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10,004,100 | Linear airway dimensions in children: including those from cleft palate. | [
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10,004,101 | Linear airway dimensions from incisor teeth to vocal cords were measured from radiographs. Normal children were slightly taller and heavier than children being treated for cleft palate and had significantly longer upper airway dimensions. Tracheal length was measured in 50 normal children breathing spontaneously under general anaesthesia and was found to correlate best with body weight. Strong positive correlation with height was also found. Data from normal children in these two studies were used to calculate the distance from lips to mid-trachea to determine optimal length for a tracheal tube. Previously published data on airway lengths in children are reviewed. | [
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10,004,102 | The fate of phenobarbitone in children in hypothermia and at normal body temperature. | [
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10,004,103 | Four critically injured children receiving large doses of phenobarbitone were studied during hypothermia (30 degrees - 31 degrees C) and at normal body temperature. The volume of distribution of phenobarbitone varied from 0.79 to 1.01 litres per kg and the serum t 1/2 ranged from 36.8 +/- 9.4 to 86.2 +/- 10.5 hrs. The percentage of dose recovered in urine in 16 days ranged from 40.5 to 65.5 per cent: 2.7 to 12.4 per cent as hydroxyphenobarbitone, 1.7 to 19.7 per cent as conjugated hydroxyphenobarbitone, 6.0 to 22.4 per cent as phenobarbitone-N-glucoside and 17.8 to 23.1 per cent as unchanged drug. After the body temperature was allowed to return to normal the rate of excretion of metabolites increased substantially and the rate of excretion of the unchanged drug decreased markedly. It is concluded that reduction in body temperature influences the volume of distribution, rate of metabolism and excretion of phenobarbitone. | [
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10,004,104 | Antacid anticholinergic regimens in patients undergoing elective caesarean section. | [
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10,004,105 | The pH and volume of gastric contents were examined in 60 patients undergoing elective Caesarean Section under thiopentone, nitrous oxide-oxygen, succinylcholine anaesthesia. All patients received Gelusil 30 ml per os preoperatively, while 20 were given atropine 7 microgram X kg-1 and another 20 glycopyrrolate 4 microgram X kg-1 intramuscularly along with Gelusil. Following tracheal intubation, gastric fluid was sampled through an orally placed 18 French Salem Sump tube. After Gelusil alone, the mean gastric fluid pH was 4.54 +/- 2.45 (SD) while it was significantly higher following the combined use of antacid and atropine (6.78 +/- 1.20) or antacid and glycopyrrolate (6.42 +/- 1.72), (P less than 0.01). Differences in gastric fluid volume between the groups were insignificant. All three regimens produced a gastric pH greater than 2.5 when given less than 75 minutes before sampling. When the premedication to sampling interval exceeded 75 minutes the addition of atropine or glycopyrrolate decreased the incidence of gastric pH less than 2.5 from 47 per cent in patients given Gelusil alone to 6 per cent and 14 per cent, respectively. In comparison to Gelusil alone, this difference was significant with atropine (P less than 0.05) but not with glycopyrrolate. Atropine and glycopyrrolate respectively produced 6 per cent and 7 per cent incidences of pH lower than 2.5 combined with gastric volume greater than 25 ml, which were significantly lower than was observed with Gelusil alone (P less than 0.05). This study demonstrates that the addition of atropine or glycopyrrolate to Gelusil premedication provides additional protection against the consequences of aspiration, especially when the premedication to anaesthetic induction period is prolonged. | [
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10,004,106 | Hypermagnesaemia and anaesthetic management. | [
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10,004,107 | The anaesthetic management of a pre-eclamptic parturient who was treated with high doses of magnesium sulphate and who developed hypermagnesaemia before delivery by Caesarean Section, is presented. The pharmacology of magnesium, particularly its effects at the neuromuscular junction, and clinical considerations of magnesium administration are discussed. | [
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10,004,108 | Masseter spasm induced by succinylcholine in children: contracture testing for malignant hyperthermia: report of six cases. | [
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10,004,109 | We evaluated six boys who had developed isolated masseter muscle spasm following intravenous succinylcholine. All were receiving halothane by inhalation.l In vitro muscle contracture tests utilizing halothane and caffeine were performed. Four of the six boys had contracture response similar to those of malignant hyperthermia susceptible patients. Rigidity following succinylcholine should prompt the clinician to consider malignant hyperthermia but has been associated with other myopathic conditions as discussed. | [
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10,004,110 | Effects of neostigmine and pyridostigmine on serum cholinesterase activity. | [
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10,004,111 | Serum cholinesterase activities were measured from 270 minutes in patients following administration of neostigmine or pyridostigmine for the reversal of pancuronium block in groups of seven patients each. The enzyme activities were significantly depressed by neostigmine for four hours and by pyridostigmine throughout the whole period of study. Whereas the immediate effects of neostigmine were more intense, the effects of pyridostigmine beyond the first 30 minutes were more profound. The clinical relevance of these findings is discussed. | [
