123rc/medical_text huggingface dataset:
The association between Type A behavior and change in coronary risk factors among young adults. The association of Type A/B behavior pattern and changes in blood pressure, total serum cholesterol, serum triglyceride, body mass, and smoking was estimated in a cohort of 375 young Black and White men and women from a rural county in Central Kentucky between 1978-79 and 1985-88. Type A participants experienced significant increases in systolic (2.90 +/- 1.29 mmHg) and diastolic (3.80 +/- 1.17 mmHg) blood pressure and in cigarette smoking (3.26 +/- 0.89 cigarettes per day) over the eight-year follow-up period, but Type B participants experienced no change. Type A and B individuals showed similar changes in total serum cholesterol, serum triglyceride, or body mass. Differences between behavioral types in blood pressure were present for women but not men, and for Blacks but not for Whites. These findings suggest a possible significance of the Type A pattern for the development of cardiovascular risk of young adults.
Dipyridamole technetium-99m-2-methoxy isobutyl isonitrile tomoscintigraphic imaging for identifying diseased coronary vessels: comparison with thallium-201 stress-rest study. A same-day double injection protocol employing 99mTc-methoxyisobutyl isonitrile (MIBI) and myocardial single-photon emission computed tomography (SPECT) for detecting coronary artery disease (CAD) was assessed in 30 patients. SPECT was performed 1 hr after a first injection (250 MBq) of 99mTc-MIBI, given after 0.56 mg/kg dipyridamole (DPD) infusion. Patients were then reinjected at rest (750 MBq) and were reimaged 1 hr later. Within 1 wk, all patients underwent a complete stress-rest SPECT thallium study. Of the 330 myocardial segments evaluated, 25 were judged ischemic by both techniques, while persistent defects were demonstrated in 50 and in 47 with 99mTc-MIBI and 201TI, respectively. Six regions were considered for diseased vessels identification. Sensitivity and specificity for CAD were 100% and 75%, respectively, for both 201TI and 99mTc-MIBI. Sensitivity for identification of diseased vessels by 201TI was 68% for LAD, 89% for RCA, and 80% for LCX as opposed to 75%, 89% and 80%, respectively, by 99mTc-MIBI. Specificity was 93% in both cases for LAD, 73% and 63% for RCA, and 53% and 46% for LCX.
A new challenge--robotics in the rehabilitation of the neurologically motor impaired. Rehabilitation robotics is a research area, originating in engineering, that has emerged in the last decade. Its broad aim is to use robot technology to assist people with movement dysfunction. The neurologically impaired population might gain considerably from the provision of robots as "assistants" or "therapy aides," but the interface with the machine must match both the physical and intellectual abilities of the user. We therefore consider a multidisciplinary approach, encompassing both behavioral and engineering perspectives, to be essential in achieving this aim. However, to date, published reports have been largely restricted to engineering journals or conference reports, and relatively little has appeared in the therapy literature. This article seeks to introduce physical therapists to robotics, describe possible applications to the rehabilitation of neurologically impaired patients, and suggest issues deserving further investigation.
Urinary tract infection: economic considerations. Urinary tract infection results in significant morbidity and mortality while consuming large amounts of national resources. The prevention, diagnosis, and treatment of urinary tract infection produce both costs and benefits, and economic analysis provides a rational framework for looking at these effects. The goals and methods of economic analysis in medicine are summarized, and strategies to address uncomplicated cystitis, nosocomial urinary tract infection, and pyelonephritis are reviewed, with an emphasis on the economic trade-offs faced by decision makers.
The association of hydrocephalus with intramedullary spinal cord tumors: a series of 25 patients. 171 patients with intramedullary spinal cord tumors were operated on, of which 25 patients (15%), mostly children, developed symptomatic hydrocephalus. Twenty patients (12%) had malignant tumors, with 13 of the 20 cases (63%) complicated by increased intracranial pressure and ventriculomegaly. Of the remaining 151 patients with benign tumors (89%), only 12 (8%) developed symptomatic hydrocephalus. In an effort to understand the relationship between hydrocephalus and intramedullary spinal cord tumor, the authors analyze the level and histology of the neoplasm, as well as its association with spinal cysts. A review of the neurosurgical literature reveals that 34 similar cases of hydrocephalus associated with intramedullary spinal cord tumors have been reported to date. The authors note that the presence of hydrocephalus in patients with malignant intramedullary astrocytomas is associated with a shorter rate of survival than in those patients with high-grade lesions but without hydrocephalus, apparently due to rapid tumor progression. The ventriculomegaly seen with benign spinal cord gliomas has no statistically significant effect upon long-term prognosis.
