123rc/medical_text huggingface dataset:
Evaluation of pulmonary arterial pressure by Doppler colour flow mapping in patients with a ductus arteriosus. Blood flow in the pulmonary artery was studied by Doppler colour flow mapping and cardiac catheterisation in 19 patients with a ductus arteriosus and different pulmonary artery pressures. In the four patients with normal pulmonary artery pressures colour Doppler flow mapping showed multicoloured wide and long systolic and diastolic jets in the pulmonary artery. In the 15 patients with raised pulmonary arterial pressure the systolic jets varied from multicoloured to red and were thinner: in patients with considerably raised pulmonary arterial pressure the jets became redder during diastole. The Doppler velocity tracings showed that in patients with normal pulmonary artery pressures the mean peak systolic velocity was higher than the mean end diastolic velocity--so that in all four the ratio of peak systolic velocity to end diastolic velocity was less than 2. The mean peak systolic velocity was much higher than the mean end diastolic velocity in 13 of the 15 patients with raised pulmonary artery pressure; this meant that the ratio of peak systolic velocity to end diastolic velocity was greater than 2 in 10 of 11 patients. The end diastolic velocity was significantly lower in those patients with raised pulmonary artery pressure than in those with normal artery pressure. There was an inverse linear correlation between the mean pulmonary artery pressure and end diastolic ductal jet velocity in 17 of the 19 patients. Colour flow mapping and this quantitative Doppler technique can detect pulmonary artery hypertension in patients with a ductus arteriosus.
Concomitant neurocysticercosis and brucellosis. A young Mexican woman had headache and left arm weakness develop shortly after immigrating to the United States. A solitary cerebral cysticercus was found at surgery, but, instead of the expected finding of clear fluid, the cyst contained pus from which Brucella melitensis was cultured. Although the patient had no signs or symptoms suggestive of brucellosis, agglutination studies revealed IgM and IgG antibodies consistent with active brucellosis. Clinicians should be alert to the possibility of multiple infections in immigrants from countries where parasites and bacteria that are uncommon in the United States are endemic.
Is phase 2 cardiac rehabilitation necessary for early recovery of patients with cardiac disease? A randomized, controlled study. In this study the effects of rehabilitation teaching plus exercise testing on perceived self-efficacy for and performance of daily activities were compared with and without exercise training. Subjects were patients who had had myocardial infarction or cardiac surgery (mean age 57.7 +/- 11.3 years) and who had already received inpatient rehabilitation services. Subjects were randomly assigned to one of three groups. Treatment group 1 (n = 11) received teaching, treadmill exercise testing, and exercise training (three times weekly for 5 weeks). Treatment group 2 (n = 15) received only teaching and exercise testing. The control group (n = 14) received only routine care without supervised exercise or teaching. Measurements of self-efficacy and activity performance were made at hospital discharge and at 4 and 9 weeks after the cardiac event. Repeated-measures analysis of variance showed an increase in self-efficacy scores (p less than 0.001) and performance of physical activity (p less than 0.001) for all groups. Both treatment groups, especially the training group, obtained the highest scores, but differences between groups were nonsignificant (p greater than 0.05). These results indicate that in a sample of uncomplicated, motivated patients who had participated in a phase 1 inpatient rehabilitation program, substantial improvements in self-efficacy and performance of daily activities were made early in recovery, before the onset of phase 2, formalized outpatient therapy.
Laparoscopic excision of ovarian neoplasms subsequently found to be malignant. One hundred fifty-six members and candidate members of the Society of Gynecologic Oncologists responded to a survey concerning the "laparoscopic management of ovarian neoplasms subsequently found to be malignant." Twenty-nine responders (19%) reported a total of 42 cases of ovarian malignancy. The laparoscopic procedure was aborted or the cyst was aspirated in 38% of the cases, and partial or complete excisions were attempted in 33 and 29%, respectively. The characteristics of the masses were as follows: less than 8 cm 67%, cystic 62%, unilocular 48%, and unilateral 81%. All four "benign" characteristics were present in 31% of the cases found to be malignant, and three of four characteristics were present in 24%. Laparotomy was performed at the time of laparoscopy in 17% of cases, after laparoscopy in 71% with an average interval of 4.8 weeks, and not at all in 12%. Fifty-seven percent of the cases were invasive epithelial malignancies, whereas 29% were tumors of low malignant potential. At least 50% of the patients had stages II-IV. We conclude that attempted laparoscopic excisions of adnexal masses that are subsequently found to be malignant are not uncommon, and that the presence of so-called "benign" characteristics does not preclude malignancy. Attempts at partial or complete excision are common, as are delays in subsequent definitive surgery. The stage of disease is often advanced, and all histologic types of malignancy are encountered. We advocate careful evaluation of this practice, with development of strict guidelines to ensure optimal patient care.
