123rc/medical_text huggingface dataset:
Retrograde continuous warm blood cardioplegia: a new concept in myocardial protection This report presents the results in our first clinical series of patients receiving continuous warm blood cardioplegia through the coronary sinus. Warm oxygenated blood cardioplegia has certain theoretical advantages, such as continuously supplying oxygen and substrates to the arrested heart while avoiding the side effects of hypothermia. Retrograde infusion of cardioplegia also offers certain advantages (eg, in valve operations and in patients with severe coronary artery disease) that are complementary to warm blood cardioplegia. Retrograde warm blood cardioplegia was used in 113 consecutive patients (85 men and 28 women with a mean age of 61 years) undergoing various procedures. Three percent of the patients died, 7% needed transient intraaortic balloon pump support, 6% had evidence of perioperative myocardial infarction, and 96% had spontaneous return of rhythm. There were no coronary sinus injuries. This new technique of retrograde continuous warm blood cardioplegia is a simple, safe, and reliable method of myocardial protection that may change the way we currently protect the heart intraoperatively.
The standardized assessment of argyrophilic nucleolar organizer regions in meningeal tumors. Tissue markers of cellular proliferation have been recently utilized as prognostic indicators in tumors of the central nervous system. Nucleolar organizer regions represent transcriptionally active sites of ribosomal deoxyribonucleic acid (DNA) and can be identified by a simple argyrophilic technique. The authors describe a standardized approach to the assessment of these argyrophilic nucleolar organizer regions in meningeal tumors. Twenty-five meningiomas were classified histologically into benign, atypical, or malignant groups. In addition, two hemangiopericytomas and one leptomeningeal melanoma were examined. Appropriate sections were silver stained and argyrophilic nucleolar organizer regions were counted in 200 nuclei. The mean argyrophilic nucleolar organizer region count was statistically different (p less than 0.001) between benign tumors (245 +/- 156, 1.23/cell), atypical tumors (497 +/- 135, 2.49/cell), and malignant tumors (921 +/- 59, 4.61/cell). The count for recurrent meningiomas (544 +/- 76) was also statistically different (p less than 0.02) from non-recurrent tumors (329 +/- 183). The standardized assessment of argyrophilic nucleolar organizer regions can be easily performed by any surgical pathology laboratory without specialized equipment and, in meningeal tumors, may be useful as an independent indicator of biological behavior.
Cancer in the families of children with soft tissue sarcoma. The cancer experience among 754 first-degree relatives (mothers, fathers, and siblings) of a population-based series of 177 children with soft tissue sarcoma is reported. The current study represents an extension of our earlier work in which the authors found an excess of breast cancer in the mothers of 143 of these children. There were 40 cancers among all first-degree relatives, compared with 24.82 expected (relative risk [RR] 1.61, P = 0.006). There was no excess in fathers, but an excess of borderline significance was seen in mothers (RR 1.67, P = 0.0545), and a significant excess in siblings (RR 4.55, P = 0.0002), mainly due to carcinoma of the breast and pediatric tumors. Results of a step forward Cox multivariate analysis identified three variables in the index child which were independently associated with high cancer risk in relatives, as follows: age younger than 24 months at diagnosis; histologic type, embryonal rhabdomyosarcoma or other and unspecified soft tissue sarcoma; and male sex. It was possible, therefore, to identify a subgroup of children whose relatives are at high risk of early onset cancer (RR in this group 10.14). The pattern of cancers is consistent with the Li-Fraumeni syndrome. The authors conclude that a marked proportion of childhood soft tissue sarcoma has a genetic basis.
Surgical treatment of a rare congenital anomaly of the vertebral artery: case report and review of the literature. A case of an abnormal loop of the vertebral artery compressing both the cervicomedullary junction and the accessory nerve is reported. The embryological development of the vertebrobasilar system may explain this anatomical anomaly. The possibility of an abnormal location of the vertebral artery may complicate the lateral C1-C2 puncture for myelography. Only five similar cases have been reported previously, but none of them presented any clinical symptomatology, and surgical treatment was never required. The present patient was cured by microvascular decompression. The pathogenetic and surgical implications are discussed in light of the literature.