Pharmacokinetics of propofol infusions in patients with cirrhosis. We have compared the pharmacokinetics of propofol as an infusion in 10 control and 10 patients with cirrhosis. Anaesthesia was induced within 3-4 min during administration of an infusion of propofol 21 mg kg-1 h-1. After 5 min, the infusion was decreased in a stepwise manner to 12 mg kg-1 h-1 and subsequently 6 mg kg-1 h-1. The mean recovery time after discontinuation of the infusion was significantly longer in the cirrhotic group; however, when patients opened their eyes, blood concentrations of propofol were similar in both groups (1 micrograms ml-1). Pharmacokinetic analysis was performed from the beginning of infusion to 8 h after termination. Total body clearance was not reduced significantly in cirrhotic (1.56 (SD 0.48) litre min-1) compared with control (1.75 (0.32) litre min-1) patients. The volume of distribution at steady state was significantly greater in patients with cirrhosis than in control patients (202 (82) litre vs 121 (49) litre). However, this difference did not change terminal elimination half-life. The pharmacokinetics of propofol given by infusion to maintain general anaesthesia were not affected markedly by moderate cirrhosis.
Platelet monoamine oxidase B activity in parkinsonian patients. Monoamine oxidase B (MAO B) plays a pivotal role in N-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) induced Parkinsonism. An increased MAO B activity in platelets of patients with idiopathic Parkinson's disease (PD) is reported in this study. The possibility that high MAO B activity may represent a trait of vulnerability for PD by enhancing the neurotoxic effects of environmental compounds is discussed.
Selenium. Nutritional, toxicologic, and clinical aspects Despite the recent findings of environmental contamination, selenium toxicosis in humans is exceedingly rare in the United States, with the few known cases resulting from industrial accidents and an episode involving the ingestion of superpotent selenium supplements. Chronic selenosis is essentially unheard of in this country because of the typical diversity of the American diet. Nonetheless, because of the growing public interest in selenium as a dietary supplement and the occurrence of environmental selenium contamination, medical practitioners should be familiar with the nutritional, toxicologic, and clinical aspects of this trace element.
The value of routine preoperative laboratory testing in predicting postoperative complications: a multivariate analysis. The purpose of this study was to evaluate the ability of preoperative laboratory testing to predict postoperative complications. Five hundred twenty patients undergoing elective surgery had their American Society of Anesthesiologists' classification, ponderal index, electrolyte values, glucose levels, blood urea nitrogen/creatinine values, complete blood counts, coagulation studies, total protein/albumin/lymphocyte count, electrocardiogram, chest radiograph, urinalysis, pulmonary function tests, type of anesthesia, and type of operation recorded preoperatively. Patients were followed prospectively after surgery for the development of complications. The data were analyzed by univariate and multivariate methods. Postoperative complications were strongly associated with American Society of Anesthesiologists' classification, type of anesthesia, and type of operation. However, only a few laboratory tests, such as electrocardiogram, chest radiograph, and nutritional status, were associated with postoperative complications. Therefore, in general, preoperative laboratory testing should only be undertaken for specific indications. Recommendations for routine tests are made depending on the age of the patient.
Raised urinary secretory IgA in chronic diarrhoea. Secretory IgA outputs in urine have been measured in 24 malnourished Gambian children who had been admitted to hospital with chronic diarrhoea and in 43 children from a rural Gambian village. Village children of poor nutritional state (less than or equal to 74% weight for age compared with the National Center for Health Statistics reference curve) had secretory IgA outputs that were only one third of those of better nourished individuals. In contrast, the patients with chronic diarrhoea had secretory IgA outputs that were significantly raised compared with village children, regardless of nutritional state. These results demonstrate that secretory IgA production in the urinary tract can be stimulated by intestinal disease, suggesting that malnourished children are able to mount a response to mucosal infection and supporting the hypothesis of a common secretory immune system.
