123rc/medical_text huggingface dataset:
Bilateral vocal cord hematomas associated with shoulder harness use. A case of bilateral vocal cord hematomas caused by a shoulder harness injury is presented. The patient was restrained by a three-point belt system and was involved in a front-end collision. She presented with mild facial and chest injuries and a contusion of the neck. One hour after injury she began to complain of hoarseness without airway compromise. Fiberoptic laryngoscopy showed bilateral true vocal cord hematomas. The patient had an uneventful hospital course and a full recovery. The importance of the mechanism of injury and associated injuries is discussed.
Multidisciplinary baseline assessment of homosexual men with and without human immunodeficiency virus infection. III. Neurologic and neuropsychological findings. We explored the possibility that neurologic and neuropsychological changes constitute the earliest detectable manifestations of human immunodeficiency virus (HIV) infection. Without knowledge of HIV status, we assessed neurologic signs and symptoms and administered a battery of neuropsychological tests to 208 homosexual men, of whom 84 were HIV negative, 49 were HIV positive and asymptomatic, 29 were mildly symptomatic, and 46 had significant medical symptoms but not the acquired immunodeficiency syndrome. There was no difference between the HIV-negative and HIV-positive men in the frequency of neurologic signs or of defective or borderline performance on any neuropsychological test. However, HIV-positive men performed slightly but significantly worse than HIV-negative men on tests of verbal memory, executive function, and language. Similar results were obtained when comparisons were limited to HIV-positive medically asymptomatic and HIV-negative men. There was no degradation of neurologic status or neuropsychological performance across stages of HIV severity, but neurologic and neuropsychological summary scores correlated with CD4/CD8 ratios in the HIV-positive group. Ratings of neurologic signs and symptoms correlated with neuropsychological summary scores in the HIV-positive group only. Cognitive complaints were more frequent in the HIV-positive men; they correlated with actual test performance in the HIV-positive but not HIV-negative men. The constellation of subjective and objective neuropsychological and neurologic findings suggests the possibility of a definable syndrome associated with HIV infection in asymptomatic individuals.
Richner-Hanhart's syndrome. Electron microscopic study of the skin lesion. The plantar hyperkeratotic skin lesion in a case of Richner-Hanhart's syndrome was investigated using ultrastructural examination. Light microscopic examination showed remarkable hyperkeratosis and some aberrant keratinocytes with multiple nuclei. On ultrastructural examination, some abnormal structures were seen in the affected keratinocytes: aggregations of tonofilaments and intracytoplasmic inclusions. The inclusions were needle shaped and were considered to be "crystal ghosts," presumably of tyrosine. The formation of tyrosine crystalline inclusions seems to be an important factor in the pathogenesis of the cutaneous lesions in Richner-Hanhart's syndrome.
The dynamic flexometer: an instrument for the objective evaluation of spasticity. Anesthesiologists may care for patients who have spasticity in the operating room or pain clinic. A number of therapeutic modalities for treatment of spasticity exist, but there are few simple objective methods for evaluating their effect. We describe one instrument, the Dynamic Flexometer, that measures the force required to move the limb passively through its maximum range of motion. The data presented validate the instrument's reliability. Two clinical cases presented here demonstrate the instrument's utility. This device may be of value to anesthesiologists involved in the care of patients with spasticity.
Biology of basal cell carcinoma (Part II). Host-tumor relationships involve several factors that can enhance or suppress neoplastic growth. This second part of a review of basal cell carcinoma biology examines the role that hormones, cytokines, local and systemic immunity, congenital and genetic syndromes, and environmental factors play in the development of this neoplasm. Theories of etiology and pathogenesis are discussed, and transplantation and cell culture techniques used to study this cancer are explored. Valuable second-line therapies for treatment of multiple tumors are reviewed, and important areas of present and future research are emphasized.
