123rc/medical_text huggingface dataset:
Prognostic factors in primary retroperitoneal soft-tissue sarcomas. We analyzed independent treatment variables (age, sex, signs and symptoms, site, size, histopathologic findings, grade, and clinical presentation) and treatment-dependent variables (resectability, type of operation, surgical margins, surgical boundaries, microscopic margins, adjuvant radiotherapy, and adjuvant chemotherapy) in 80 patients with primary retroperitoneal soft-tissue sarcomas admitted from 1982 through 1988. Both univariate and multivariate analysis of survival and disease-free survival were performed. The major factor in survival outcome was the ability to completely resect the lesion. When the 62 patients who underwent complete resection were examined, the only independent prognostic factor for both survival and disease-free survival was grade. We conclude that completeness of resection and grade of the lesion are primary determinants of survival. Once all tumor is macroscopically removed, no advantage could be demonstrated by more extensive surgical resection or current adjuvant therapy.
Left superior vena cava: a pitfall in computed tomographic diagnosis with surgical implications. We report 2 cases in which computed tomography of the mediastinum demonstrated an abnormality originally misinterpreted as lymphadenopathy but subsequently shown to represent a left superior vena cava. Misinterpretation may result in errors in optimum treatment and may complicate surgical exploration of the mediastinum. These 2 cases are presented to remind radiologists and surgeons of the possibility of this unusual anatomy.
Long-term follow-up of patients operated on for recurrent carotid stenosis. We reviewed our experience with 29 operations for recurrent carotid stenosis in 27 patients who underwent both their primary carotid endarterectomy and their reoperations at our institution. These 27 patients represent 4% of the 667 patients who underwent primary carotid endarterectomies at our institution and who are included in our carotid follow-up registry. Reoperation was prompted by recurrent symptoms in 19/29 (65.5%) cases. Comparison of long-term stroke prevention in those patients who did (84% at 5 years, 78.6% at 10 years) and did not (90.3% at 5 years, 83.6% at 10 years) develop recurrent stenosis requiring reoperation revealed no statistically significant difference (p = 0.48) when measured from the time of primary operation. The perioperative stroke and death rates for reoperation (3.4% and 0%) were acceptable. We conclude that with our acceptably low perioperative stroke morbidity (3.4%), surgery for recurrent carotid stenosis in symptomatic patients or in asymptomatic patients with high-grade (greater than or equal to 75%) stenosis maintains the durable stroke prevention offered by primary carotid endarterectomy.
Tumor-targeted chemotherapy with lipid contrast medium and macromolecular anticancer drug (SMANCS) for renal cell carcinoma. Twenty-five patients with renal cell carcinoma were treated with a lipophilic macromolecular drug, poly(stylene-co-maleic acid)-conjugated neocarzinostatin (SMANCS) dissolved in lipid contrast medium (Lipiodol). The drug was injected by catheterizing the renal artery and another feeding artery in 24 patients, and in the common hepatic artery in 1 patient with metastases to the liver after a radical nephrectomy. The procedure of selective arterial administration of 3-20 mg/mL of SMANCS/Lipiodol was simple to perform and was required once every two to three weeks. Total dose of SMANCS for each patient varied from 3 to 57 mg. Both SMANCS and Lipiodol accumulated more selectively in tumor than in any other tissue and remained in the neovasculature and extracapillary space for a long time. CT pattern of the remaining oil contrast medium in the tumor was characterized by the high-density area localized mainly in the periphery of the tumor around the central necrosis. When hyperviscosity Lipiodol (Lipiodol HV) was used as lipid contrast medium, it remained more persistently in the tumor and disappeared more slowly than Lipiodol. Moreover, the pronounced anticancer effect was recognized when SMANCS/Lipiodol HV was administered compared with only SMANCS/Lipiodol. Severe side effects, such as myelosuppression, unendurable pain, paralytic ileus, etc., were not observed. This targeting chemotherapy may be of great significance for advanced renal cell carcinoma.