Avulsion of the rectus femoris tendon: an unusual type of pelvic fracture. We present the case of a 15-year-old boy evaluated in the emergency department after sustaining an acute hip injury during track and field practice. Pelvic radiograph demonstrated an avulsion fracture of the anterior inferior iliac spine. Review of the literature reveals this to be a well recognized, yet unusual and interesting injury.
Infection with Chlamydia pneumoniae in Brooklyn. Of 91 children and adults with lower respiratory tract infection, 17 (18.7%) had evidence of infection with Chlamydia pneumoniae. Infection was more common in older adolescents and adults than in children. Only 3 of 8 culture-positive patients with paired sera had serologic evidence of acute infection. Two patients were culture positive over a 12-month period. Two other culture-positive patients had evidence of coinfection with other bacterial respiratory tract pathogens, which in these cases appeared to be responsible for the acute episode of pneumonia. Patterns of infection ranged from acute pneumonia to apparent chronic asymptomatic carriage, and there was no characteristic clinical presentation. Studies using cultures in other populations, including asymptomatic individuals, are needed for a better understanding of the epidemiology and clinical relevance of this organism.
Pulmonary effects of ischemic limb reperfusion: evidence for a role for oxygen-derived radicals. OBJECTIVE: To evaluate the lung as a reperfusion target after limb ischemia-reperfusion, and to measure specifically the oxygen radical response to this reperfusion. DESIGN: Paired simple randomized, with continuous interval data in dependent variable and both continuous and nominal independent variables. SUBJECTS AND INTERVENTION: Sprague-Dawley male rats (n = 195) were anesthetized and both hind limbs occluded for 3.75 hr, the overnight LD50. Alveolar lavage was performed on the animals 1 hr after reperfusion or on survivors 20 hr after reperfusion. Groups were either undosed or pretreated with alpha-tocopherol as an antioxidant (50 mg/kg.day) 2 days before ischemia. MEASUREMENTS AND MAIN RESULTS: Luminol-enhanced chemiluminescence was measured in both phorbol myristate acetate-stimulated and unstimulated macrophages. Nanomoles of superoxide radicals per 10(6) alveolar cells/min were also measured using a cytochrome c reduction assay. A significant (p less than .01, Student's t-test), time-dependent increase in response of cells from ischemic-reperfused rats was seen. Pretreatment with antioxidant had no effect at 1 hr, but significant differences were seen in the 20-hr survivors. CONCLUSIONS: These studies show that alveolar lavage cells, 95% macrophages, reflect the reperfusion of ischemic-reperfused hind limbs by a significant increase in oxygen radical activity, an effect partly suppressed in antioxidant-dosed survivors.
Management of selected cystic adnexal masses in postmenopausal women by operative laparoscopy: a pilot study. Twenty-five postmenopausal patients were predicted to have benign masses by screening criteria that included ultrasonographic findings of a cystic adnexal mass less than 10 cm with distinct borders and no evidence of irregular solid parts, thick septa, ascites, or matted bowel, and a normal serum CA 125 value (less than 35 U/ml). All 25 masses were accurately predicted to be benign. The size of the cysts on ultrasonography ranged from 3 to 9 cm with a mean of 5 cm. Twenty-two patients (88%) were successfully managed by operative laparoscopy and adnexectomy. Mean operative time was 70 minutes and mean postoperative hospital stay was 12 hours. Mean time of return to normal activity was 5 days. Three patients required laparotomy. We conclude that removal of these cystic adnexal masses by operative laparoscopy is an acceptable alternative in carefully selected postmenopausal women.