Mandibular reconstruction with composite microvascular tissue transfer. Microvascular free tissue transfer has provided a variety of methods of restoring vascularized bone and soft tissue to difficult defects created by tumor resection and trauma. Over 7 years, 26 patients have undergone 28 free flaps for mandibular reconstruction, 15 for primary squamous cell carcinoma of the floor of the mouth or tongue, 7 for recurrent tumor, and 6 for other reasons [lymphangioma (1), infection (1), gunshot wound (1), and osteoradionecrosis (3)]. Primary reconstruction was performed in 19 cases and secondary in 9. All repairs were composite flaps including 12 scapula, 5 radial forearm, 3 fibula, 2 serratus, and 6 deep circumflex iliac artery. Mandibular defects included the symphysis alone (7), symphysis and body (5), symphysis-body-ramus condyle (2), body or ramus (13), and bilateral body (1). Fourteen patients had received prior radiotherapy to adjuvant or curative doses. Eight received postoperative radiotherapy. All patients had initially successful vascularized reconstruction by clinical examination (28) and positive radionuclide scan (22 of 22). Bony stability was achieved in 25 of 26 patients and oral continence in 24 of 26. One complete flap loss occurred at 14 days. Complications of some degree developed in 22 patients including partial skin necrosis (3), orocutaneous fistula (3), plate exposure (1), donor site infection (3), fracture of reconstruction (1), and fracture of the radius (1). Microvascular transfer of bone and soft tissue allows a reliable reconstruction--despite previous radiotherapy, infection, foreign body, or surgery--in almost every situation in which mandible and soft tissue are absent. Bony union, a healed wound, and reasonable function and appearance are likely despite early fistula, skin loss, or metal plate or bone exposure.
Pericarditis with tamponade due to cytomegalovirus in the acquired immunodeficiency syndrome. A 35-year-old male homosexual with AIDS presented with headache and fever and was found to have cryptococcal meningitis. During the patient's hospital course, his hemodynamic status deteriorated as a result of pericardial tamponade. Antemortem analysis of the fluid was unrevealing; however, postmortem examination of the pericardium revealed typical intranuclear inclusions of cytomegalovirus infection. Cytomegalovirus should be included in the differential diagnosis of pericardial effusion in patients with AIDS.
Examination by logistic regression modelling of the variables which increase the relative risk of elderly women falling compared to elderly men. In a community based, prospective study to determine risk factors for falls, 465 women and 296 men 70 years and over were followed for 1 year and 507 falls were documented. A greater proportion of women (32.7%) than men (23.0%) experienced at least one fall in which there was no or minimal external contribution. Using unconditional logistic regression models we investigated the effect of physical and sociological variables on the sex difference in fall rate. Controlling for the variables age, use of psychotropic drugs, inability to rise from a chair without using arms, going outdoors less than daily and living alone decreased the relative risk of women falling compared to men from 2.02 (95% CI, 1.40-2.92) to 1.55 (95% CI 1.04-2.31). Some of the increased risk of falling associated with being a women was able to be explained and is potentially correctable. But even after controlling for the physical and social variables which we had assessed, women compared to men still had a significantly increased relative risk of falling.
A phosphatase activity present in peripheral blood myeloid cells of chronic myelogenous leukemia patients but not normal individuals alters nuclear protein binding to transcriptional enhancers of interferon-inducible genes. Cytoplasmic protein from peripheral blood myeloid cells of chronic myelogenous leukemia (CML) patients altered the electrophoretic mobility of complexes formed between nuclear proteins and interferon-inducible transcriptional enhancers. Immature myeloid marrow cells (blasts and promyelocytes) have a higher level of this activity than do mature myeloid marrow cells (bands and polys). This activity, which is not detectable in the peripheral blood cells of normal individuals, is at least 50-fold higher in CML marrow blasts and promyelocytes than that found in marrow blasts and promyelocytes of normal individuals. This activity was inhibited by in vivo incubation of immature myeloid cells with the phosphatase inhibitor, sodium orthovanadate (0.2 mM), and by adding orthovanadate (20 mM) directly to cytoplasmic proteins of myeloid cells. Interferon-alpha (1,000 U/ml) reduced the effects of the CML myeloid cell cytoplasmic protein on the electrophoretic mobility of nuclear protein-DNA complexes. These data suggest that a unique phosphatase may be involved in the abnormalities in CML which are modulated by interferon-alpha.
