123rc/medical_text huggingface dataset:
Renal transplants: can acute rejection and acute tubular necrosis be differentiated with MR imaging? Magnetic resonance (MR) imaging was used in 40 renal transplant recipients to determine whether this modality can enable distinction of acute tubular necrosis (ATN) and acute rejection by means of corticomedullary differentiation (CMD). Each patient underwent initial MR imaging after allograft renal transplantation. Twenty-nine of these 40 patients (72%) also underwent subsequent follow-up MR imaging. Seventeen studies were obtained during episodes of ATN; 12 of these studies (71%) showed poor CMD. Eleven studies were obtained during episodes of acute rejection; eight of these studies (73%) showed poor CMD. In addition, six of seven studies (86%) showing various combinations of renal disease (ATN, acute rejection, chronic rejection, and cyclosporine toxicity) also showed poor CMD. Loss of CMD is reversible after improvement of ATN and acute rejection. Because loss of CMD is a nonspecific though sensitive sign reflecting renal transplant dysfunction, MR imaging is of limited value in the differentiation of ATN from acute rejection.
Lateral temporal bone resections. Eighteen consecutive patients underwent a lateral temporal bone resection for the treatment of tumors originating in the auricle, the external auditory canal, the periauricular skin, or the parotid and were retrospectively analyzed. The different lateral temporal bone resections performed have been categorized into four types. The type I resection consists of the removal of the tympanic bone and the external auditory canal lateral to the tympanic membrane. The type II resection consists of the removal of the entire tympanic bone, the tympanic membrane, the incus, and the malleus, preserving the facial nerve and the inner ear. Type III resections remove, in addition to the those structures removed in type II resections, the distal facial nerve and fallopian canal, the mastoid tip, the styloid process, and the stylomastoid foramen. The type IV resection consists of the removal of only the mastoid tip and the inferior portion of the tympanic bone. When the techniques of lateral temporal bone resection are used appropriately, adequate surgical treatment of patients with selected advanced and recurrent malignant tumors of the external ear, the periauricular skin, and the parotid is possible with low morbidity and a high probability of local regional control.
Percutaneous pedestal in cochlear implantation. Direct electrical connection between an external sound-processing device and intracochlear electrodes is accomplished via a percutaneous pedestal. Patient pedestal complaints and experience have been recorded. Pedestal problems have been classified into six classes, with class 0 indicating no problems and the severity of problem increasing in classes 1 through 4. Class 5 indicates pedestal trauma. No class 5 problems were encountered. At 48 months of experience, 53% of patients were class 0 and 26% were class 1. The pedestal experience is detailed in the paper. The percutaneous pedestal has been found to be a well-tolerated, efficient system for information transfer in cochlear implant patients.
Lack of prognostic value of nucleolar organizer region enumeration in transitional cell carcinoma of the bladder. Enumeration of silver-stained nucleolar organizer regions is of limited use in grading transitional cell tumors of the bladder. We attempted in this article to establish whether or not such a technique would be helpful in predicting the prognosis of such tumors within rather than between grades. In the study population of 11 high-grade transitional cell carcinomas of the bladder, no correlation was found between clinical outcome and mean nucleolar organizer region count.
Oncogene amplification in squamous cell carcinoma of the head and neck. Cellular oncogenes appear to be involved in the control of normal cell growth and differentiation. The abnormal activation of these genes in naturally occurring and experimentally induced cancers may have an important role in the expression of the malignant phenotype in cancer cells. Mechanisms for the activation of these genes include chromosomal translocation, point mutation, and DNA amplification. The amplification of specific oncogenes correlates with clinical prognosis in several human malignancies, including breast cancer and neuroblastoma. We examined 21 fresh-frozen human squamous cell carcinomas of the aerodigestive tract for amplification of 10 known cellular oncogenes (c-myc, N-myc, L-myc, N-ras, H-ras, K-ras, erb-B, erb-B2, raf, and int-2), using Southern blotting techniques. Eleven of 21 tumors demonstrated a two-fold to 11-fold amplification of the int-2 oncogene, one member of a family of genes related to basic fibroblast growth factor. Amplification of c-myc, a gene that codes for a DNA-binding protein involved in the regulation of cell growth, was seen in two tumors. None of the other eight genes studied were amplified in any of the tumor specimens.