Serological evidence of infection with Helicobacter pylori may predict gastrointestinal intolerance to non-steroidal anti-inflammatory drug (NSAID) treatment in rheumatoid arthritis. Specific circulating antibodies to the spiral gastric organism, Helicobacter pylori (HP) were detectable in 43% of 68 patients with rheumatoid arthritis by complement fixation test (CFT) and enzyme-linked immunosorbent assay (ELISA), a frequency comparable with that of a normal, age-matched population. Presence of these antibodies correlated strongly with a previous history of peptic ulcer disease (PUD) and to the severity of NSAID-related dyspeptic symptoms, the latter often leading to multiple drug intolerance. This contrasts with short term, prospective NSAID toxicity data, which show little relationship between ulceration and HP carriage. This result suggests, however, that HP may have a definite role in the pathogenesis of symptomatic PUD associated with more chronic NSAID usage, and may have important implications for ulcer prophylaxis in these patients.
Abnormal single motor unit behavior in the upper motor neuron syndrome. We studied the discharge pattern of single motor units (SMUs) in the left and right biceps muscles from a patient with nonspastic weakness of the left arm. Detailed statistical analysis of the behavior of discharge patterns of 4 of 4 single motor units on the affected side showed abnormalities with characteristic features of an upper motor neuron lesion. Five out of 5 single motor units recorded from the right biceps were normal. An upper motor neuron lesion affecting the left arm, predicted by our results, was confirmed by magnetic resonance imaging (MRI), which showed a lesion in the right precentral gyrus. It appears that changes in single motor unit firing characteristics, caused by an upper motor neuron lesion, can be detected at a time when there is no evidence of increased "tone" and/or hyperreflexia (spasticity) in the affected extremity.
Transient renal acidification defect during acute infantile diarrhea: the role of urinary sodium. We studied urinary acidification daily during the hospital course of 16 infants with acute gastroenteritis and metabolic acidosis. Urine pH value on admission was higher than 5.5 in 14 (87%) patients. We hypothesized that inappropriate urinary acidification was due to sodium deficiency and inadequate sodium delivery to the distal nephron. Forty-one urinary samples were collected during metabolic acidosis. The mean pH of 24 urine samples with sodium concentration less than 10 mmol/L was significantly higher than the pH of 17 samples with sodium concentration greater than 10 mmol/L (6.04 +/- 0.06 vs 5.19 +/- 0.1; p less than 0.001). The urine ratios of titratable acid to creatinine and of total acidity to creatinine were significantly higher in urine samples containing more sodium (p less than 0.02), whereas the ammonium/creatinine ratio was not. After administration of furosemide or correction of the sodium deficit, appropriate acidification was observed. We conclude that impaired urinary acidification is frequently found during metabolic acidosis in infants with acute gastroenteritis and results from a sodium deficit rather than from transient distal renal tubular acidosis.
Comparison of cefuroxime axetil, cefaclor, and amoxicillin-clavulanate potassium suspensions in acute otitis media in infants and children. In this randomized, blinded, multicenter comparison study, 377 infants and children with acute otitis media (AOM) received a 10-day course of an oral suspension of one of the following: cefuroxime axetil (CAE), 30 mg/kg/day; cefaclor (CEC), 40 mg/kg/day; or amoxicillin-clavulanate potassium (AMX-CL), 40 mg/kg/day. Clinical efficacy was determined by pneumatic otoscopy and tympanometric testing 3 to 5, 11 to 14, and 22 to 26 days after the initiation of therapy. There was a statistically significant difference among the three treatment groups with respect to clinical outcome; more patients in the CAE group (62%) than in the CEC group (46%) or the AMX-CL group (52%) had complete resolution of signs and symptoms of AOM (including effusion). Paired comparisons revealed a significant difference in efficacy between CAE and CEC and a nearly significant difference between AMX-CL and CEC. Taste acceptability was highest for CEC and lowest for this formulation of CAE. Significantly more patients in the AMX-CL group than in the CAE or CEC group had a side effect, primarily diarrhea, vomiting, or diaper rash. We conclude that CAE suspension has greater clinical efficacy than CEC and fewer side effects than AMX-CL.