Ultrasonographic detection of the second-trimester fetus with trisomy 18 and trisomy 21. Biparietal diameter/femur length ratio and nuchal thickness were found to be sensitive indicators for the prenatal detection of trisomy 18 and trisomy 21. A biparietal diameter/femur length ratio greater than 1.5 SD above the control mean correctly identified 5 of 11 (46%) fetuses with trisomy 21 and 3 of 4 (75%) fetuses with trisomy 18. Nuchal thickening (6 mm or more) correctly identified 5 of 12 (41%) fetuses with trisomy 21 and 2 of 4 (50%) fetuses with trisomy 18. The sensitivity and specificity of the biparietal diameter/femur length ratio in detecting either aneuploidy was 53% and 93%, respectively, whereas a thickened nuchal fold had a sensitivity of 44% and a specificity of 100%. The combined use of the two ultrasonographic measurements had an overall sensitivity of 81% and a specificity of 93%. Prospective ascertainment of these two trisomies appears warranted in low-risk populations.
Synaptic transmission in human neocortex removed for treatment of intractable epilepsy in children. Synaptic transmission to pyramidal cells was studied in slices of neocortex resected from infants and children (n = 10, age 8 months to 13 years) undergoing surgical treatment for intractable epilepsy. Most specimens were from the least abnormal area of the resection. Stable intracellular recordings could be obtained for up to 8 hours. Most of the recorded neurons had electrophysiological characteristics similar to those of regular-firing pyramidal cells and were in layers III to V, which was confirmed by intracellular staining with Lucifer yellow. Local extracellular stimulation evoked a sequence of excitatory and inhibitory postsynaptic potentials. After application of the gamma-aminobutyric acid antagonist, bicuculline (10-30 microM), extracellular stimulation induced large excitatory postsynaptic potentials and epileptiform bursts. Spontaneous bursts occasionally occurred in bicuculline. This effect of bicuculline was observed in all the tissue samples, even those from infant patients (n = 4, age 8-16 months). Kynurenic acid depressed or abolished both spontaneous and stimulation-induced bursts. The competitive antagonist for N-methyl-D-aspartate receptors, DL-2-amino-5-phosphonopentanoic acid decreased the duration of bicuculline-induced bursts. These data provide evidence that, similar to rat and cat neocortex, excitatory and inhibitory amino acids are important transmitters to pyramidal cells in immature human neocortex.
Improvement of septic syndrome after administration of recombinant human growth hormone (rhGH)? Twenty patients with generalized sepsis were studied prospectively to evaluate the effects of recombinant human growth hormone (rhGH) administration. Five patients had developed sepsis after major abdominal surgery, 15 patients after multiple trauma with head injury (HTI-ISS 38 +/- 2 and Glasgow Coma Scale 4 +/- 1). The urea production rate (UPR) could be significantly reduced by the intramuscular administration of 1.5 IU of rhGH/kg bodyweight (BW) per day (UPR day: 5, 62 +/- 6.7 gm/d vs. UPR day: 10, 42.6 +/- 5.9 gm/d). The catabolic index of Bistrian (BI) was significantly lower after rhGH therapy on day 10 compared to day 5. IGF-1 increased significantly after the administration of rhGH. The nitrogen balance, however, did not become positive, despite the administration of rhGH. The changes in sepsis were estimated by the scoring system according to Elebute and Stoner on days 3, 5, 7, 10, and 13. In those patients who were available for post-treatment evaluation the parameters had returned to baseline values after the withdrawal of rhGH. Results indicate that this therapy might ameliorate the nitrogen intake, but has no influence on the course of sepsis. Compared to previously published results in nonseptic patients, the somatomedin inhibitors as well as the split-products of the complement system and the metabolites of arachidonic acid may have been responsible for this weak effect of rhGH and IGF-1 in septicemia.