Progress in psychosocial and behavioral cancer research. The need for enabling strategies. A major component of the Second Workshop on Methodology in Behavioral and Psychosocial Cancer Research was a discussion of enabling strategies, that is, strategies by which future goals and needs in the area of psychosocial and behavioral oncology might be accomplished. This report describes and comments on the discussion that took place at a special plenary session at which representatives from four funding agencies, the American Cancer Society, National Cancer Institute, National Institute of Mental Health, and National Science Foundation, presented their views and their agencies' programs for promoting research in psychosocial and behavioral oncology. It is concluded that much progress has been made in the field and that strategies are in place for ensuring continued progress. However, suggestions are also made for new strategies that might accelerate and broaden that progress.
Giant enterocystoma within an infant's tongue. A rare developmental cyst within the tongue and submandibular triangle of a male infant containing heterotopic gastric and intestinal epithelium (enterocystoma) is described and its derivation discussed. This cyst was of such a size as to cause feeding difficulties and partial airway obstruction during sleep. Following C.T. scanning, total obstruction necessitated an emergency tracheostomy. Successful enucleation via a median labiomandibulotomy was performed without further complication and two years later there is no sign of recurrence.
Acute biologic response to excimer versus thermal laser angioplasty in experimental atherosclerosis. Vascular injury and platelet accumulation after balloon angioplasty are two potentially important triggers of the process of restenosis that may be minimized by the use of laser energy to ablate atherosclerotic plaque. The type of laser most suitable to achieve these goals remains unknown. Accordingly, angiographic and histologic studies and quantitative platelet deposition analysis were performed on 27 atherosclerotic rabbit iliac arteries randomized to treatment with excimer laser or thermal laser angioplasty. Excimer laser angioplasty was achieved with 35 to 40 mJ/mm2 of 308 nm xenon chloride irradiation delivered through a 4.5F catheter made of 13 concentrically arranged 200 microns fiber optics, at a repetition rate of 25 to 30 Hz and a pulse duration of 135 ns; thermal laser angioplasty was achieved with a 1.7 mm metal probe heated with 10 W of continuous wave argon laser energy. The baseline and post-laser luminal diameters of excimer laser-treated vessels (0.92 +/- 0.28 and 1.56 +/- 0.48 mm, respectively) were similar to those observed in thermal laser-treated vessels (1.05 +/- 0.44 and 1.61 +/- 0.41 mm, respectively). Perforation occurred in 4 (29%) of 14 thermal laser-treated arteries and in 0 of 13 excimer laser-treated arteries (p = 0.04); spasm was observed in only 1 thermal laser-treated vessel. On the basis of a quantitative histologic grading scheme (damage scores of 0 to 4), greater degrees of injury were measured in thermal versus excimer laser-treated vessels (2.4 +/- 1.0 versus 1.3 +/- 0.4, p = 0.009).
Low-dose aspirin versus anticoagulants for prevention of coronary graft occlusion. The prevention of graft occlusion by aspirin (100 mg/day) or heparin followed by phenprocoumon was investigated in a randomized trial in 235 patients after aortocoronary bypass operation. Aspirin treatment started 24 hours before, and heparin 6 hours and phenprocoumon 2 days after surgery. The results of the vein graft angiography and the clinical outcome 3 months postoperatively did not differ: 22% of 218 vein graft distal anastomoses in the aspirin group and 20% of 272 in the anticoagulant group were occluded. At least 1 occluded distal anastomosis was present in 38% of 74 patients in the aspirin-treated group and in 39% of 86 in the anticoagulant group. Worst-case analysis of all randomized patients showed graft occlusions, cardiovascular complications or lost to follow-up in 42% of 122 aspirin-treated patients compared with 41% of 113 patients treated with anticoagulants. For grafts with endarterectomy the occlusion rate was lower in the aspirin (12% of 49) than in the anticoagulant (22% of 41) group (p less than or equal to 0.05). Increased perioperative blood loss in the aspirin group (1,211 +/- 814 ml in the first 48 hours vs 874 +/- 818 ml in the anticoagulant group [p less than or equal to 0.001]) without a higher reoperation rate indicates effective platelet inhibition with low-dose aspirin. Because occlusion rates were equal but high in these patients with advanced stage of coronary artery disease, a combination of low-dose aspirin and anticoagulation should be investigated to reduce graft occlusion rates further.
