123rc/medical_text huggingface dataset:
Urological manifestations of HIV-related disease. A case of AIDS-associated testicular seminoma, Kaposi's sarcoma and possible intracranial lymphoma. A wide variety of pathologies afflicting the genitourinary tract can be displayed by patients infected with the human immunodeficiency virus (HIV), including both infective and neoplastic conditions. Treatment can often be offered for such conditions using a combination of therapeutic approaches. These conditions should be looked for specifically in patients with HIV infection as treatment may improve their quality of life. A case is presented of a testicular seminoma (appearing in association with an intracranial mass and Kaposi's sarcoma) in a male patient with the acquired immune deficiency syndrome (AIDS); he made a good response to orchiectomy and radiotherapy for his seminoma. A short review is also given of the range of HIV-associated genitourinary pathologies which have been described to date.
Ethyl chloride and venepuncture pain: a comparison with intradermal lidocaine. One hundred and twenty unpremedicated patients undergoing gynaecological surgery were randomly allocated to one of three equal treatment groups to assess the effectiveness of ethyl chloride in producing instant skin anaesthesia to prevent the pain of venepuncture from a 20 G cannula. They received either no anaesthetic, 0.2 ml one per cent lidocaine plain intradermally or a ten-second spray of ethyl chloride at the cannulation site. Ethyl chloride produced skin anaesthesia that significantly reduced the pain of venepuncture. However, it was not as effective as intradermal lidocaine. It had no effect on vein visualisation or ease of cannulation. Ethyl chloride can be recommended as a method of producing instant skin anaesthesia.
Argon green (514 nm) versus krypton red (647 nm) modified grid laser photocoagulation for diffuse diabetic macular edema. Between 1984 and 1988, 225 eyes of 132 patients were entered in a prospective, randomized clinical trial to determine if any significant differences exist between treatment with argon green (514 nm) and krypton red (647 nm) modified grid laser photocoagulation for patients with diffuse diabetic maculopathy with or without cystoid macular edema. At the 12- and 24-month follow-up visits, no statistically significant difference was found between the two groups with respect to all of the following: reduction or elimination of macular edema, improvement in visual acuity, worsening of visual acuity, number of treatments per eye, and effect on the visual field. At the 12-month follow-up visit, none of the following factors statistically affected the visual outcome in either of the two groups: a history of systemic hypertension, systemic vascular disease, cystoid macular edema, or initial poor visual acuity.
Resistance to ischaemia of small afferent nerve fibres in diabetes mellitus. Thermal thresholds were measured in the left forearms of 26 healthy subjects and 10 patients with diabetes mellitus during ischaemic compression block. During the period when ischaemic block of large fibres caused paraesthesia and loss of touch sensation, the cold threshold rose in normals. The cold threshold was less clearly elevated and the warm perception remained unaltered by ischaemia in diabetics. These results show that not only large afferent and efferent nerve fibres but also thinly myelinated A delta and unmyelinated C fibres are resistant to ischaemia in the diabetic nerve.
A phase I study of a new cisplatin derivative for hematologic malignancies. DWA2114R (DWA) is a new derivative of platin compounds that is currently being used in Phase II studies of solid tumors in Japan. The dose-limiting factor is myelotoxicity with mild extramedullary toxicity. This Phase I study consisted of adult patients with relapsed hematologic malignancies. Eight patients received a total of 15 treatment courses of DWA. The starting dose was 800 mg/m2 over 24 hours by continuous infusion. The dose was first increased to 1200 mg/m2 and then to 1600 mg/m2. Clinical toxicity and urinary excretion studies of DWA suggested that 1200 mg/m2/d for successive days would be the best type of administration. When 1200 mg/m2/d was given for 5 days, Grade 2 to 3 diarrhea and nausea and vomiting were encountered requiring parenteral fluids and nutritional support. This suggested that the dose-limiting factor with this schedule was gastrointestinal toxicity. Myelotoxicity was severe, as expected, but tolerable. One of the five patients with acute nonlymphocytic leukemia (ANLL) entered into complete remission and one patient with chronic myelogenous leukemia (CML) in crisis returned to the chronic phase. A Phase II trial of DWA is warranted for hematologic malignancies, especially in myeloid diseases.
