123rc/medical_text huggingface dataset:
Laboratory parameters to monitor safety and efficacy during thrombolytic therapy. Thrombolytic therapy is being used with increasing frequency in myocardial infarction (MI), pulmonary embolism, deep venous thrombosis (DVT), and peripheral arterial occlusion. Use of these agents, however, is hampered by concerns regarding safety and efficacy. Numerous laboratory parameters have been evaluated for monitoring the risk of bleeding complications, with levels of fibrinogen (and percentage of decrease) and fibrin/fibrinogen degradation products (FDPs) correlating to a variable extent with clinical bleeding. The bleeding time (BT) test has also been proposed as a potential predictor of bleeding during thrombolytic therapy. With respect to efficacy, the D-dimer fragment of FDPs, when corrected for soluble fibrin polymers, has been shown to correlate with clot lysis in venous thromboembolism but not MI. The BT also is being considered as a marker of lysis in patients with DVT. Given the increasing concomitant use of antiplatelet agents during thrombolytic therapy, the BT, as an in vivo test of hemostasis and platelet function, has potential utility as a noninvasive, adjunctive marker of thrombolytic efficacy.
Renal oncocytoma: long-term follow-up and flow cytometric DNA analysis. We report a retrospective study on the clinicopathologic features and flow cytometric DNA analysis of ten renal oncocytomas compared with a control group of ten randomly selected renal cell carcinomas. Among the oncocytoma patients, no recurrences or metastases were noted over an average follow-up of 6.7 years (range = 6 months to 16 years). Reproducible, high-quality DNA histograms were obtained on the paraffin-embedded specimens by using our modified flow cytometric procedure. One aneuploid (10%) and two hyperdiploid tumors (20%) were found in the oncocytoma group. There was no correlation between these abnormal DNA histographic patterns and survival or tumor stages. On the contrary, a good correlation was found between tumor grades and DNA ploidy in the controls. We conclude that renal oncocytoma is a clinically benign tumor, yet it may exhibit varying degrees of flow cytometric DNA abnormalities, which have no predictive value on survival and probably reflect the characteristics of oncocytes rather than its malignant potential.
Measurement of resistance versus flow in assessing efficiency of aortocoronary bypass grafts. Measurement of flow in saphenous bypass grafts with an electromagnetic flowmeter is complicated and poorly reproducible. Since coronary flow is largely dependent on variable factors the stable value of resistance seems more appropriate for comparison. A simple method has been developed for intraoperative measurement of resistance in the respective coronary bed. Pressure is recorded in the saphenous graft by an electromanometer during continuous flushing with known amounts of blood, and resistance is calculated instantaneously. The procedure is very simple and takes less than one minute. The quality of the saphenous vein itself can be assessed simultaneously by the same method. Resistances were measured during coronary surgery in over 500 saphenous grafts. The results were highly reproducible and comparable. Excellent flows can be expected if resistance is below 200 Peripheral Resistance Units (PRU); if this is over 800 PRU flow is very poor.
Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. OBJECTIVE: To assess the prognostic significance of left ventricular mass and geometry in initially healthy persons with essential hypertension. DESIGN: An observational study of a prospectively identified cohort. SETTING: University medical center. PATIENTS: Two hundred and eighty patients with essential hypertension and no pre-existing cardiac disease were evaluated using echocardiography between 1976 and 1981. Two hundred and fifty-three subjects or their family members (90%) were contacted for a follow-up interview an average of 10.2 years after the initial echocardiogram was obtained; the survival status of 27 patients lost to follow-up was ascertained using National Death Index data. MEASUREMENTS AND MAIN RESULTS: Left ventricular mass exceeded 125 g/m2 in 69 of 253 patients (27%). Cardiovascular events occurred in a higher proportion of patients with than without left ventricular hypertrophy (26% compared with 12%; P = 0.006). Patients with increased ventricular mass were also at higher risk for cardiovascular death (14% compared with 0.5%; P less than 0.001) and all-cause mortality (16% compared with 2%; P = 0.001). Electrocardiographic left ventricular hypertrophy did not predict risk. Patients with normal left ventricular geometry had the fewest adverse outcomes (no cardiac deaths; morbid events in 11%), and those with concentric hypertrophy had the most (death in 21%; morbid events in 31%). In a multivariate analysis, only age and left ventricular mass--but not gender, blood pressure, or serum cholesterol level--independently predicted all three outcome measures. CONCLUSIONS: Echocardiographically determined left ventricular mass and geometry stratify risk in patients with essential hypertension independently of and more strongly than blood pressure or other potentially reversible risk factors and may help to stratify the need for intensive treatment.