Increased epidermal growth factor receptors in seborrheic keratoses and acrochordons of patients with the dysplastic nevus syndrome. Seborrheic keratoses and acrochordons may change in biologic behavior with pregnancy or during treatment with sex steroids. Because epidermal growth factor receptor localization may change in hyperproliferative skin diseases, we compared epidermal growth factor receptor immunolocalization in seborrheic keratoses and acrochordons from women who were or were not pregnant or taking oral sex steroid hormones. Epidermal growth factor receptor was further investigated in growing and quiescent seborrheic keratoses and acrochordons from women with and without the dysplastic nevus syndrome. The epidermal growth factor receptor concentration was strikingly elevated in suprabasilar keratinocytes of growing seborrheic keratoses and acrochordons from patients with the dysplastic nevus syndrome who were pregnant or taking sex steroid hormones and less elevated in growing seborrheic keratoses from other patients. In contrast, the epidermal growth factor receptor distribution pattern in acrochordons did not correlate as well with the history of growth of these lesions in normal patients. These data suggest sex steroids may affect epidermal growth factor receptor metabolism in benign epidermal hyperproliferative lesions, particularly in patients with the dysplastic nevus syndrome.
A patient-oriented approach to perilymph fistula. The subject of perilymph fistula is controversial in part because the preoperative diagnosis of perilymph fistula is difficult. Patients suffering auditory and vestibular symptoms secondary to perilymph fistula, therefore, present a dilemma to the practicing physician. In some instances, patients with auditory and vestibular symptoms in the absence of perilymph fistula will be subjected to middle ear exploration without benefit, while in other instances patients with auditory and vestibular symptoms secondary to perilymph fistula will be denied surgical treatment. Auditory and vestibular symptoms are a quality of life issue. Therefore, in an effort to provide care of the highest quality the patient must be actively involved in the decision process. Such involvement can be meaningful only after the patient is carefully counseled as to the pros and cons of surgery, as well as the alternatives. A prognostic paradigm based on the personal experience of one of us (W.L.M.) with perilymph fistula patients is described and is used in patient consultation in an effort to facilitate decision making.
Itraconazole in opportunistic mycoses: cryptococcosis and aspergillosis. Striking results were obtained with oral itraconazole therapy in two opportunistic mycoses. Of 28 patients with cryptococcal meningitis, 18 achieved complete responses, including 16 of 24 patients with acquired immunodeficiency syndrome. Other manifestations of cryptococcosis were similarly responsive. In aspergillosis 12 of 15 patients responded, including 8 of 10 immunocompromised hosts. These patients included those with invasive pulmonary disease (4/5), skeletal disease (2/2), pleural disease (1/2), and pericardial, sinus, mastoid, hepatosplenic, or nail disease (1/1). These results with itraconazole compare favorably to conventional (parenteral) therapy, and toxicity was minimal. This suggests that comparative trials are now in order.
Detection of HTLV-I proviral sequences in CD30-positive large cell cutaneous T-cell lymphomas. To investigate the possibility that cutaneous T-cell lymphomas of large cell type may be associated with human T-cell leukemia/lymphoma virus type I infection in nonendemic regions, tissue samples from six cases of large cell cutaneous T-cell lymphoma and four cases of small cell cutaneous T-cell lymphoma were screened for the presence of integrated proviral human T-cell leukemia/lymphoma virus type I DNA. Combined use of Southern blot hybridization and enzymatic DNA amplification revealed human T-cell leukemia/lymphoma virus type I-specific sequences in all cases of large cell cutaneous T-cell lymphoma and in none of the cases of small cell cutaneous T-cell lymphoma. These results suggest that in nonendemic areas, a significant proportion of large cell cutaneous T-cell lymphoma cases are associated with human T-cell leukemia/lymphoma virus type I.