Bactericidal effect of doxycycline associated with lysosomotropic agents on Coxiella burnetii in P388D1 cells. There is no consistently reliable treatment for endocarditis resulting from chronic Coxiella burnetii infection, the causative agent of Q fever. Although certain antibiotics are recommended on the basis of their in vitro bactericidal activities, results of therapy with these antibiotics are often disappointing. To evaluate whether the currently recommended antibiotic susceptibility tests for C. burnetii give misleading results because of continued division of uninfected cells, thereby resulting in the dilution of infected cells and, hence, a false picture of antibiotic efficacy, we blocked cell division during antibiotic susceptibility testing with cycloheximide. Using this new method, we found that the currently recommended antibiotics for the treatment of Q fever, doxycycline, pefloxacin, and rifampin, did not reduce the ratio of infected to noninfected cells (either L929 or P388D1) by 9 days postinfection. To test the hypothesis that this lack of antibacterial activity is due to antibiotic inactivation by the low pH of the phagolysosomes in which C. burnetii is found, we used alkalinizing lysosomotropic agents (chloroquine or amantadine) concurrently with doxycycline. This resulted in the sterilization of C. burnetii infection in P388D1 cells. This finding seems to confirm our suspicion that the acidic conditions of the phagolysosomes in which C. burnetii is located inhibit antibiotic activity. This inhibition can be reversed in vitro when lysosomotropic alkalinizing agents are used.
Genital human papillomavirus infection Human papillomavirus is one of the most common causes of sexually transmitted diseases. In the past ten years, 60 different types of papillomavirus have been identified. Although the virus often causes asymptomatic genital infection, it has been strongly associated with lower genital tract carcinoma; therefore, its detection and eradication are important. All patients with evidence of human papillomavirus infection should undergo colposcopy and, depending on the extent of infection and the type of histology, should receive definitive treatment.
Familial incidence of Paget's disease and secondary osteogenic sarcoma. A report of three cases from a single family. This report describes a family of three siblings with a long history of polyostotic Paget's disease. Because of the severe osseous involvement with Paget's disease, all three patients had problems that required orthopedic surgery. Subsequent to these surgeries, two patients developed osteogenic sarcoma at sites unrelated to their past procedures, one in the sacrum and one in the calvarium. Both patients died shortly after their diagnosis because of the aggressive spread of the tumor. Although the etiology of Paget's disease and its complication of osteogenic sarcoma still remain to be clarified, this and other case reports suggest a possible environmental or hereditary contribution to developing osteogenic sarcoma in Paget's disease. Patients with a familial clustering of polyostotic Paget's disease may benefit from more thorough screening tests to detect malignant transformation.
Recurrent herpes gestationis with postpartum flare: a case report. A case of herpes gestationis recurring in each pregnancy, with a postpartum flare-up in the last pregnancy, is described. The diagnosis was confirmed by skin biopsy. The first pregnancy ended in a term stillbirth, but there were favorable outcomes in four subsequent pregnancies. Histopathologic examination of the placentas of the last three pregnancies revealed varying grades of villositis. Symptoms improved with oral corticosteroids.
Assessment of experimental pericardial effusion using nuclear magnetic resonance imaging techniques. An experimental canine model of pericardial effusion was designed to validate previous clinical nuclear magnetic resonance imaging (NMR) studies. Saline (n = 7), serum (n = 4), blood (10% hematocrit [n = 5]; 20% hematocrit [n = 5]), and lipid (n = 4) effusions were chosen to resemble: (1) transudative/exudative, (2) nonhemorrhagic/hemorrhagic, and (3) chylous effusions, respectively. There was a linear correlation between the infused volume and the pericardial/epicardial distance measurements on the nuclear magnetic resonance images. Hemorrhagic and nonhemorrhagic exudative effusions were distinguished from transudative effusions by the low signal intensity of transudative effusions images obtained at a TR (repetition time) of 400 and 800 msec. Nonhemorrhagic effusions had significantly lower effusion-to-myocardial signal intensity ratio at TR of 400 msec than did hemorrhagic effusions. Differences in hematocrit were not appreciated qualitatively or quantitatively. Compared with other effusion types, only chylous effusions were hyperintense to myocardium at a TR of 400 msec. Chylous effusions were further uniquely characterized by a decreasing effusion-to-myocardial signal intensity ratio with increasing TR. These experimental findings corroborate the findings of earlier clinical reports and suggest that NMR can provide important assistance in the evaluation of pericardial effusions.
