123rc/medical_text huggingface dataset:
Surgical therapy of the eyelids in patients with facial paralysis. Patients with facial paralysis have a degree of lagophthalmos and paralytic ectropion. We present our experience in the surgical management of 25 consecutive patients treated for these problems. Paralytic lagophthalmos was corrected using gold weights inserted into the upper eyelid. The advantages and disadvantages of this surgical technique are reviewed. Medial canthoplasty and lateral canthoplasty were performed to rectify paralytic ectropion. Ancillary procedures included browpexy, upper-lid blepharoplasty, and temporalis sling. The results were excellent in 23 of 25 patients and good in the remaining two. After a minimum of 6 months' follow-up, there were no complications. The authors believe that the above procedures will yield consistently excellent cosmetic and functional results in patients with paralysis of the eyelids.
Surgical indication and significance of portal vein resection in biliary and pancreatic cancer. Tumor and vascular resection was carried out in 27 patients with biliary and pancreatic cancer. Vascular resection included resection and reconstruction of the both the portal vein and hepatic artery in two of the patients. Portal vein resection only was carried out in 23 patients, and resection of the side wall and plasty of the portal vein was carried out in the other two patients. The technical limit of portal vein resection without graft was 4 cm in the hepatic hilus and 7 cm after total pancreatectomy or pancreatoduodenectomy without grafts. On temporary occlusion of the portal vein between resection and reconstruction, simple occlusion was sufficient if it occurred within 30 minutes. In occlusion of more than 30 minutes, simultaneous occlusion of the superior mesenteric artery is better to prevent congestion of the intestine. If occlusion of more than 60 minutes is anticipated, a bypass between the superior mesenteric vein and the femoral vein with Anthron tube is recommended. The postoperative course was uneventful in 20 of the 27 patients. Two patients died within 1 month after surgery. The mortality rate for this aggressive surgery was 8.4%. Minor complications such as hydrothorax, small bile leakage, and localized abscess were observed but soon subsided in five patients. Fourteen of 27 patients survived or are alive after more than 1 year, and 9 of 14 patients survived or are alive after 2 years. Forty-seven percent of the patients who had no lymph node metastasis or peritumor lymph node metastasis without cancerous invasion of the portal vein intima survived more than 2 years. The longest length of survival of a patient with nonfunctioning islet cell carcinoma of the pancreatic head was 5 years 9 months. The longest surviving patient with ductal cell carcinoma of the pancreas is still living after 4 years. This approach is recommended in certain patients with vascular involvement but without lymph node metastasis or those patients with only peritumor lymph node involvement. Frozen section of mesenteric and paraaortic nodes should be standard practice before this aggressive resection.
Tension pneumopericardium as a complication of single-lung transplantation. Tension pneumopericardium is distinctly uncommon in the adult population. We present a case of tension pneumopericardium as a complication of lung transplantation in a 54-year-old woman with thromboembolic pulmonary hypertension who underwent single-lung transplantation.
Nephrotic syndrome complicating adenocarcinoma of the lung with resolution after resection. Nephrotic syndrome is an uncommon complication of lung cancer. We present a case in which adenocarcinoma was complicated by the nephrotic syndrome, which resolved after resection of the cancer.
The validity and reliability of the navicular fat stripe as a screening test for detection of navicular fractures. STUDY OBJECTIVE: The purpose of this study was to determine if the navicular fat stripe (NFS) is a valid and reliable screening tool in assessing potential navicular fractures. DESIGN: Retrospective analysis. SETTING: Minor trauma section of the Los Angeles County-University of Southern California Medical Center emergency department. TYPE OF PARTICIPANTS: Study population included patients seen for wrist injury between January 1987 and December 1988. The individuals who interpreted the radiographs included eight observers with varying degrees of radiographic experience. INTERVENTIONS: None MEASUREMENTS AND MAIN RESULTS: The positive predictive value averaged 12% or 15% depending on how we counted a straight NFS, and the negative predictive value averaged 93% or 95%, again depending on how we counted a straight NFS. A straight NFS was ten times as likely to occur among normal wrists than among those with navicular fractures. Interobserver reliability was found to be high with a Hoyt reliability coefficient of .79. CONCLUSIONS: An abnormal NFS is a poor predictor of a navicular fracture while both a straight and a normal NFS are good predictors of no navicular fracture. A normal NFS may allow less stringent treatment by the emergency physician. Extremes of radiographic experience were found to have no significant effect on NFS interpretation.