Events associated with rupture of intra-aortic balloon counterpulsation devices. Nineteen intra-aortic balloon (IAB) ruptures occurred in sixteen patients during a three-year period. Perforation occurred secondary to abrasion with material failure or mishandling of the device during insertion. To avoid serious sequelae, it is important to be aware of the possibility of IAB rupture and to remove any defective device immediately upon recognition of an event.
Pancreatic ascites presenting in infancy, with review of the literature. We report a 4-month-old boy with massive ascites in whom a diagnosis of pancreatitis was made on a raised ascitic amylase level after two inconclusive laparotomies. He developed a pseudocyst which was managed with repeated percutaneous needle aspirations, nutrition being maintained intravenously. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a congenital intra-pancreatic cyst. He thrived after operation drainage for recurrent pseudocyst, but repeat ERCP shows that the cyst in the head of the pancreas remains. Pancreatic ascites is rare in children and diagnosis is frequently delayed. A third of reported cases in childhood present in the first year of life. A search for the underlying cause should include an ERCP to demonstrate abnormalities of the pancreaticobiliary ducts.
Administered dose and tumor dose of bleomycin labeled with cobalt-57 in mice and men. Tumor concentrations of the chemotherapeutic drug, bleomycin, labeled with cobalt-57 (Co-bleo) were compared in mouse tumor models and in human lung tumors using quantitative single-photon emission computed tomography. Drug concentrations in histologically similar human tumors showed marked variability for the same injected dose (ID). Small cell carcinomas showed concentrations between 1.09 and 8.85 %ID/cc x 10(-3) while non-small cell lung tumors showed a concentration variation between 0.36 and 6.75 %ID/cc x 10(-3). In contrast to the situation in human tumors, uptake in mouse tumors showed only slight variability in animals with the same tumor model. EMT-6 tumors in mice showed at 6 hr significantly higher uptake of Co-bleo (p less than 0.001) and significantly higher tumor-to-lung ratio (p less than 0.001) when compared to murine fibrosarcomas. The EMT-6 tumors in contrast to the fibrosarcomas responded to bleomycin treatment in a dose dependent manner. The results indicate that while in mice the tumor dose closely follows the administered dose, in humans, the tumor dose and the tumor-to-lung ratio in the individual patient cannot be predicted from the administered dose.
The J-curve phenomenon and the treatment of hypertension. Is there a point beyond which pressure reduction is dangerous? We critically appraised the medical literature to evaluate whether there is a point beyond which blood pressure reduction in hypertensive subjects is no longer beneficial and possibly even deleterious. Thirteen studies that stratified cardiovascular outcomes by level of achieved blood pressure in treated hypertensive subjects who had been followed up for at least 1 year were critiqued by four independent reviewers. Data addressing population, protocol, and methodological characteristics were evaluated. Studies did not show a consistent J-shaped relationship between treated blood pressure and stroke, but they did demonstrate a consistent J-shaped relationship for cardiac events and diastolic blood pressure. The beneficial therapeutic threshold point was 85 mm Hg. We conclude that low treated diastolic blood pressure levels, ie, below 85 mm Hg, are associated with increased risk of cardiac events.
Colonic glycoproteins in monozygotic twins with inflammatory bowel disease. Colonic glycoprotein composition was evaluated in monozygotic twins with inflammatory bowel disease using ion-exchange chromatography. Fifty-three individuals, 12 pairs and 1 single twin with ulcerative colitis and 14 pairs with Crohn's disease, were evaluated. Seven twin pairs were concordant for the presence of ulcerative colitis or Crohn's disease, whereas twin siblings of 10 ulcerative colitis probands and 9 Crohn's disease probands were not known to have inflammatory bowel disease. Content of one chromatographically defined component of colonic mucin, designated HCM species IV, was reduced in both patients with ulcerative colitis (1040 +/- 300 cpm/10,000 cpm total HCM) and their apparently healthy twins (1340 +/- 540 cpm/10,000 cpm total HCM) compared with control subjects (4030 +/- 1,000 cpm/10,000 cpm total HCM). Composition of mucin in Crohn's disease patients and their nonaffected twins was not significantly different than in controls. These observations suggest that altered profiles of mucin glycoprotein may be present before the onset of ulcerative colitis and may be genetically defined. Conversely, it appears that alterations in glycoproteins only are not sufficient to initiate mucosal inflammation.