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10,004,112 | Effect of protamine on plasma ionized calcium in the dog. | [
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10,004,113 | The anaesthetized, heparinized health adult dogs were infused with protamine sulphate 3 mg X kg-1 and plasma ionized calcium was measured. A significant (p less than 0.01) decrease in ionized calcium occurred which preceded the maximal reduction in cardiac output and systemic arterial pressure. The clinical implications of these results are discussed. | [
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10,004,114 | Recurrent ventricular tachycardia associated with gangrene. | [
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10,004,115 | Ventricular tachycardia occurs with myocardial ischaemia, hypoxia, hypercarbia, hypokalaemia, and digitalis toxicity. We report recurrent ventricular tachycardia occurring in a patient with gangrene of the lower extremities in whom none of the common aetiologies for dysrhythmia could be demonstrated. Ventricular tachycardia stopped and did not recur after amputation. This course leads us to speculate that release of a toxic substance from gangrenous tissue may contribute to the development of ventricular tachycardia. | [
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10,004,116 | Subcutaneous facial emphysema complicating dental anaesthesia. | [
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10,004,117 | A 20 year-old female developed swelling and protrusions of the tongue and marked facial swelling while under general anaesthesia for dental restoration and gigivectomy. The initial diagnosis was angioedema; however x-rays showed marked subcutaneous emphysema more extensive in the perimandibular area with a minimal amount in the neck. There was no evidence of pneumomediastinum or pneumothorax. The iatrogenic subcutaneous emphysema was felt to be due to air-driven dental equipment. Tracheal intubation was maintained for 21 hours to prevent airway obstruction. The patient was treated with oxygen and antibiotics. Subcutaneous emphysema may occur following root canal therapy, tooth extraction, periodontal surgery and operative dentistry, due to the use of air-driven dental equipment. It has the potential to cause obstruction. | [
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10,004,118 | Man-machine interface: the position of the anaesthetic machine in the operating room. | [
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10,004,119 | The question posed for this study was: "While holding a watching brief during an uneventful intra-abdominal surgical procedure do anaesthetics adopt the same position in the operating room with reference to the patient's head and "anaesthetic machine" and, if they do, what is it?" A study of the relative positions of the patient, the anaesthetist, and the "anaesthetic machine" during routine laparotomy showed great variation. The implication was that there was also great variation in the amount of movement necessary by the anaesthetist if the same amount of information was to be obtained with the same frequency. The significance of this with reference to the quality of patient care is discussed. The role of changes in apparatus and the declared need for this by anaesthetics is mentioned and recommendations regarding the visual acquisition of data during anaesthesia are made. | [
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10,004,120 | Epidural morphine. | [
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10,004,121 | Failure of 4-aminopyridine positive inotropic effect. | [
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10,004,122 | Premedication for paediatric day-care surgery. | [
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10,004,123 | Defective tracheal tube connector. | [
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10,004,124 | Postoperative oxygen. | [
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10,004,125 | Surgical management of pulmonary metastases. | [
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10,004,126 | A pre-formed paediatric orotracheal tube designed based on anatomical measurements. | [
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10,004,127 | Primary hyperparathyroidism in children. | [
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10,004,128 | Primary hyperparathyroidism is rare in children. This report describes a 15-year-old boy who had an intrathymic chief cell adenoma. The literature related to this condition in neonates and children is reviewed. Neonatal hyperparathyroidism differs from hyperparathyroidism in children. The severity of symptoms and osseous lesions, genetic inheritance in many, pathological changes in the parathyroid glands and the need for more extensive treatment in neonates and infants indicate that primary hyperparathyroidism in these patients should be considered as a different entity from that occurring in older children. | [
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10,004,129 | Effect of surface roughness on platelet adhesion under static and under flow conditions. | [
