hyperparathyroidism as a consequence of such a hyperfunctioning fifth gland. It is apparent that these patients are similar to the usual patients with primary hyperparathyroidism with respect to complications of the disease, type of pathology, and care after surgical excision of the abnormal parathyroid tissue. Significantly different, however, is the fact that the majority of these fifth-gland tumors were located in the mediastinum. The circumstances under which a supernumerary gland should be expected and the recommended surgical approach are reviewed. | [
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10,002,420 | Coronary artery spasm. | [
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] |
10,002,421 | General considerations in the diagnosis and treatment of infective endocarditis. | [
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10,002,423 | Infective endocarditis is a rare disease in the general pediatric population. Nonetheless, children with congenital heart disease have a substantial lifetime risk for development of endocarditis, and recent advances in the management of these children should increase the number of patients who survive infancy and early childhood. During the 30-year period from 1950 through 1979, 50 cases of endocarditis in children were diagnosed at the Mayo Clinic. Of these 50 patients, 37 had congenital heart disease, and 8 were diagnosed as having endocarditis within 3 months after having undergone a cardiac surgical procedure. Nineteen patients died of the disease or its complications. The most common organism isolated at Staphylococcus aureus (19 patients), followed by viridans streptococci (14 patients). Children younger than 10 years of age experienced a particularly high mortality, as did patients of all ages with S. aureus infection. Any unexplained fever in a child with congenital heart disease deserves close investigation; if endocarditis is suspected, early empiric antibiotic therapy is indicated after appropriate culture specimens have been obtained. Moreover, localized bacterial infections in children at risk must be treated aggressively to prevent metastatic spread to the heart. | [
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10,002,424 | Treatment of penicillin-sensitive streptococcal infective endocarditis. | [
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10,002,425 | Patients with infective endocarditis caused by penicillin-sensitive streptococci (minimal inhibitory concentration less than or equal to 0.1 microgram/ml of penicillin) may be treated successfully with one of the following three regimens: (1) aqueous penicillin G administered intravenously for 4 weeks, (2) aqueous penicillin G administered intravenously for 4 weeks in combination with streptomycin for the first 2 weeks of therapy, or (3) parenterally administered penicillin plus streptomycin for 2 weeks. No substantial difference in the relapse rate exists among the three regimens, and a cure rate of at least 98% may be anticipated with each of the three forms of therapy. The major advantage of the 2-week regimen is that it is more cost-effective than 4 weeks of hospitalization and therapy. The major disadvantage of the 2-week regimen and the 4-week regimen that uses streptomycin is the relatively low risk of streptomycin-associated vestibular toxicity. Patients unable to tolerate penicillin may be treated with vancomycin or a cephalosporin administered parenterally for 4 weeks. | [
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10,002,426 | [Morbidity and mortality following intraperitoneal closure of transverse loop colostomy (author's transl)]. | [
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10,002,427 | The postoperative course of 104 patients, who underwent closure of a transverse loop colostomy at the Surgical Department of the Teaching Hospital Herford between 1974 and 1980 after distal resection and anastomosis of the large bowel for neoplastic or diverticular disease has been reviewed in detail. The mortality was 0.9% and the morbidity rate was 25%, including 25% wound infections and 4.8% fecal fistulas. The highest complication rate was noted, when colostomies were closed during the first 6 weeks. Wound infections and fecal fistulae did not occur more frequently than in patients with diverticulitis. The intraperitoneal procedure of transverse loop colostomy closure can be recommended as to be straightforward and safe. | [
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10,002,428 | Jejunoileal bypass versus gastric bypass or gastroplasty in the operative treatment of obesity. | [
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] |