Pharmacokinetics and pharmacodynamics of doxacurium in normal patients and in those with hepatic or renal failure. We determined the pharmacokinetics and duration of action of a bolus dose of doxacurium (15 micrograms/kg) in 27 patients anesthetized with isoflurane and nitrous oxide. Nine patients had normal renal and liver functions and were undergoing a variety of surgical procedures, nine were undergoing cadaveric kidney transplantation because of end-stage renal disease, and nine were undergoing cadaveric liver transplantation because of end-stage hepatocellular disease. Plasma concentrations of doxacurium were measured for 6 h after administration using a sensitive and specific capillary gas chromatographic assay. Plasma concentration versus time data were analyzed by a noncompartmental method based on statistical moments. Neuromuscular blockade was assessed by measuring the electromyographic evoked response of the adductor pollicis muscle to train-of-four stimulation of the ulnar nerve. The degree of neuromuscular blockade after doxacurium administration was described as the percent of control of the first train-of-four response. The pharmacokinetic variables were (normal vs hepatic failure vs renal failure, respectively): volume of distribution at steady state (220 +/- 110 vs 290 +/- 60 vs 270 +/- 130 mL/kg [mean +/- SD]), plasma clearance (2.7 +/- 1.6 vs 2.3 +/- 0.4 vs 1.2 +/- 0.7 mL.kg-1.min-1), mean residence time (95.2 +/- 57 vs 129.4 +/- 30 vs 270 +/- 210 min), and elimination half-life (99 +/- 54 vs 115 +/- 31 vs 221 +/- 156 min). Plasma clearance and mean residence time differed significantly between patients with renal failure and control patients.
Nerve growth factor stimulates protein tyrosine phosphorylation in PC-12 pheochromocytoma cells. The cellular actions of nerve growth factor (NGF) and epidermal growth factor (EGF) may be mediated by changes in protein phosphorylation. The tyrosine phosphorylation of two predominant proteins of molecular mass 40 and 42 kDa is seen in PC-12 cells treated with NGF or EGF, correlating with activation of a previously identified serine/threonine protein kinase that phosphorylates microtubule-associated protein (MAP). Stimulation of phosphoprotein (pp) 40 and 42 phosphorylation and MAP kinase activity by NGF but not EGF is selectively attenuated by staurosporine and K-252A. Moreover, the time courses of pp40/42 phosphorylation and MAP kinase activation produced by NGF or EGF are identical. Chromatography of lysates from growth factor-treated cells on ion-exchange or hydrophobic-interaction HPLC resolves MAP kinase into two peaks, neither of which precisely coelutes with pp40 or pp42. One of these peaks (II) exhibits no detectable phosphotyrosine. The other peak (I) has some overlap with pp40. However, the activity residing in both peaks is almost completely inhibited after treatment with alkaline phosphatase, suggesting that, at least, serine/threonine phosphorylation is required for the activity of these enzymes. These data indicate that while tyrosine phosphorylation appears to be a critical early event in NGF action, the role of this modification in activation of MAP kinases remains unclear.
Portacaval shunt as an experimental model of impaired hepatic release of vitamin A in liver disease. Vitamin A concentrations in serum and liver were studied in rats with a portacaval shunt for 48 days after shunt surgery. In addition, serum and tissue concentrations of zinc were analyzed. Following portacaval shunting serum vitamin A concentration decreased to 25% of the level in sham-operated controls, whereas serum zinc concentration decreased to 80%. The mean urinary excretion rate of zinc increased in shunted rats [18.7 +/- 2.1 micrograms/day (0.28 +/- 0.03 mumol/day)] compared with controls [13.8 +/- 1.7 micrograms/day (0.21 +/- 0.03 mumol/day)] (P less than 0.01). The concentration of retinol and total retinoids in liver tissue increased 2-3-fold in rats with a portacaval shunt, and the ratio of retinol to retinoids was slightly increased. The differences were reduced when the total organ content was calculated, because of the reduced liver weight in the shunted rats. The concentration of zinc in liver tissue decreased in rats with portacaval shunts [30.8 +/- 4.9 micrograms/g wet wt (0.47 +/- 0.07 mumol/g) vs. 35.6 +/- 3.7 micrograms/g wet wt (0.54 +/- 0.06 mumol/g) in controls; P less than 0.01]. The concentration of zinc was inversely correlated with retinol (r = -0.52, P less than 0.05) and total retinoid levels (r = -0.70, P less than 0.05) in rats with portacaval shunts but not in controls. The data are consistent with the hypothesis of an impaired release of vitamin A from the liver in rats with portacaval shunts, an impairment that could be due to liver zinc deficiency.