Thymic carcinoma. A clinicopathologic study of 60 cases. The clinicopathologic features of 60 patients with thymic carcinoma were studied. Patients ranged in age from 10 to 76 years (mean, 46), of whom 24 were females and 36 were males. Overall survival at 1, 3, and 5 years was 56.6%, 40%, and 33.3%, respectively. The following morphologic features were correlated with survival: type of tumor margins; presence or absence of a lobular growth pattern; nuclear atypia; necrosis; mitotic activity; and histologic tumor type and grade. Eighty eight percent of patients with poorly circumscribed/infiltrating neoplasms died of their tumors as compared with 16.6% of patients with well-circumscribed neoplasms (P less than 0.0000). Of patients whose tumors had mitotic counts exceeding 10/10 high-power fields (HPF), 84.3% died, as compared with 21.4% of patients with lower mitotic counts (P less than 0.0000). Of patients whose tumors showed lack of lobular growth pattern, 91.6% died, as compared with 29% of those whose tumors had a lobular growth pattern (P less than 0.0000). Finally, 84.6% of patients whose tumors displayed a high-grade histology (lymphoepithelioma-like carcinoma, small cell/neuroendocrine carcinoma, clear cell carcinoma, sarcomatid carcinoma, and anaplastic/undifferentiated carcinoma) died of tumor, as compared with 0% of patients whose tumors were of low-grade histology (well-differentiated squamous carcinoma, mucoepidermoid carcinoma, and basaloid carcinoma) (P less than 0.0000). Evaluation of the various treatment modalities used to treat these patients did not yield any statistically significant correlations with survival. Two clinically distinct groups of patients were identified: one after a relatively favorable clinical course with long survival, and one after a rapidly fatal outcome. The morphologic features of the tumors in these patients correlated well with their clinical behavior; histologic type (and the grade to which it was assigned) constituted the most reliable and important predictor of prognosis.
CA72-4: a new tumour marker for gastric cancer. To date, tumour markers for gastric cancer have proved unreliable. In this study the value of a new serum marker, CA72-4, was compared with the serum activities of carcinoembryonic antigen (CEA) and CA19-9 in a consecutive series of patients with gastric cancer. The results show that the CA72-4 assay is significantly better at separating stage I and II disease from normal controls (P less than 0.01) than CEA (n.s.) or CA19-9 (n.s.). CA72-4 also gave better differentiation between patients with positive and negative nodes (P less than 0.01) and between those who were serosa positive and negative (P less than 0.01). CEA differentiated between patients with positive and negative nodes (P less than 0.05) but CA19-9 could not. CA19-9 and CEA could not discriminate between patients who were serosa positive and negative. In this study, at a specificity of 95 per cent, the sensitivities of CEA, CA19-9 and CA72-4 were 0.25, 0.41 and 0.94 respectively. These preliminary findings indicate that CA72-4 is a reliable tumour marker of disease stage and activity in gastric cancer. Further longitudinal studies are required for full evaluation of its clinical utility.
The influence of dialysate sodium and variable ultrafiltration on fluid balance during hemodialysis. An important factor in the development of hypotension during hemodialysis (HD) is a decrease in blood volume, due to ultrafiltration (UF) and an insufficient refill of the intravascular compartment. This insufficient refill might be caused by a transcellular fluid shift from the extracellular to the intracellular compartment. We studied the influence of dialysate sodium concentration and UF rate on the refill rate, blood volume, intracellular (ICV) and extracellular fluid volume (ECV). Three different HD strategies were studied in 15 patients: (A) conventional HD (dialysate sodium 140 mmol/L); (B) HD with a sodium profile (140-148 mmol/L); and (C) HD with a sodium profile and a variable UF rate (high-low UF rate). ICV and ECV were measured by non-invasive conductivity measurements, blood volume was calculated from erythrocyte counts before and after treatment. Blood volume decrease was most pronounced during conventional HD, due to insufficient refilling without a detectable transcellular fluid shift. The sum of the decrease in ICV and EVC was less than during (B) and (C). The insufficient refill led to a higher prevalence of hypotension and cramps. The strategies (B) and (C) led to an significant and comparable transcellular fluid shift to the extracellular compartment. Thus, the use of a sodium profile led to a better intravascular refill and clinical tolerance of HD. Addition of a UF profile did not improve this any further.