The early diagnosis and treatment of developmental patella infera syndrome. Developmental patella infera and associated arthrofibrosis after knee surgery require prompt recognition and treatment. The condition develops because of contracture of peripatellar tissues, fatpad tissues, and quadriceps weakness, and may rapidly progress to permanent patella infera and disabling patellofemoral arthrosis. Case studies for five patients with acute developmental patella infera are described. All patients required an early arthroscopic release of contracted tissues. To establish normal right to left patellar, vertical-height ratios, lateral roentgenograms were obtained in 202 normal knees (101 pairs). The data showed that although essentially no difference existed between right and left sides, large variations existed in the ratios from one individual to another (range, 0.75-1.46). Thus, the diagnosis of developmental patella infera requires comparison of patellar height ratios in the same knee or between knees in the same individual. A decrease in the vertical-height ratio of 11%-15%, depending on the method used, indicates developmental patella infera.
Intestinal obstruction by distension of a Foley jejunostomy catheter. Jejunostomies can be effective in permitting postoperative nutritional support, particularly in the patient with complicated gastrointestinal disease. In the case presented, however, distension of the Foley balloon catheter, used as the jejunostomy tube, led to intestinal obstruction which was not initially detected. Following radiographic identification of the problem, removal of the air from the Foley balloon allowed the patient to complete his convalescence from surgery. The possibility of obstruction from the Foley jejunostomy catheter should be recognized as a potential problem in the postoperative period.
Mechanical ventilation in medical and neurological diseases: 11 years of experience. Mechanical ventilation (MV) is imperative in many forms of acute respiratory failure (ARF). The aim of this work was to review all episodes of MV in a Medical Intensive Care Unit (MICU) during the 11-year period 1976-1986. Four per cent (n = 1008) of 24,899 admissions to the MICU were treated with MV. The mean age of ventilator-treated patients was 53 +/- 18 years, and obviously it increased during the period of study. The average duration of MV was 4.7 d. MICU mortality, hospital mortality and 2-year mortality rates for patients subjected to MV were 33%, 38% and 46%, respectively. The mortality rate did not change during the study period. Cerebrovascular and malignant diseases carried the highest mortality rates, 75 and 79%, respectively, whereas mortality in patients ventilated because of drug overdose (n = 313) was only 2%. The results of this study confirm previously published findings concerning the outcome of MV, and we conclude that the effects of MV remain discouraging in medical and neurological patients. Improved quality of ventilator therapy and monitoring, as well as continued research directed at the causes of ARF, are equally important in reducing the mortality in ARF.
Relationship of parental smoking to wheezing and nonwheezing lower respiratory tract illnesses in infancy. Group Health Medical Associates. The relationship between parental smoking and lower respiratory tract illness (LRI) was studied in a large cohort of infants followed prospectively from birth. Illnesses were diagnosed by physicians using agreed-on criteria, and parental smoking histories were obtained by questionnaire. The LRIs were differentiated into wheezing and nonwheezing episodes, and the age at first illness of either type was evaluated in relation to smoking by parents. The odds of having an LRI were significantly higher in children whose mothers smoked (odds ratio 1.52; confidence interval 1.07 to 2.15). The odds were higher if the mother smoked a pack of cigarettes or more per day and if the child stayed home rather than attending day care (odds ratio 2.8; confidence interval 1.43 to 5.5). Logistic regression indicated that the LRI rate was significantly elevated both in children exposed to heavy maternal smoke in the absence of day care, and in those who use day care but were not exposed to maternal smoking of a pack or more per day. These findings could not be attributed to other confounding variables. Neither paternal smoking nor smoking by other household members was consistently related to the LRI rate. The relationship of maternal smoking to LRI rate was evident for both wheezing and nonwheezing illnesses. Maternal smoking of a pack or more per day was also related to an early age at first LRI, for both wheezing (p less than 0.05) and nonwheezing (p less than 0.002) illnesses. In sum, maternal smoking is associated with a higher rate of LRIs in the first year, particularly when mothers smoked a pack or more per day and when the child did not use day care.
