123rc/medical_text huggingface dataset:
Diabetes mellitus and hypertension: a physiologic basis for a rational therapeutic approach. The basic mechanisms that initiate and sustain hypertension in the diabetic population are poorly understood. Obesity, insulin, genetic factors, and abnormalities in calcium homeostasis may contribute, and could be related to an elevated Na+/H+ antiport activity. In the first study described in this investigation, hypertensive subjects with insulin-dependent diabetes mellitus (IDDM) who had an elevated Na+/Li+ countertransport activity were found to have a lower whole body glucose utilization, a lower insulin-stimulated forearm carbohydrate oxidation, larger ultrasound kidney volume, and increased left ventricular mass index when compared with hypertensive IDDM subjects with a normal Na+/Li+ countertransport activity or normotensive IDDM subjects. Thus an elevated Na+/Li+ countertransport activity appears to identify a subset of IDDM patients who are more susceptible to the development of the renal and cardiac complications associated with hypertension. This underlines the importance of choosing an appropriate antihypertensive therapy that will not produce a deterioration in glucose and lipid metabolism. In the second part of the report, results are presented for the treatment of hypertensive patients with non-insulin-dependent diabetes mellitus with doxazosin. The selective alpha 1-inhibitor produced a significant reduction in blood pressure, together with favorable changes in the serum lipid profile. As a result, the calculated risk of developing coronary heart disease was significantly reduced. Throughout the study no patients required a dose reduction or discontinuation of doxazosin because of side effects, and no clinically significant changes in laboratory tests were apparent. Thus doxazosin could be considered a useful antihypertensive agent in hypertensive patients with IDDM who are insulin-resistant and who have renal and cardiac abnormalities.
Outcome of pregnancies experienced during residency. To investigate potential adverse effects of residency training on pregnancy outcome, a cohort study was conducted among 45 university-affiliated residency programs. Outcomes of the first pregnancy experienced during residency were compared between 92 female residents and 144 spouses of male residents. 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. For white cohort members, an increased risk of premature labor without delivery was identified (RR = 12.3, 95% confidence interval 2.4-61.6). No significant differences were found in prematurity, spontaneous and therapeutic abortions, or presence of congenital abnormalities in the infants. Method of delivery and use of anesthetics and of other medications were similar in both groups. 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.
Increased incidence of respiratory distress syndrome in babies of hypertensive mothers. There is controversy over the effect of hypertension in pregnancy on the incidence of neonatal respiratory distress syndrome. We investigated the association between maternal hypertension and the incidence of respiratory distress syndrome in 268 very low birthweight babies of less than 34 weeks' gestation. A lower incidence of respiratory distress syndrome was associated with growth retardation and membrane rupture greater than 24 hours. Maternal hypertension was associated with an increased incidence of respiratory distress syndrome. We used the multiple logistic regression model to control for confounding variables, as the maternal and neonatal factors associated with respiratory distress syndrome were not evenly distributed between the two groups. After adjustment for birth weight, gestational age, growth retardation, and membrane rupture greater than 24 hours, the risk of developing respiratory distress syndrome was significantly greater in babies of hypertensive mothers. Significance was lost when labour before delivery and mode of delivery were taken into account. The increased incidence of respiratory distress syndrome in babies of hypertensive mothers may be due to the absence of labour before delivery because of the greater likelihood of caesarean section.
Occipital condyle fracture presenting as retropharyngeal hematoma. 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. Although subsequent computed tomography demonstrated no cervical-spine fracture, it did reveal a fracture of one occipital condyle. The mechanism, diagnosis, and treatment of occipital condyle fractures are reviewed, as is the ligamentous and fascial anatomy of the cervicocranium. Dissection of fracture hematoma inferiorly along vertically oriented tissue planes is hypothesized as the pathogenesis of our patient's retropharyngeal hematoma. In addition to being a sign of potential cervical-spine injury, post-traumatic prevertebral soft-tissue swelling may also indicate occipital condyle fracture. 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.
Spinal nerve stimulation in the diagnosis of lumbosacral radiculopathy. Direct spinal nerve stimulation was compared with needle electromyography (EMG) in 40 patients who were suspected of having an L5 or S1 radiculopathy. For spinal nerve stimulation, we adapted a monopolar needle electrode inserted deep into the paraspinal muscle. The minimal latency, amplitude, and negative phase area of compound muscle action potential from myotomal muscles were recorded with computer assistance. Abnormality was considered to be significant when the value fell outside of 2 SD of control mean values. Among 17 patients with clinical evidence of radiculopathy, needle EMG was abnormal in 10 patients (58.8%), whereas in the nerve stimulation test the abnormalities were shown in 16 patients (94.1%); in amplitude difference and the abnormal area, differences were shown in 12 patients (70.6%). Among 23 patients with only subjective symptoms of radiculopathy, needle EMG was abnormal in nine patients (39.1%), whereas the abnormal amplitude differences were shown in 18 patients (78.3%) and 15 patients (65.2%) with abnormal area difference by spinal nerve stimulation, respectively. Direct spinal nerve stimulation is recognized as an objective and sensitive test in the diagnosis of lumbosacral radiculopathy.