10,002,429 | A comparative study has been made of three methods for the operative treatment of obesity. Of my own cases, 235 underwent a jejunoiliac bypass procedure, and the results have been analyzed: operative lethality 2.1%; postoperative complications 21%. Of the patients whose residual ileum was quite short (about 45 cm), about 70% reached their ideal weight. Metabolic late complications were considerable (e.g., liver damage in 15%, electrolyte deficit in 12%, and arthritis in 10%). In the late observation time of 14 years, 14 patients died, 10 of them as a result of the operation. Three different stomach-bypass procedures are described. The collective statistics compiled on 1585 patients indicated 1.6% postoperative lethality and 22% postoperative complications. Of the total patients. 90% were very satisfied with the procedure and in only 5% was a weight gain recorded after 5 years. The latest procedure is gastroplasty according to the Gomez method: the first 200 cases show 0.5% postoperative lethality and postoperative complications in 18.5%. Although this procedure is technically simple, the late observation time is not yet adequate for a definitive comparison. | [
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10,002,430 | Comparison of 5- and 10-year survival rates in operated gastric cancer patients. Assessment of the 5-year survival rate as a valid indicator of postoperative curability. | [
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10,002,431 | To evaluate whether it is appropriate to estimate the postoperative curability of gastric cancer based on the 5-year survival rate, we compared 5- and 10-year survival rates in 477 primary gastric cancer patients who had undergone gastrectomy during the 8-year period from 1960-1967. In patients who had died more than 5 years after surgery, the cause of death was investigated. The 10-year survival rate of 315 curatively operated patients was 59.1%, 2.9% lower than the 5-year survival rate. Of 176 patients who survived more than 5 years postoperatively, only 9 (5.1%) died of cancer recurrence, suggesting that the 5-year survival rate adequately reflects the curative success of gastric cancer surgery. The postoperative curability of gastric cancer is usually estimated by the 5-year survival rate. However, even in patients who survived for more than 5 years postoperatively, cancer recurrence has been observed. Therefore, we deemed it useful to assess whether it is appropriate to estimate the postoperative curability of gastric cancer based on the 5-year survival rate. From this point of view, we compared the 5- and 10-year survival rates of operated primary gastric patients and investigated the cause of death in patients who died more than 5 years postoperatively. Furthermore, in patients with cancer recurrence more than 5 years postoperatively, the pathologic findings on the cancer in the originally resected specimen were re-evaluated. | [
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10,002,432 | [Potentiation of temporary ischemic liver damage by blockage of lymph flow (author's transl)]. | [
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10,002,433 | [Serum results following experimental fracture alignment and thyrocalcitonin treatment (author's transl)]. | [
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10,002,434 | Serum alkaline phosphatase activity, serum calcium and phosphorus concentrations were determined during bone healing under treatment of thyrocalcitonin. The right tibiae of 160 albino rats were osteotomized. Of these, 80 were treated with thyrocalcitonin. During the 50-day observation period, the calcium level in the thyrocalcitonin-treated sample never differed significantly from that of the control group. However, the alkaline phosphatase activity and the serum phosphorus level significantly differed from the control levels (P less than 0.05) during 4 days of observation. The increased serum alkaline phoshatase activity--a sign of osteoblastic activity--suggests that thyrocalcitonin may aid in osteogenesis and bone healing. | [
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10,002,435 | Myocardium in hypertrophy: oxygen consumption by isolated cardiac myocytes and working hearts from spontaneously hypertensive rats. | [
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10,002,436 | Oxygen consumption was measured on suspensions of calcium tolerant myocytes obtained from hearts of Spontaneously Hypertensive Rats (SHR) and normotensive Wistar Kyoto Rats (WKY). Oxygen consumptions of the isolated cells were not significantly different from each other either in the presence or absence of added calcium (1.5 mM). Additionally, there was excellent agreement between the oxygen consumption of the isolated cells and estimates of basal oxygen consumption between work and myocardial oxygen utilization in isolated perfused working hearts. At any given workload there was no significant difference in oxygen consumption between SHR hearts and WKY hearts. The mechanical performance of the SHR hearts was lower compared to that of the WKY hearts at low preloads. At high preloads and high afterloads the SHR hearts developed higher pressures than did hearts obtained from WKY rats. The data suggest that: (1) basal oxygen consumption of the two hearts are similar and (b) the contractile defects in the SHR heart are not the result of hypoxia. | [