Growth velocity before sudden infant death. Weight velocities of 136 infants who died from sudden infant death syndrome (SIDS) were compared with those of 136 controls matched for sex, birth weight, and type of feeding. It was found that the SIDS infants gained weight more slowly overall and that the differences were significantly different for infants who were not breast fed in the last two weeks in which it was possible to estimate their growth velocity. Breast fed infants had more periods of growth below the 25th centile than expected. These differences are unlikely to be useful in the prediction of which babies are likely to die from SIDS as there are frequent episodes of poor growth in infants who do not die.
Expression of leukocyte adhesion molecules by mucosal mononuclear phagocytes in inflammatory bowel disease. Leukocyte adhesion molecules are important in cell-cell interactions of the immune system. Lymphocyte function-associated antigen 1 (cluster designation 11a) mediates interactions between T cells and mononuclear phagocytes through its ligand, the intercellular adhesion molecule 1 (CD54), whereas complement receptors 3 (CD 11b) and 4 (CD11c) are involved in complement-mediated phagocytosis. Expression of CD11 molecules and intercellular adhesion molecule 1 was studied in colonic biopsy specimens from 20 patients with inflammatory bowel disease and 10 normal controls. In normal colon, few mononuclear phagocytes expressed lymphocyte function-associated antigen 1 and intercellular adhesion molecule 1 at high densities. The major adhesion molecule was CD11c. Thus, the largest population of normal colonic mononuclear phagocytes was represented by quiescent, resident macrophages with likely phagocytic function. In inflammatory bowel disease, mononuclear phagocytes showed only a slight increase in CD11a expression and no significant change in expression of CD11b and CD11c. By contrast, the percentage of mononuclear phagocytes expressing intercellular adhesion molecule 1 was increased from 6.9% +/- 3.9% in controls to 69.2% +/- 12.8% in ulcerative colitis (P less than 0.001) and to 45.7% +/- 22.8% in Crohn's disease (P less than 0.01), showing a close relationship with histological activity. The increased expression of intercellular adhesion molecule 1 in inflammatory bowel disease indicates a state of immunological activation induced by local release of inflammatory cytokines. Such induction of intercellular adhesion molecule 1 on mononuclear phagocytes may be important in the maintenance of chronic inflammation by facilitating interactions with T cells and T-cell antigen recognition.
The real impact of mechanical bridge strategy in patients with severe acute infarction. Results obtained in the past 3 years in patients referred with acute myocardial infarction (AMI) and cardiogenic shock for a mechanical bridge to urgent transplantation permit one to assess the real impact of the present strategy in clinical practice. Ten patients (mean age = 49) were admitted in serious condition (CI = 1.8 +/- 0.2 L/min/m2, PCWP = 28 +/- 6 mmHg, systolic aortic pressure = 88 +/- 20 mmHg, urine output 11 +/- 20 ml/hr) and were treated by maximal sympathomimetic support and i.v. enoximone. Two had to be implanted with a total artificial heart (TAH) and one with a left ventricular assist device (LVAD) for recurrent fibrillation despite hemodynamic improvement, within 8 hr. Two have received transplants and are living well after 20 months. Seven who initially improved markedly have been listed as urgent transplant candidates: two of these have been successfully transplanted, and three died suddenly after 6, 25, and 45 days, respectively. One has undergone successful coronary surgery. One patient (age 62, diabetic) was secondarily rejected for a transplant and died. This experience clearly shows that despite initial spectacular hemodynamic improvement, which was due to optimized medical management, death rate before transplant because of sudden ventricular fibrillation remains unacceptably high. This should prompt early mechanical support, with less invasive systems, in patients with AMI.