Removal of large symptomatic intrauterine growths by the hysteroscopic resectoscope. Fifty-three patients underwent 55 procedures with a resectoscope for the removal of large symptomatic intrauterine growths. The presenting complaint was menorrhagia, menometrorrhagia, or heavy postmenopausal bleeding in 38 patients; excessive menses plus infertility in 13 patients; and infertility alone in two patients. Forty-three patients had pedunculated or sessile submucous myomas and ten patients had large endometrial polyps. The long-term results are based on 45 patients followed for longer than 1 year. Excessive bleeding was controlled in 40 of the 43 women (93%). Failure to control abnormal bleeding was apparent within the first year. Seven of the 12 infertility patients (58%) delivered live-born infants. Five patients have undergone subsequent hysterectomies (9%). Two patients had repeat resectoscopic removal of myomas and two had subsequent non-resectoscope myomectomies. No major complications were encountered.
Acute splenic sequestration crisis in two adults with sickle cell disease: US, CT, and MR imaging findings. Acute splenic sequestration crisis (ASSC) is a rare complication in adults with sickle cell disease that is diagnosed clinically by means of sudden splenic enlargement and a rapid fall in hematocrit. Two cases of ASSC in adults with heterozygous sickle cell disease (sickle cell-thalassemia and sickle cell-hemoglobin C disease) were studied with use of duplex Doppler ultrasound (US), computed tomography (CT), and magnetic resonance (MR) imaging. In both cases, US showed patency of the splenic vein and multiple hypoechoic lesions on the periphery of an enlarged spleen that were of low attenuation on CT scans and hyperintense on both T1- and T2-weighted MR images. These findings were believed to be suggestive of subacute hemorrhage. This was confirmed pathologically in one case and suggested in the other by the presence of a low-signal-intensity ring, probably hemosiderin, surrounding one of the lesions. Also, the remainder of the spleen in both patients was of normal signal intensity, unlike the diminished signal intensity seen in patients with homozygous sickle cell disease. Further study is needed to determine the role of imaging in the diagnosis and treatment of ASSC.
Uniparental paternal disomy in Angelman's syndrome. Angelman's syndrome and Prader-Willi syndrome are both causes of mental retardation with recognisable, but quite different, clinical phenotypes. Both are associated with deletions of chromosome 15q11-13, of maternal origin in Angelman's and paternal in Prader-Willi. Prader-Willi can arise by inheritance of two chromosomes 15 from the mother and none from the father (uniparental maternal disomy). In 2 patients with Angelman's syndrome we found evidence of uniparental paternal disomy. The phenotypic effects of maternal and paternal disomy of chromosome 15 are very different and inheritance of two normal 15s from one parent does not lead to normal development--strong evidence in man for genomic imprinting, in which the same gene has different effects dependent upon its parental origin.
Horner's syndrome from hypothalamic infarction. We report a case of Horner's syndrome due to ipsilateral posterior hypothalamic infarction, occurring in the absence of other signs of hypothalamic dysfunction. Associated symptoms of contralateral faciobrachial weakness and dysarthria correlated with the extension of the infarct into the posterior limb of the internal capsule seen by magnetic resonance imaging. The likely vascular anatomy of this lesion is discussed.
Managing the whole patient with hypertension: practical applications in a clinical setting. Physicians are aware of the value of treating hypertension. Complications such as stroke and congestive heart failure are less likely to occur in the well-controlled patient. In our quest to add coronary heart disease to this list, we must go beyond simple reduction of blood pressure. We must consider other risk factors such as hypercholesterolemia, cigarette smoking, diabetes mellitus, and family history. The presence of one or more of these may indicate a more aggressive treatment approach. Similarly the presence of left ventricular hypertrophy, coronary disease, or renal disease may indicate specific pharmacotherapy. On the other hand, the low-risk patient with no other problems or conditions may be treated with only nonpharmacologic therapy such as weight loss, dietary sodium reduction, and/or alcohol restriction. Every patient has a different constellation of findings. Every patient should be treated individually. It is no longer sufficient just to lower blood pressure; we need to manage the whole patient with hypertension; keeping in mind that most antihypertensive agents are equally effective, the side effect profile is often the decisive factor in choosing an antihypertensive agent.