Assessment of the components of observed chronic pain behavior: the Checklist for Interpersonal Pain Behavior (CHIP). This article describes the development of the Checklist for Interpersonal Pain Behavior (CHIP), an observation scale which assesses overt pain behavior. The study is an extension of an earlier study in which the dimensions and components of observed chronic pain behavior were examined. A broad definition of pain behavior is chosen (interpersonal pain behavior), namely the interaction between the pain patient and his/her direct environment. The list of pain behaviors, taken from the earlier study, has been transformed into a 78-item global rating scale to be used by nurses to quantify observed pain behavior in a clinical setting. Six studies examine the factor structure and the psychometric properties of this behavioral observation method. In the first study, 6 internally reliable factors are derived using factor analytic techniques from a sample of 152 chronic pain patients. They are labeled as: 'distorted mobility,' 'verbal complaints,' 'non-verbal complaints,' 'nervousness,' 'depression' and 'day sleeping.' Internal consistency of all factors, except 'day sleeping' was excellent. The following studies show that the CHIP is sufficiently reliable and valid. After a discussion on the advantages of this observation scale, the conclusion seems justified that the CHIP is a useful tool in pain assessment that can easily be used by nurses.
Lymphocyte subset distribution after radiation therapy for cancer of the uterine cervix. Possible prognostic implications and correlation with disease course. An analysis of lymphocyte subpopulations was done in patients with cancer of the uterine cervix before and at different intervals after the commencement of radiation therapy. A common feature was a duration of T-cell and B-cell lymphopenia after therapy. The findings relating to the T-cell subsets were interesting. Although the CD4/CD8 ratio remained unchanged in Stages I/IIA for 24 months after treatment, patients with Stages IIB and III showed a lowering of the ratio immediately after treatment. Distinctive patterns of lymphocyte subset distribution were seen in a comparison between patients who were disease-free and those with recurrent disease. The CD4+ cell counts and CD4/CD8 ratio differed between the two groups, with consistent lowered values during the follow-up associated with recurrent disease. This study demonstrates the effects of radiation therapy in altering lymphocyte subset distribution, resulting in characteristic patterns which could be used as clinical and prognostic indicators.
Facilitating clinical trials. The expanding role of the nurse. Clinical trials are becoming increasingly difficult to carry out in the face of a changing health care delivery system. The reluctance of third party payers to reimburse for experimental therapy and the growing practice of providers to limit resources allocated for the care of cancer patients undergoing such therapies seriously curtail the ability of investigators to test new cancer treatments clinically. In addition, certain beliefs, attitudes, and perceptions held by the public may interfere with patient case accrual. Nurses can help facilitate both accrual to and conduct of clinical research. This article addresses selected consumer- and provider-centered factors that inhibit clinical research. The expanding role of the nurse in the areas of public education, informed consent, direct care, and collaborative research is also described.
Chronic hypomagnesemia caused by cisplatin: effect of calcitriol. A group of six patients with hypomagnesemia (serum magnesium less than or equal to 0.5 mmol/L), previously given treatment with cisplatin for ovarian or testicular cancer, received calcitriol at a dose of 0.5 to 1.0 microgram/day for a period of 4 weeks to determine whether treatment with this vitamin D metabolite could improve their hypomagnesemia. In response to treatment, the serum magnesium concentration fell progressively in association with a rise in serum and urinary calcium levels and a decrease in parathyroid hormone level. In a single previous report, active vitamin D metabolites markedly improved renal magnesium wasting. However, in the present study, increases in serum and urinary calcium levels and suppression of parathyroid hormone, factors known to decrease magnesium reabsorption, presumably overwhelmed any direct effect calcitriol may have had to enhance magnesium reabsorption, so that the net effect was a marked exacerbation of the renal magnesium wasting.