Suicide attempts by the old and the very old. Attempted suicide by the elderly is a major psychiatric problem. Ninety-five patients between 60 and 90 years of age were evaluated by a psychiatric consultation service after a suicide attempt. Characteristics of this group included (1) a high degree of premeditation, (2) a tendency toward firearm use and wounds to the head, (3) male sex, (4) coexisting medical problems, (5) serious intent that increased by decade, (6) solitary living arrangements, (7) presence or history of a major psychiatric illness, and (8) ill health reported as a precipitant to suicidality. Major depression was the most common psychiatric diagnosis, with congestive heart failure and chronic obstructive pulmonary disease the most frequently noted physical ailments. This elderly population of attempters resembled older persons who actually completed suicide and differed significantly from 1630 persons aged 16 to 59 years who attempted suicide. Heightened investigation of depressive features, treatment of alcohol abuse, early referral for psychiatric care, limited access to firearms, and strategies aimed at decreasing social isolation are recommended to decrease the likelihood of completed suicide in the elderly.
Embryonic stem cell virus, a recombinant murine retrovirus with expression in embryonic stem cells. The expression of Moloney murine leukemia virus and vectors derived from it is restricted in undifferentiated mouse embryonal carcinoma and embryonal stem (ES) cells. We have developed a retroviral vector, the murine embryonic stem cell virus (MESV), that is active in embryonal carcinoma and ES cells. MESV was derived from a retroviral mutant [PCC4-cell-passaged myeloproliferative sarcoma virus (PCMV)] expressed in embryonal carcinoma cells but not in ES cells. The enhancer region of PCMV was shown to be functional in both cell types, but sequences within the 5' untranslated region of PCMV were found to restrict viral expression in ES cells. Replacement of this region by related sequences obtained from the dl-587rev retrovirus results in MESV, a modified PCMV virus that confers G418 resistance to fibroblasts and ES cells with similar efficiencies. Expression of MESV in ES cells is mediated by transcriptional regulatory elements within the 5' long terminal repeat of the viral genome.
Accidental death from a black-powder rifle breech plug. Authentic black-powder muzzle-loader weapons and replicas are used today primarily for hunting game such as deer and hogs. The following is a case presentation of accidental death from cerebral trauma caused by a .45-caliber black-powder-rifle breech plug implanting in the victim's brain.
Cardiac calcific deposits in patients with primary hyperparathyroidism: preliminary results of a prospective echocardiographic study. To explain the incidence and significance of mitral and aortic valve calcification and calcific deposits in the myocardium, a prospective echocardiographic study was performed with 21 consecutive patients who had primary hyperparathyroidism (PHP) and with 21 age- and sex-matched control subjects with normocalcemia. Calcific deposits in the myocardium were seen in 13 patients (62%) with PHP, mainly in the interventicular septum, and in one control subject. Aortic valve calcification was observed in 12 patients (57%) with PHP and in one control subject. Calcification of the mitral valve was found in seven patients with PHP (33%) and three controls (14%). Calcification led to mild or moderate stenosis of the aortic valve in three patients with PHP and of the mitral valve in two patients with PHP. No stenosis was found in the subjects in the control group. Both calcification of the aortic and mitral valves and calcific deposits in the myocardium are common in patients with PHP and can be detected noninvasively by echocardiography. Because of the potential relationship of elevated calcium, calcification, and valvular heart disease, clinical evaluation of PHP should include echocardiographic studies before surgery is performed and during follow-up examination.
Diclofenac for day-care arthroscopy surgery: comparison with a standard opioid therapy. Sixty unpremedicated patients presenting for day-care arthroscopy surgery were allocated randomly to receive diclofenac 1 mg kg-1 i.m., fentanyl 1 microgram kg-1 i.v. or no analgesic during the course of anaesthesia. Patients receiving fentanyl had slightly, although not significantly prolonged recovery times. Patients receiving diclofenac had significantly improved postoperative visual analogue pain scores compared with patients receiving placebo medication (P less than 0.05). With fentanyl, pain scores were reduced also, but the effect was not statistically significant. Both fentanyl and diclofenac produced significant reduction in postoperative analgesic requirements (P less than 0.05). We conclude that diclofenac 1 mg kg-1 i.m. was an effective analgesic for arthroscopic procedures on the knee and is a useful alternative to opioids for day-care patients.