Chronic hyperglycemia increases the density of glucose transporters in human erythrocyte membranes. We investigated the effect of chronic hyperglycemia on glucose transporters in erythrocytes of subjects with and without diabetes mellitus. We found a 22% increase in D-glucose-displaceable cytochalasin-B binding in erythrocyte membranes of diabetic subjects over those of controls (311 +/- 13 vs. 254 +/- 8 pmol/mg protein; P less than 0.001). This increased binding was due to a higher density of binding sites without a significant change in binding affinity. Cytochalasin-B binding to erythrocyte membrane correlated positively with both erythrocyte glycohemoglobin and serum glucose levels, but not with plasma C-peptide levels. The data are compatible with up-regulation of glucose transporters in the erythrocytes of subjects with chronic hyperglycemia. We suspect that this is brought about by increased synthesis and membrane incorporation of the glucose transporter during erythropoiesis.
Selective catheterization of the inferior petrosal sinuses: new catheter design. Catheters for selective catheterization of the right and left inferior petrosal sinuses have been developed to replace the complex tip-deflector catheter-guide-wire system currently used. The new catheters are easily formed from commonly available straight catheters with the use of steam. They have been successfully tested in 22 patients; the only complications were minor groin hematomas.
Effect of coronary occlusion and myocardial viability on myocardial activity of technetium-99m-sestamibi The timing effect of sestamibi administration with respect to the onset of myocardial ischemia and reperfusion was studied in swine. In different groups of animals sestamibi was administered prior to coronary artery occlusion, during occlusion, or 1/2 hour following reperfusion. Sestamibi administered prior to coronary occlusion resulted in an insignificant decrease in 99mTc activity in the ischemic zone. However, infarct zone activity was reduced to 62 +/- 14% of the nonischemic zone. In contrast, administration during coronary occlusion resulted in similar significant reductions of both ischemic and infarct zone activity. Administration of sestamibi during reperfusion resulted in normal ischemic zone activity and markedly reduced activity in the infarct zone. Significantly reduced activity in the infarct zone was found to be independent of the timing of sestamibi administration with respect to the onset of myocardial ischemia and/or reperfusion. Thus, cell viability appears required for uptake and retention of isotope activity.
Meningitis in the neurosurgical patient. In the patient with a basilar skull fracture and CSF leak, the risk of meningitis is greatly increased. The diagnosis of both leak and infection can be obscured by the patient's other injuries, and requires aggressive investigation of symptoms that suggest infection. Although the diagnosis is made with CSF cultures, when clinically suspected, treatment should begin after appropriate cultures have been obtained. Treatment should be directed against the most likely organisms, Streptococcus pneumoniae, Haemophilus influenzae, and the other organisms common to the upper respiratory tract. There are no good indications for prophylactic antibiotic usage in patients with known CSF leaks. The patient with a shunt or other CNS prosthetic device may have various manifestations of infection, depending on the type of device and its termination. Frank meningitis or ventriculitis is not always present. Diagnosis requires direct culturing of the shunt milieu, with the most frequent isolates being staphylococcal species and gram-negative enteric bacilli. The most effective therapy, for both eradication of the infection and minimization of the duration and morbidity of therapy, involves removal of the infected shunt, external drainage during parenteral antibiotic therapy, and complete replacement of hardware at the time of internalization. The postsurgical patient will not develop meningitis very frequently, but like the posttrauma patient, concurrent factors can make the diagnosis difficult. Differentiating infectious from chemical meningitis must often be initially based on CSF cell counts and chemistries alone. Treatment to cover the most likely organism, staphylococcal species and respiratory flora, should be started before the culture results are finalized.
Rectal prolapse in infants and children. Rectal prolapse that is intractable to the usual medical therapy was successfully managed without significant complications in 10 patients by simple subcutaneous encirclement of the anus with a heavy nonabsorbable suture, which was in place until the suture was removed or broke after 4 to 6 months. Four patients required two sutures and one needed a third insertion. Since this procedure is simple, has no serious complications, and controls rectal prolapse, it is recommended as the preferred initial surgical treatment of this condition.