Cytotoxic T cell clones isolated from ovarian tumor-infiltrating lymphocytes recognize multiple antigenic epitopes on autologous tumor cells. CTL clones were developed from tumor infiltrating lymphocytes (TIL) from the ascites of a patient with ovarian carcinoma by coculture of TIL with autologous tumor cells and subsequent cloning in the presence of autologous tumor cells. These CTL clones expressed preferential cytolytic activity against autologous tumor cells but not against allogeneic ovarian tumor cells and the NK-sensitive cell line K562. The cytolytic activity of these CTL against autologous tumors was inhibited by anti-TCR (WT31 mAb), anti-HLA class I, and anti-CD3 mAb but not by the NK function antibody Leu 11b. Cloning of the autologous tumor cells in vitro revealed that the CTL clones of the ovarian TIL expressed differential abilities to lyse autologous tumor cell clones. The specificity analysis of these autologous tumor specific CTL suggested that they recognize several antigenic determinants present on the ovarian tumor cells. Our results indicate the presence of at least three antigenic epitopes on the tumor cells (designated OVA-1A, OVA-1B, and OVA-1C), one of which (OVA-1C) is unstable. These determinants are present either simultaneously or separately, and six types of ovarian clones can be distinguished on the basis of their expression. These results indicate that CTL of the TIL detect intratumor antigenic heterogeneity. The novel heterogeneity identified within the ovarian tumor cells in this report may be of significance for understanding cellular immunity in ovarian cancer and developing adoptive specific immunotherapeutic approaches in ovarian cancer.
Epidermal dendritic S100 positive cells in necrobiosis lipoidica and granuloma annulare. Using an antibody to S100 protein, the number of dendritic cells above the basal layer in the epidermis was assessed in necrobiosis lipoidica and granuloma annulare. A statistically significantly higher number of these cells was found within the epidermis in necrobiosis lipoidica compared with granuloma annulare and normal skin. The numbers were similar to those seen in sarcoidosis and tuberculous reactions in the skin, which raises the possibility of an immune pathogenesis for necrobiosis lipoidica.
Characterization of the morphonuclear features and DNA ploidy of typical and atypical carcinoids and small cell carcinomas of the lung. The authors analyzed several cytomorphonuclear parameters related to chromatin distribution and DNA ploidy in typical and atypical carcinoids and in small cell lung cancers. Nuclear measurements and analysis were performed with a SAMBA 200 (TITN, Grenoble, France) cell image processor with software allowing the discrimination of parameters computed on cytospin preparations of Feulgen-stained nuclei extracted from deparaffinized tumor tissues. The authors' results indicate a significant increase in DNA content--assessed by integrated optical density (IOD)--from typical carcinoids to small cell lung carcinomas, with atypical carcinoids showing an intermediate value. Parameters related to hyperchromatism (short and long run length and variance of optical density) also characterize the atypical carcinoids as being intermediate between typical carcinoids and small cell lung cancers. The systematic measurement of these cytomorphonuclear parameters seems to define an objective, reproducible "scale" of differentiation that helps to define the atypical carcinoid and may be of value in establishing cytologic criteria for differential diagnosis.
Magnetic resonance imaging in idiopathic retroperitoneal fibrosis: measurement of T1 relaxation time. Magnetic resonance imaging at 0.08 Tesla was performed in nine patients with proven idiopathic retroperitoneal fibrosis. A total of 11 scans was performed. Three patients were scanned before diagnosis; one of these also had two follow-up scans. A further six patients were scanned a variable time after diagnosis and treatment. On each scan, a periaortic soft-tissue mass was readily identified, the distribution corresponding to that seen on computed tomography. There was no difference in the mean T1 relaxation time of the mass between patients scanned before diagnosis and those scanned after treatment. However, the patient followed with serial scans showed a progressive reduction in the T1 value of the mass with time. Comparison with results obtained in patients with lymphoma suggests that the T1 values in retroperitoneal fibrosis are lower than in lymphoma, particularly non-Hodgkin's lymphoma.
