123rc/medical_text huggingface dataset:
Systolic wall stress and ventricular arrhythmia: the role of acute change in blood pressure in the isolated working rat heart. 1. The effect of a sudden acute change in blood pressure upon arrhythmia provocation has been studied in an isolated working heart model from the Wistar-Kyoto strain of rat. Twenty-four hearts were studied. 2. They were perfused with two different, modified, Krebs-Henseleit solutions at a fixed left atrial pressure. 3. Acute changes in pressure, both increases and decreases, were arrhythmogenic. Whilst ectopic activity was more predictably produced by pressure reductions, this consisted of simple ventricular ectopics only. Pressure increases, in contrast, were capable of provoking more complex and sustained arrhythmias. 4. The effect of pressure changes were highly dependent upon electrolyte concentrations in the perfusate. Low potassium and magnesium concentrations increased the amount of arrhythmia provoked by pressure increases but tended to reduce that provoked by pressure reductions. 5. We conclude that the direct effect of an acute change in pressure upon the myocardium is arrhythmogenic. However, the myocardial response to a pressure change is interdependent upon prevailing electrolyte concentrations.
Increased microvascular permeability in vivo in response to intradermal injection of neutrophil-activating protein (NAP-2) in rabbit skin. Neutrophil-activating protein-2 (NAP-2), an NH2-terminally processed form of the platelet-release product beta thromboglobulin (beta TG), was purified to homogeneity from stimulated human blood leukocytes. In the presence of a vasodilator substance (PGE2, CGRP) picomolar (pmol/l) amounts of NAP-2 induced neutrophil accumulation and plasma leakage on intradermal injection in rabbit skin, whereas the longer forms, beta TG itself and connective tissue-activating peptide III (CTAP-III), had no such effect. NAP-2-induced increased in microvascular permeability was neutrophil dependent and fast in onset, with a half-life of 65 to 75 minutes, comparable to that previously reported for the structural-related neutrophil-activating protein-1/interleukin-8 (NAP-1/IL-8). However NAP-2 showed a lower potency in that more protein was needed to provoke skin reactivity. Nevertheless the finding that a platelet release product can elicit neutrophil-mediated inflammation further narrows the gap between thrombotic events and inflammatory disorders.
Early tracheostomy for primary airway management in the surgical critical care setting. During a 12-month period, 264 patients with multiple injuries who required mechanical ventilation were admitted to the surgical intensive care unit. One hundred twenty patients (46%) were disengaged from the ventilator, and 38 patients (14%) died. Of the remaining 106 patients (40%) 51 patients (group I) were to receive tracheostomy within 1 to 7 days, and 55 patients (group II) underwent late (8 or more days after admission) tracheostomy. Multiple variables in four categories (admission, operative, ventilatory, and outcome) were analyzed prospectively to define the impact that early tracheostomy had on duration of mechanical ventilation, intensive care stay, and hospital stay. Morbidity and mortality rates of the procedures were assessed. Early tracheostomy, in a homogeneous group of critically ill patients, is associated with a significant decrease in duration of mechanical ventilation, as well as shorter intensive care unit and hospital stays, compared with translaryngeal endotracheal intubation. There were no deaths attributable to tracheostomy, and overall morbidity of the procedures was 4%. We conclude that early tracheostomy has an overall risk equivalent to that of endotracheal intubation. Furthermore, early tracheostomy shortens days on the ventilator and intensive care unit and hospital days and should be considered for patients in the intensive care unit at risk for more than 7 days of intubation.
Pars plana vitrectomy for acute retinal detachment in penetrating ocular injuries. We studied 41 eyes with acute retinal detachment after penetrating ocular trauma in a retrospective cohort analysis. Pars plana vitrectomy was performed in 28 eyes, while the remaining 13 eyes had only primary repair and closure of the wound. The two groups differed in the type of trauma (more gunshot wounds in the vitrectomy group and more blunt injuries in the nonvitrectomized group). Visual success (visual acuity of 5/200 or better) was observed in 10 (37%) of the eyes treated by vitrectomy compared with one (8%) of the eyes in the nonvitrectomy group. Anatomic success was achieved in 21 (75%) of the eyes in the vitrectomy group but in only one (8%) of those in the nonvitrectomy group. Enucleation or phthisis was observed in seven (54%) of the eyes in the nonvitrectomy group compared with only five (18%) in the vitrectomy group. Significant prognostic factors for anatomic outcome in the vitrectomy group were the location of the laceration and the presence of the lens.