The hypotympanum and infralabyrinthine cells in chronic otitis media. Despite the localization implied by the term "chronic otitis media," little attention has been paid to the role of the hypotympanum in chronic active otitis media. Most authors have emphasized the role of recurrent cholesteatoma or unexenterated cells in the mastoid cell system as causes of recurrent disease. Seven cases are reported in which clinical evidence indicated that recurrent chronic otitis media was limited to the hypotympanum and infralabyrinthine cell system. In the five cases in which revision surgery was done, exenteration of this area resulted in an asymptomatic ear. The anatomy, radiographic evaluation, and surgical approach to the hypotympanum are reviewed. Careful inspection of the hypotympanum in primary surgery for chronic ear disease and exenteration of the hypotympanic and proximal infralabyrinthine cell tract are advocated when these regions contain cholesteatoma or extensive granulomatous disease.
Sexually transmitted parasitic diseases. Sexual activity is the primary method of transmission for several important parasitic diseases and has resulted in a significant prevalence of enteric parasitic infection among male homosexuals. The majority of parasitic sexually transmitted diseases involve protozoan pathogens; however, nematode and arthropod illnesses are also included in this group. Trichomoniasis, caused by Trichomonas vaginalis, is the most common parasitic STD. Infection with this organism typically results in the signs and symptoms of vaginitis. Trichomoniasis can be diagnosed in the office setting by performing a microscopic evaluation of infected vaginal secretions and can be successfully treated with metronidazole. Both pediculosis pubis, caused by the crab louse Pthirus pubis, and scabies, caused by the itch mite Sarcoptes scabiei, present with severe pruritus. A papular or vesicular rash and linear burrows seen in the finger webs and genital area are characteristic of scabies. Pediculosis pubis is diagnosed by observing adult lice or their nits in areas that bear coarse hair. The diagnosis of scabies is confirmed by scraping suspicious burrows and viewing the mite or its byproducts under the microscope. Lindane, 1% used in treating scabies, is also very effective for treating pediculosis pubis. Synthetic pyrethrins, also applied as a cream or lotion, are less toxic alternatives for the treatment of either condition. Oral-anal and oral-genital sexual practices predispose male homosexuals to infection with many enteric pathogens, including parasitic protozoans and helminths. The most common of these parasitic infections are amebiasis, caused by Entamoeba histolytica, and giardiasis caused by Giardia lamblia. Both entities may cause acute or chronic diarrhea, as well as other abdominal symptoms. Most gay men with amebiasis are asymptomatic, and invasive disease in this group is extremely rare. Both amebiasis and giardiasis can be diagnosed on the basis of microscopic examination of stool specimens, although duodenal aspiration is occasionally necessary to confirm a diagnosis of giardiasis. Multiple treatment regimens exist for amebiasis. Iodoquinol is a good choice for asymptomatic cyst carriers, whereas the combination of metronidazole plus iodoquinol is used for symptomatic patients. Quinacrine and metronidazole are both efficacious in the treatment of giardiasis.
Pathogenesis of hyperadrenergic orthostatic hypotension. Evidence of disordered venous innervation exclusively in the lower limbs. The pathogenesis of hyperadrenergic orthostatic hypotension was studied in eight patients. Correction of the abnormal orthostatic changes by an inflated pressure suit (MAST) confirmed previous evidence of excessive gravitational pooling of blood in the leg veins. Intravenous L-norepinephrine infusion raised diastolic blood pressure in the same relationship to the infusion-induced increments in plasma norepinephrine concentrations as in normal subjects, indicating normal arteriolar responses. Contractile responses of the veins to infused L-norepinephrine were measured with a linear variable differential transformer (LVDT). The venous responses of hand veins in the patients fell within the 95% confidence limits of the responses of normal hand veins, as did the responses of foot veins in the seven normal subjects. However, foot veins of the patients with hyperadrenergic orthostatic hypotension, and both hand and foot veins of patients with "diffuse" autonomic failure, were supersensitive to norepinephrine, as reflected by a steeper slope of the regression of log (norepinephrine infusion rate) on percentage reduction in venous distensibility, and a significantly lower ED50 (i.e., norepinephrine infusion rate that induced 50% reduction in venous distensibility). The findings suggest anatomical or functional postganglionic denervation of lower limb veins causing excessive gravitational blood pooling with consequent orthostatic hypotension in these patients.
