123rc/medical_text huggingface dataset:
Acinic cell carcinoma. Clinicopathologic review. The authors reviewed 90 cases of acinic cell carcinoma treated at the Mayo Clinic to assess long-term follow-up and to study features predictive of disease progression. Sixty-three patients (55 females and 35 males) were seen for primary treatment; 27 had recurrent disease when first evaluated. Histologically, these tumors were composed of serous acinar cells and intercalated duct-type cells. Morphologic patterns included solid, microcystic, follicular, and papillary-cystic. All patients were followed for at least 10 years or until death. Of the primary treatment group, 44% had local recurrence, 19% had metastasis, and 25% died of disease. Disease first recurred locally up to 30 years after presentation and resulted in death after as many as 38 years. Poor prognostic features include pain or fixation; gross invasion; microscopic features of desmoplasia, atypia, or increased mitotic activity; and excision as initial treatment. Neither morphologic pattern nor cell composition was a predictive feature.
Pineal hyperactivity in spontaneously hypertensive rats: muscarinic regulation of indole metabolism. 1. Choline acetyltransferase activity and [3H]quinuclidinyl benzylate-binding sites were detected in the pineal gland of normotensive Wistar-Kyoto rats and of spontaneously hypertensive rats. 2. In vitro, muscarinic activation by pilocarpine increased the pineal metabolic production of hydroxyindole derivatives up to 5-hydroxytryptamine and produced a less marked stimulation of melatonin biosynthesis. 3. Electrical field stimulation of pineal gland slices caused similar metabolic effects. 4. Muscarinic blockade with atropine inhibited the effects on hydroxyindole metabolism. 5. [3H]Quinuclidinyl benzylate-binding sites, indicative of muscarinic receptors, were more numerous, and basal 5-hydroxytryptamine and melatonin levels were higher, in the pineal gland of spontaneously hypertensive rats compared with Wistar-Kyoto rats. 6. The atropine-sensitive metabolic effects of pilocarpine and electrical field stimulation on the pineal gland were increased in spontaneously hypertensive rats compared with Wistar-Kyoto rats.
An in vitro evaluation of an artificial heart. Interactions between human blood and the Penn State Artificial Heart were examined in vitro to study the effects of various operating conditions on the hematologic response. A dual-loop recirculating flow system that accommodated human blood was developed and blood was subjected for 3 hr to various operating conditions known to alter fluid mechanics in the artificial ventricle. The operating conditions investigated were: 60 beats/min at 50% systolic duration, 60 beats/min at 30% systolic duration, and 90 beats/min at 50% systolic duration. Quantification of plasma free hemoglobin provided a direct indicator of hemolysis in the flow system. Platelet number and beta-thromboglobulin levels were monitored to investigate thrombotic activity, and levels of complement 3a were measured to examine complement system activation. The system was effective in demonstrating the relative hemolytic properties of the operating conditions. Ninety beats/min induced 37% more hemolysis than 60 beats/min at 50% systolic duration, and 50% systolic duration induced 32% more hemolysis than 30% systolic duration at 60 beats/min. There were no statistically significant changes in either platelet number or beta-thromboglobulin levels during the 3 hr recirculation period. Increases were seen in complement 3a levels, but these appeared to be surface-induced and not sensitive to the different operating conditions. These studies demonstrate the usefulness of the flow system in examining the relative hemolytic properties of the artificial ventricle, and suggest that bulk turbulent stresses may play a more important role than laminar wall shear stresses in mediating blood damage in this artificial ventricle.
Buffered versus plain lidocaine as a local anesthetic for simple laceration repair. STUDY OBJECTIVE: Buffered lidocaine was compared with plain lidocaine as a local anesthetic for simple lacerations. DESIGN: Randomized, double-blind, prospective clinical trial. SETTING: Urban emergency department. TYPE OF PARTICIPANTS: Ninety-one adult patients with simple linear lacerations were enrolled. Patients with allergy to lidocaine and patients with an abnormal mental status were excluded. INTERVENTIONS: Each wound edge was anesthetized with either plain or buffered lidocaine using a randomized, double-blind protocol. The pain of infiltration was measured with a previously validated visual analog pain scale. MEASUREMENTS AND MAIN RESULTS: Analysis of pooled data and paired data (using patients as their own controls) revealed that infiltrating buffered lidocaine was significantly less painful than plain lidocaine (P = .03 and P = .02, respectively). There was no significant difference in the anesthetic effectiveness of the two agents during suturing. CONCLUSION: Buffered lidocaine is preferable to plain lidocaine as a local anesthetic agent for the repair of simple lacerations.