Sudden death behind the wheel from natural disease in drivers of four-wheeled motorized vehicles. The heart was studied in 30 persons who died suddenly from natural causes in the driver's seat of an automobile, truck or bus. Twenty had cardiac arrest while driving and the other 10 while sitting in the driver's seat of a parked vehicle. Of the 20 drivers, 16 died from atherosclerotic coronary artery disease (CAD): 12 (75%) had minor collisions and 4 did not. Of the 16 with fatal CAD, an average of 2.3 +/- 0.8 of the 4 major coronary arteries were narrowed greater than 75% in cross-sectional area (CSA) by plaque; of 668 five-mm segments of the 4 major (right, left main, left anterior descending, left circumflex) coronary arteries in 13 of these 16 cases, 27 (4%) were narrowed 96 to 100% and 127 (19%) were narrowed 76 to 95% in CSA by plaque. The remaining 4 drivers died from noncoronary conditions: aortic rupture associated with the Marfan syndrome in 1; cardiac sarcoidosis in 1; thoracic aortic dissection in 1; and severe mitral regurgitation from infective endocarditis, which had healed in 1. The other 10 persons were found dead in the driver's seat of a parked vehicle and 8 of them had fatal CAD. Of the 8 CAD victims, an average of 2.5 +/- 1.2 of the 4 major coronary arteries was narrowed greater than 75% by plaque; of the 283 five-mm segments of coronary arteries in 7 of the 8 cases, 44 (16%) were narrowed 96 to 100% and 69 (24%) were narrowed 76 to 95% in CSA by plaque.
Orbital rim and malar advancement for unilateral coronal synostosis in the older pediatric age group. The authors describe a technique for lateral orbital rim and malar advancement in patients in the older pediatric age group. The technique makes use of a strip craniotomy containing the supraorbital margin, greater sphenoid wing, and temporal bone, with en bloc inclusion of the lateral orbital rim, zygoma, and malar prominence. The method allows a contoured yet stable construction secured in a tongue-in-groove fashion with plate-and-screw fixation. It creates a symmetrical reconstruction of both frontal and lateral orbital aspects in the untreated or inadequately treated older plagiocephalic child with orbital dystopia. The accompanying malar recession is likewise corrected.
Immunoreactivity of anti-streptococcal monoclonal antibodies to human heart valves. Evidence for multiple cross-reactive epitopes. Association of group A streptococci with acute rheumatic fever and valvular heart disease is well established; however the basis of valve injury remains unclear. In this study, anti-streptococcal monoclonal antibodies (MAbs) cross-reactive with myocardium were reacted with sections from 22 rheumatic valves, nine normal, five endocarditic, one 'floppy,' and one Marfan valve. In immunohistochemical studies, MAb reactivity was observed with cardiac myocytes, smooth muscle cells, cell surface and cytoplasm of endothelial cells lining valves, and valvular interstitial cells. Endothelial basement membrane and elastin fibrils reacted with the MAbs, whereas collagen was unreactive. Similar reactivity was seen with sera from acute rheumatic fever patients. The anti-streptococcal MAbs reacted with intravalvular myosin and vimentin in Western blots, and purified elastin competitively inhibited the binding of the anti-streptococcal MAbs to whole group A streptococci. The data show that human heart valves have numerous sites of immunoreactivity with anti-streptococcal MAbs and acute rheumatic fever sera of potential importance in the pathogenesis of rheumatic valvular injury.
Determination of plasma calcitonin gene-related peptide concentrations by a new immunochemiluminometric assay in normal persons and patients with medullary thyroid carcinoma and other neuroendocrine tumors. There is doubt about concentrations of circulating calcitonin gene-related peptide (CGRP) and the value of plasma CGRP measurements in the detection and follow-up of medullary thyroid carcinoma (MTC). Thus, we developed an immunochemiluminometric sandwich assay for CGRP using antibodies purified from a polyclonal antiserum against human CGRP. The assay was sensitive (limit of detection, 0.4 pmol/L; multiply by 3.7892 to derive nanograms per L) and highly specific [no cross-reaction with human calcitonin (CT)]. Normal plasma CGRP values ranged from less than 0.4 to 4.5 pmol/L (median, 0.8; n = 31), with 61% having detectable levels. Values in samples from patients with MTC were elevated: unoperated patients (n = 10), 4.7-137 pmol/L (median, 7.1); and operated patients with gross persistent or recurrent tumor (n = 14), 4.7-171 pmol/L (median, 23.2). In contrast, CGRP values were normal in 78% of nine postoperative patients with elevated CT, but no detectable tumor (range, less than 0.4 to 6.3 pmol/L; median, 1.6). CGRP levels increased after pentagastrin injection in MTC patients, but less than did CT values. Cultured MTC cells in vitro secreted large amounts of CGRP, and rat nerve root ganglia, human osteoblasts, and microvessel endothelial cells secreted lesser amounts. We conclude that CGRP circulates in normal plasma, but at very low levels. Plasma CGRP concentrations are frequently high in patients with MTC, but primarily in those with gross tumor or metastases. Plasma CT assay is the preferable test for MTC, but CGRP assay deserves prospective study for a possible role in predicting gross metastasis.