Conditioning of the spinal stretch reflex: implications for rehabilitation. The purpose of this article is to describe a new technique that can potentially be applied to patients with hyperactive spinal stretch reflexes (SSRs). The progression of clinical research from conditioning of individual muscles or muscle groups (electromyographic biofeedback) to conditioning SSRs is explained. Research data from subhuman primates in addition to the first human experiments are reviewed. Potential applications of SSR conditioning are discussed, as are the issues requiring further delineation and research before the specificity of a training effect can be ascertained.
Esophageal obstruction after ingestion of a fiber-containing diet pill. Foreign bodies of the esophagus in adults may be the result of a food bolus that becomes lodged proximal to a structural abnormality of the distal esophagus. A case of peptic stricture of the esophagus in a patient who presented with acute dysphagia after ingesting an over-the-counter diet pill composed of guar gum is discussed. It is recommended that anorectics composed of dietary fiber should not be used in patients with a history of esophageal stricture.
Hemicorporectomy: a collective review. Hemicorporectomy or translumbar amputation has been described as the most revolutionary of all operative procedures. Frederick E. Kredel, who first voiced the concept of the operation in 1950, referred to it as halfectomy. Demonstration of his cadaver studies established the feasibility of the operation. Amputation is effected through the lower lumbar area of the body. Necessary life functions are preserved in the upper torso. Kredel envisioned hemicorporectomy as a curative operation for locally advanced cancer, limited to the pelvis, not encompassable by standard operative intervention. Additional indications are intractable decubitus ulcers with malignant change, particularly in paraplegics; pelvic organs, and bone infection with nonhealing fistulae; and crushing trauma to the pelvis. The first hemicorporectomy operation was reported in 1960. Thirty-four operations have been recorded in the world literature. Two heretofore unreported cases are added, raising the total to 36. Review of these 36 cases confirms the conviction that hemicorporectomy is a humane and ethical alternative to the suffering encumbered by advancing, painful, malodorous malignant disease not treatable by conventional means. While cure rates are not substantial, the best results are reported in paraplegics with intractable decubitus ulcers with or without malignancy. Rehabilitation is prolonged and costly. Most survivors have been restored to preoperative occupations or other gainful employment.
Polycystic ovary syndrome and bulimia. One hundred fifty-three patients classified as suffering from polycystic ovarian syndrome (PCOS) and 109 patients who were suffering from a clear organic disorder or endocrinopathy received the bulimia investigation test (Edinburgh) (BITE) questionnaire for abnormal eating behaviors. Patients with PCOS showed a significant increase in their mean BITE score for approximately a third had abnormal eating patterns, and 6% have scores suggestive of clinical bulimia compared with only 1% of women in the group with organic endocrinopathies. The work suggests that women with PCOS should be screened for abnormal eating behaviors and raises the possibility that treatment by psychological means should be considered when abnormal eating behaviors are present.
Dacron-woven pacemaker pouch. Influence on long-term pacemaker mobility. Pacemaker migration can interfere with correct pacing system function and patient comfort. A Dacron pouch has been developed which may prevent these problems. To assess the efficacy of the pouch, we measured various factors of pacemaker mobility in 100 patients after long-term follow-up. The patients were divided into three groups on the basis of their dictated operative reports: group 1, no pouch or anchoring stitch; group 2, pouch only; group 3, anchoring stitch to pacemaker header or pouch. The average age of the study population was 74.3 +/- 11 years. Total follow-up time was 42 +/- 28 months (group I, 53 +/- 32 months; group 2, 36 +/- 23 months; group 3, 34 +/- 25 months). There were no significant differences when pacemakers were measured for movement in the inferosuperior and lateromedial directions, nor was there any difference in the distance between the incision scar and the pacemaker header in any group. There was a significant difference between group 1 and groups 2 and 3 when the degree of tilt of the pacemaker off the chest wall was compared. This was 46 degrees +/- 34 degrees for group 1 and 27 degrees +/- 26 degrees and 26 degrees +/- 27 degrees for groups 2 and 3, respectively (p less than 0.02 for both). These data suggest that the Dacron pouch does not restrict pacemaker mobility parallel to the chest wall during long-term follow-up but does reduce the angle to which the pacemaker can be tilted relative to the chest wall.