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10,002,437 | Lysophospholipase activity in rabbit skeletal muscle. | [
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10,002,438 | Skeletal muscle contains appreciable lysophospholipase activity which is differentiated by muscle type with red muscle subcellular fractions having greater activity than the corresponding white ones. | [
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10,002,439 | Inhibition by D 600 of norepinephrine- and clonidine-induced responses of the aortae from normotensive (WKY) and spontaneously hypertensive rats (SHR). | [
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10,002,440 | Comparison was made of the inhibition by D 600 of the norepinephrine (NE)- and clonidine-induced responses of aortic strips from normotensive (WKY) and spontaneously hypertensive rats (SHR). Clonidine-induced responses of aortae from both strains of rats were markedly more susceptible to inhibition by D 600 than those of NE. Omission of calcium from the physiological solution resulted in a greater reduction in response to clonidine. Aortae from SHR were less susceptible to inhibition by D 600 but showed no difference from WKY rats in their responses in nominally calcium-free physiological solutions. Our results clearly indicate a greater dependence on extracellular calcium by clonidine-induced responses of the aortae relative to those of NE. | [
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10,002,441 | Comparison of the effects of GABA and chloride ion on the affinities of ligands for the benzodiazepine receptor. | [
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] |
10,002,442 | The effects of gamma-aminobutyric acid (GABA), Cl- ion, and their combination were examined on the affinity for the benzodiazepine (BDZ) receptor of various ligands including BDZ's, putative endogenous ligands, and CL218872. When the binding was performed at 0 degrees, the ligands could be classified into four types according to the action of the modulators. The affinity of the first type including some BDZ's increased with GABA, Cl- ion, or their combination while that of the second type consisting of 3-hydroxy-benzodiazepines, CL218872, and inosine increased only with GABA. In the third type, designated as the beta-carboline type, only Cl- ion increased the affinity of the ligands. The fourth inactive type included pentylenetetrazole and nicotinamide and the affinities of these ligands were not affected by GABA or Cl- ion. At 37 degrees, although GABA still retained the property to increase the affinity of prototype compounds of the first and second types, the effect of C1- ion became somewhat ambiguous. Comparison of the present results with published data on the pharmacological and electrophysiological activities of the ligands suggested that the compounds with affinity increased by GABA act as BDZ-mimetics, while those belonging to types 3 and 4 act as antagonists. Also, our results seem to throw some additional light upon the relationships among the benzodiazepine receptor, the GABA receptor, and the chloride ionophore. | [
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10,002,443 | Neurotensin-induced release of endogenous noradrenaline from rat hypothalamic slices. | [
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10,002,444 | Effects of neurotensin on the release of endogenous noradrenaline (NA) from rat hypothalamic slices were investigated. NA was extracted by the aluminum adsorption method, and assayed electrochemically by high-performance liquid chromatography. Neurotensin (30-300 microM) enhanced the release of NA, in a dose dependent manner. Neurotensin 2 and 10 microM, doses without effect on the spontaneous release of NA, potentiated the potassium-induced release of this amine. Neurotensin 100 microM repetitively added to tbe medium at 40 min intervals induced a consistent and reproducible increase in the release of NA. This neurotensin-induced release of NA was completely abolished in calcium free medium containing EGTA 1 mM. The presence of tetrodotoxin 2 microM did not alter the effect of neurotensin 100 microM. These results of in vitro investigations suggest that neurotensin has a direct effect on NA nerve terminals in the hypothalamus and releases NA, in a Ca++-dependent manner. | [
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10,002,445 | The calcium abnormality in cystic fibrosis mitochondria: relative role of respiration and ATP hydrolysis. | [
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10,002,446 | Calcium uptake by mitochondria isolated from skin fibroblasts of patients with cystic fibrosis and controls was studied in the presence and absence of inhibitors. Since mitochondrial calcium accumulation may be supported by ATP hydrolysis or respiration, inhibitors of each were used to characterize the basis of previously described alterations in calcium uptake by mitochondria from patients with cystic fibrosis. Calcium uptake measurements under the influence of oligomycin and antimycin A suggest that the increased calcium uptake by mitochondria from patients with cystic fibrosis is related to altered respiratory system activity. Binding constants of calcium to the carrier system in mitochondria were not different between genotypes. | [