Treatment of status migrainosus: the American experience. Dependence upon a variety of drugs--ergotamine, analgesics, benzodiazepines, corticosteroids--is a major reason for patients to enter an intractable phase of their migrainous disorders. Repeated dosing of dihydroergotamine has proven to be remarkably effective in stabilizing the mechanism of migraine, allowing these patients to make the transition to a more reasonable as well as more specific form of therapy.
Diltiazem increases late-onset congestive heart failure in postinfarction patients with early reduction in ejection fraction. The Adverse Experience Committee; and the Multicenter Diltiazem Postinfarction Research Group The Multicenter Diltiazem Postinfarction Trial (MDPIT) reported no consistent diltiazem effect on new or worsened congestive heart failure (CHF) during 12-52 months' follow-up after acute myocardial infarction. This was puzzling in light of the observation that patients with findings suggesting left ventricular dysfunction (LVD) at baseline on diltiazem had more cardiac events (cardiac mortality or recurrent nonfatal infarction) than such patients on placebo. We hypothesized that diltiazem increased the frequency of late CHF as well as of cardiac events, but only in patients predisposed by LVD. Using the same characterizing variables as the primary MDPIT analysis, we found that patients with pulmonary congestion, anterolateral Q wave infarction, or reduced ejection fraction (EF) at baseline were more likely to have CHF during follow-up than those without these markers of LVD. CHF was particularly frequent in the patients with LVD who were randomized to diltiazem. Among those with a baseline EF of less than 0.40, late CHF appeared in 12% (39/326) receiving placebo and 21% (61/297) receiving diltiazem (p = 0.004). Life table analysis in patients with an EF of less than 0.40 confirmed more frequent late CHF in those taking diltiazem (p = 0.0017). In addition, the diltiazem-associated rise in the frequency of late CHF was progressively greater with increasingly severe decrements in baseline EF. This diltiazem effect was absent in patients with pulmonary congestion at baseline but an EF of 0.40 or more, suggesting a unique association between diltiazem-related late CHF and systolic LVD.
Hemolytic-uremic syndrome in children. A serious hazard of undercooked beef. Hemolytic-uremic syndrome is the leading cause of acute renal failure in childhood. Its incidence in North America is increasing. Escherichia coli O157:H7 is the most common infectious trigger and is spread by contaminated beef products as well as from person to person. Antibiotics or antidiarrheal medications should not be used in the treatment of E coli hemorrhagic colitis or hemolytic-uremic syndrome. Mortality in children with the syndrome has fallen to less than 10% in North America, largely because of careful attention to nutrition, maintenance of a normal fluid and electrolyte balance, and careful monitoring. Education and emotional support of the family are important aspects of the treatment program.
Is there a place for conservative surgery in the treatment of renal carcinoma? Since 1981, 31 patients have undergone conservative surgery for malignant renal tumours and have been followed up for at least 2 years. The techniques included enucleation or resection (wedge resection or partial nephrectomy). In 10 patients the indications for kidney-sparing surgery were absolute, while in the remainder the conservative surgical approach was a deliberate choice. The tumours varied in diameter from 1.3 to 12 cm and no metastases were detected on pre-operative screening. One patient died post-operatively from myocardial infarction. In the remaining 30 there were no local recurrences. Two patients died from skeletal metastases (1 with bilateral malignancy) and 2 underwent surgery in the post-operative period for haemorrhagic complications. The efficacy of conservative surgery in the local control of renal cancer is an argument in favour of its wider use.
Pyoderma gangrenosum followed by subcorneal pustular dermatosis in a patient with IgA paraproteinemia. Six months after the occurrence of pyoderma gangrenosum, subcorneal pustular dermatosis developed in a 60-year-old woman. The patient's serum was found to contain an IgA-lambda paraprotein. Although similar cases have been reported, this case is unique in that a distinct episode of pyoderma gangrenosum was followed by subcorneal pustular dermatosis.