123rc/medical_text huggingface dataset:
Inner ear cholesteatoma and the preservation of cochlear function. Labyrinthine destruction by direct cholesteatoma invasion has always been considered a serious threat to the inner ear function. A number of reports in the literature have cited both patients who had preservation of hearing despite widespread erosion of the labyrinth by cholesteatoma and patients who had retained auditory function despite surgical removal of the matrix from the labyrinth. In most cases the vestibular portion of the inner ear was invaded but cases of cochlear involvement have been described as well. Twelve cases with pre-operative auditory function preservation despite extensive labyrinthine destruction treated at our Institution are reported. Seven cases retained cochlear function post-operatively. Possible explanations of this occurrence and implications of related with hearing preservation in the presence of widespread inner ear destruction by chronic inflammatory disease are discussed.
Neuro-ocular Lyme borreliosis. Any patient who has a Bell's palsy (unilateral or bilateral), aseptic meningitis, chronic fatigue syndrome, atypical radiculoneuropathy, presenile dementia, atypical myopathy, or symptoms of atypical rheumatoid arthritis should be asked specifically about the following: visits to highly endemic areas, any known tick bites, any skin lesion suggestive of erythema migrans, any history of palpitations or of prior Bell's palsy, aching in joints (especially the knees), paresthesias, chronic fatigue and depression, forgetfulness, and eye problems. Any patient showing a chronic iritis with posterior synechiae, vitritis in one or both eyes, an atypical pars planitis-like syndrome, big blind spot syndrome, and swollen or hyperemic optic discs should be asked the same questions. The physician should send one red-top tube of blood containing 2 to 3 ml serum to Microbiology Reference Laboratory, 10703 Progress Way, Cypress, CA 90630-4714, requesting a Lyme/treponemal panel. For $90 the patient will receive an RPR test with titer, serum FTA-ABS test, serum Lyme IFA IgG and IgM, and a serum Lyme ELISA test. If these tests are within normal limits and the physician is still suspicious, a Western blot can be ordered on serum. A green top tube with fresh white blood cells sent out by overnight express on a Monday or Tuesday will produce a Lyme PCR and a lymphocyte stimulation test. Finally, R.K. Porschen, director of MRL Laboratory, will provide information on the urine antigen test on an investigational basis. A careful history with emphasis on the specific questions noted above, a complete neuro-ophthalmological and physical examination ruling out other causative problems, and the laboratory studies here discussed will usually provide sufficient data to choose therapy. Much further active research into Lyme borreliosis is an important priority in medicine.
Rectus abdominis muscle flap with microvascular anastomoses for repair of recurrent sarcoma. After radical resection of a recurrent leiomyosarcoma, the thoracic wall was stabilized with a Gore-Tex graft. The skin and soft tissue defect was repaired with a large rectus abdominis flap in which the circulation was secured by end-to-end microvascular anastomosis of the inferior epigastric artery to the internal mammary artery, which had to be cut during tumor removal.
Increase of intraplatelet free calcium ion during extracorporeal circulation with a hollow fiber oxygenator: arterial filter and dynamics of platelet thrombosis on oxygenator and filter in a pig model. Intraplatelet free calcium (IPFC) ions provide a common pathway for platelet activation leading to thrombosis and embolization. IPFC levels were determined by chlorotetracycline fluorometry during extracorporeal circulation (ECC) with systemic heparin in eight Yorkshire pigs (weighing 30-40 kg; 3 control and 5 ECC); the ratio of slow phase organelle calcium sequestration to fast phase platelet-membrane binding is an index of free calcium. During 3 hr of ECC with a hollow fiber oxygenator (HFO) (Bentley CM-50) and AF (Bentley 1025), seven blood samples were collected 5 min before and during ECC. The platelet deposition (CPM/microCi) on HFO (PDHFO) was simultaneously measured with In-111-labeled autologous platelets (300-400 microCi) and a Geiger probe detector at -5, 0, 5, 30, 45, 60, 120, and 180 min. During ECC, IPFC and HFO thrombus increase significantly (p less than 0.05) at 45 min with respect to control IPFC values of 0.4 +/- 0.1, suggesting direct participation of calcium activated platelets in thrombosis on HFO. The decline of IPFC is due to extrusion and sequestration by dense granules, and decline in HFO thrombus is due to embolization. On the other hand, the embolus in the arterial filter was trapped in a linear fashion, with a consistent increase with time of ECC.