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10,002,447 | Oxidation of carbon tetrachloride, bromotrichloromethane, and carbon tetrabromide by rat liver microsomes to electrophilic halogens. | [
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10,002,448 | In order to determine whether CCl4, CBrCl3, CBr4 or CHCl3 undergo oxidative metabolism to electrophilic halogens by liver microsomes, they were incubated with liver microsomes from phenobarbital pretreated rats in the presence of NADPH and 2,6-dimethylphenol. The analysis of the reaction mixtures by capillary gas chromatography mass spectrometry revealed that 4-chloro-2,6-dimethylphenol was a metabolite of CCl4 and CBrCl3 whereas 4-bromo-2,6-dimethylphenol was a metabolite of CBr4. The formation of the metabolites was significantly decreased when the reactions were conducted with heat denatured microsomes, in the absence of NADPH or under an atmosphere of N2. These results indicate that the chlorines of CBrCl3 and CCl4 and the bromines of CBr4 are oxidatively metabolized by rat liver microsomes to electrophilic and potentially toxic metabolites. | [
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10,002,449 | The efficacy of anti-inflammatory agents with respect to extracellular phospholipase A2 activity. | [
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10,002,450 | The effects of steroidal and non-steroidal anti-inflammatory agents on extracellular phospholipase A2 (PLA2) activity were investigated. Enzyme release was inhibited by 5 x 10(-8) M dexamethasone but not by indomethacin, whereas the soluble extracellular enzyme was inactivated by mepacrine but not by dexamethasone or indomethacin. PLA2, released into the interstitium by activated macrophages is both pro-inflammatory and vasoactive. The anti-inflammatory efficacy of steroidal and non-steroidal drugs may partially reside in their ability to inhibit the release of PLA2, or inactivate preformed extracellular PLA2 in chronically inflamed sites. | [
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10,002,451 | Barium responsiveness of the rat aorta and femoral artery during pregnancy. | [
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10,002,452 | The barium responses of isolated aortic strips and femoral arteries from non-pregnant and pregnant rats were investigated. Barium caused concentration-related increases in tension of vessels from both pregnant and non-pregnant rats. The concentration-response curves of femoral arteries from non-pregnant and 3 week pregnant rats were not different; however contractility and slopes of concentration-response lines for thoracic aortas from 1, 2 and 3 week pregnant rats were significantly less than those of aortas from non-pregnant rats. In addition, barium caused rhythmic contractions to develop in both femoral arteries and aortas of 3 week pregnant rats more frequently than vessels from non-pregnant rats. Rhythmic contractions did not develop in aortas from 3 week pregnant rats in calcium-free Krebs. Since the effects of barium on the electrical and mechanical activity of various muscles have been postulated to be similar to and/or dependent on calcium, these results may indicate that changes in calcium sensitivity of vascular smooth muscle occur during pregnancy. Such changes may contribute to the blood flow redistribution and other cardiovascular adaptations of pregnancy. | [
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10,002,453 | Saliva cortisol levels following dexamethasone administration in endogenously depressed patients. | [
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10,002,454 | Saliva and serum cortisol levels were measured in 11 patients with primary major depression, endogenous subtype, and in 9 control subjects before and 8, 16, and 24 hours after dexamethasone administration (1.0 mg p.o.). Six of the 20 subjects had postdexamethasone serum cortisol concentrations greater than 50 ng/ml and thus were considered "escapers" from dexamethasone suppression. These six subjects also had saliva cortisol concentrations which were significantly elevated compared to those of the suppressors. Measurement of saliva cortisol holds promise as a non-invasive technique for assessing CNS-pituitary-adrenal function in endogenously depressed patients. | [
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10,002,455 | Changes in the chain length of folylpolyglutamates during liver regeneration. | [