Systematic computer-aided search of optimal staging system for colorectal cancer. Two hundred and ninety-eight patients with curatively resected colorectal cancer were classified into 12 categories according to the depth of tumour penetration (T1-T4), and lymph node status (N0-N2). Using a computer, these categories were grouped into 2-12 stages in every possible combination, so a total of 146,975 logical classifications were generated. The optimal model was selected for each group of classifications with equal stage number, thus giving the greatest prognostic information on 5-year survival according to the Akaike criterion. The results showed that (1) 13% of the total classifications, including 85% of the 3-stage classifications, were better than the Dukes system in predicting our patients' outcomes; (2) the T-level was a stage-determinant even more important than the N-level; and (3) major changes in prognosis occurred at more advanced stages than the classical "turning points". We conclude that in order to find an optimal staging of cancer, systematic computer-aided search through all the possible classifications is necessary, using the appropriate database.
Diagnostic fine-needle puncture of the gallbladder with US guidance From February 1988 to January 1990, 118 fine-needle diagnostic punctures of the gallbladder (DPG) were performed under continuous ultrasound (US) guidance on symptomatic patients with gallstones. The first attempt at gallbladder puncture and aspiration was successful in every patient with use of a 22-gauge needle and continuous US visualization of the needle tip. The aspirated volume varied between 3 and 88 mL (average +/- standard deviation, 25.0 mL +/- 15.3). Biliary analysis revealed an elevation of the cholesterol saturation index in patients with cholesterol gallstones (attenuation at computed tomographic examination of 50 HU or less) relative to that in patients with pigment stones (attenuation more than 50 HU) (1.3 +/- 0.2 vs 1.0 +/- 0.1, P less than .05). The nucleation time was prolonged in patients with pigment stones (19.3 days +/- 3.5 vs 1.8 days +/- 0.8 for patients with cholesterol stones, P less than .001). All patients remained hospitalized for 24 hours after DPG and were reexamined on an outpatient basis at 1 and 3 months thereafter. No complications were detected during either short-term observation or long-term follow-up. The authors conclude that DPG is a safe and valuable technique in the diagnostic work-up of gallstone patients to establish their suitability for nonoperative treatment.
Reversal of cardiac dysfunction secondary to type 1 primary hyperoxaluria after combined liver-kidney transplantation. A 23-year-old man with type 1 primary hyperoxaluria, renal failure, and oxalosis developed a severe cardiomyopathy while awaiting combined liver-kidney transplantation. This manifested as radiographic cardiomegaly, a dilated hypokinetic left ventricle with a decreased ejection fraction, ventricular arrhythmias, and cardiac uptake on bone scanning. On liver and kidney transplantation, these abnormalities markedly improved and/or reversed. The cardiac size almost normalized, the left ventricular ejection fraction increased from 20% to 34%, the ventricular arrhythmias resolved, and the cardiac uptake on bone scanning disappeared. This coincided with normalization of oxalate production and excretion. Severe cardiac involvement secondary to oxalosis in patients with primary hyperoxaluria may improve or reverse with combined liver-kidney transplantation.
Babbling in the manual mode: evidence for the ontogeny of language. Infant vocal babbling has been assumed to be a speech-based phenomenon that reflects the maturation of the articulatory apparatus responsible for spoken language production. Manual babbling has now been reported to occur in deaf children exposed to signed languages from birth. The similarities between manual and vocal babbling suggest that babbling is a product of an amodal, brain-based language capacity under maturational control, in which phonetic and syllabic units are produced by the infant as a first step toward building a mature linguistic system. Contrary to prevailing accounts of the neurological basis of babbling in language ontogeny, the speech modality is not critical in babbling. Rather, babbling is tied to the abstract linguistic structure of language and to an expressive capacity capable of processing different types of signals (signed or spoken).