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10,004,130 | Normal blood clots when exposed to surfaces other than endothelial. Various unsuccessful attempts have been made to find a synthetic material that is compatible with blood. Both platelets and clotting factors are involved in thrombosis at foreign surfaces. The authors are concerned with platelet adhesion as a first step in thrombus formation. The determination of the number of platelets adhering per unit area, therefore, appears to be a useful criterion for the choice of appropriate biomaterials contacting blood. However, laboratory tests are often carried out with specially prepared, well-defined biomaterials with a smooth surface, whereas biomaterials in clinical use may have a variable degree of roughness. In this paper the authors present data on platelet adherence to a hydrophilic (glass) and to a hydrophobic (silane) material, with smooth and rough surfaces. Additional data are presented that document the extent of platelet adhesion to a wide range of smooth polymer materials having a large variation in surface hydrophobic quality. There was no difference in platelet adherence between the smooth and rough surfaces when tested under static conditions. When the surfaces were tested in a laminar flow cell, the addition of roughness caused a decrease in platelet adhesion on the hydrophilic surface and an increase in platelet adhesion on the hydrophobic surface. | [
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10,004,131 | Appendicovesical fistula caused by ileocecal actinomycosis. | [
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10,004,132 | Blunt renal trauma: the value of a conservative approach to major injuries in clinically stable patients. | [
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10,004,133 | A 10-year retrospective study of 393 cases of blunt renal trauma was carried out to evaluate the use of a conservative approach to therapy in clinically stable patients with major renal injuries. Injuries were minor in 357 patients who were successfully treated conservatively. Major injuries occurred in 36 patients; 28 were treated conservatively. Of the 28, 17 had no complications. Seven required total or partial nephrectomy to control bleeding and four had drainage, one with marsupialization of a large renal cyst, 1 year after injury. The authors advocate conservative treatment of major blunt renal injuries in clinically stable patients. | [
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10,004,134 | Vesicopsoas hitch: a versatile procedure. | [
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10,004,135 | The vesicoposoas hitch is an ideal operation for the management of lower ureteral injury and disease requiring replacement of varying lengths of ureter. It is safe and easy to perform, complications are minimal and the success rate is high. In combination with the Boari flap and downward mobilization of the kidney, up to 70% of the ureter may be replaced by this technique. The authors describe their experience between 1970 and 1980 with 52 patients treated by the vesicopsoas hitch, with and without the Boari flap. | [
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10,004,136 | Intravesical therapy with adriamycin in urothelial dysplasia and early carcinoma in situ. | [
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10,004,137 | The authors studied the effect of instilling Adriamycin intravesically in 21 patients with urothelial dysplasia and early carcinoma in situ. The effectiveness of the treatment was assessed by repeated urine cytology, cystoscopy and repeated biopsy of the bladder mucosa. No serious side effects were noted. Adriamycin causes the death of malignant cells, general improvement in the appearance of the bladder mucosa at cystoscopy and histologic evidence of endothelial damage to the bladder mucosa. The cytologic changes continue for many months after treatment. | [
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10,004,138 | Vasoepididymostomy: the role of the microscope. | [
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10,004,139 | Reconstructive surgery of the epididymis has been facilitated by the use of the microscope. The author describes his technique for end-to-end and end-to-side anastomoses and reports the results of reconstruction in 23 patients over a 10-year period. The pregnancy rate following reconstructive surgery was 39% overall: 40% after vasoepididymostomy (performed in 10 patients) and 35% after repair of primary epididymal obstruction (performed in 13 patients). With the aid of the microscope end-to-side and end-to-end anastomoses between the vas deferens and epididymis can be performed with greater precision because the anatomy can be defined precisely and reconstruction planned better. | [
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10,004,140 | Intermittent percutaneous infusion into the hepatic artery of cytotoxic drugs for hepatic tumours. | [
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10,004,141 | Between June 1, 1976 and Apr. 30, 1981, 157 patients were treated for inoperable cancer of the liver by intermittent percutaneous infusion of chemotherapeutic agents into the hepatic artery. The majority of these patients had metastatic colorectal cancer. The regimen of chemotherapeutic infusion evolved during the study and is described. The survival of the total group of patients is analysed according to type of cancer, extent of disease, dosage and combination of drugs. This therapeutic modality appears to benefit patients with metastases from colorectal cancer confined to the liver. The complication rate for this procedure is relatively low. The results from this study suggest that intermittent percutaneous infusion of cytotoxic agents into the hepatic artery is worthwhile for selected patients and should be studied further in combination with other forms of therapy. | [
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10,004,142 | Structure and function of small bowel allografts in the dog: immunosuppression with cyclosporin A. | [