Multimodality cisplatin treatment in nonresectable alpha-fetoprotein-positive hepatoma. Twenty-eight patients with alpha-fetoprotein-positive (AFP+) nonresectable hepatoma have been enrolled in a new multimodality Phase I, II program. Induction therapy consisted of 50 mg/m2 intravenous cisplatin followed by 2100 cGy irradiation to the tumor volume in seven fractions over 10 days. Hepatic arterial infusion of 50 mg/m2 cisplatin (IA-CDDP) was then administered at monthly intervals. Twenty-one patients have completed induction and at least two cycles of IA-CDDP. Twelve-month cumulative survival was 52% for all 28 patients and 69% for the 21 patients completing induction and IA-CDDP. Median survival has not yet been reached. Response rate (complete and partial) was 36% overall and 48% among the 21 patients who completed treatment. The improved survival of the present series of patients as well as the minimal hematologic toxicity suggests possible further integration of new modalities for therapy.
Musculoskeletal abnormalities in a patient with juvenile hypothyroidism. Abnormalities in growth and development are the most striking clinical features of juvenile acquired hypothyroidism. Therefore, physicians should consider the diagnosis of hypothyroidism in any child with musculoskeletal growth dysfunction. Drs Kilpatrick and Fincher describe a case demonstrating the severe and potentially irreversible effects of prolonged, untreated hypothyroidism.
Fertility-sparing treatment of patients with ovarian cancer. The variety of malignant neoplasms produced by the ovary are legion. Each must be considered individually in the young woman with early disease who wishes to preserve her childbearing capability. The risks of conservative surgery are often low, and the patient can be so advised. Careful monitoring of this group of patients is essential regardless of the approach.
Steroid anabolic drugs and arterial complications in an athlete--a case history. Serious side effects and complications have been attributed to anabolic and androgenic steroids when used for medical reasons or when taken in sports in hopes of increasing strength and, hence, performance. The author presents a case of an athlete who experienced two metachronous arterial complications after taking these drugs: a cerebrovascular accident caused by a carotid artery thrombus that partially embolized to the brain and, later, a severe ischemic episode in a lower limb caused by a diffused distal arterial thrombosis. This patient represents the first reported case of vascular events in an otherwise healthy athlete taking androgens to increase his skeletal muscle mass.
Enhanced chemiluminescence as a measure of oxygen-derived free radical generation during ischemia and reperfusion. It has been suggested that oxygen-derived free radicals may contribute to the myocardial injury associated with ischemia and reperfusion. As the presence of enhanced free radical generation is a prerequisite for such damage, several techniques have been used to provide evidence of increased oxygen free radical production during reperfusion; however, all such techniques have substantial limitations. In this study, we used enhanced chemiluminescence to evaluate oxygen free radical generation during ischemia and reperfusion in the isolated Langendorff-perfused rat heart. The chemiluminescent technique, which has high sensitivity and can monitor radical generation continuously, avoids some of the limitations of earlier methods. Chemiluminescence (expressed as counts per second) decreased from 219 +/- 11 at baseline to 142 +/- 9 during ischemia and markedly increased to a peak of 476 +/- 36 during the first 3-5 minutes of reperfusion. This was followed by a slow decline over 11-16 minutes to a steady-state level of 253 +/- 14 (each sequential change in chemiluminescence was highly significant; p less than 0.001). Superoxide dismutase (2,000 units/min) significantly decreased peak reperfusion chemiluminescence to 316 +/- 17 (p less than 0.01). Hearts subjected to a second period of ischemia and reperfusion had a higher peak chemiluminescence (626 +/- 62), which also was significantly attenuated by 1,000 units/min superoxide dismutase (398 +/- 16; p less than 0.01).