Continuous muscle fiber activity, peripheral neuropathy, and thymoma. Two patients, one of them with myasthenia gravis, presented symptoms of continuous muscle fiber activity syndrome before discovery of a thymoma. Peripheral neuropathy was present in both patients, with axonal and demyelinating lesions in sural nerve biopsy. The syndrome remained unchanged or worse after thymectomy. Both patients died of associated complications.
Open-heart surgery in Jehovah's Witnesses. During a 7-year period, 11 adult members of the religious sect Jehovah's Witnesses underwent cardiac surgery with extracorporeal circulation. No homologous blood transfusions were given. Blood-conserving procedures were employed, viz. initial collection of autologous blood, haemofiltration or processing (Cell Saver) of blood collected during extracorporeal circulation and reinfusion of shed mediastinal blood. The total perioperative blood loss averaged 1080 ml (15 ml/kg body weight), equalling 19% of total body blood volume. The mean haemoglobin on discharge from hospital was 11.0 g/100 ml. There was no perioperative mortality. Postoperative pulmonary function was good and there was no serious morbidity. Jehovah's witnesses with serious, surgery-necessitating heart disease can be offered operation comprising recognized blood-conserving procedures.
Diagnosis of pneumoperitoneum on supine abdominal radiographs. A blinded, retrospective study was performed to determine the value of supine abdominal radiographs in diagnosing pneumoperitoneum. Supine films from 44 cases of pneumoperitoneum were randomly interspersed among supine films from 87 control subjects without free air, and the films were reviewed for the presence or absence of various signs of pneumoperitoneum, including Rigler's sign (gas on both sides of the bowel wall), the falciform ligament sign (gas outlining the falciform ligament), the football sign (gas outlining the peritoneal cavity), the inverted-V sign (gas outlining the medial umbilical folds), and the right-upper-quadrant gas sign (localized gas in the right upper quadrant). One or more of these signs were present in 26 cases (59%) of pneumoperitoneum, including the right-upper-quadrant gas sign in 18 cases (41%), Rigler's sign in 14 cases (32%), and the falciform ligament and football signs in one case each (2%). Unfortunately, there were frequent errors in the interpretation of the right-upper-quadrant gas sign and Rigler's sign, with a total of 11 false-positive cases (13%). Further analysis of the true-positive right-upper-quadrant gas signs showed that these gas collections were always triangular or linear with an inferolateral to superomedial orientation and, if triangular, a concave superolateral border. In the true-positive Rigler's signs, the bowel wall thickness ranged from 1 to 8 mm, whereas the false positives all had a bowel wall thickness of 1 mm or less. Proper interpretation of the various signs of pneumoperitoneum on supine films should lead to more accurate diagnosis of this condition.
Options for surgical repair in hearts with univentricular atrioventricular connection and subaortic stenosis. Thirteen patients have undergone surgical treatment because of subaortic obstruction in hearts with a univentricular atrioventricular connection. Nine patients underwent surgical enlargement of the ventricular septal defect and four patients had construction of an aortopulmonary anastomosis and closure of the pulmonary trunk (the Damus-Kaye-Stansel procedure). Two patients undergoing enlargement of the septal defect and two having the Damus-Kaye-Stansel procedure also had a modified Fontan procedure. One patient had complete atrioventricular dissociation after direct enlargement of the ventricular septal defect, which necessitated insertion of an epicardial pacemaker. One patient died within 30 days of the operation after enlargement of the defect and two patients after the Damus-Kaye-Stansel procedure. There was one late death, occurring in a patient who underwent enlargement of the ventricular septal defect. Ten patients have subsequently undergone conventional cardiac catheterization and angiography or transcutaneous Doppler flow studies to assess the relief of the subaortic obstruction. The result has been satisfactory in all. Because of this experience, we now recommend direct surgical enlargement of the restrictive ventricular septal defect for direct relief of subaortic stenosis occurring with a univentricular atrioventricular connection to a dominant left ventricle, inasmuch as it appears to be hemodynamically effective with a low operative mortality and morbidity. The Damus-Kaye-Stansel procedure can also have a role in relieving subaortic stenosis when the atria are connected to a dominant right ventricle.