Morbidity and disability in older persons in the years prior to death. BACKGROUND: A large proportion of the disease and disability which affects older persons occurs in the years just prior to death. Little prospective evidence is available which quantifies the burden of morbidity and disability during these years. METHODS: In three community-based cohorts of persons age 65 and older, chronic conditions and disability were evaluated for the three years prior to death in 531 persons who had three annual assessments and then died within one year of the third assessment. Number of chronic conditions, prevalence of disability in activities of daily living (ADLs), and prevalence of disability on a modified Rosow-Breslau scale were determined for these decedents and compared to 8821 members of the cohorts known to have survived. RESULTS: Prevalence rates of disease and disability increased during the follow-up for both decedents and survivors, with decedents generally having higher rates than survivors. Disability rates prior to death, but not the number of diseases, increased with increasing age at death. The odds ratio for disability in ADLs at any of the three assessments for decedents versus survivors ranged from 3.0 to 4.2 in the three communities. In each community the odds ratio for ADL disability was higher in women decedents versus survivors than in men decedents versus survivors. CONCLUSIONS: These results have important implications for disability levels in future older populations in which death is projected to occur at increasingly higher ages.
Stance duration under sensory conflict conditions in patients with hemiplegia. Standing balance was evaluated in ten subjects with hemiplegia using a sensory organization balance test (SOT). The SOT is a timed balance test which evaluates somatosensory, visual, and vestibular function for maintenance of upright posture. The duration of bilateral stance was assessed using combinations of three visual and two support surface conditions. Stance time was measured with eyes open, eyes closed, and with each patient wearing a visual dome to produce inaccurate visual information. The support surface conditions involved stance on a hard flat floor followed by attempted stance on a compliant foam surface. Visual deprivation or visual conflict conditions did not cause a loss of balance when stance was performed on a stable surface. However, a lower stance duration was found when patients stood on a compliant surface (p less than .05). Visual compensation was evident during the compliant-surface condition because stance duration showed the greatest reductions with eyes closed and with the visual dome. These findings suggest that the ability to integrate somatosensory information from the lower extremities for balance is compromised after cerebrovascular disease. The implications for diagnosing the specific cause of balance dysfunction and for developing sensory-specific therapeutic interventions are discussed.
Neurologic and psychiatric manifestations of HIV disease. Neuropsychiatric problems have assumed an increasingly prominent role in HIV-infected individuals. Disease occurs at all levels of the central and peripheral nervous systems by a variety of mechanisms. The AIDS dementia complex is the prototypical example of "direct" effects of HIV on the neuraxis, while infections such as toxoplasmosis and cryptococcal meningitis are complications of HIV-induced immunosuppression. Neurologic manifestations vary in frequency depending upon the overall stage of HIV disease; diagnostic difficulties may be encountered because of HIV's effect on cerebrospinal fluid parameters. The uncertainties of management of neurosyphilis in this setting provide and example of these problems. As is the case with other organ systems, the main goal of neurodiagnostic efforts is to find the increasing number of treatable components of neuropsychiatric dysfunction.
The acute and insidious onset of pulmonary metastatic transitional cell carcinoma. Transitional cell carcinoma is a common urologic neoplasm. Although pulmonary metastases from this tumor are often not appreciated clinically, they are frequently documented in autopsy studies. Therefore, the clinical recognition of this condition can be problematic. To illustrate this point, we present three patients with progressive unexplained dyspnea and histories of transitional cell carcinoma. Since ineffective and possibly detrimental therapeutic approaches may be initiated, a high index of suspicion for pulmonary metastatic embolization must be maintained. Early histologic identification of these metastatic emboli and initiation of effective chemotherapy may prove beneficial for improved quality of life.