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10,004,143 | Pairs of mongrel dogs received orthotopic total small bowel allografts. Half were treated with the immunosuppressive agent cyclosporin A and the other half were not. Ten untreated dogs survived a mean of 12.5 days (range from 7 to 25 days). They lost up to 30% of their initial body weight and rejection with hemorrhagic necrosis was usually the cause of graft failure. The mean survival of 11 dogs treated with cyclosporin A was 90.6 days (range 9 to 286 days) with early deaths being due to pneumonia or volvulus. Intestinal mucosa appeared normal, but there was some smooth muscle hypertrophy. Reconnection of lymph vessels was complete in all dogs examined more than 21 days after allografting. Two dogs survived for 203 and 221 days, respectively, and one dog remains alive and well 287 days after operation. The long-term survivors remained healthy, with steady body weights, formed stools, normal plasma protein values and xylose absorption curves that did not differ from those of autografted dogs. Roentgenography after a barium meal and follow-through study showed normal mucosa. The transit time was around 60 minutes (normal 150 minutes). Late, acute episodes of rejection occurred in two dogs, when blood levels of cyclosporin A were low (less than 400 ng/ml). Bowel mucosa showed ulceration and villous atrophy, with lymphoid infiltration, leading to malabsorption as a terminal event. Cyclosporin A is effective in increasing the duration of survival in dogs with small bowel allografts while maintaining essentially normal bowel structure and good function. | [
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10,004,144 | Rotator cuff tears: the role of surgery. | [
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10,004,145 | The indications for operative intervention in patients with rotator cuff tears and the reasonable expectations of such surgery are not well defined. This retrospective study of 37 such patients treated operatively at Ottawa General Hospital showed good results in 65% of cases. However, efforts to re-establish continuity of the cuff did not always result in a permanent cuff reconstruction. The persisting defect did not impede functional recovery as long as the edges of the tear were debrided along with division of the coracoacromial ligament, acromioplasty, or excision of osteophytes at the greater tuberosity. Impingement plays a major role in the disability associated with this condition. | [
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10,004,146 | Gastrointestinal complications after radiotherapy for carcinoma of the uterine cervix. | [
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10,004,147 | Radiotherapy for invasive carcinoma of the uterine cervix caused gastrointestinal complications in 52 of 441 patients. External beam and intracavitary radiation together caused greater bowel damage than either method alone. Twenty-eight of the 52 patients required surgical intervention. Ileal stenosis in nine patients required primary resection with anastomosis in seven while the stenosis was bypassed in the other two. Acute perforation with peritonitis would require a diverting ileostomy and creation of a mucous fistula. A defunctioning colostomy was indicated for relief of pain, bleeding and stenosis of the rectum in 11 of 15 patients; 2 patients were treated by primary resection, 1 underwent abdominoperineal resection and another a pelvic exenteration. Of four patients with ileal and rectal involvement, one underwent right hemicolectomy and transverse colostomy, two had ileal resection and sigmoid colostomy and the other had hemicolectomy and rectal resection. All patients were well at follow-up from 3 to 120 months after operation. A Hartmann's procedure is indicated when it appears that primary closure may not succeed. Individualized management is essential. | [
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10,004,148 | The paraduodenal hernias. | [
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10,004,149 | Right paraduodenal hernia. | [
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10,004,150 | Right paraduodenal hernias are uncommon. Approximately 50 cases have been reported and 2 more are reported in this paper. The diagnosis of internal hernia should be considered in all patients with abdominal cramps and intermittent small bowel obstruction. The most valuable investigation is roentgenography of the small intestine after barium ingestion; this usually shows a clumping of the intestine, as in a bag, with incomplete rotation of the cecum and ascending colon. Duodenal hernias should be treated surgically even if they are asymptomatic, because they may cause potentially lethal complications such as obstruction. gangrene or bowel perforation. | [
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10,004,151 | Benign solid teratoma of the ovary with rupture into the rectum. | [
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10,004,152 | The authors present an unusual case of benign, solid, complex teratoma of the ovary with rupture into the rectum. A young woman, investigated for bowel problems, was found to have a prolapsing tumour in the upper rectum. A diagnosis of benign solid teratoma of the ovary was made by histologic examination of the surgical specimen; the tumour had perforated the rectal wall and protruded into the bowel lumen, a most unusual complication for this type of tumour. Pararectal teratomas can arise from either the ovaries or the soft tissues of the sacrococcygeal region. The latter do, on rare occasions, perforate the rectum. The possible mechanisms of rectal perforation by these teratomas are briefly discussed. | [
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10,004,153 | Retroperitoneal leiomyoma with periorbital and peripheral edema. | [
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10,004,154 | Removal of a large retroperitoneal leiomyoma from a 51-year-old woman resulted in complete resolution of periorbital edema and pitting edema of the hands and feet from which she had suffered for 8 months. Cardiac, renal and dietary studies gave normal results. The diagnosis of leiomyoma, which is uncommon in the retroperitoneal region, was supported by the findings on light and electron microscopy. The patient remains asymptomatic after 3 years. The association of such widespread edema with a retroperitoneal tumour is rare; the cause is unknown. | [