Usefulness of tomographic thallium-201 imaging for detection of restenosis after percutaneous transluminal coronary angioplasty. The role of tomographic thallium-201 exercise and redistribution imaging in the detection of restenosis after percutaneous transluminal coronary angioplasty (PTCA) was evaluated in 116 patients: 61 (53%) with 1- and 55 (47%) with multivessel PTCA, with a total of 185 dilated vessels. Complete revascularization was performed in 89 (77%) and partial revascularization in 27 (23%) of the patients. Restenosis was angiographically demonstrated in 69 (60%) of the patients and 85 (46%) of the vessels 6.4 +/- 3.1 months after PTCA. Disease progression in previously normal vessels was noted in 11 patients. The results were: (1) for detection of restenosis in the group of patients, single-photon emission computed tomographic (SPECT) versus exercise electrocardiographic sensitivity was 93 vs 52% (p less than 0.001), specificity 77 vs 64%, and accuracy 86 vs 57% (p less than 0.001). The results were similar in the complete and partial revascularization groups. (2) SPECT was 86% sensitive, specific and accurate for restenosis detection in specific vessels with comparable results for 1-versus multivessel PTCA and complete versus partial revascularization. Sensitivity, specificity and accuracy were: 89, 95 and 92% for the left anterior descending coronary artery; 88, 79 and 82% for the right coronary artery; and 76, 83 and 85% for the left circumflex coronary artery. Eighty-one percent of the diseased nondilated vessels were correctly identified. (3) Disease progression to greater than 50% stenosis was detected with 91% sensitivity, 84% specificity and 85% accuracy. SPECT thallium-201 imaging is an excellent tool for the detection of restenosis and disease progression after PTCA in the settings of 1- and multivessel angioplasty and complete and partial revascularization.
Prune belly syndrome in females: a triad of abdominal musculature deficiency and anomalies of the urinary and genital systems. We describe seven female patients with deficient abdominal wall musculature and urinary tract and genital anomalies that represent the female equivalent of the prune belly syndrome. Urethral atresia, uterine duplication, and anorectal anomalies occurred frequently. The perinatal mortality rate was high; of the four surviving patients, renal failure developed in two and renal transplantation was required. The analysis of these cases suggests that urethral obstruction is an important factor contributing to the development of the prune belly syndrome in females.
Cervicography for evaluating the "atypical" Papanicolaou smear. A study was designed to compare various case-finding procedures in the evaluation of patients with an "atypical" Papanicolaou smear. Six hundred eighty-one consecutive patients were referred to the Denver General Hospital Colposcopy Clinic for smears showing evidence of atypical nuclear and/or cytoplasmic changes insufficient to justify a cytologic diagnosis of dysplasia. A full colposcopic evaluation with appropriate directed biopsies was carried out on all the patients. Fourteen percent of the patients demonstrated cervical intraepithelial neoplasia (CIN), and 29% had condyloma without CIN. Both cervicography and the colposcopist's impression, though not ideal, were superior to a repeat smear, human papillomavirus typing or both. Cost effectiveness criteria and ease of training appear to justify the use of cervicography in the evaluation and triage of patients with atypical Papanicolaou smears.
Pulmonary artery-bronchus ratios in patients with normal lungs, pulmonary vascular plethora, and congestive heart failure. The pulmonary artery-bronchus ratio (ABR), defined as the external diameter of a pulmonary artery divided by the external diameter of its accompanying bronchus, was measured in the upper and lower lung zones on frontal chest radiographs in the following groups of subjects: erect healthy subjects, erect subjects with pulmonary vascular plethora, erect subjects with clinical evidence of decompensated left-sided congestive heart failure (CHF), supine normal subjects, and supine subjects with clinical evidence of decompensated CHF. Characteristic vascular patterns were found in each group. The positive predictive value of an abnormal vascular pattern determined by means of changes in the ABR on the erect chest radiograph was 100%, with the negative predictive value of a normal pattern being 97%. The erect chest radiograph was 93% accurate in distinguishing between plethora and CHF. The positive predictive value of an abnormal vascular pattern on the supine chest radiograph was 100%, with the negative predictive value of a normal vascular pattern being 97%. Measurements of ABR can be a helpful adjunct to the interpretation of supine and erect chest radiographs.