Sustained calcium channel blockade in the treatment of severe hypertension. A two year experience. Thirty-nine patients with severe hypertension (diastolic blood pressure greater than 120 mm Hg) predominantly drawn from an inner-city population were placed on nifedipine gastrointestinal therapeutic system (GITS) for long-term treatment to achieve a sustained diastolic blood pressure less than 95 mm Hg. Fourteen patients failed to complete 6 months of therapy. For the 25 who remained in treatment for 6 months or more, systolic/diastolic blood pressure reductions were 62 +/- 5/40 +/- 2 mm Hg at 6 months; for those followed more than 12 months (n = 18), 58 +/- 7/37 +/- 3 mm Hg at 12 months; and for those followed more than 18 months (n = 11), 54 +/- 6/37 +/- 3 mm Hg at 18 months. Overall, 75% of these severely hypertensive patients were controlled with nifedipine GITS alone; 80% required 90 mg/day or more. During the two years of observation, no patient had a severe medical event, and 44% of those who entered remain in treatment. Left ventricular hypertrophy, as determined by echocardiography, diminished significantly during the course of treatment. These results indicate nifedipine GITS is well-tolerated and effective as monotherapy in the treatment of severe hypertension.
The epidemiology of ophthalmic malignancies in New York State. The epidemiologic characteristics of more than 1400 primary eye cancers (ICD-9, site 190) diagnosed among New York State (NYS) residents between 1975 and 1986 are described. Among NYS male residents, the average annual age-adjusted incidence rate was 7.5 per 1,000,000, and among NYS female residents, the rate was 5.4 per 1,000,000 (male:female rate ratio, 1.39). The majority of ophthalmic malignancies were included within three histologic groupings: melanomas (70.4%), retinoblastomas (9.8%), and squamous cell carcinomas (9.2%). The average annual incidence of retinoblastoma among persons in NYS who were less than 5 years of age was 9.5 per 1,000,000 for boys and 8.7 per 1,000,000 for girls (male:female rate ratio, 1.09). The average annual incidence (age-adjusted) of ocular melanomas was 4.9 per 1,000,000 among men and 3.7 per 1,000,000 among women in NYS (male:female rate ratio, 1.32). Expanded knowledge of the epidemiology of ophthalmic cancers can help to develop a foundation on which to monitor disease patterns and can serve to stimulate further etiologic research involving these rare malignancies.
Nonbacterial thrombotic endocarditis in Hong Kong Chinese. Fifty-two Hong Kong Chinese cases of nonbacterial thrombotic endocarditis at autopsy were reviewed to ascertain if there was any difference in autopsy incidence, associated diseases, age and sex incidence, distribution of infarcts, and pattern of valve involvement compared with that in previously reported series. The overall autopsy incidence was 0.68%, within the range of previous reports. Forty-one cases (79%) were associated with malignant neoplasms; the remaining 11 cases were associated with miscellaneous disorders. Adenocarcinoma was associated with 27 (52%) of the cases. Unusual findings were the association of five cases with intrahepatic cholangiocarcinoma and four cases with esophageal squamous carcinoma. This is explicable on the basis of a higher incidence of these two tumors in Hong Kong Chinese than in Western populations, ie, the source of most other reported series. Sex and age incidence, the distribution of infarcts, and the pattern of valve involvement were similar to those reported in other series of nonbacterial thrombotic endocarditis.
High or low hepaticojejunostomy for bile duct strictures? The 19 patients who underwent 22 postoperative repairs of bile duct stricture in our institution between 1973 and 1984 were evaluated to assess whether the recognition of the tenuous blood supply of the supraduodenal bile duct in 1979 had improved the results thereafter. Thirteen of these 22 operations followed a previous biliary tract repair; in 10 of the operations a low anastomosis had been performed without taking blood supply into account. Follow-up was complete and ranged from 5 to 15 years. There were no operative deaths and minimal morbidity. There were three deaths at a later time. Five of the 11 patients treated by surgery to 1979 had a clinically unsatisfactory result: recurrent strictures developed in all five patients. All but one of the eight patients receiving a high hepaticojejunostomy from 1980 had a clinically satisfactory result with no recurrent strictures. The one exception was the patient who had a second repair with separate high right and left hepatic duct anastomoses and who has ongoing symptoms from preexisting secondary sclerosing cholangitis. The results in the five high repairs performed for low strictures were particularly striking: All five were asymptomatic. This study lends support to the hypothesis of an ischemic basis for biliary strictures and to the recommendation that strictures be repaired with a high hepaticojejunostomy.