Leukemias of indeterminant lineage. Two biologically and clinically important forms of acute leukemia have been described. Evidence suggests that both undifferentiated acute leukemia and many types of hybrid leukemia arise from relatively fewer differentiated cells than do the more straightforward acute leukemias. Clinical correlations suggest that patients with these leukemias may have a poorer prognosis, although some findings may be associated with an improved prognosis. More data in which multiple techniques are applied to the same leukemic cells are clearly needed. Patients with certain types of hybrid leukemias may be suitable candidates for more aggressive forms of chemotherapy or, possibly, combinations of therapy directed at cells of both lineages.
Chondrosarcomas of the synovium. Chondrosarcoma of the synovium, either primary or secondary to synovial chondromatosis, is rare. Ten cases of synovial chondrosarcoma were studied (four from the Mayo Clinic files and six from the authors' consultation files). Two were considered primary. In five cases there was evidence of preexisting synovial chondromatosis, and in the remaining three, there was a suggestion of preexisting disease. Several histologic features were found that were helpful to diagnose malignancy. The most important ones were loss of the "clustering" growth pattern typical of synovial chondromatosis, myxoid change in the matrix, areas of necrosis, and spindling at the periphery of chondroid lobules. Pulmonary metastasis developed in five of nine patients; three of these patients died.
Pediatric sinusitis. The role of endoscopic sinus surgery in cystic fibrosis and other forms of sinonasal disease. Functional endoscopic sinus surgery has altered the surgical treatment of sinus disease in adults. We report our experience with functional endoscopic sinus surgery in the pediatric population. Functional endoscopic sinus surgery was safe and effective and compared favorably with traditional surgery with regard to operative time, blood loss, and parental opinion.
Regional diastolic mechanics of ischemic and nonischemic myocardium in the pig heart. To assess the role of segmental dyssynchrony as a determinant of ischemic diastolic dysfunction, systolic and diastolic mechanics of ischemic and nonischemic myocardium were compared in the open chest pig heart (n = 7). Pacing tachycardia (1.8 x heart rate at rest) was imposed for 3 to 5 min in the presence of a single critical stenosis of the left anterior descending artery (demand ischemia, n = 7). After 30 min of recovery, the left anterior descending artery was totally occluded for 1.5 min in the same pigs (primary ischemia, n = 6). Both demand and primary ischemia increased left ventricular end-diastolic pressure and prolonged the time constant of left ventricular pressure decline. Percent systolic shortening of ischemic segments (perfused by the left anterior descending artery) decreased by 32% during demand ischemia and by 120% during primary ischemia, but that of nonischemic segments (perfused by the left circumflex artery) did not change significantly during either type of ischemia. During demand ischemia (but not during primary ischemia), left ventricular diastolic pressure increased relative to segment length so that a higher diastolic pressure was needed to stretch the ischemic segment to the same length (decreased distensibility). In nonischemic areas, diastolic pressure and segment length increased commensurately during both types of ischemia, indicating no change in diastolic distensibility. During demand ischemia, peak early diastolic lengthening rates increased in nonischemic segments but remained unchanged in ischemic segments. Diastolic segmental dyssynchrony developed during both types of ischemia, but was more pronounced during primary ischemia. Therefore, segmental dyssynchrony is unlikely to account for the rise in diastolic pressure relative to segment length seen during demand ischemia.
Morbidity associated with childhood systemic lupus erythematosus. A complete analysis of the outcome of childhood onset systemic lupus erythematosus (SLE) requires determination of survival statistics and consideration of disease and treatment morbidity. The course of 32 patients with SLE diagnosed at or prior to age 16 and followed from 1979-1988 was analyzed with emphasis on the morbidity of pediatric SLE. Clinical characteristics were similar to those in previous studies. Five year survival, calculated by life-table analysis, was 85.3%, comparable to recent studies. Treatment consisted of corticosteroids (32 patients), antimalarials (14), cyclophosphamide (9) or azathioprine (2). Eighty-four percent of patients experienced a noninfectious drug related complication. A major infection contributed in all 5 patients who died. Higher total corticosteroid dose was associated with more severe infections. Eighty-eight percent of patients were left with chronic organ dysfunction. Survival in childhood onset SLE has improved, but morbidity remains a significant problem from organ dysfunction and complications of therapy. Our study is the first to address the issue of morbidity in childhood SLE.
