123rc/medical_text huggingface dataset:
Secular trends in Q wave and non-Q wave acute myocardial infarction. The Minnesota Heart Survey. The Minnesota Heart Survey examined trends of Q wave and non-Q wave acute myocardial infarction (AMI) using a 50% random sample of all hospital discharges of patients with AMI or another acute coronary disease from 35 of 36 hospitals in 1970 and 30 of 31 hospitals in 1980 in the Minneapolis-St. Paul metropolitan area. A total of 1,901 and 1,864 potential AMI cases were abstracted in 1970 and 1980, respectively. Electrocardiograms were coded according to the Minnesota code. AMIs were validated by computerized algorithm based on chest pain, enzymes, electrocardiograms, and autopsy. This study shows that with the use of a consistent, standard diagnostic algorithm, attack rates for Q wave AMI did not change significantly between 1970 and 1980 and that attack rates for non-Q wave AMI decreased significantly during the same decade. However, when the more sensitive cardiac enzymes creatine phosphokinase and creatine phosphokinase-MB were considered, attack rates of both Q wave and non-Q wave AMIs increased. This research documents four important trends for community AMI rates that are at variance with those reported by others. There was a decline in non-Q wave AMI attack rates from 1970 to 1980; women had outcomes equal to or worse than those for men for both case-fatality and 7-year survival rates; patients with non-Q wave AMIs had worse in-hospital prognoses than those with Q wave AMIs; and 7-year survival rates were worse for Q wave AMI in 1980. These findings demonstrate the need for standard diagnostic criteria for Q wave and non-Q wave AMI if trends are to be monitored. In the future, as new trials of operative and nonoperative therapies of AMI are undertaken, these considerations will increase in importance.
Response of plasma endorphins, corticotropin, cortisol, and luteinizing hormone in the corticotropin-releasing hormone stimulation test in eumenorrheic and amenorrheic athletes. We compared pituitary response in the corticotropin-releasing hormone (CRH) test between 9 eumenorrheic and 10 amenorrheic endurance athletes. The maximal oxygen capacity (VO2max), determined using an exercise test on a bicycle ergometer, was larger in amenorrheic (62.7 +/- 1.0 SE mL/min per kg) than in eumenorrheic (54.7 +/- 2.3 mL/min per kg) athletes. A 100 micrograms bolus of human CRH was administered intravenously, and blood samples were collected at -15, 0, 30, 60, 90, and 120 minutes. The mean basal concentrations of endorphins, adrenocorticotropic hormone (ACTH), and cortisol did not show significant differences between the groups. The cumulative response of ACTH in the CRH test was larger in eumenorrheic (7.7 +/- 1.3 pmol/L) than in amenorrheic (3.6 +/- 0.6 pmol/L) athletes, but the response of endorphins and cortisol did not differ between the groups. A negative correlation was found between the VO2max and the ACTH response during the CRH test in the total group of athletes. These findings indicated changes in the function of hypothalamic-pituitary-adrenal axis in amenorrheic athletes that can be attributed to intensive training.
Identification and preliminary characterization of protein-cysteine farnesyltransferase. Ras proteins must be isoprenylated at a conserved cysteine residue near the carboxyl terminus (Cys-186 in mammalian Ras p21 proteins) in order to exert their biological activity. Previous studies indicate that an intermediate in the mevalonate pathway, most likely farnesyl pyrophosphate, is the donor of this isoprenyl group. Inhibition of mevalonate synthesis reverts the abnormal phenotypes induced by the mutant RAS2Val-19 gene in Saccharomyces cerevisiae and blocks the maturation of Xenopus oocytes induced by an oncogenic Ras p21 protein of human origin. These results have raised the possibility of using inhibitors of the mevalonate pathway to block the transforming properties of ras oncogenes. Unfortunately, mevalonate is a precursor of various end products essential to mammalian cells, such as dolichols, ubiquinones, heme A, and cholesterol. In this study, we describe an enzymatic activity(ies) capable of catalyzing the farnesylation of unprocessed Ras p21 proteins in vitro at the correct (Cys-186) residue. This farnesylating activity is heat-labile, requires Mg2+ or Mn2+ ions, is linear with time and with enzyme concentration, and is present in all mammalian cell lines and tissues tested. Gel filtration analysis of a partially purified preparation of protein farnesyltransferase revealed two peaks of activity at 250-350 kDa and 80-130 kDa. Availability of an in vitro protein farnesyltransferase assay should be useful in screening for potential inhibitors of ras oncogene function that will not interfere with other aspects of the mevalonate pathway.