Magnetic resonance imaging: a reliable test for the evaluation of proximal atherosclerotic renal arterial stenosis. Symptomatic renal artery stenosis is a significant and treatable clinical problem. A reliable and accurate noninvasive method of screening for renal artery stenosis has not yet been found. We used magnetic resonance imaging to study 37 patients who had undergone recent renal angiography. Fourteen patients had normal renal arteries by angiography. In 23 patients either unilateral or bilateral stenosis or occlusion was present. The disease process in all patients appeared to be atherosclerosis. The average age of the 37 patients was 68 years. The magnetic resonance scans and angiograms were read independently by two different radiologists, each of whom was blinded to the clinical history and the results of the other study. Renal arterial stenoses found on angiogram and magnetic resonance scans were graded as absent (0% to 24%), mild (25% to 49%), moderate (50% to 74%), or severe (75% to 99%). The magnetic resonance imaging results concurred with the angiographic findings in 70 of 77 arteries (91%). Magnetic resonance imaging predicted the presence of a greater than 50% stenosis of the renal artery with a sensitivity of 100% and a specificity of 94%. Magnetic resonance imaging may prove to be the best noninvasive screening test for proximal atherosclerotic renal arterial stenosis.
Cholangiocarcinoma complicating primary sclerosing cholangitis. Cholangiocarcinoma is more likely to develop in patients with primary sclerosing cholangitis. Our aims were to describe the clinical presentation, course, and management of patients afflicted with both cholangiocarcinoma and primary sclerosing cholangitis and to estimate the prevalence of cholangiocarcinoma in patients with primary sclerosing cholangitis. A retrospective analysis was conducted of 30 patients with both primary sclerosing cholangitis and cholangiocarcinoma managed at our institution during an 8-year period. Development of cholangiocarcinoma was heralded by rapid clinical deterioration with jaundice, weight loss, and abdominal discomfort. Cholangiocarcinoma complicating primary sclerosing cholangitis often was detected at an advanced tumor stage, which precluded effective therapy, and overall median survival was 5 months. Earlier recognition and treatment of cholangiocarcinoma in such patients will be necessary to increase survival rates. Seventy patients with primary sclerosing cholangitis were followed prospectively in a clinical trial of medical therapy for an average of 30 months. Twelve patients died and five were found at autopsy to have cholangiocarcinoma. The potential for cholangiocarcinoma to develop in patients with primary sclerosing cholangitis may indicate that liver transplantation should be considered earlier in the course of the disease.
Steal-prone coronary anatomy and myocardial ischemia associated with four primary anesthetic agents in humans. To examine the relationship between myocardial ischemia in patients with steal-prone coronary anatomy and the administration of isoflurane anesthesia, we reviewed coronary angiograms of 955 patients who had participated in a randomized trial of the use of one of four primary anesthetics for coronary artery bypass operations. Steal-prone anatomy was found in 31.8% of patients who had received enflurane; 40.0%, halothane; 32.6%, isoflurane; and 31.7%, sufentanil. Detected by greater than or equal to 0.1 mV ST segment displacement, ischemia during anesthesia occurred in 290 (30.4%) of all patients with no difference in the incidence among the four primary anesthetics (27.5%-32.9%). Patients with steal-prone anatomy did not suffer more ischemia than patients who needed coronary artery bypass surgery but with other varieties of coronary anatomy. In patients with steal-prone coronary anatomy, the incidence of myocardial ischemia by primary anesthetic was 24.0% with enflurane, 34.4% with halothane, 32.1% with isoflurane, and 38.2% with sufentanil. Systolic blood pressure less than 90 mm Hg during anesthesia occurred in 416 (45.6%) patients and was twice as common during administration of volatile anesthetics than during that of sufentanil. Hypotension did not increase ischemia frequency in patients with steal-prone anatomy with use of any of the four primary anesthetics including isoflurane. Ischemia was temporally related to hypotension in only 9 patients (0.9%). In none of the 42 patients who had steal-prone anatomy and hypotension during isoflurane anesthesia was ischemia temporally related to hypotension.