Characterization in vitro of a human tumor necrosis factor-binding protein. A soluble form of a tumor necrosis factor receptor. Tumor necrosis factor (TNF) is a pleiotropic mediator of inflammatory responses. A cysteine-rich, highly glycosylated 30-kD TNF-binding protein (TNF-BP) purified from urine may have a role in regulation because it protects in vitro against the biological effects of TNF. The cytotoxic effect of TNF on the fibrosarcoma cell line WEHI 164 was inhibited by 50% at a 10-fold excess of TNF-BP. The binding of TNF to the receptor was partially reversed after the addition of TNF-BP. Results from biosynthetic labeling of cells with 35S-cysteine followed by immunoprecipitation with anti-TNF-BP indicated that TNF-BP is formed and released at the cell surface by cleavage because no corresponding cellular polypeptide was observed. A cellular 60-kD polypeptide, which was immunoprecipitated with anti-TNF-BP, may correspond to the transmembrane TNF-receptor molecule and be the precursor of TNF-BP. Thus, TNF-BP appears to be a soluble form of a transmembrane TNF-receptor. Moreover our results demonstrate that the production of TNF-BP is increased when the TNF receptor is downregulated in cells by treatment with TNF or by activation of protein kinase C with phorbol esters. TNF-BP may be an important agent that blocks harmful effects of TNF, and, therefore, useful in clinical applications.
Clinical features and natural history of von Hippel-Lindau disease The clinical features, age at onset and survival of 152 patients with von Hippel-Lindau disease were studied. Mean age at onset was 26.3 years and 97 per cent of patients had presented by aged 60 years. Retinal angioma was the first manifestation in 65 patients (43 per cent), followed by cerebellar haemangioblastoma (n = 60, 39 per cent) and renal cell carcinoma (n = 15, 10 per cent). Overall, 89 patients (59 per cent) developed a cerebellar haemangioblastoma, 89 (59 per cent) a retinal angioma, 43 (28 per cent) renal cell carcinoma, 20 (13 per cent) spinal haemangioblastoma and 11 (7 per cent) a phaeochromocytoma. Renal, pancreatic and epididymal cysts were frequent findings but their exact incidence was not accurately assessed. Mean age at diagnosis of renal cell carcinoma (44.0 +/- 10.9 years) was significantly older than that for cerebellar haemangioblastoma (29.0 +/- 10.0 years) and retinal angioma (25.4 +/- 12.7 years). The probability of a patient with von Hippel-Lindan disease developing a cerebellar haemangioblastoma, retinal angioma or renal cell carcinoma by age 60 years was 0.84, 0.7 and 0.69, respectively. A comprehensive screening protocol for affected patients and at-risk relatives is presented, based on detailed analysis of age at onset data for each of the major complications. Median actuarial survival was 49 years, with renal cell carcinoma the leading cause of death.
Sincalide-aided ultrasonography of the common bile duct as a predictor of biliary obstruction determined by ERCP and biliary manometry. Sonographically observed changes in common bile duct caliber following intravenous sincalide injection were correlated with distal common duct pathology as defined by endoscopic retrograde cholangiopancreatography and biliary manometry. Thirty-two patients, 17 with prior cholecystectomies, were studied. In post-cholecystectomy patients, a 1-mm or greater diminution of duct caliber within 5 min represented a normal response. When gallbladder contraction occurred in normal patients with an intact gallbladder, no change or a diminution in duct caliber was observed. When gallbladder contraction was not observed, a normal response was considered to be the same as that in post-cholecystectomy patients with a diminution in duct caliber occurring. By using these criteria two false negatives, both with hypertensive sphincters of Oddi that responded normally to sincalide injection, were encountered. This technique was valuable in defining non-obstructed post-cholecystectomy dilated bile ducts which demonstrated a prompt diminution in caliber following sincalide injection.