Late rupture of a superior intercostal artery following repair of aortic coarctation. Having had surgical repair of aortic coarctation at the age of 12 years, and re-operation at the age of 19 years for stenosis at the site of the previous repair, a 29 years old man presented as an emergency with a 24 hour history of interscapular pain, haemoptysis and collapse. At thoracotomy he was found to have a ruptured superior intercostal artery which was ligated. Spontaneous rupture of an intercostal artery has not been previously recorded.
Severe anaphylactoid reaction to hydroxyethyl starch. A case is presented of a severe anaphylactoid reaction to hydroxyethyl starch solution that occurred peri-operatively and required extended intensive management of the resultant bronchospasm and hypotension. Subsequent intradermal injection of hetastarch produced a delayed positive response, suggestive of a complement-mediated mechanism.
Is the treatment of metastatic carcinoid tumor with interferon not as successful as suggested? Eight patients with metastatic carcinoid tumor, seven of whom had symptoms of the carcinoid syndrome, were treated with either human leukocyte interferon (seven patients) or recombinant alpha-interferon (IFN alpha-2b) (one patient) at doses of 4.5 to 21 x 10(6) IU weekly for 1 to 21 (mean, 8.5) months. Tumor regression on computed tomography (CT) scan was found in one patient, the CT findings remained unchanged in three, and the tumor progressed in four patients. A clearcut and continuing decrease in urinary levels of 5-hydroxyindoleacetic acid (5-HIAA) was observed in one patient and a transient one in four patients. The symptoms improved in only two of seven patients. Four patients had leukopenia develop, which was circumvented by reducing the dose. The authors conclude that interferon therapy of the carcinoid tumor is not as successful as has been suggested in previous reports.
Long-term follow-up of 24 patients undergoing radical resection for ampullary carcinoma, 1953 to 1988. Potentially curative radical pancreaticoduodenectomy for ampullary adenocarcinoma was performed in 24 patients over a 35-year period. The overall operative mortality was 12.5%. Actuarial survival rate at 5 years was 61% +/- 13.4 standard error of the mean (SEM) and subsequently remained unchanged. In the same time period, 21 patients underwent potentially curative radical pancreaticoduodenectomy for periampullary tumors of pancreatic origin. Similar analysis showed an overall operative mortality of 23.8% and a survival rate at 5 years of 27% +/- 12.5 SEM. The results of radical pancreaticoduodenectomy for ampullary carcinoma in the most recent years (1976 to 1988) were compared with those of former years (1953 to 1975). There were no statistically significant differences in the 5-year survival rate; however, the operative mortality decreased from 25% in the former period to 6.3% in the recent period. Survival was dependent on nodal status. The 5-year survival rate was 78% +/- 11.5 SEM in the absence of nodal metastasis versus 50% +/- 25 SEM in the presence of regional nodal metastasis. These findings support the concept that radical pancreaticoduodenectomy offers a realistic probability for cure in a selected group of patients with carcinomas of the ampulla of Vater.
Dynamic analysis of the Harrington system using a spinal simulator. The authors constructed a spinal simulator for the thoracolumbar spine with mechanical properties similar to those of cadaver specimens, and studied the effectiveness of the Harrington system in unstable fractures of the thoracolumbar spine. Distraction and compression rods were applied under various conditions. External bending moment was applied to the model to measure the internal bending moment on the vertebral body and ligaments. Optimal spinal stability was obtained when the distraction system was combined with the compression system with hooks at laminas three levels above and below the fracture.