Expression of intercellular adhesion molecule-1 (CD54) on hematopoietic progenitors. The distribution of intercellular adhesion molecule-1 (ICAM-1), a ligand for lymphocyte function antigen-1, on hematopoietic tissue was determined using the anti-ICAM-1 monoclonal antibody CL203.4 with flow cytometry and short-term semi-solid hematopoietic progenitor cultures. After timed incubation in media with fetal bovine serum, 29% of erythroid burst-forming units (BFU-E), 24% of erythroid colony-forming units (CFU-E), and 52% of granulocyte-macrophage colony-forming units (CFU-GM) bone marrow progenitors expressed ICAM-1. This finding, which is consistent with the detection of ICAM-1 on acute non-lymphoblastic leukemic blasts, is at variance with recent reports. ICAM-1 was also detected on bone marrow blasts, proerythroblasts, promyelocytes, and cells of monocyte/macrophage lineage, but was not detected on erythroblasts, normoblasts, neutrophilic myelocytes, metamyelocytes, bands, or on most lymphocytes. These results indicate that maturation of cells of the erythroid and myeloid lineage is associated with loss of ICAM-1. The distribution of ICAM-1 on bone marrow progenitors, early precursor cells, and accessory cells in conjunction with the function of this molecule in cell-cell interactions suggests that ICAM-1 may play a role in the cell-cell and cell-stromal interactions that regulate hematopoiesis.
Alternative therapies, 1990. An overview. The availability of alternative therapies for many health problems is a well-documented historical fact. Alternative therapies are generally understood to be those therapies outside of the usually accepted medical therapies for disease processes, such as cancer, arthritis, diabetes, psoriasis, lupus, and AIDS. Some other descriptive terms utilized include questionable, unproven, dubious, unorthodox, and unconventional. These alternative therapies vary from active involvement in promotion of one's own health (exercise, diet) to quackery. In today's society, with emphasis on self-involvement with individual health, metabolic therapies have become the most widely practiced alternative therapy. In an antiestablishment, anti-intellectual climate, with an increasingly mobile, rootless population, alternative therapies are in somewhat of a renaissance. Some confusion exists regarding clinical trials and alternative therapies in the general population and in the noninvolved health profession. Various studies indicate that from 10% to 50% of cancer patients use some alternative therapy, with national expenditures ranging as high as $10 billion annually. Better-educated patients with higher-than-average income are more likely to choose alternative therapies and are frequently supported by a physician in this choice. Most cancer patients continue under a physician's care and continue usual therapy while pursuing alternative methods. Approximately 5% of cancer patients abandon appropriate therapy and pursue potentially harmful alternative methods. A variety of sociomedical questions are brought forth by studies of the use of alternative therapies. A great need for public and professional education regarding this subject is evident.
Multimodality evoked potential testing in acute mild closed head injury. Multimodality evoked potential (MEP) testing, including brainstem auditory, visual, and somatosensory evoked potentials, have been reported to be useful in predicting outcome in severe closed head injury. Brainstem auditory evoked potentials have been demonstrated to be abnormal in 10% to 40% of acute mild head injury. A prospective study of 18 patients with mild closed head injury was undertaken to determine the usefulness of MEP screening within two weeks of the acute event. Long latency event-related potentials (P300s), in response to auditory stimuli with an oddball paradigm, were included in the screening. The subjects had several symptoms consistent with the postconcussive syndrome at the time of the evoked potential testing. Only one patient had an abnormal evoked potential response (greater than three standard deviations from the mean) from all the testing done. The standard methods of MEP testing were insensitive to quantifying the possible physiologic changes that are associated with memory deficits, lethargy, and emotional irritability after mild closed head injury.