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10,004,155 | Early gastric cancer. | [
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10,004,156 | Early gastric cancer confined to the mucosa or submucosa, similar to that described in the Japanese literature, exists in Newfoundland, on area of North America in which gastric cancer is four times more prevalent that on the rest of the continent. If untreated, this early gastric cancer will progress to advanced disease. The clinical presentation of 10 patients suffering from cancer confined to the mucosa and submucosa of the stomach is described. The disease presents with acute or chronic bleeding or unexplained dyspepsia; no abnormality of the stomach can be seen on roentgenograms. The diagnosis may be suspected at endoscopic examination. Cytologic studies using touch preparations may be suggestive but the diagnosis should be confirmed by biopsy before operation is performed. | [
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10,004,157 | Cesarean section: recent trends. | [
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10,004,158 | There has been a rapid increase in the number of cesarean sections performed. At the Sir Mortimer B. Davis-Jewish General Hospital in Montreal, the authors reviewed the records of all cesarean sections performed between Jan. 1, 1973 and Dec. 31, 1979. The rate increased from 10,8% in 1973 to 19% in 1977, due primarily to an increasing trend to diagnose, and perform cesarean section for, dystocia. All breech presentations are also delivered by cesarean section but fewer cesarean sections are being performed for fetal distress. Cesarean section is still a major operation and the procedure is associated with substantial maternal morbidity. | [
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10,004,159 | Mania operativa: an uncommon, unrecognized cause of limb amputation. | [
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10,004,160 | Mania operativa is an obsession with pain and disability and the seeking of relief from this pain by repeated surgical procedures. The authors report eight patients in whom a minor injury was followed by multiple operations, culminating in amputation of the upper or lower limb, at increasingly higher levels, in an unsuccessful attempt to relieve the patient's pain. They believe these patients had mania operativa. There are many varieties of psychogenic pain, which present the surgeon with a problem in both diagnosis and management. The authors discuss identifiable factors in the patient, the surgeon and society. By calling attention to this condition, they hope to avoid unnecessary multiple surgical procedures on such patients. | [
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10,004,161 | Management of ulnar artery aneurysm in the hand: a case report. | [
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10,004,162 | Despite the common occurrence of trauma to the hand, arterial aneurysms in this area are rare. The authors describe the symptoms, signs and microvascular treatment of a true aneurysm of the ulnar artery in the palm of an 18-year-old youth. Although there is no clear evidence that vascular restoration is needed after resection of the aneurysm, the authors believe that reconstruction of the ulnar artery using microvascular techniques will ensure that blood supply to the digits is adequate. | [
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10,004,163 | [A new simplified method for implanting temporary epicardial electrodes]. | [
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10,004,164 | The authors present a new simplified method for implanting temporary epicardial electrodes, which can be carried out extemporaneously during operation from a standard electrode. The modified electrode showed an improvement over the standard electrode in the myocardial thresholds with respect to milliamperage as well as voltage at both atrial and ventricular levels (p less than 0.05 for atrial and P less than 0.005 for ventricular). On the 7th day after placement the modified electrode appears to be more reliable than the standard electrode and demonstrates less degeneration of its threshold and current characteristics (P less than 0.05). | [
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10,004,165 | Retinoic acid-binding protein in human squamous cell carcinomas of the ORL region. | [
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10,004,166 | In some squamous cell carcinomas of the otorhinolaryngologic region with different grades of differentiation, a protein was found that specifically binds vitamin A acid. In 28 of 37 tumors, the retinoic acid-binding sites were found in significant amounts, according to the authors' data. Areas with metastases showed a lower incidence of retinoic acid-binding, whereas in all normal epiglottis and vocal cord tissue specimens the binding was present. The possible significance of the protein-binding for the biologic effect of the vitamin A acid is discussed. | [
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10,004,167 | Steroid receptor proteins in human meningiomas. | [
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10,004,168 | Steroid receptor assays play an important role in determining the efficiency of endocrine therapy for patients with breast cancer. Other tumors could also be hormonally dependent and patients with these tumours might also benefit from endocrine manipulation. Thus, patients with meningiomas were tested for the presence or absence of estrogen and progesterone receptors. The results showed that a majority of meningiomas lacked estrogen receptors but contained large amounts of progesterone receptor. Therefore, it should be possible to use antiprogestin therapy in cases where complete surgical resection of meningiomas is not possible. | [