Low doses of IL-4 injected perilymphatically in tumor-bearing mice inhibit the growth of poorly and apparently nonimmunogenic tumors and induce a tumor-specific immune memory. The ability of rIL-4 to trigger host reactivity against both a chemically induced fibrosarcoma (CE-2) and a spontaneous adenocarcinoma (TS/A) of BALB/c mice was studied. Daily local s.c. administration around tumor draining lymph nodes of 10 injections of progressive amounts (0.00001 to 1000 pg/day) of rIL-4 induced appreciable inhibition of the growth of both tumors after a dose-response survival curve peaking at 0.1 pg/day. Inasmuch as rIL-4 has no direct antitumor activity, as shown by in vitro tests, host immune reactivity plays a fundamental role in this lymphokine activated tumor inhibition (LATI). LATI, in fact, is abolished when recipient mice are sublethally irradiated or treated with cyclosporin A, or when the reactivity of CD4+ lymphocytes is suppressed, whereas it is not affected by anti-asialo GM1 antibody. The morphologic data show that rIL-4 LATI rests on the recruitment of several cell reaction mechanisms, among which those that are nonspecific seem to predominate. rIL-4 LATI also leads to a state of long lasting and specific immune memory: the growth of a second contralateral tumor challenge is significantly impaired after LATI. This immune memory takes place after LATI of both the poorly immunogenic CE-2 fibrosarcoma and the TS/A adenocarcinoma, previously classed as nonimmunogenic on the basis of immunization-protection tests. In the latter case, adoptive transfer experiments show that Thy-1+ lymphocytes and, in particular, the CD4 cell-depleted T lymphocyte subpopulation, are responsible for the immune memory. Finally, the ability of rIL-4 to trigger LATI is greater than that of the most effective doses of rIL-2, rIL-1 beta, and IFN-gamma, whereas its association with rIL-1 beta induces a more effective immune memory.
Clinical judgments in pain management. From research reports published over the last 20 years, it appears that moderate to severe uncontrolled pain may be the norm for hospitalized patients despite recent advances in the management of pain. Research on the extent of under-management of pain and the factors associated with it is examined and summarized in this paper. Methodological imperfections of the research are identified. Several explanations for pain under-management have been proposed and these are reported. A clinical decision making model is also reviewed and it is suggested that this model could be applied to pain management problems. Further, it is suggested that this model may be very useful in developing educational interventions to improve health practitioners' clinical skills in pain management.
Response to treatment of detrusor instability in relation to psychoneurotic status. A total of 53 females who entered a double-blind crossover trial of oxybutynin and placebo for idiopathic detrusor instability were questioned about life events and associated medical disorders and were given a psychometric test. Their response to treatment was studied in relation to these factors. It was found that 11% of patients had nocturnal enuresis beyond age 8 and 25% had irritable bowel syndrome: their response to treatment was generally poor. Life events were not consistently related to treatment response. The mean psychoneurotic score of "poor responders" (43.7) was similar to that of female psychoneurotic out-patients (47.7), although one-third of poor responders were normal. Patients who responded well to simple anticholinergic treatment had a mean score (30.7), which was similar to that of normal urban females (33.5). Most good responders and one-third of poor responders showed little evidence of psychoneuroticism: a further search for neurophysiological abnormality in idiopathic detrusor instability is needed.