Cholesterol screening in a black inner-city pediatric population. A screening for total blood cholesterol levels was conducted by the University of Louisville Department of Family Practice in association with the National Youth Sports Program in Louisville, Kentucky. On May 30, 1987, 224 inner-city children between 10 and 16 years of age were tested; 109 (49%) were girls and 115 (51%) were boys. All participants were black. Of the entire population, the girls had a slightly lower mean level of cholesterol than the boys (160 mg/dL vs 165 mg/dL, respectively). Because of the large number of participants aged 10 to 14 years (211), this subset of children was studied more closely. In this age group, 47 (22%) of the children were at moderate risk for future cardiovascular disease and 48 (23%) were at high risk. The serum cholesterol levels were relatively constant in all children until age 12, after which a slight reduction occurred. This decrease is more evident in boys. Our study also showed a correlation between increased blood cholesterol and above normal weight/height indices (ie, Quetelet scores), with nearly 70% of all children having elevated cholesterol levels also exhibiting above normal Quetelet scores. We observed no correlation between high cholesterol levels and high blood pressure in this study population. Dietary intervention is recommended as the initial treatment for elevated cholesterol levels in children.
Identification of a highly polymorphic microsatellite VNTR within the argininosuccinate synthetase locus: exclusion of the dystonia gene on 9q32-34 as the cause of dopa-responsive dystonia in a large kindred. Dopa-responsive dystonia is a clinical variant of idiopathic torsion dystonia that is distinguished from other forms of dystonia by the frequent occurrence of parkinsonism, diurnal fluctuation of symptoms, and its dramatic therapeutic response to L-dopa. Linkage of a gene causing classic dystonia in a large non-Jewish kindred (DYT1) and in a group of Ashkenazi Jewish families, to the gelsolin (GSN) and arginino-succinate synthetase (ASS) loci on chromosome 9q32-34, respectively, was recently determined. Here we report the discovery of a highly informative (GT)n repeat VNTR polymorphism within the ASS locus. Analysis of a large kindred with dopa-responsive dystonia, using this new polymorphism and conventional RFLPs for the 9q32-34 region, excludes loci in this region as a cause of this form of dystonia. This provides proof of genetic heterogeneity between classic idiopathic torsion dystonia and dopa-responsive dystonia.
Proton magnetic resonance of exercise-induced water changes in gastrocnemius muscle. Exercise-induced water concentration changes have been determined in the medial gastrocnemius muscle noninvasively with image-guided in vivo proton magnetic resonance spectroscopy (MRS). These measurements were performed on seven normal male volunteers during and after isometric and ischemic-isometric exercise at 5, 10, and 20% maximum voluntary contraction (MVC). The observed water flux changes during different phases of exercise have been interpreted in terms of fluid transfer between the vasculature and exercising muscle. Good correlation between individual MVC and changes in water fluxes and the decay of water content was observed after 20% MVC exercise level. MRS results have been found to be consistent with those reported in the literature based on invasive biopsy techniques.
Anti-atherosclerotic and vasculoprotective actions of calcium antagonists. Treatment of hypertension may prevent many of the complications attributable to blood pressure elevation, particularly those that are "pressure-related," such as stroke. However, the atherosclerotic complications of hypertension, e.g., coronary artery disease manifested as coronary morbidity and mortality, have not been reduced significantly with antihypertensive therapy. This disappointing outcome may reflect the adverse metabolic effects of the traditional therapies, diuretics and beta blockers, and their lack of specific vasoprotective properties. Increasing attention is thus being paid to the newer antihypertensive agents, which typically have fewer adverse effects and perhaps more physiologic mechanisms of antihypertensive action. Since calcium plays a key role in the genesis of atherosclerosis, calcium antagonists may positively affect the course of vascular disease. Investigators have observed that calcium antagonists display clear antiatherosclerotic properties in experimental as well as clinical studies. In one recently published clinical study, coronary artery disease was shown to develop more slowly, with a slower progression of individual stenoses, higher regression rate and less frequent occurrence of new lesions in patients treated chronically with verapamil compared to those receiving conventional therapies. Other similar investigations are currently under way to evaluate the antiatherogenic properties of calcium antagonists, including the Frankfurt Isoptin Progression Study (FIPS), the Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS), the International Nifedipine Trial on Atherosclerosis Coronary Therapy (INTACT), and the large-scale Montreal Heart Institute Study. Results of these studies, which use precise end points such as myocardial infarction, cerebral infarction and peripheral vascular disease, may revolutionize the treatment of hypertension by identifying therapeutic approaches that control both the pressure-related and atherosclerotic complications of the disease.