Helicobacter pylori in dyspeptic patients in Kuwait. Two hundred and four patients, mainly Arabs, attending for upper gastrointestinal endoscopy at the gastroenterology clinic in Mubarak Al-Kabeer Hospital, Kuwait, were examined for evidence of infection with Helicobacter pylori and associated inflammation. Biopsy specimens of antrum, body, and duodenum; gastric juice; and antral mucosal brushings were investigated by microbiological, cytological, and histopathological methods. Clinical conditions diagnosed at endoscopy included gastritis, gastric ulcer, duodenitis and duodenal ulcer, but half the patients had endoscopically normal gastric and duodenal mucosae. H pylori was detected by one or more of the procedures in at least one specimen from 197 (96.6%) of the patients. Histological and cytological analysis showed equal sensitivity, but bacteriological culture was less reliable. The proportion of positive cases was high, compared with other reported series, which may have been accounted for by the variety of diagnostic techniques used in this study, the selected population (all with gastrointestinal symptoms) or genetic or environmental predisposing factors peculiar to the sample population.
Renal dysfunction after angiography; a risk factor analysis in patients with peripheral vascular disease. Angiography is required for a detailed anatomical investigation before reconstructive surgery or percutaneous transluminal angioplasty can be performed. Although angiography is a safe procedure, it is associated with renal dysfunction, usually transient, in about 10% of the cases. This study concentrates on the evaluation of renal dysfunction induced by "conventional" (i.e. film-screen) Seldinger angiography and a consecutive series of 396 angiographic procedures have been evaluated. Induced Renal Dysfunction was defined as an increase of more than 10% in the serum creatinine after angiography. To identify "risk factors" for Induced Renal Dysfunction we have studied whether clinical and angiographical variables were associated with the occurrence of Induced Renal Dysfunction. These variables included: age, hypertension, the use of antihypertensive drugs, diabetes mellitus, technique of angiography, site of contrast injection and type and quantity of contrast medium. Induced Renal Dysfunction was found in 21 cases (5.7%) and appeared to be associated with age above 70, hypertension, administration of more than 150 ml contrast medium and the presence of renal disease prior to angiography. More than 95% of the 21 patients with dysfunction had two or more of these "risk factors". The presence of diabetes was not clearly associated with Induced Renal Dysfunction and haemodialyses was not required in any of the patients. The incidence of Induced Renal Dysfunction after angiography was 5.7% which is low but not negligible. However, renal dysfunction was always transient and never severe. Furthermore, the identification of "risk factors" allows the prompt identification of patients at risk before angiography, which may help to reduce the incidence of Induced Renal Dysfunction.
Visual recovery in patients with optic neuritis and visual loss to no light perception. We reviewed the records of 151 patients with optic neuritis examined over an eight-year period. Of these patients, 12 developed visual acuity of no light perception during the first episode of optic neuritis in the affected eye. Eight of the 12 patients recovered visual acuity of 20/40 or better. Of these, five patients had visual acuity of 20/20 or better, one had visual acuity of 20/25, one had visual acuity of 20/30, and one had visual acuity of 20/40. Four of the 12 patients recovered peripheral visual fields but had dense central scotomas and visual acuity of less than 20/400. Dyschromatopsia persisted after visual recovery in 11 of 12 patients.
Job's syndrome: a rare cause of recurrent lung abscess in childhood. A clinical syndrome characterized by recurrent staphylococcal infection of the skin and respiratory tract from birth was described in 1966 and referred to as Job's syndrome. Marked hyperimmunoglobulinemia E was later found to be associated with this syndrome. This article describes a case of Job's syndrome as a cause of recurrent lung abscess during childhood necessitating lung resection.
Inguinal hernia complicating flexible sigmoidoscopy. Flexible sigmoidoscopy has become part of routine preoperative workup for patients over the age of fifty who present with an inguinal hernia. A recent experience with two patients with a left inguinal hernia allowing sigmoid colon to herniate into the scrotum bring awareness of the possibility for an increased risk of perforation of the sigmoid colon during flexible sigmoidoscopy, or possible iatrogenic incarceration of the hernia. These cases are presented so this clinical entity can be recognized and the complications prevented.