Characterization of rat hyperplastic bile ductular epithelial cells in culture and in vivo. A novel intrahepatic biliary cell culture/in vivo transplantation system has been developed with an essentially pure population of bile ductular epithelial cells isolated from rat liver 6-12 weeks after bile duct ligation. In primary culture, these cells retain staining strongly for gamma-glutamyltranspeptidase and glutathione S-transferase P. The cytoplasm of cultured bile ductular cells reacts with an anti-laminin antibody, but loses immunoreactivity with a monoclonal anti-cytokeratin 19 antibody. Semiconservative DNA synthesis in the cultured cells was dependent upon the continued presence of 10% fetal calf serum in the medium. Replicating bile ductular cells could be subcultured for a finite number of passages. In addition, freshly isolated bile ductular epithelial cells gave rise to well differentiated bile ductular structures when transplanted into the interscapular fat pads of syngeneic recipient rats.
Development and reversal of contingent inefficacy and tolerance to the anticonvulsant effects of carbamazepine. The relationship of the timing of drug administration to anticonvulsant efficacy against amygdala kindled seizures was studied. During kindling development, rats received carbamazepine (CBZ, 15mg/kg) before (CBZ-before) or after each amygdala stimulation (CBZ-after). After kindling to full seizures, when all animals were given CBZ before the stimulation, only the CBZ-after group showed a good anticonvulsant response. The rats that had received CBZ before (during development of kindled seizures) remained unresponsive to CBZ treatment (contingent inefficacy). When drug-naive or CBZ-after animals repeatedly received CBZ before electrical stimulation, they developed tolerance to its anticonvulsant effects (contingent tolerance). The tolerance could be reversed by a period of treatment with CBZ-after or by kindling the animal drug-free, but not by CBZ administration alone or by time off from both drug and seizures. These findings suggest that inefficacy and tolerance to CBZ may be affected by the temporal contingencies of drug administration and that responsiveness can be reinstated by altering these contingencies.
Bidirectional cavopulmonary anastomosis as interim palliation for high-risk Fontan candidates. Early results. Thirty-eight patients considered to be at increased risk for a Fontan repair underwent bidirectional cavopulmonary anastomosis. Twenty-one of the 38 had concurrent pulmonary artery reconstruction. Fontan risk factors included pulmonary artery distortion, elevated pulmonary artery resistance (greater than 2 Woods units) and/or pulmonary artery pressure (mean, greater than 18 mm Hg), atrioventricular valve regurgitation, systemic ventricular dysfunction, complex venous anatomy, and subaortic obstruction. There were no deaths, either early or late. Median arterial oxygen saturation increased from 79% to 84% (p less than 0.01). Median hospital stay was 8 days. No patient had pleural effusions after 7 days. Three patients had significant surgical complications. Five patients had inadequate relief of cyanosis; three of these had venous collaterals and two had severe ventricular dysfunction; the latter two patients subsequently had strokes. One of the patients with persistent cyanosis required a systemic-to-pulmonary artery shunt. We conclude that a bidirectional cavopulmonary shunt, with pulmonary artery reconstruction when indicated, provides adequate relief of cyanosis in most patients with single-ventricle lesions who are considered to be at increased risk for a Fontan repair. Relief of ventricular volume overload and pulmonary artery distortion may improve Fontan candidacy. Also, patients with persistent cyanosis after bidirectional cavopulmonary anastomosis should be catheterized for location and occlusion of venous collaterals. Further follow-up is necessary to determine the place of bidirectional cavopulmonary anastomosis in the management of patients at increased risk for a Fontan repair.
Spinal cord decompression via a modified costotransversectomy approach combined with posterior instrumentation for management of metastatic neoplasms of the thoracic spine. Fifteen patients with thoracic spinal cord compression from metastatic neoplastic processes were managed by spinal canal decompression via a modified costotransversectomy approach. Ten of the patients also underwent sequential posterior stabilization with Luque or Harrington instrumentation based upon proximity of the lesion to the thoracolumbar junction, prognosis for regaining or maintaining ambulatory ability, and additional spinal stability considerations. A modified lateral decubitus position with the scapula falling away from the side of exposure was used for T1-5 segment lesions, and a prone position was used for the (T-6)-(T-12) segment. Adequate decompression of the spinal canal was achieved in all cases. All patients who were ambulating preoperatively maintained ambulatory ability, and pain and/or further neurological improvement as well occurred in 75%.