Clinical antecedents to in-hospital cardiopulmonary arrest. While the outcome of in-hospital cardiopulmonary arrest has been studied extensively, the clinical antecedents of arrest are less well defined. We studied a group of consecutive general hospital ward patients developing cardiopulmonary arrest. Prospectively determined definitions of underlying pathophysiology, severity of underlying disease, patient complaints, and clinical observations were used to determine common clinical features. Sixty-four patients arrested 161 +/- 26 hours following hospital admission. Pathophysiologic alterations preceding arrest were classified as respiratory in 24 patients (38 percent), metabolic in 7 (11 percent), cardiac in 6 (9 percent), neurologic in 4 (6 percent), multiple in 17 (27 percent), and unclassified in 6 (9 percent). Patients with multiple disturbances had mainly respiratory (39 percent) and metabolic (44 percent) disorders. Fifty-four patients (84 percent) had documented observations of clinical deterioration or new complaints within eight hours of arrest. Seventy percent of all patients had either deterioration of respiratory or mental function observed during this time. Routine laboratory tests obtained before arrest showed no consistent abnormalities, but vital signs showed a mean respiratory rate of 29 +/- 1 breaths per minute. The prognoses of patients' underlying diseases were classified as ultimately fatal in 26 (41 percent), nonfatal in 23 (36 percent), and rapidly fatal in 15 (23 percent). Five patients (8 percent) survived to hospital discharge. Patients developing arrest on the general hospital ward services have predominantly respiratory and metabolic derangements immediately preceding their arrests. Their underlying diseases are generally not rapidly fatal. Arrest is frequently preceded by a clinical deterioration involving either respiratory or mental function. These features and the high mortality associated with arrest suggest that efforts to predict and prevent arrest might prove beneficial.
Cross-linked hemoglobin solution as a resuscitative fluid after hemorrhage in the rat. Intramolecularly (alpha-alpha) cross-linked hemoglobin has been reported to have oxygen transport properties similar to those of whole blood. The present study evaluated the efficacy of diaspirin alpha-alpha cross-linked hemoglobin solution as a resuscitation fluid, with heart rate, mean arterial pressure, and transcutaneous oxygen tension as the study parameters. Rats were bled and approximately one third of their total blood volume (20 ml/kg) was removed while they were anesthetized; they were then resuscitated with 14% hemoglobin solution. Animals that received either 10 mg/kg (n = 10) or 20 mg/kg (n = 10) of hemoglobin solution responded quickly and positively to the infusions: mean arterial pressure (which had dropped to less than 40% of prehemorrhage levels) returned to baseline within 2 minutes of initiating infusion; by 4 minutes, the mean arterial pressures of the hemoglobin-infused groups were significantly higher (p less than or equal to 0.05) than those in both the autologous shed blood (n = 8) and lactated Ringer's (n = 10) groups. The heart rate and transcutaneous oxygen tension responses in both the half-volume and full-volume replacement hemoglobin groups matched the response to autologous shed blood throughout the hour of observation. The favorable hemodynamic response to infusion of cross-linked hemoglobin solution after hemorrhage suggests that this material is comparable to autologous shed blood and superior to lactated Ringer's solution as a resuscitative fluid as assessed in this model.
Prevention of complications in surgical management of back pain and sciatica. Accurate diagnosis of lumbar disc disease requires a thorough examination. Appropriate neurodiagnostic studies are required to confirm the suspected diagnosis. Other diagnoses should be considered prior to surgery, especially when there is a lack of correlation between the history, physical examination, or radiologic investigation. Proper surgical techniques should also help in preventing complications and are further discussed in this article.