Brainstem auditory evoked response and subcortical abnormalities in autism. Previous studies of the neurobiology of autism that have used the brainstem auditory evoked response have given contradictory results. The authors of this study considered two supplementary aspects; they added an ipsilateral masking procedure, and they compared the results for every subject to the values (corrected for age and sex) of a large number of normal children. Twenty autistic (according to DSM-III-R criteria) and 13 mentally retarded (nonverbal IQ less than 75) subjects were assessed. Eighty percent of the autistic subjects had abnormal interpeak latencies, compared to 15% of the mentally retarded subjects. The I-V and III-V prolonged interpeak latency values were seen only in the autistic subjects. The ipsilateral masking procedure doubled the rate of detection of higher-brainstem abnormalities in the autistic children.
Nondiagnosed left main ostial stenosis partly due to the use of 5 French coronary angiographic catheters. Two cases have been reported in which the use of 5 F angiographic catheters is associated with a failure to diagnose an ostial stenosis of the left main coronary artery (LMCA). In both cases, the erroneous diagnosis led to an inappropriate indication for percutaneous transluminal coronary angioplasty (PTCA) on other stenosed vessels, and the ostial left main lesion was unexpectedly discovered when using 8F guiding catheters. It is supposed that the ability of performed 5F catheters to pass easily through an ostial lesion makes detection of such proximal stenosis much more difficult. We suggest that the choice of 5F catheters must be approached with caution when left main disease is potentially expected from the clinical features.
A frameshift mutation leading to type 1 antithrombin deficiency and thrombosis. Type 1 antithrombin III (ATIII) deficiency, which is the commonest form of inherited ATIII defect, is characterized by a quantitative reduction in both immunologically and functionally detectable protein. This condition is associated with a high incidence of thromboembolic disorder. Previous investigations have shown that the ATIII genes in the majority of cases are grossly intact, but the precise underlying molecular defects remain unknown. We have investigated the molecular basis of a type 1 ATIII deficiency in an Italian kindred by enzymatic amplification of the ATIII gene sequences in affected family members and direct sequencing of the amplified genomic DNA. A novel mutation, the deletion of a single T in the second position of codon 119, was identified in each of the affected individuals. The resulting frameshift leads to a premature termination in codon 126, effectively resulting in a null allele.
Surgical management of oculomotor nerve palsy We treated seven patients with unilateral oculomotor nerve palsy by transposition of the insertion of the superior oblique tendon to a point anterior and medial to the insertion of the superior rectus muscle without trochleotomy (Scott procedure). Additionally, large recessions of the lateral rectus muscle of involved eyes and, occasionally, recess/resect procedures of horizontal recti muscles of non-involved eyes were performed. All patients were followed up between one and eight years. Orthophoria in the primary position was achieved and maintained with one operation in four patients. A fifth patient had only a small residual exotropia. In two patients who had aberrant regeneration of the oculomotor nerve, surgery on horizontal recti muscles of the noninvolved eye improved the eyelid position of the involved eye after three operations.
Changes in left ventricular diastolic performance after aortic balloon valvuloplasty: acute and late effects To evaluate acute and follow-up changes in left ventricular diastolic performance, simultaneous digital left ventriculography and micromanometry were performed in 49 patients undergoing aortic balloon valvuloplasty. All patients improved symptomatically after valvuloplasty, and 26 returned 6.3 +/- 1.5 months later for follow-up catheterization. Immediately after valvuloplasty, aortic valve area increased (before 0.5 +/- 0.2 versus after 0.8 +/- 0.2 cm2, p less than 0.01), cardiac output (before 4.3 +/- 1.2 versus after 4.4 +/- 1.3 liters/min) and ejection fraction (before 51 +/- 18% versus after 52 +/- 17%) did not change and diastolic indexes worsened, signified by a decrease in peak filling rate (before 247 +/- 80 versus after 226 +/- 78 ml/s, p less than 0.01) and increase in the time constant of isovolumetric relaxation (tau) (before 78 +/- 29 versus after 96 +/- 40 ms, p less than 0.01) and the modulus of chamber stiffness (before 0.107 +/- 0.071 versus after 0.141 +/- 0.083, p less than 0.01). At follow-up catheterization, 16 patients continued to have symptomatic improvement (group 1) and 10 had recurrence of symptoms (group 2). Aortic valve area, cardiac output and ejection fraction at follow-up catheterization in both groups were similar and unchanged from values before valvuloplasty.