Relationships of somatic symptoms to behavioral and emotional risk in young adolescents. Junior high students (n = 1508) from a midwestern community completed a health behavioral questionnaire that asked the frequency of headache and abdominal pain and of a number of behavioral and emotional risk indicators. Headache (24%) and abdominal pain (13%) were frequently reported among these young adolescents, particularly among girls. Those reporting frequent somatic complaints also reported significantly more behavioral and emotional symptoms indicative of risk (p less than 0.001). Further, the interaction between somatic complaint and gender significantly affected risk status (p less than 0.01). This interaction was greater with behavioral risk: boys with both abdominal pain and headaches reported higher behavioral risk than all other groups (p less than 0.0001). Somatic symptoms continued to account for a significant amount of variance in behavioral risk after the effects of emotional risk and age were removed. This suggests that behavioral risk and emotional risk are independently associated with somatic complaints. The evaluation of persistent somatic complaints in adolescents, particularly in boys with abdominal symptoms, should include careful examination of emotional risk factors and other health-endangering behaviors such as substance use, early sexual activity, and delinquency.
Nimodipine after resuscitation from out-of-hospital ventricular fibrillation. A placebo-controlled, double-blind, randomized trial. One hundred fifty-five consecutive patients resuscitated after out-of-hospital ventricular fibrillation by a physician-manned advanced life support unit were randomly assigned to receive nimodipine or placebo at a dosage of 10 micrograms/kg as an intravenous injection immediately after restoration of spontaneous circulation, followed by an infusion of 0.5 micrograms/kg per minute for 24 hours. No significant difference was found in the 1-year survival rate of nimodipine-treated (30 [40%] of 75 patients) and placebo-treated patients (29 [36%] of 80 patients). Recurrent ventricular fibrillation during the treatment occurred in one patient in the nimodipine group compared with 12 patients in the placebo group. In a post hoc analysis of patients with very long delays in advanced life support (more than 10 minutes), the 1-year survival rate was higher with nimodipine (eight [47%] of 17 patients) than with placebo (two [8%] of 26 patients). Nimodipine may be of benefit in patients with delayed resuscitation.
Primary repair for complete atrioventricular canal: recommendation for early primary repair. Forty patients with complete atrioventricular canal (CAVC) underwent primary repair at Fukuoka Children's Hospital in Fukuoka, Japan, between August 1, 1981 and July 31, 1989. The age at repair ranged from 2 months to 6 years (mean 19 months); weight ranged from 2.3 to 22 kg. The surgical mortality was 2.5%. Justification for early primary repair was examined. Eleven patients underwent repair before 6 months of age (Group 1), 12 patients, between 7 and 11 months of age (Group 2), and 17 patients, after 12 months of age (Group 3). Degenerative changes in the atrioventricular valve increased significantly as age at repair increased (p less than 0.05 Group 1 versus Group 3). The incidence of residual mitral regurgitation tended to increase in the order of Group 1, 2 and 3, though the degree ranged from trivial to mild. Study of the left atrium/aorta ratio by echocardiography revealed that stable values of around 1.1 in Groups 1 and 2 and around 1.3 in Group 3 continued during the follow-up period of 3 years. Assessment of the diameter of the repaired mitral valve in the mean interval of 26 months in groups 1 and 2 revealed normal growth of the mitral valve annulus. The angle between the repaired mitral valve and ventricular septum, which can be affected by the growth of the ventricular septum, converged to normal range in the mean interval of 26 months. Postoperative pulmonary vascular resistance in Groups 2 and 3 was higher at 4.4 +/- 2.3 and 6.3 +/- 2.2, respectively, than in Group 1 at 3.3 +/- 2.2 (p less than 0.01 versus Group 3).