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10,004,169 | Cancer chemotherapy-induced lactose malabsorption in children. | [
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10,004,170 | To determine whether lactose malabsorption can be induced in children receiving cancer chemotherapy, lactose breath hydrogen tests (LBHT) were performed on 27 patients (ages 2 months to 16 10/12 years, mean 4 3/12 years) with neoplastic disease. Nine patients had an LBHT before their first course of chemotherapy and then 7--26 days afterwards. Eighteen other patients, less than 5 years old and presumed by virtue of age to be normal lactose absorbers, had an LBHT 7--24 days after their last course of chemotherapy. All nine in the first group had a normal LBHT before chemotherapy, and three had an abnormal LBHT 7--21 days later. Six of eighteen patients in the second group had an abnormal LBHT. Of the nine patients with an abnormal LBHT, six had a history of diarrhea associated with chemotherapy. These findings have important implications for children receiving cancer chemotherapy. High-calorie, milk-containing solutions used in nutritional support may precipitate cramps and diarrhea in some of these patients. A therapeutic trial of a low lactose diet in children in whom diarrhea develops during chemotherapy may be indicated. | [
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10,004,171 | Brain metastases in breast cancer patients receiving adjuvant chemotherapy. | [
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10,004,172 | A retrospective analysis was performed comparing the incidence of brain metastases as a site of first recurrence in patients receiving adjuvant chemotherapy during the period from 1973--1979 for node-positive operable carcinoma of the breast, compared to a matched control group of patients presenting during the same period treated by local measures only. Five of 115 patients (4.3%) receiving adjuvant chemotherapy have had brain metastases as first site of distant recurrence compared to zero of 115 (0%) in the control group. This comprised 12.8% of first distant recurrences in the adjuvant group. The authors suggest that this increased incidence of brain metastases, as site of first recurrence, reflects prolonged suppression of systemic disease by adjuvant chemotherapy with less effect in controlling metastases in the brain. | [
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10,004,173 | The significance of laryngeal edema following radiotherapy of carcinoma of the vocal cord. | [
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10,004,174 | Laryngeal edema persisting for more than three months following radiotherapy developed in 38 of 247 (15.4%) patients irradiated for carcinoma of the vocal cord. In 17 (44.7%) of these patients, the laryngeal edema was associated with persistent or recurrent disease, although only 25.4% of the patients with uncontrolled disease had laryngeal edema. The incidence of laryngeal edema was 13.1% for T1 disease, 23.8% for T2, and 21.4% for T3 and T4 disease. It increased significantly with increase of minimum tumor dose greater than or equal to 7000 rads or with NSD greater than 1900 ret, being 46.2% with minimum tumor dose greater than or equal to 7000 rad and 13.7% with minimum tumor dose less than 7000 rad and 43% with NSD greater than 1900 ret and 17% with NSD less than or equal to 1900 ret. It also increased with increase of field size, being 13.4% with field sizes less than 6.0 x 6.0 cm2, and 24.4% with field sizes greater than or equal to 6.0 x 6.0 cm2. When laryngeal edema is progressive and unresponsive to conservative measures, multiple biopsies should be performed to establish the presence of persistent or recurrent disease before salvage surgery is attempted. However, if it is mild, stable, no visible recurrence develops, and especially if it is limited to the arytenoids, no biopsy should be attempted because of the risk of inducing laryngeal necrosis. | [
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10,004,175 | Active specific immunotherapy of established micrometastases with BCG plus tumor cell vaccines: effective treatment of BCG side effects with isoniazid. | [
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10,004,176 | Intradermal vaccinations with Bacillus Calmette-Guérin (BCG) and viable but nontumorigenic syngeneic hepatocarcinoma cell vaccines were used successfully to treat micrometastatic disease experimentally induced in inbred guinea pigs at 100 times the minimal lethal dose. Several complications have been associated with the use of viable BCG organisms in the treatment of cancer patients and, in this animal model, intradermal administration of BCG uniformly results in severe ulceration and eschar formation at the injection sites leading to secondary microbial invasion and regional lymphadenopathy. We now report the use of isoniazid (Nydrazid) as part of an active specific immunization regimen. Incorporation of isoniazid into the immunization procedure for two weeks alleviates or reduces the side effects of BCG infection. Moreover, with proper consideration of BCG dosage, isoniazid does not impair the efficacy of the BCG plus tumor cell vaccines. | [
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10,004,177 | Malignant Leydig cell tumor: clinical, histologic and electron microscopic features. | [