Pedunculated giant lipoma of the esophagus. A patient with a giant lipoma of the esophagus presented with progressive dysphagia and odynophagia, fever, and recurrent melena. Two years previously, when the symptoms were less pronounced, it had been misdiagnosed as achalasia. After surgical removal of the lipoma, the patient became symptom free.
Elective radical neck dissection in epidermoid cancer of the head and neck. A retrospective analysis of 853 cases of mouth, pharynx, and larynx cancer. A retrospective analysis of 853 patients with cancer of the mouth, pharynx, and larynx operated on over a 30-year period was performed. Four hundred fifty-seven of them had a radical neck dissection (RND) at some point. Five hundred ninety patients had no clinically positive nodes (N-o) necks at the time of primary treatment; 99 of these had elective neck dissection, whereas 95 others had a delayed RND when nodes became clinically involved. Twenty-three percent of all N-o patients had microscopically involved nodes and less than half of these were among those patients selected for elective RND. Furthermore, 58% of those patients who had elective RND did not have positive nodes. Comparative analysis of elective RND, delayed therapeutic RND after clinical appearance of nodes, and composite operations for patients with N1-N3 disease indicates little difference in disease-free survival when the nodes in the elective RND were positive microscopically for tumors (56%, 49% and 47% respectively). It thus seems that elective RND offers no real advantage over a careful watchful waiting approach in most patients.
A comparative study of histopathology, hormone receptors, peanut lectin binding, Ki-67 immunostaining, and nucleolar organizer region-associated proteins in human breast cancer. The current study was performed on 71 cases of human female breast cancer and compares the results of five morphologic methods developed for the detection of estrogen receptors (ER), progesterone receptors (PgR), lectin Peanut agglutinin (PNA) binding sites, monoclonal antibody Ki-67 immunoreactivity, and the mean number of argyrophilic nucleolar organizer regions (Ag-NOR). All the parameters were evaluated on serial cryostat sections representative of a closely related, if not identical, neoplastic population. A significant positive correlation was found between the occurrence of estrogen, progesterone, and peanut receptors and between Ki-67 immunoreactivity, mean number of NOR, and mitotic index. Furthermore, ER, PgR, and PNA receptors showed a significant, inverse correlation with Ki-67 immunoreactivity, mitotic index, and mean number of Ag-NOR. These results provide further data that support the hypothesis that (1) progesterone and PNA receptors are estrogen-induced and indicate a metabolic response of the target cells to functioning estrogen receptors; (2) the mean number of NOR reflects the cell kinetics of the tumor; and (3) metabolic differentiation of neoplastic cells is inversely correlated to the proliferation index.
Clinical use of the Berlin Biventricular Assist Device as a bridge to transplantation. The Berlin Artificial Heart System/Biventricular Assist Device (BVAD) was used in 38 patients. 1) Twenty-eight patients were awaiting cardiac transplantation (Tx) (age 23-56 yrs). All patients had contraindications not allowing immediate Tx. 2) Five patients were emergency cases not on our Tx list (postcardiotomy cardiac failure, acute myocarditis) (age 28-59). 3) Five patients were post Tx patients with graft failure (age 22-52). Extracorporal circulation was used for implantation of the BVAD. In group 1, 21 of 28 patients (pts) recovered, and all were subsequently transplanted after 6 hours to 39 days, when all organ function was restored. In 7 pts, mechanical circulation was terminated after 1-40 days because of further deterioration. Five of the transplanted pts died, 14 pts survived (greater than 30 days), and 2 pts were just transplanted with satisfactory postoperative courses. Of group 2 and 3 pts, two were successfully weaned. In one patient the allograft recovered after 11 days of support.