Use of the polymerase chain reaction to monitor the effectiveness of ex vivo tumor cell purging. The polymerase chain reaction (PCR) was used to detect residual malignant disease before and after ex vivo purging with monoclonal antibodies and complement or immunomagnetic treatment of BM samples contaminated with known numbers of t(14;18)-carrying tumor cells. Sensitivity of the PCR was demonstrated by detecting a specific t(14;18) amplification product in DNA extracted from a preparation consisting of one tumor cell among 10(5) normal cells. When BM contaminated with 1% to 5% t(14;18)-carrying cells from the B-cell lymphoma line SU-DHL-4 was subjected to two rounds of anti-B-cell pool of antibodies and complement (Ab-C) treatment a 3- to 4-log reduction of the pretreatment PCR signal was observed. A similar log-cell kill was detected using an independent clonogenic assay confirming the utility of the PCR approach. BM contaminated with a second B-cell lymphoma cell line, OCI-Ly8, was more resistant because a third cycle of Ab-C treatment was required to obtain a similar reduction in the PCR signal. A similar 4 logs of tumor cell removal was obtained using anti-B-cell antibodies conjugated to magnetic beads. These studies demonstrate that the t(14;18) PCR can be used to detect levels of tumor cells as low as 0.001%. This approach can be used to determine the effectiveness of BM purging in patients undergoing autologous BM transplantation as well as to assess the biologic role of minimal marrow disease.
The changing face of dermatology out-patient referrals in the south-east of Scotland. A study of out-patient dermatological services (NHS and private) in the south-east of Scotland was carried out by medical staff in the Department of Dermatology in Edinburgh during the month of November 1988. The aim was to assess changes in referral patterns and workload compared with the findings of an identical investigation undertaken in November 1981. Of particular interest were the possible effects of recent publicity campaigns aimed at increasing public awareness about skin cancer. The medical complement of the dermatology department had changed minimally since 1981 and the population increase in the south-east of Scotland over the same period was 1.5%. During November 1988 1592 new patients and 2037 review patients were seen. This represented an increase of 29.2% and 28.3%, respectively, since 1981. The most striking changes in diagnostic groups were a 173% rise in new cases presenting with benign tumours (excluding viral warts) and a 106% increase in new patients with malignant tumours. Viral warts and eczema were, as in 1981, the second and third most common diagnostic categories amongst new patients. There was a 98% increase in the number of surgical procedures performed on new patients compared with 1981. We conclude that the substantial increase in numbers of both benign and malignant tumours and the consequent doubling in surgical treatments was due to increased public awareness and concern about skin cancer.
Adjunctive surgery after chemotherapy for nonseminomatous germ cell tumors: recommendations for patient selection. One hundred eighty-five patients who underwent surgery within 6 months of completing chemotherapy were identified from 360 patients with nonseminomatous germ cell tumors (NSGCT) treated with Memorial Hospital front-line cisplatin- or carboplatin-based combination chemotherapy protocols between 1979 and 1988. Clinical, pathologic, and radiologic features were correlated with the pathologic findings at surgery. The size of a residual retroperitoneal mass, the degree of shrinkage that occurred with chemotherapy, and the presence of teratomatous elements in pretreatment pathology specimens were each correlated with the pathologic findings of retroperitoneal resections after chemotherapy. Multivariable logistic regression analysis of those undergoing retroperitoneal resections identified the size and shrinkage of the residual mass and the prechemotherapy lactate dehydrogenase (LDH) and alphafetoprotein (AFP) levels as the best predictors of finding only necrotic debris. No factors could be found, however, that could selectively exclude patients who had residual viable malignancy or teratoma in the retroperitoneum. Of 39 patients with residual retroperitoneal masses measuring less than or equal to 1.5 cm in maximal diameter, three had residual malignancy and five had teratoma resected. No factors were identified for residual lung or mediastinal masses that could be used to select a group of patients who could safely avoid surgery. If serum markers have normalized after chemotherapy for NSGCT, resection of all residual abnormalities on imaging studies of the retroperitoneum, lungs, and mediastinum is recommended. In addition, retroperitoneal lymph node dissection (RPLND) is recommended for all patients with initial bulky metastases (greater than or equal to 3 cm in diameter) in the retroperitoneum, irrespective of the findings of postchemotherapy computed tomography (CT).