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10,004,178 | A 51-year-old man had a malignant Leydig cell tumor of the testis with elevation of serum estrone and androstenedione as well as urine chorionic gonadotropin. The fine structural features of the neoplasm resembled those of nontumorous Leydig cells as well as cells of Leydig cell adenomas, except for, nuclear pleomorphism, the absence of Reinke's crystals and the infrequency of microvilli. The abundance of smooth surfaced endoplasmic reticulum, well-developed mitochondria with tubular and vesicular cristae were regarded as representing ultrastructural expressions of enhanced secretory activity and consistent with the biochemical findings of increased hormonal production by tumor cells. Since Leydig cells have distinct ultrastructural features, ultrastructural investigation represents a valuable tool in establishing the Leydig cell origin of a tumor. | [
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10,004,179 | Lymphomas and leukemias in the relatives of patients with mycosis fungoides. | [
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10,004,180 | Of 526 consecutive patients with cutaneous T-cell lymphomas, 21 had first-degree relatives with lymphoproliferative or hematopoietic malignancies. Twenty-nine such tumors occurred in the 21 kindreds. Hodgkin's disease accounted for one-third of this total, with various leukemias (11 cases), non-Hodgkin's lymphoma (five cases), and multiple myeloma (three cases) comprising the remainder. These data suggest that genetically-determined immunoregulatory abnormalities may represent a shared pathway of oncogenesis in diverse lymphoproliferative and hematopoietic malignancies. | [
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10,004,181 | Prognostic significance of STNMP and velocity of tumor growth in oral cancer. | [
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10,004,182 | Regression analysis using actuarial life tables has been applied to the STNMP system for the grading and staging of oral cancer. Based on 170 patients, the five-year survival figures were 78% for Stage 1, 67% for Stage 2, 36% for Stage 3, and 20% for Stage 4. This represents a considerable improvement in prognostic differentiation over existing TNM system applied to the same cohort of patients. A further variable, velocity of tumor growth, was also assessed and shown to be of value in predicting the ultimate survival of the patients. | [
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10,004,183 | Fluorescence bronchoscopy in the localization of bronchogenic carcinoma. | [
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10,004,184 | Fluorescence bronchoscopy using hematoporphyrin derivative as a tumor marker has been developed for localization of early bronchogenic carcinoma. Recent clinical results have been obtained with a krypton laser and a fused quartz fiber illumination system, which is clearly superior to the mercury vapor lamp system used previously. Fifteen patients have been examined, two with the laser. The potential of the technique is demonstrated by a case study of a patient with positive sputum cytology and a negative chest radiograph. The small early invasive tumor could be detected only with difficulty by subtle mucosal changes under white light bronchoscopy. Positive fluorescence was observed in the suspicious area. Malignancy was confirmed by biopsy and histologic examination upon subsequent lobectomy. | [
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10,004,185 | Gastric carcinoma with psammomatous calcification: report of a case, with reference to calculogenesis. | [
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10,004,186 | A case of gastric adenocarcinoma with argyrophilic property and psammomatous calcification is reported. Histologically, the psammoma bodies are found most frequently within the glandular lumina. Electron microscopy, however, reveals that calcium first appears within the cytoplasm of tumor cells. Electron probe x-ray microanalysis demonstrates calcium and phosphorus in granular or floccular osmiophilic deposits found in intracytoplasmic electronlucent zones of tumor cells. By x-ray diffractometry, the calcium component is presumed to be hydroxyappatite (Ca5(PO4)3.(OH). The findings strongly support the view of the intracytoplasmic origin of psammomatous calcification. The tumor yielded a parathyroid hormone (PTH)-like substance, and a possible relationship between this substance and psammomatous calcification is spectulated. | [
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10,004,187 | Thirteen primary adenocarcinomas of the ileum and appendix: a case report. | [
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10,004,188 | Adenocarcinomas of the ileum and appendix are uncommon. Multiple synchronous adenocarcinomas of the small bowel without carcinoid features are even more unusual, with only seven reported cases in the literature. The radiologic and pathologic findings are reported in a case with 13 separate, well-documented synchronous primary adenocarcinomas of the ileum and appendix. The value of the double-contrast small bowel enema is emphasized. | [
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10,004,189 | Malignant carcinoid tumors in children. | [
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10,004,190 | The clinical, light microscopic, and ultrastructural features of four malignant carcinoid tumors in children, three boys and one girl ages 8--14 years, are described. Extensive metastases to multiple organs were present in three, and in the fourth child there was diffuse local infiltration of the bowel wall, which resembled a lymphoma. The primary tumor arose in the ileum in one child and in the transverse colon in another. In two children, the primary sites could not be determined; one patient is still alive and in the other, permission for autopsy was refused. Electron microscopy showed moderate numbers of neurosecretory granules in some cells in all cases. One patient with extensive metastases showed repeated partial response to radiotherapy and chemotherapy. Eight benign appendiceal carcinoids were seen at the same hospital over the same period, suggesting malignant carcinoids may be more common in children than often assumed. | [