Kindling susceptibility and genetic seizure predisposition in inbred mice. Olfactory bulb kindling rates were studied in two inbred strains of genetically seizure-prone mice (DBA/2 and El) and in three non-epileptic inbred strains [C57BL/6 (B6), ddY, and C3H/He (C3H)]. None of the DBA/2 mice had been stimulated to seizure before or during the kindling and all mice were studied at 4-6 weeks of age, before development of spontaneous or movement-induced seizure activity in the El strain. The audiogenically seizure-susceptible DBA/2 mice required the fewest number of stimulations to reach stage 5 seizure (mean +/- SE = 4.0 +/- 0.6). The nonepileptic C3H mice required the most stimulations to reach stage 5 seizures (22.6 +/- 1.4). Kindling rates for B6 (9.6 +/- 0.6), El (14.8 +/- 1.1), and ddY (18.5 +/- 1.0) strains were intermediate, and the kindling rate for each strain was significantly different from that of the other strains. These findings show that the seizure-susceptible El mouse kindles more rapidly than the genetically similar but nonepileptic ddY control and suggest that an inherited seizure susceptibility accelerates the kindling rate. Nonepileptic B6 mice kindled more rapidly than El mice, however, suggesting that genetic factors other than those that influence seizure susceptibility are of primary importance in the determination of the kindling rate.
Occurrence of beta-hexachlorocyclohexane in breast cancer patients. The residues of polycyclic aromatic hydrocarbon (PAH) and neutral organochlorine compounds in breast fat of 44 breast cancer patients and 33 women free of cancer were determined. No statistically significant differences appeared between the two comparison groups with regard to occurrence of PAH compounds. Of the neutral organochlorine compounds, residues of beta-hexachlorocyclohexane (HCH) were found more frequently in breast cancer patients. After adjusting for age and parity by stepwise logistic regression, beta-HCH remained a significant risk factor of breast cancer. Using a cutoff point for the residue level of beta-HCH in breast adipose tissue of more than 0.1 mg/kg fat, the odds ratio was 10.51 (95% CI, 2.00-55.26).
Use of the diaphragm to reinforce anastomosis of the intestines. Use of a diaphragmatic flap to buttress and help secure persistent intestinal fistula is described. The potential for the use of muscle flaps in the management of recurrent intestinal fistula is presented.
Physical features of Prader-Willi syndrome in neonates. A retrospective study of 16 patients was undertaken to identify physical features that may typify neonates with Prader-Willi syndrome. Several features known to be typical of Prader-Willi syndrome in early infancy were confirmed, including hypotonia and genital hypoplasia. A number of features that have not previously been emphasized as characterizing Prader-Willi syndrome were also identified, most notably abnormal cry and, in males, signs of genital hypoplasia but with an apparently normal phallus. Other features included disproportionately large head circumference, disproportionately large anterior fontanelle, mild micrognathia, mild anomalies of the gingivae or alveolar ridges, and changes in the appearance of the skin. Appreciation of these features may assist the pediatrician in recognizing the child with Prader-Willi syndrome during the neonatal period, before the appearance of better-known findings of later onset, such as obesity and acromicria.
Congestive heart failure: a current overview. Congestive heart failure (CHF), a disease seen primarily in the older patient, can be due to either systolic or diastolic dysfunction. Management is quite different if the heart failure is due to a filling abnormality as compared to poor ventricular systole. The disorder also poses many diagnostic pitfalls in the elderly. Current understanding of CHF and its influence on diagnosis and management is the focus of this review.