Management of asymptomatic chronic aortic regurgitation with left ventricular dysfunction: a decision analysis STUDY OBJECTIVE: To determine the optimal strategy for the timing of aortic valve replacement in patients with chronic, severe aortic regurgitation with left ventricular dysfunction. DESIGN: Decision analysis comparing early surgery (timed at the onset of left ventricular dysfunction) with delayed surgery (timed at the onset of symptoms) using data from the literature and expert opinion for variables in a representative case scenario (40-year-old man with bicuspid aortic valve disease). SETTING: Tertiary care center doing valve replacement surgery. MEASUREMENTS AND MAIN RESULTS: The early-surgery approach was preferred based on quality-adjusted life years. Sensitivity analysis showed that the result was not affected by the following variables within their derived ranges: rate of symptom development after onset of left ventricular dysfunction for the delayed-surgery approach, perioperative mortality for both approaches, and occurrence of major nonfatal stroke or congestive heart failure for both approaches. Although the decision was sensitive to the yearly postoperative mortality rates, the delayed-surgery operative mortality rate had to be almost as low as the early-surgery rate to change the preference to the delayed-surgery approach. The preference could also change if survival were much more important to the patient in the first five years than after five years or if the patient disliked living on anticoagulants enough to value a year on anticoagulants as worth only 80% of a year not on anticoagulants. CONCLUSION: This decision analysis provides quantitative support for the impression that patients similar to the case scenario do better with surgery timed at the onset of ventricular dysfunction than with surgery delayed until symptoms develop. It thus supports the practice of following these patients noninvasively in order to time surgery.
Pharyngeal adenocarcinoma with intestinal features. A high grade adenocarcinoma arising primarily in the pharynx of a 67-year-old man is presented. A CT-scan revealed a tumour mass growing in the pharynx, largely affecting parapharyngeal soft tissues. Lymph node metastases were found at clinical presentation. Both morphological and immunohistochemical studies displayed similar features to those of intestinal origin. To our knowledge, no previous examples of such neoplasm have been reported at this site. Its possible histogenetical origin is discussed.
Enteric neuronal autoantibodies in pseudoobstruction with small-cell lung carcinoma. Severe gastrointestinal dysmotility is a newly recognized paraneoplastic syndrome that occurs with small-cell lung carcinoma. Thirty-four patients with small-cell carcinoma, of whom 5 had chronic intestinal pseudoobstruction and 29 had no digestive symptoms, were studied serologically. Four of the 5 patients with gut dysmotility had immunoglobulin G antibodies reactive with neurons of the myenteric and submucosal plexuses of jejunum and stomach in an indirect immunofluorescence assay. Antibodies of this type were not found in any of the 29 patients who had no gut dysmotility, nor were they found in patients with chronic idiopathic intestinal pseudoobstruction (n = 8), ovarian cancer (n = 20), or epilepsy (n = 4) or in normal subjects (n = 9). In 4 of the patients with paraneoplastic pseudoobstruction, antibodies in highly diluted serum (1:4000-1:8000) bound selectively to nuclei and cytoplasm of neuronal elements in the gut. This novel autoantibody activity suggests that intestinal pseudoobstruction occurring in patients with small-cell carcinoma may have an autoimmune basis. From a clinical standpoint, serological testing offers a simple means for determining which patients with gut dysmotility syndromes may have associated small-cell carcinoma, thereby enabling earlier diagnosis and treatment of the tumor.
Platelet volume, aggregation, and adenosine triphosphate release in cerebral thrombosis. We compared whole blood platelet aggregation, adenosine triphosphate release, platelet count, platelet crit (percentage volume of platelets), and mean platelet volume during the acute, subacute, and chronic periods of cerebral thrombosis in 22 patients with value in 29 controls. During the acute and subacute periods, platelet aggregation, platelet count, platelet crit, and mean platelet volume were significantly less in the patients than in the controls (p less than 0.05-0.01) while the adenosine triphosphate release rate per volume of platelets was significantly greater (p less than 0.05). During the acute period, infarct size showed a significant positive correlation with platelet aggregation (r = 0.59, p less than 0.01) and adenosine triphosphate release rate (r = 0.70, p less than 0.001) but a negative correlation with platelet count (r = -0.44, p less than 0.05). Our results suggest that platelet aggregation is reduced during the acute period due to the consumption of platelets during thrombogenesis but that the remaining individual platelets are hyperactive. Platelet consumption during the acute period increases with infarct size. During the chronic period, platelet crit and mean platelet volume were significantly less in the patients than in the controls (p less than 0.01) while the adenosine triphosphate release rate was significantly greater (p less than 0.01), suggesting sustained platelet consumption and chronically enhanced secretion of individual platelets.