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10,004,191 | Botryoid rhabdomyosarcoma of the gallbladder in a child. | [
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10,004,192 | The first case of botryoid rhabdomyosarcoma of the gallbladder in a child is described and compared with previously reported cases from the world literature. Despite its rarity, rhabdomyosarcoma of the liver and biliary system should be considered when an obstructive jaundice is seen in children. Radical surgery with additional chemotherapy and radiotherapy are necessary for long-term survival. | [
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10,004,193 | The prevalence of polyps of the large intestine in Oslo: an autopsy study. | [
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10,004,194 | The colon and rectum were removed from 445 consecutive autopsies and examined for the presence of polypoid lesions under an illuminating magnifying lens. There were seven clinically undiagnosed carcinomas, 329 adenomas, 174 hyperplastic polyps, 59 mucosal tags, 34 other polypoid lesions, and 54 polyps in which no histologic diagnosis could be made. Adenomas were present in 34% of the men and 32% of the women. The adenoma prevalence rate increased smoothly with age in men, whereas the rate in women showed a biphasic variation with a peak at 50--59 years followed by a second increase after 70 years of age. The distribution of adenomas within the bowel showed a marked change with age, from a moderate left-sided predominance before 60 years of age to a marked right-sided predominance in patients over 80 years of age, particularly in men. Hyperplastic polyps were present in 27% of the men and 18% of the women. In men, their frequency and distribution within the bowel showed similar changes with age as were seen for the adenomas. In women, no such age-dependency was observed for hyperplastic polyps. Multiplicity of polyps increased with age and was more pronounced in men than in women. Adenomas in women tended to be larger, more atypical, and more villous than in men. A comparison with a similar study from Northern Norway showed no difference in the prevalence of adenomas in spite of a 70% higher incidence rate for colorectal cancer in Oslo. | [
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10,004,195 | Adenosis of the prostate: a dysplastic lesion that can be confused with prostate adenocarcinoma. | [
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10,004,196 | A ten-year period, 1966 through 1975, provided 2842 prostate specimens at The Wesley Medical Center, These specimens were classified as (1) adenocarcinoma, (2) adenosis, or (3) hyperplasia. During a follow-up period of 5--15 years (average 7.7 years), prostate carcinoma developed in seven of 108 patients (6.5%) with adenosis. During the same follow-up period prostate carcinoma developed in at least 84 of 2263 patients (3.7%) with hyperplasia. Adenosis is considered to be a dysplastic lesion because patients with histologic lesions limited to adenosis have approximately the same likelihood of prostate carcinoma developing as patients with hyperplasia. | [
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10,004,197 | Tumor sponge implantation: an in vivo method for studying syngeneic, primary antitumor lymphocyte responses. | [
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10,004,198 | Sponge matrices surgically implanted in the s.c. space of the back of normal BALB/c mice were injected with a "regressor" dose of Moloney virus-induced BALB/c tumor cells. The kinetics of the generation of cytotoxic cells within the sponge was studied over a 22-day period in a short-term 51Cr release assay. Cytotoxic activity peaked on Day 16 and then declined to negligible levels by Day 22. No cytotoxicity was detectable when nontransformed BALB/c blast cells, Moloney leukemia virus-induced tumor (LSTRA) cells, or unrelated chemically induced tumor (EL4) cells were used as targets. When the cellular composition of implanted tumor sponges was examined on Day 16, it was found to be 30 to 40% myeloperoxidase-positive cells, 15 to 25% surface immunoglobulin-positive cells, and 40 to 50% theta-positive cells. Treatment with anti-Thy 1.2 plus complement eliminated the cytotoxic response on Day 16. The ratio of T-cells to tumor cells within the sponge was determined by immunofluorescence. Kinetic studies showed that the number of theta-positive cells increased well before cytolytic activity was detected, possibly reflecting increasing numbers of amplifier T-cells or cytotoxic cell precursors. A later decline in theta-positive cells correlated directly with decreased cytotoxicity. Furthermore, onset of cytotoxic activity also correlated with a decline in the percentage of Moloney murine sarcoma virus tumor cells within the sponge. Sponge cells isolated on Day 16 (peak cytotoxicity), mixed with lethal dosages of moloney murine sarcoma virus tumor cells, successfully neutralized the lethal challenge demonstrating the in vivo antitumor efficacy of these effector cells. Sponges were also implanted in mice which had been immunized with single injection of Moloney murine sarcoma virus cells. Inoculation of the sponge with tumor cells resulted in a second set response in which cytotoxic cells appeared much earlier than in unsensitized animals. Cells from spleen, lymph node, or peritoneal cavity of normal or presensitized animals with tumor sponge implants were not cytotoxic, suggesting a highly localized response. | [
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10,004,199 | Monoclonal antibody against A1 Lewis d antigen produced by the hybridoma immunized with a pulmonary carcinoma. | [
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0.... |
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