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10,002,456 | Partial hepatectomy significantly alters the proportions of folylpolyglutamates of different chain lengths in rat liver. Hexa- and heptaglutamates increase at the expense of tetra- and pentaglutamates. Methyl hexaglutamates account for most of the increase in hexaglutamates, and folates with formyl oxidation-level one-carbon substituents for most of the increase in heptaglutamates. These changes are reversible and believed to represent an element of regulation of one-carbon metabolism. | [
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10,002,457 | In vivo effect of adenosine on adenine nucleotides and inorganic phosphate in rat blood. | [
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] |
10,002,458 | The effect of adenosine and the time response on adenine nucleotide and Pi levels in rat blood was investigated. An increase in adenine nucleotide with a concomitant decrease in Pi concentration 30, 60, and 90 minutes after the nucleoside administration were observed. Though the 100 mg/Kg dose showed the highest effect on nucleotide concentration, the maximal response on Pi content was achieved with the 50 mg/Kg dose. The results are discussed at the light of previous data obtained in hepatocytes, and using as indicators the energy charge and the phosphorylation potential. | [
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10,002,460 | HB 4867: The laboratory referrals bill. | [
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10,002,461 | Aspartame and other sweeteners. | [
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10,002,462 | Saralasin for diagnosis of renovascular hypertension. | [
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] |
10,002,463 | Unusual cavitary paratracheal mass. | [
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10,002,464 | Acoustic tumors: surgical results in 42 consecutive operations. Case reports. | [
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10,002,465 | Snoring, sleepiness and the obstructive sleep apnea syndrome. | [
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10,002,466 | Hypomagnesemia. | [
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10,002,467 | Nocturnal hypoxemia and associated electrocardiographic changes in patients with chronic obstructive airways disease. | [
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10,002,468 | To study the direct effects of nocturnal hypoxemia on the heart, we recorded electrocardiographic tracings and arterial oxygen saturation (SaO2) during the night in patients with chronic obstructive airways disease. In seven "blue-bloater" patients the mean basal SaO2 was less than 80 per cent, and it fell by more than 10 per cent during 29 episodes of transient hypoxemia. Only five such episodes occurred in three of five "pink-puffer" patients. All "blue bloaters" with low basal mean SaO2 had multiple atrial and ventricular premature contractions and a high heart rate at rest; six patients has a prolonged QTc, three had ST-T depression, and one had right-bundle-branch block. Oxygen therapy increased basal mean SaO2, reduced ectopic activity, abolished ST-T changes and bundle-branch block, significantly reduced the resting heart rate and the amplitude of the R and S waves, and shortened the QTc in four nonsmokers. These results suggest that sustained hypoxemia contributes to myocardial dysfunction and heart failure in "blue-bloater" patients. | [
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10,002,469 | Spallation and migration of silicone from blood-pump tubing in patients on hemodialysis. | [
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10,002,470 | Spalled particles of silicone were observed in the livers of patients with chronic renal failure treated by hemodialysis. The refractile particles of silicone were associated with various degrees of hepatic inflammation and fibrosis, and granulomatous hepatitis was evident in nine cases. Retrospective examination revealed the material in 18 of 38 liver-biopsy samples from patients on hemodialysis who had clinical hepatic dysfunction. Of 31 autopsies of patients who had undergone hemodialysis, 22 revealed silicone in the liver, and silicone was also present in the spleen in all cases and in the marrow, lungs, and nodes in some. Giant cells containing silicone were also observed in these organs. Silicone was present in patients who had undergone hemodialysis for six weeks to 84 months (mean, 24 months). The identity of the material was confirmed by atomic absorption and by electron microprobe analysis. The silicone was traced to a segment of silicone tubing located in the roller pump of the dialysis machine. | [
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10,002,471 | No association between coffee consumption and adverse outcomes of pregnancy. | [