Penetration of the pericardium by a gastric ulcer--survival after pericardiocentesis. Elderly patients often have unusual manifestations of common illnesses. We describe a geriatric patient having a pneumopericardium from pericardial penetration by a gastric ulcer. Benign gastric ulceration causing perforation of the pericardium or other cardiac structures was recognized as early as 1854; however, until 1964, the condition was invariably fatal. Our patient survived the episode after early pericardiocentesis and medical treatment. Aspects of this uncommon clinical entity and a brief review of the literature are described.
Expected gains in life expectancy from various coronary heart disease risk factor modifications BACKGROUND. Despite much evidence that modifying risk factors for coronary heart disease can decrease morbidity and mortality, little is known about the impact of risk-factor modification on life expectancy. METHODS AND RESULTS. We used the Coronary Heart Disease Policy Model, a state-transition computer simulation of the US population, to forecast potential gains in life expectancy from risk-factor modification for the cohort of Americans turning age 35 in 1990. Among 35-year-old men, we projected that the population-wide increase in life expectancy would be about 1.1 years from strict blood pressure control, 0.8 years from smoking cessation, 0.7 years from reduction of serum cholesterol to 200 mg/dl, and about 0.6 years from weight loss to ideal body weight. For women, reducing cholesterol to 200 mg/dl would have the greatest estimated impact-a gain of 0.8 years-whereas smoking cessation, blood pressure control, or weight loss would yield population-wide gains of 0.7, 0.4, and 0.4 years, respectively. Gains for 35-year-old individuals having a given risk factor are greater. We estimate that, on average, male smokers would gain 2.3 years from quitting smoking; males with hypertension would gain 1.1-5.3 years from reducing their diastolic blood pressure to 88 mm Hg; men with serum cholesterol levels exceeding 200 mg/dl would gain 0.5-4.2 years from lowering their serum cholesterol level to 200 mg/dl; and overweight men would gain an average of 0.7-1.7 years from achieving ideal body weight. Corresponding projected gains for at-risk women are 2.8 years from quitting smoking, 0.9-5.7 years from lowering blood pressure, 0.4-6.3 years from decreasing serum cholesterol, and 0.5-1.1 years from losing weight. Eliminating coronary heart disease mortality is estimated to extend the average life expectancy of a 35-year-old man by 3.1 years and a 35-year-old woman by 3.3 years. CONCLUSIONS. Population-wide gains in life expectancy from single risk-factor modifications are modest, but gains to individuals at risk can be more substantial.
A mutation in the gene for type III procollagen (COL3A1) in a family with aortic aneurysms. Experiments were carried out to test the hypothesis that familial aortic aneurysms, either thoracic or abdominal, are caused by mutations in the gene for type III procollagen (COL3A1) similar to mutations in the same gene that have been shown to cause rupture of aorta and other disastrous consequences in the rare genetic disorder known as Ehlers-Danlos syndrome type IV. A family was identified through a 37-yr-old female captain in the United States Air Force who was scrutinized only because many of her direct blood relatives had died of ruptured aortic aneurysms. The woman was heterozygous for a single-base mutation that converted the codon for glycine 619 of the alpha 1(III) chain of type III procollagen to a codon for arginine. Studies on cultured skin fibroblasts demonstrated the mutation caused synthesis of type III procollagen that had a decreased temperature for thermal unfolding of the protein. The same mutation was identified in DNA extracted from pathologic specimens from her mother who had died at the age of 34 and a maternal aunt who died at the age of 55 of aortic aneurysms. Examination of DNA from samples of saliva revealed that the woman's daughter, her son, a brother, and an aunt also had the mutation. The results demonstrated that mutations in the type III procollagen gene can cause familial aortic aneurysms and that DNA tests for such mutations can identify individuals at risk for aneurysms.