Inhibition by 1,25 dihydroxyvitamin D3 of chemically induced erythroid differentiation of K562 leukemia cells. The physiologically active form of vitamin D, 1,25 dihydroxyvitamin D3 [1,25(OH)2D3], was found to inhibit erythroid differentiation of human leukemic K562 cells. Differentiation was induced by 1 mumol/L arabinocytosine (Ara-C), 40 mumol/L tiazofurin, 1 mumol/L aphidicolin, or 1 mumol/L hydroxyurea, and was monitored daily by the appearance of hemoglobin in an increasing proportion of cells. Pretreatment for 48 hours with 2.4 x 10(-8) mol/L 1,25(OH)2D3, a concentration that is also optimal for induction of monocytic differentiation of HL-60 cells, reproducibly inhibited subsequent induction of erythroid differentiation by all of the above inducers, and modified the morphologic changes that Ara-C produced in these cells. The inhibition of hemoglobinization was approximately 50% irrespective of the degree of differentiation produced by the various inducers, but growth inhibition associated with exposure to the inducers was not affected by 1,25(OH)2D3. Similar inhibition of differentiation by 1,25(OH)2D3 was observed in mouse erythroleukemia cells MEL-D1B treated with 5 mmol/L hexamethylenebisacetamide. The inhibitory effect of 1,25(OH)2D3 on erythroid differentiation of K562 cells was abrogated by cyclohexamide (20 micrograms/mL), an inhibitor of protein synthesis. The mRNA for 1,25(OH)2D3 receptor (VDR) was detected in K562 cells, and was downregulated by a 96-hour exposure to 1,25(OH)2D3 or a 48-hour exposure to Ara-C. The presence of VDR mRNA suggests a physiologic role for 1,25(OH)2D3 in K562 cells that are precursors of erythroid cells. This role is perhaps to shift the pathways of differentiation from the erythroid to the monocytic lineage.
Surgical aspects of sclerosing cholangitis. Results in 178 patients. Of 178 patients with sclerosing cholangitis treated since 1950, 88 patients had associated inflammatory bowel disease, 72 had no such history, and 18 had iatrogenic injury or stone disease. A total of 233 biliary operations were performed, with a 75% rate of temporary improvement after initial operation. Subsequent operations resulted in a lower success rate and a higher mortality rate. Radiologic findings included predominant extrahepatic, intrahepatic, and diffuse disease in 29%, 28%, and 43% of patients, respectively; no survival differences were noted. Seventy-five of one hundred three deaths (73%) were related to liver failure, bleeding, or sepsis. Of 14 patients undergoing portosystemic shunt, 13 died of surgical complications or related disease. Orthotopic liver transplantation was performed in 16 patients and resulted in eight deaths, mainly in patients who had previously undergone extensive surgical treatment. No survival differences were seen between the patients with inflammatory bowel disease, those without the condition, or those who had colectomy. Surgical treatment in patients with sclerosing cholangitis should be minimized. Orthotopic liver transplantation should be offered as the treatment of choice for patients with portal hypertension, refractory cholangitis, advanced cirrhosis, or progressive liver failure.
Management and outcomes of pregnancies complicated by human B19 parvovirus infection: a prospective study During a large statewide outbreak of fifth disease in Connecticut in 1988, 39 pregnant women were identified who had serologic evidence of recent human B19 parvovirus infection. The patients were followed up prospectively with targeted fetal ultrasonographic examinations to detect signs of fetal hydrops. Of these 39 pregnant women, 37 had healthy infants and two patients had miscarriages. None of the fetuses developed hydrops. We propose that pregnant women exposed to B19 parvovirus be tested for evidence of IgG and IgM B19-specific antibodies and that targeted fetal ultrasonography be considered when IgM antibodies are found. Percutaneous umbilical blood sampling and intrauterine transfusion can be considered in cases of B19 parvovirus-associated hydrops and anemia. The overall fetal loss rate in this prospective follow-up group was 5%.
Diagnosis of metastatic lesions to the stomach by salvage cytology. A report of three cases. Secondary neoplasms of the stomach are rare and are often clinical and diagnostic problems. Three patients with bleeding "volcano-like" ulcers were diagnosed by combined endoscopic "salvage" cytology and surgical biopsy as having metastatic submucosal lesions from hematologic spread. The combination of endoscopic appearance, clinical findings, and tissue and cytologic examination can lead to the correct diagnosis. The results from these cases support the utility of this cytologic technique in combination with biopsy in this clinical setting.