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10,002,472 | We analyzed interview and medical-record data of 12,205 non-diabetic, non-asthmatic women to evaluate the relation between coffee consumption and adverse outcomes of pregnancy. Low birth weight and short gestation occurred more often among offspring of women who drank four or more cups of coffee a day and more often among the offspring of smokers. After controlling for smoking, other habits, demographic characteristics, and medical history by standardization and logistic regression, we found no relation between low birth weight or short gestation and heavy coffee consumption. Furthermore, there was no excess of malformations among coffee drinkers. These negative results suggest that coffee consumption has a minimal effect, if any, on the outcome of pregnancy. | [
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10,002,473 | Acute polyneuropathy after poisoning by a new organophosphate insecticide. | [
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10,002,474 | Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 3-1982. An elderly woman with mild rheumatoid arthritis and progressive pulmonary fibrosis. | [
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10,002,475 | Dangerous sleep: oxygen therapy for nocturnal hypoxemia. | [
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10,002,476 | Environmental and iatrogenic obstacles to long life on hemodialysis. | [
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10,002,477 | Sounding Board. Performance-based rating of methadone maintenance programs. | [
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10,002,478 | Report from the Committee on Maternal Welfare. Fatal respiratory distress. | [
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10,002,479 | Potential toxicity of a new sugar substitute in patients with liver disease. | [
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10,002,480 | Cycloplegia from transdermal scopolamine. | [
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10,002,481 | Pulmonary edema after ritodrine therapy in a patient with preeclampsia. | [
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10,002,482 | Influence of paddle-electrode location and size on success of cardioversion. | [
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10,002,483 | Prevalence of hepatitis B among men admitted to a federal prison. | [
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10,002,484 | Choline content of mothers' milk in Ecuador and Boston. | [
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10,002,485 | More on nipple shadows in x-ray films. | [
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10,002,486 | Toward a male contraceptive. | [
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10,002,487 | CSF rhinorrhea after bromocriptine for prolactinoma. | [
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] |
10,002,488 | Treatment of Hunan hand. | [
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] |
10,002,489 | Relation between surgical volume and postoperative wound infection. | [
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] |
10,002,490 | Is the problem-oriented autopsy enough? | [
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10,002,491 | Prognosis, survival, and costs in an intensive-care unit. | [
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10,002,492 | Home remedies revisited. | [
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10,002,493 | How doth the busy little bee. | [
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10,002,494 | Larger methods. | [
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10,002,496 | Alleged direct promotion of prescription drugs to consumers. | [
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10,002,497 | Occasional notes. Origin of the term "internal medicine". | [
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10,002,498 | Catheter technique for closed-chest ablation of the atrioventricular conduction system. | [
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] |
10,002,499 | This report describes a catheter technique for ablating the His bundle and its application in nine patients with recurrent supraventricular tachycardia that was unresponsive to medical management. A tripolar electrode catheter was positioned in the region of the His bundle, and the electrode recording a large unipolar His-bundle potential was identified. In the first patient, two shocks of 25 and 50 J, respectively, were delivered by a standard cardioversion unit to the catheter electrode, resulting in an intra-His-bundle conduction defect. Subsequent delivery of 300 J resulted in complete heart block. In the next eight patients, an initial shock of 200 J was used. The His bundle was ablated by this single shock in six of these patients and by an additional shock of 300 J in one. In the remaining patient, conduction in the atrioventricular node was modified, resulting in alternating first and second-degree atrioventricular block. A stable escape rhythm was preserved in all patients. The procedure was well tolerated, without complications, and all patients have remained free of arrhythmia, without medication, for follow-up periods of two to six months. | [
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