The nursing role in limb salvage surgery. Limb salvage surgery has proven itself as a valuable option for sarcoma patients. The reconstruction options are vast and include metallic implants, allografts, and a combination of both. The nursing implications for these patients are unlimited. The patient needs to be educated and assessed closely for complications such as infections, nonunion of the allograft, and limited mobility. Although the nursing care is more complicated, the rewards with working with these patients are great.
Mechanism of nonresponsiveness to AKR/Gross leukemia virus in AKR.H-2b:Fv-1b mice. An analysis of precursor cytotoxic T lymphocyte frequencies in young versus moderately aged mice. As young adult AKR.H-2b:Fv-1b mice reach about 9 wk of age, they begin to develop a nonresponsiveness to AKR/Gross leukemia virus. Unlike young mice that are responders, moderately aged AKR.H-2b:Fv-1b mice, after immunization and secondary in vitro restimulation in bulk culture with AKR/Gross virus induced tumors, can not generate anti-AKR/Gross virus-specific CTL. The mechanism of conversion to nonresponsiveness in moderately aged AKR.H-2b:Fv-1b mice is not understood, but it is correlated with increased expression of endogenous ecotropic viral antigens. Our present investigation focuses on determining the frequency of anti-AKR/Gross virus precursor CTL in AKR.H-2b:Fv-1b mice as a function of age. This was achieved by performing limiting dilution cultures of immune spleen cells obtained from young and moderately aged AKR.H-2b:Fv-1b mice. Although spleen cells obtained from immune moderately aged mice can not differentiate in bulk cultures into anti-AKR/Gross virus-specific CTL, there was no evidence of substantially decreased frequencies of virus-specific precursor CTL, relative to precursor CTL frequencies observed in young responder AKR.H-2b:Fv-1b mice.
Combined hemorrhagic shock and head injury: effects of hypertonic saline (7.5%) resuscitation. Hypertonic saline resuscitation was compared to isotonic fluid resuscitation in a large animal model combining hemorrhagic shock with head injury. Sheep were subjected to a freeze injury of one cerebral hemisphere as well as 2 hours of hypotension at a mean arterial pressure (MAP) of 40 mm Hg. Resuscitation was then carried out (MAP = 80 mm Hg) for 1 hour with either lactated Ringer's (LR, n = 6) or 7.5% hypertonic saline (HS, n = 6). Hemodynamic parameters and intracranial pressure (ICP) were followed. At the end of resuscitation brain water content was determined in injured and uninjured hemispheres. No differences were detected in cardiovascular parameters; however, ICPs were lower in animals resuscitated with HS (4.2 +/- 1.5 mm Hg) compared to LR (15.2 +/- 2.2 mm Hg, p less than 0.05). Additionally, brain water content (ml H2O/gm dry weight) in uninjured brain hemispheres was lower after HS resuscitation (HS = 3.3 +/- 0.1; LR = 4.0 +/- 0.1; p less than 0.05). No differences were detected in the injured hemispheres. We conclude that hypertonic saline abolishes increases in ICP seen during resuscitation in a model combining hemorrhagic shock with brain injury by dehydrating areas where the blood-brain barrier is still intact. Hypertonic saline may prove useful in the early management of multiple trauma patients.
The somatic patient. A significant proportion of patients seen in the Emergency Department will present with somatic complaints for which there is no apparent physiologic cause. Such patients may be divided into two broad categories: (1) those with symptoms and signs consciously synthesized by the patient, either for obvious secondary gain (malingering) or as a result of more subtle and complex motivations (factitious disorders); and (2) those patients with symptoms that are the unconscious expression of psychological stress (somatoform disorders). The somatoform disorders include (1) somatization disorder (characterized by a chronic history of numerous and widely divergent somatic complaints), (2) psychogenic pain disorder (somatization expressed in terms of persistent pain), (3) hypochondriasis (a conviction that one is diseased and disabled in conjunction with a well-focused constellation of supporting symptoms), and (4) conversion disorder (a single, usually nonpainful neurologic symptom, often with identifiable coping value for the patient). The first three disorders have been aggregately termed the "common somatization syndrome." Management of the somatically focused patient includes the communication of a caring attitude to the patient in conjunction with a cautious and diligent search for treatable medical or psychiatric illness. Resocialization and development of patient links with ongoing, nurturing nonmedical as well as medical support systems is of benefit.