Evaluating and influencing periodontal diagnostic and treatment behaviors in general practice. Providers' periodontal diagnostic and treatment behaviors were assessed in 34 practices in two North Carolina counties. Regularly attending patients had a low prevalence of gingival pocketing on index teeth, moderate attachment loss, and fairly prevalent bleeding and calculus. Treatment frequency and patient knowledge were generally adequate, but the notation of periodontal status in the patient record was insufficient. A continuing education intervention resulted in substantial and significant improvement in notation rates. Changes in rates with which services were provided, and changes in patient periodontal status were smaller and mixed. The study shows that continuing education can be effective in helping some but not all providers adopt needed, appropriate behaviors.
Comparison of cardiac catheterization and Doppler echocardiography in the decision to operate in aortic and mitral valve disease Clinical decisions utilizing either Doppler echocardiographic or cardiac catheterization data were compared in adult patients with isolated or combined aortic and mitral valve disease. A clinical decision to operate, not operate or remain uncertain was made by experienced cardiologists given either Doppler echocardiographic or cardiac catheterization data. A prospective evaluation was performed on 189 consecutive patients (mean age 67 years) with valvular heart disease who were being considered for surgical treatment on the basis of clinical information. All patients underwent cardiac catheterization and detailed Doppler echocardiographic examination. Three sets of two cardiologist decision makers who did not know patient identity were given clinical information in combination with either Doppler echocardiographic or cardiac catheterization data. The combination of Doppler echocardiographic and clinical data was considered inadequate for clinical decision making in 21% of patients with aortic and 5% of patients with mitral valve disease. The combination of cardiac catheterization and clinical data was considered inadequate in 2% of patients with aortic and 2% of patients with mitral valve disease. Among the remaining patients, the cardiologists using echocardiographic or angiographic data were in agreement on the decision to operate or not operate in 113 (76% overall). When the data were analyzed by specific valve lesion, decisions based on Doppler echocardiography or catheterization were in agreement in 92%, 90%, 83% and 69%, respectively, of patients with aortic regurgitation, mitral stenosis, aortic stenosis and mitral regurgitation. Differences in cardiac output determination, estimation of valvular regurgitation and information concerning coronary anatomy were the main reasons for different clinical management decisions. These results suggest that for most adult patients with aortic or mitral valve disease, alone or in combination, Doppler echocardiographic data enable the clinician to make the same decision reached with catheterization data.
Pterygia: single-fraction postoperative beta irradiation. A retrospective evaluation was performed with records of 128 patients with 146 eyes that underwent applications of strontium-90 after pterygium excisions performed between 1982 and 1988. With a median follow-up of 13 months, 135 eyes were evaluable. Most pterygia (127 of 135) were treated with a single postoperative application of Sr-90 that delivered 3,000 cGy of beta radiation in one fraction. The actuarial freedom from relapse was 87%; all recurrences occurred within the first 18 months, and 46% of these within the first 3 months. Of the 13 recurrences, 10 have been re-treated with surgery and a second course of beta irradiation with excellent results. All eight eyes for which follow-up was available had no evidence of disease. The ultimate control rate was 96.3% for the series. Correlation of various treatment parameters, including age, bilaterality, prior recurrence, and interval from surgery to irradiation, was performed, and no statistically significant difference was seen. No serious complications have developed. Transient conjunctivitis and photophobia were almost universally seen, with five cases lasting beyond 5 months. The authors conclude that a single application of Sr-90 after surgery is effective and safe in managing pterygia.
Effects of radiation therapy on skeletal growth in childhood. Ionizing radiation was used to treat childhood cancer long before the advent of chemotherapy, and it took little time for physicians to appreciate the deleterious effects it had on skeletal growth. The cause of this complication results predominantly from alteration of chondroblastic activity. This may stem directly from irradiation at the epiphyseal plate or indirectly from irradiation of glands that secrete growth-mediating hormones. The complication can go far beyond the obvious physical afflictions and extend into the psychologic domain, rendering deeper, more permanent scars. Presently, many of these effects are predictable, reducible, and treatable without compromising the cure that so often depends on the use of irradiation. Because of the complexities of childhood cancer therapy, strategies aimed at diminishing these effects are challenging. It is imperative that these effects be understood so that they can be reduced in current patients and prevented in future patients.