Primary total knee arthroplasty in patients with psoriasis. Between 1976 and 1988, 50 primary total knee arthroplasties were performed on 34 patients with psoriasis vulgaris. The skin lesions were graded for severity in all patients and the extent of affected body surface was mapped. All patients received peri-operative antibiotics. Only one deep infection, with Staphylococcus aureus, occurred 25 months after operation. The average length of follow-up was nearly four and a half years, being to a minimum of two years or until failure of the arthroplasty. There appears to be no increased risk of deep infection in patient with psoriasis vulgaris undergoing primary total knee arthroplasty.
Oral findings in HIV-infected patients attending a department of internal medicine: the contribution of intraoral examination towards the clinical management of HIV disease The occurrence of oral mucosal lesions was studied in 70 consecutive human immunodeficiency virus (HIV)-infected patients, including 35 patients with AIDS, who had been admitted to a Department of Internal Medicine. Lesions of the oral mucosa were observed in 52 patients (74 per cent). Oral candidiasis (50 per cent), hairy leukoplakia (14 per cent), periodontal disease (13 per cent), and oral Kaposi's sarcoma (4 per cent) were the most common lesions. Oral mucosal lesions suggestive of HIV infection were present in ten of 12 patients of unknown HIV status in whom Pneumocystis carinii pneumonia was suspected. Close cooperation between the medical and dental professions is recommended since accurate intraoral examination can make a valuable contribution towards the clinical management of HIV-infected patients and may influence the CDC classification of this disease.
Adenocarcinoma arising in Barrett's esophagus. A review of nine adenocarcinomas of the esophagus arising in Barrett's epithelium was undertaken. We found the disease among white males disproportionately. Risk factors and incidence rate remain to be clarified. Only one patient was in a surveillance program and only he had carcinoma discovered "early." He still survives while only one of the eight whose diagnosis followed investigation of symptoms remains alive.
Percutaneous balloon pulmonary valvuloplasty in sickle cell anemia: a case report. Percutaneous balloon pulmonary valvuloplasty was performed on a 19-year-old female who had moderate pulmonary valve stenosis with sickle cell anemia. The patient developed sickle cell crisis resulting in occipital infarction, but she made a good recovery. We describe this case and the methods of reducing the risk of sickle cell crisis.
Does increased detection account for the rising incidence of breast cancer? BACKGROUND: The incidence of breast cancer has been increasing over time in the United States. METHODS: To determine the role of screening in this increase, trends in the incidence of in situ and invasive carcinoma of the breast were evaluated using records of the metropolitan Atlanta SEER program between 1979 and 1986. From a sample of records, evidence of symptoms and mammographic screening prior to diagnosis was recorded. RESULTS: The average annual age-adjusted incidence of invasive disease rose 29 percent among Whites and 41 percent among Blacks. Incidence increased in all age groups. A trend towards earlier detection of invasive disease was found. Asymptomatic tumors accounted for only 40 percent of the increased incidence among whites and 25 percent of the increased incidence among blacks, with mammography as the principal contributing procedure. CONCLUSIONS: These data suggest that increased detection accounts for some but not all of the rising incidence of breast cancer in the United States.
Endophthalmitis after removal of an encircling band. A case of endophthalmitis following the removal of an encircling band is presented. A possible route of entry in the absence of scleral perforation during the procedure is proposed.