Anomalous origin of the left coronary artery from the pulmonary artery. Surgical alternatives depending of the age of the patient. Four cases of anomalous origin of the left coronary artery from the pulmonary artery, three of which were operated upon in our Centre, are presented. An aortocoronary bypass with reversed autologous saphenous vein was carried out in both of the children; and in the adult, the anomalous ostium was closed from the interior of the pulmonary artery. After 84, 72, and 4 months of evolution, respectively, they were found to be asymptomatic, the mitral insufficiency had disappeared and the venous graft remained patent. In this paper, the clinical form of presentation, diagnostic possibilities and surgical treatment are analysed.
Candidal infection in oral lichen planus. The prevalence of candidal infection in lichen planus (LP) and its possible association with ulceration were independently examined in two archived series of 108 and 77 cases derived from two separate populations. To ensure that similar material was being compared, each case was histopathologically reassessed and confirmed as LP or reclassified as nonspecific lichenoid stomatitis (NSLS), lichenoid dysplasia (LD), or other (O). Three further sections, cut at 25 microns intervals, were stained with periodic acid-Schiff reagent for the identification of intraepithelial candidal pseudohyphae. As control specimens, 61 normal and 59 hyperkeratotic mucosal samples were similarly processed and examined. Candidal infection was found in 17.4% and 16.4% of ulcerated and nonulcerated LP cases, respectively, and in 40.0% and 16.7% of ulcerated and nonulcerated NSLS cases, respectively. One case of LD was infected. Each control series contained one infected case. The results indicate that candidal infection occurs more readily in LP and NSLS, with no apparent association with ulceration in LP. The comparatively marked increase in the infection prevalence of ulcerated NSLS cannot be statistically confirmed, and its significance remains uncertain.
The role of chemotherapy for node-negative breast cancer. Approximately 25% of women with early stage breast cancer and negative axillary nodes will eventually die of metastatic disease. Some studies have shown a recurrence rate of 40% or more at 10 years in this relatively good prognostic group. The incidence of breast cancer continues to increase approximately 1% per year with a great increase in the frequency of early stage disease (particularly in situ carcinoma). The increased use of mammography and physical examination with appropriate follow-up will increase the frequency of diagnosis of node-negative patients compared with those with more advanced stages. Women with positive axillary nodes who are premenopausal benefit from adjuvant chemotherapy, whereas those who are postmenopausal have shown a clear reduction in mortality when treated with tamoxifen. It is even more reasonable to speculate that women with node-negative disease could have an even greater benefit from adjuvant therapy because they have a lower tumor burden at the time of diagnosis. Compared with earlier clinical adjuvant trials, more recent studies (1981-89) have shown a disease-free survival advantage for node-negative breast cancer patients treated with adjuvant chemotherapy. Hopefully, the differences noticed in disease-free survival will show a similar survival advantage with further observations. The results of these clinical trials suggest that adjuvant chemotherapy may be of benefit to patients with node-negative disease but do not support the contention that all node-negative patients with breast cancer should receive adjuvant chemotherapy. Some prognostic subgroups (tumor size greater than 2 cm) have shown an overall 10-year survival rate of 92% for women who have not received adjuvant therapy. The benefits versus toxicities of adjuvant therapy should be carefully evaluated before the initiation of adjuvant therapy.
An interdisciplinary nutrition assessment and intervention protocol for children with disabilities. Because of the multifactorial nature of the nutrition problems associated with developmental disabilities, a well-organized, interdisciplinary effort is necessary to deal with such problems. A team composed of professional and support staff, the client, and the family needs to be involved in an integrated approach to service. The team members share their knowledge and expertise in developing an individual program plan to meet identified needs. This article describes the development and implementation of a prototype for interdisciplinary nutritional evaluation and intervention in an outpatient setting. In 1987, a Regional Nutrition and Feeding Diagnosis and Evaluation Clinic was established through a contractual agreement between the University of Georgia University Affiliated Program and St. Mary's Hospital in Athens, GA. The purposes of the clinic are twofold: to offer direct services to developmentally disabled infants and children who require outpatient services and to provide a unique community-based interdisciplinary training experience for graduate students in nutrition and other health disciplines. The interdisciplinary treatment protocol is based on current knowledge in the treatment of developmental disabilities.