Acute lobar atelectasis. A comparison of two chest physiotherapy regimens. Fourteen cases of acute lobar atelectasis were alternately allocated to one of two chest physiotherapy regimens for treatment. Treatment in group 1 comprised positioning, vibrations, hyperinflation, and suction, and in group 2, treatment consisted of hyperinflation and suction alone. Treatment in either group was given hourly for six hours. Patients in group 1 had a significantly higher mean percentage resolution of their atelectasis (mean value, 60.1 percent), as seen on chest roentgenogram, after one treatment intervention than patients in group 2 (mean value, 7.6 percent; p less than .006). After the intensive six-hour treatment period, the difference between the groups was marginally statistically significant, still favoring group 1 over group 2 (p less than .055). Follow-up roentgenograms at 24 and 48 hours revealed no significant difference between the treatment groups (p greater than .10 and greater than .20, respectively). These results suggest that, at least initially in the course of acute lobar atelectasis, positioning and vibrations add to the efficacy of a treatment of hyperinflation and suction alone.
Hashimoto's encephalopathy: a steroid-responsive disorder associated with high anti-thyroid antibody titers--report of 5 cases. We describe 5 patients with a relapsing encephalopathy in association with Hashimoto's disease and high titers of anti-thyroid antibodies. The presentation is usually with a subacute onset of confusion, alteration in conscious level, and focal or generalized seizures. The relapsing course, association with myoclonus or tremulousness, and episodes of stroke-like deterioration are characteristic features. The long-term prognosis is favorable with steroid therapy, though additional immunosuppressive therapy may be required. Neurologic investigation typically shows a diffusely abnormal EEG, high CSF protein level without pleocytosis, and normal brain CT and cerebral angiogram. Isotope brain scan may show patchy abnormal uptake. Hashimoto's encephalopathy should be recognized as a definite neurologic entity and added to the list of CNS complications of thyroid disease.
Polycystic ovary syndrome. Polycystic ovary syndrome is a disorder of unknown cause characterized by anovulation, hyperandrogenism, and gonadotropin secretory abnormalities producing oligo-ovulation or anovulation. Hyperinsulinemia and insulin resistance are important features of this syndrome. Because other causes of androgen excess may produce similar clinical and biochemical findings, PCO remains a diagnosis of exclusion. Treatment is directed toward relieving symptoms of hyperandrogenemia in order to stimulate ovulation, correcting obesity, and inducing regular menses to reduce the risk of endometrial cancer.
The automatic implantable cardioverter-defibrillator in young patients. An international survey identified 40 patients less than 20 years old who underwent surgical implantation of an automatic implantable cardioverter-defibrillator (AICD). There was a history of aborted sudden cardiac death or sustained ventricular tachycardia in 92.5% of these patients. Twenty-two patients (55%) had structural heart disease; dilated and hypertrophic cardiomyopathy were the most common diagnoses. Eighteen patients (45%) had primary electrical abnormalities including seven with the congenital long QT syndrome. There were no perioperative deaths associated with device implantation. Concomitant drug therapy was administered to 75% of the patients. Defibrillator discharge occurred in 70% of the patients, with 17 patients (42.5%) receiving at least one appropriate shock. There were two sudden and two nonsudden deaths at 28.2 months' median follow-up. Sudden death-free survival rates by life table analysis at 12 and 33 months were 0.94 and 0.88, respectively. Total survival rates at 12 and 33 months were 0.94 and 0.82, respectively. The AICD represents an effective treatment approach for young patients with life-threatening ventricular tachyarrhythmias.