Screening for early dementia using memory complaints from patients and relatives. 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. Both self-assessment and relatives' responses on a new memory questionnaire differentiated patient groups from control subjects. The relatives' form measuring deterioration in memory function over time identified dementing individuals from those with non-dementing causes for their memory complaints. 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. Stepwise discriminant function analyses showed that objective memory testing greatly improved specificity but not sensitivity of the subjective memory questionnaire alone.
Long-term outcome after surgery for biliary atresia. Study of 40 patients surviving for more than 10 years. 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. Forty of the 122 children (32.7%) were alive after 10 years. Firm hepatomegaly was present in 31 and splenomegaly in 29 children. 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. Twenty-four had esophageal varices and 15 experienced gastrointestinal bleeding. Normal liver-function tests and absence of portal hypertension were observed in 11 of 122 children. These results indicate that Kasai's procedures were helpful in a significant proportion of children with biliary atresia who underwent surgery during this period. However, 80% of children who initially underwent surgery with Kasai's procedures should eventually undergo liver transplantation.
Mobile knee reconstructions after resection of malignant tumors of the distal femur. Limb-salvage surgery involving mobile knee reconstructions for malignant tumors about the distal femur is a desirable and achievable goal. With limb salvage, the survival rate does not decrease significantly, and the resulting function is superior to when an amputation plus a prosthesis are used. Immediate and delayed morbidity is greater after limb-salvage surgery than after amputation. However, with thorough preoperative planning, use of neoadjuvant chemotherapy as indicated, and an experienced team of surgeons, limb-salvage surgery can provide a mobile knee with excellent function in the vast majority of cases for patients with malignant tumors of the distal femur.
Clinical and prognostic assessment of patients with resected small peripheral lung cancer lesions. 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. The authors investigated several prognostic factors of these cases. The 5-year survival rate of these 115 patients was 70%. Various factors such as histologic type, nodal involvement, pleural involvement, pathologic stage, and curativity of the operation were revealed to affect survival significantly. 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. 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).
Adjunctive use of beta-adrenergic blockers, calcium antagonists and other therapies in coronary thrombolysis. The availability of thrombolytic agents for use in the treatment of acute myocardial infarction is an important step in the management of a common, often debilitating, and potentially lethal disorder. However, despite the proven benefits of coronary thrombolysis, the importance of adjunctive treatment modalities is being increasingly recognized. Beta-adrenergic blockers, calcium antagonists, nitrates, magnesium, and angiotensin-converting enzyme inhibitors each exert favorable cardiovascular properties that may offer additional benefits. Clinical trials combining thrombolytic and adjunctive pharmacologic agents offer hope for further advances in the treatment of acute myocardial infarction.
Systemic chemotherapy for urothelial cancer in patients with ureteric obstruction. The aims of this study were to document the toxicity of systemic chemotherapy and response rates in patients with ureteric obstruction caused by urothelial cancer. The study group included 91 patients who received cisplatin and methotrexate; 36 (40%) had upper tract dilatation, 9 of whom had drainage by stenting or nephrostomy and 55 (60%) had normal upper tracts. The response rate was documented in 65 patients (71%) who had measurable primary or metastatic disease. No significant differences were found between the dilated/drained group, the dilated/undrained group and the normal group in biochemical measurements of renal function during or after the courses of chemotherapy. Serious haematological toxicity occurred in 10% (10/104 cycles) of the dilated/undrained group and in 6% (12/200 cycles) of the normal group. The complete response rate in the dilated group was 15% compared with 41% in the normal group. No increased chemotherapy toxicity was observed in patients with upper tract dilatation and a significant complete response rate was found in patients with upper tract dilatation without renal impairment.
Synergism of herpes simplex virus and tobacco-specific N'-nitrosamines in cell transformation. Previous studies indicate that herpes simplex virus (HSV) enhances the carcinogenic activity of smokeless tobacco and tobacco-related chemical carcinogens in animals. Since tobacco-specific N'-nitrosamines (TSNAs) such as N'-nitrosonornicotine (NNN) and 4-(N-methyl-N'-nitrosamino)-1-(3-pyridyl)-1-butanone (NNK) are major chemical carcinogens of smokeless tobacco and are known to be responsible for the development of oral cancers in smokeless tobacco users, the combined effects of TSNAs and HSV in cell transformation were investigated. Exposure of cells to NNN or NNK followed by virus infection resulted in a significant enhancement of transformation frequency when compared with that observed with chemical carcinogens or virus alone. This study suggests that TSNAs and HSV can interact together and show synergism in cell transformation.