Rapid control of refractory atrial tachyarrhythmias with high-dose oral amiodarone. To shorten the delay in the onset of antiarrhythmic effect when using amiodarone for the conversion of refractory atrial tachyarrhythmias to sinus rhythm, 19 patients were given oral amiodarone according to a high-dose loading protocol. In 18 of 19 patients (95%), sinus rhythm was restored 36 hours (range, 0 to 96 hours) after starting amiodarone. The conversion occurred as a result of amiodarone therapy alone within 48 hours in 12 patients (63%), and by amiodarone therapy plus electrical cardioversion at 48 to 96 hours in six patients (32%). Minor side effects were noted in eight patients (42%). No major side effects were encountered. The length of hospital stay after initiating amiodarone therapy was 3.6 days (range, 2 to 5 days). High-dose oral amiodarone loading is a safe and effective method for the rapid conversion of atrial tachyarrhythmias to sinus rhythm.
Peripheral ameloblastoma with clear cell differentiation. This report details a case of mandibular peripheral ameloblastoma having a clear cell component. The latter consisted of ovoid cells with vacuolated or clear cytoplasm and vesicular or pyknotic nuclei that may be disposed as discrete clusters or show direct transition from typical acanthomatous areas. Comparison of this lesion with other odontogenic and nonodontogenic tumors that contain clear cells is discussed in the context of the differential diagnosis.
Perioperative myocardial injury in patients undergoing aortic valve replacement. In cases of myocardial hypertrophy myocardial protection may be insufficient. In order to determine the factors responsible for myocardial injury we assessed myocardial injury in 54 patients undergoing isolated aortic valve replacement. In all cases hypothermic cardioplegic arrest was induced. At 13 different times we measured the serum level of creatine-kinase (CK), myocardial bound creatine-kinase (CKmb), lactic dehydrogenase (LDH), alpha-hydroxybutyrate dehydrogenase (alpha-HBDH), glutamic oxaloacetic transferase (GOT) and myoglobin. The mean duration of ischemia was 52.6 +/- 16.2 minutes and the mean time of extracorporeal circulation was 85.85 +/- 20.25 minutes. By performance of a multiple regression analysis a significant correlation between ischemia and LDH and alpha-HBDH was found; CK, GOT, LDH and alpha-HBDH correlated with duration of extracorporeal circulation. In none of the patients was a low cardiac output syndrome observed. From our results we conclude that in our study myocardial protection was sufficient and therefore the detrimental effects of extracorporeal circulation were the determining factors of enzyme release.
Elevated serum tumor markers in patients with testicular cancer after induction chemotherapy due to a reservoir of markers in cystic differentiated mature teratoma. Elevated serum tumor markers in patients with testicular cancer after induction chemotherapy indicate in most instances the presence of residual malignant disease. We describe 2 patients with elevated tumor markers after chemotherapy and before retroperitoneal lymph node dissection who did not prove to have residual malignant disease but cystic differentiated mature teratoma with a high content of alpha-fetoprotein and beta-human chorionic gonadotropin, respectively, in the cysts. It is postulated that leakage of the contents of these cysts to the plasma compartment was responsible for maintaining elevated serum tumor marker levels. Recognition of such entities is of consequence since unnecessary salvage chemotherapy in these patients may be avoided.
Diagnosis and treatment of pneumonia in the surgical intensive care unit [published erratum appears in Surg Gynecol Obstet 1991 Apr;172(4):324] It is often difficult to detect the onset of parenchymal pulmonary infection (pneumonia) in a surgical intensive care unit (SICU) setting. Clinical and laboratory parameters that usually indicate the presence of pneumonia, such as fever, elevated white blood cell count and abnormal sputum culture, may also be present in patients with nonpneumonic infection. Prompt diagnosis is particularly important for patients in SICU because the mortality rate associated with pneumonia in these patients may be as high as 50 per cent. In the SICU setting, pneumonia is best diagnosed using well-defined roentgenologic criteria. Treatment should consist of a broad-spectrum antibiotic regimen to which all sputum pathogens are sensitive. Such a regimen significantly reduces the mortality rate for patients with pneumonia in an SICU setting. Aztreonam has been found to be as effective against susceptible gram-negative bacilli as traditional agents, such as the aminoglycosides, and to have a significantly milder side effect profile.