Desensitization in the management of vancomycin hypersensitivity. Vancomycin is the preferred antimicrobial agent in the treatment of methicillin-resistant staphylococcal infections. One of the well-known hypersensitivity reactions to this agent is the "red-man syndrome," which is believed to involve drug-induced histamine release in certain individuals. Although rate and/or dose reductions may be effective in some cases, some hypersensitivity reactions necessitate the discontinuation of vancomycin. In this article one patient is described who developed vancomycin-associated reactions consistent with the red-man syndrome despite having tolerated vancomycin administration previously. This case was managed by sequential increments in vancomycin administration over several days that allowed for therapeutic doses of the drug to be administered. Prior to desensitization, vancomycin administration at a lowered rate and dose was unsuccessfully attempted, despite the presence of combination antihistamine therapy. A loss of skin prick test reactivity to vancomycin was demonstrated after successful desensitization. This desensitization method may be useful in managing certain refractory cases of vancomycin hypersensitivity.
Studies evaluating antioxidants and beta-carotene as chemopreventives. Cancer chemoprevention research takes leads from epidemiologic and laboratory research and develops them through in vitro and in vivo preclinical research and initial human studies into randomized controlled clinical trials. At present, the chemoprevention program is sponsoring 21 human efficacy studies. These trials are testing the potential of agents (beta-carotene, folic acid, 13-cis retinoic acid, 4-hydroxyphenyl retinamide, vitamins C and E, and minerals) as inhibitors of a variety of cancers in humans (colon, lung, esophagus, cervix, bladder, and skin). Endpoints in these studies include overall incidence of cancer, incidence of specific cancers, rate of regression or progression of preneoplastic changes, and changes in cellular or biochemical parameters. Study participants include volunteers from the general population; populations at high risk for cancer because of occupation, lifestyle, or place of residence; persons with previously treated cancers; and persons with preneoplastic lesions. Study designs include single agent randomization, combination of agents and complete factorial designs.
The infant with a reddish diaper. The infant with a reddish diaper presents a diagnostic challenge to the primary care physician. As described by Dr Baumgardner, the cause may be benign, but more ominous disorders must be ruled out.
Tanning salons: an area survey of proprietors' knowledge of risks and precautions. An area survey of tanning salon proprietors was conducted in a medium-sized midwestern city. Proprietors reported they were in compliance with federal safety regulations, but not all had age, frequency, or duration restrictions. Similarly, proprietors were not uniformly informing patrons of potential tanning hazards, including the possibility of skin cancer, and were not knowledgeable about the risk and benefits of tanning. Some establishments reported selling psoralens to patrons to enhance tanning. More explicit guidelines regarding the use of tanning equipment and more accurate consumer information are needed.
Noninvasive assessment of cardiac output in children using impedance cardiography. This study evaluated the effect of intracardiac shunting on the accuracy of thoracic bioimpedance-derived cardiac output determinations. Twenty-six patients, ranging in age from 3 months to 17 years, underwent cardiac catheterization during which simultaneous Fick and impedance measurements of cardiac output were obtained. The subjects were divided into three groups: 10 children with no intracardiac shunts, nine children with predominant left-to-right intracardiac shunts, and seven children with predominant right-to-left intracardiac shunts. Positive correlations between impedance and Fick-derived cardiac output determinations were obtained in the non-shunt group (r = 0.84), with lower correlations in the left-to-right shunt group (r = 0.70). In the right-to-left shunt group, the impedance derived cardiac output correlated with Fick pulmonary flow (r = 0.82), but the variability was unacceptably large. Although further study is needed, impedance cardiography appears to have validity as a methodology in pediatric critical care and cardiovascular health research.
Persistent uptake of indium-111-antimyosin monoclonal antibody in patients with myocardial infarction. Indium-111(111In)-antimyosin scintigraphy was investigated in 27 patients with myocardial infarction. 111In-antimyosin Fab was administered intravenously, and planar and single photon emission computed tomographic images were obtained 48 hours later. Uptake of 111In-antimyosin was present in 9 of 10 patients (90%) studied within 6 days of infarction. During the second week positive scans were seen in 16 of 16 patients (100%) including 13 (81%) who had normal creatine kinase levels. The mechanism of persistent positive antimyosin images in the subacute stage of myocardial infarction remains to be clarified. 111In-antimyosin scintigraphy may be useful as a noninvasive method for the detection of myocardial injury late and early after a suspected acute myocardial infarction.