The human immunodeficiency virus type 1 polyadenylylation signal: a 3' long terminal repeat element upstream of the AAUAAA necessary for efficient polyadenylylation. Several polyadenylylation (PA) signals containing elements upstream of the AAUAAA have recently been characterized. Similar to PA elements found downstream of the AAUAAA, the upstream elements function to increase efficiency of AAUAAA use as a signal for cleavage and PA. Using deletion and linker scanning mutations we show that the PA signal of human immunodeficiency virus type 1 contains upstream elements transcribed from the U3 region of the 3' long terminal repeat. The element that has the greatest effect on PA site use lies 77 to 94 nucleotides upstream of the AAUAAA, between the TATA element and the transcriptional initiation site. Mutations in the adjacent region, between 59 and 76 nucleotides upstream of the AAUAAA, have a smaller effect on PA efficiency. Mutations in a region further upstream, between 141 and 176 nucleotides upstream of the AAUAAA, also affected PA modestly. Functional similarity between upstream elements was indicated by the ability of the human immunodeficiency virus upstream region to replace the upstream region of the simian virus 40 late PA signal. The sequence of the major upstream element of human immunodeficiency virus is uracil-rich, analogous to many defined downstream PA elements. This fact may imply that upstream and downstream elements have similar mechanisms of action.
Pharmacodynamics in cancer therapy. Our understanding of anticancer pharmacodynamics, and the relationships between pharmacologic measurements and clinical effects, has grown markedly in recent years due to advances in analytical and computational technology. Although methotrexate plasma levels have been empirically used to guide leucovorin dosing during high-dose methotrexate therapy, there has been no other standard use of therapeutic drug monitoring in oncology. More recently, investigators have attempted to titrate precisely the dose of antineoplastic agents based on previously derived models and real-time analysis of plasma drug or tissue concentrations. Studies have been completed or are in progress using hexamethylene bisacetamide, etoposide, teniposide, fluorouracil (FUra), and cytarabine (ara-C). Future studies will focus on optimal sampling strategies, analysis of intermediate biochemical end points, combination chemotherapy, modulation by colony-stimulating factors, and more sophisticated pharmacodynamic models.
Immunocytochemical estrogen and progestin receptor assays in breast cancer with monoclonal antibodies. Histopathologic, demographic, and biochemical correlations and relationship to endocrine response and survival. Breast cancer specimens from 600 women were assayed for estrogen receptors (ER) using an immunocytochemical assay (ICA) employing the monoclonal antiestrophilin antibody H222 Sp gamma. Results showed significant correlation with biochemical ER determinations as well as with tumor grade and menopausal status. In 449 cases, results of progesterone receptor assay by ICA using the monoclonal anti-PgR antibody KD 68, also correlated significantly with biochemical PgR measurements. The ERICA/PgRICA positivity was significantly more frequent in postmenopausal white women. Colloid carcinomas were most likely to be ERICA positive and PgRICA positive whereas medullary carcinomas were most often negative. In 47 patients with advanced mammary carcinoma, results of ERICA and PgRICA were more closely related to endocrine response than those of ER and PgR by dextran-coated charcoal assay (DCC). In 339 women with Stage I or Stage II breast cancer, ERICA was significantly associated with disease-free survival. Analysis by Cox's proportional hazard model, however, showed PgRICA to be the best predictor of survival and disease-free survival in 197 women at the same stages of disease. These data indicate that ICA is more predictive of prognosis than biochemical ER and PgR. The ease of ICA performance coupled with these results indicate that the method is an acceptable substitute for DCC in analyzing breast cancers for ER/PgR.
Mohs micrographic surgery fixed-tissue technique for melanoma of the nose. Mohs micrographic surgery, fixed-tissue technique, for excision of nasal melanoma provides three important benefits: 1) assurance of eradication of the main mass along with its "silent" contiguous outgrowths, 2) safe management of non-contiguous satellites too small to be visible initially, and 3) safe sparing of maximal amounts of surrounding normal tissues. These benefits are achieved because all incisions are through chemically fixed (killed) tissue, eliminating the danger of disseminating the highly transplantable melanoma cells and permitting the excision of successive layers for microscopic scanning of their undersurfaces by the systematic use of frozen sections. The process is continued to the termination of each ramification. There is no need to remove a wide margin of normal tissue as is customary with conventional surgery. Clinically invisible satellites are not moved or disturbed and can be removed safely by the same method if they appear. The reliability of the method is manifested by the 62.5% 5-year cure in a series of 10 consecutive patients, all of whom had no local recurrence after micrographic surgery.