123rc/medical_text huggingface dataset:
Development and validation of an index for scoring baseline respiratory disease in the very low birth weight neonate. Severity Index Development and Validation Panels and Newborn Lung Project. An accurate description of the population at risk for neonatal chronic lung disease is clearly of prime importance for comparative studies and the planning of interventions. Attempts to explain variations in chronic lung disease rates in such studies have been compromised by lack of a way of estimating the severity of the initial pulmonary disease as a risk factor. Therefore, a severity index was developed for use in very low birth weight (less than 1501 g) neonates. Special emphasis was placed on applicability of the index in the multicenter observational setting. Development followed a clinician panel approach, with the resulting index designed to capture clinical judgment of severity. The index was validated prospectively on neonates in a neonatal intensive care unit, and retrospectively using charts from nine hospitals nationwide. Correlations of the index with clinical judgment in the two samples were .95 and .93, respectively. In an additional validation the index combined with birth weight correctly predicted oxygen dependence status at 30 days in 36 of 42 neonates consecutively admitted to five neonatal intensive care units (P = .002). Birth weight and the severity index contributed about equally to the prediction, and therefore they seem to represent partly independent components of baseline propensity for prolonged oxygen dependence.
Prevalence of angioid streaks and other ocular complications of Paget's disease of bone. Seventy randomly selected patients with Paget's disease of bone were examined for ocular complications. The prevalence of macular degeneration and cataract was 24.3%. Only one patient was found to have angioid streaks. Eight patients had peripapillary chorioretinal atrophy. These findings suggest that the prevalence of serious ocular complications of Paget's disease is not as high as previously thought. The significance of peripapillary chorioretinal atrophy requires further evaluation.
Function after amputation, arthrodesis, or arthroplasty for tumors about the knee. We studied the function of twenty-two patients who had had a malignant skeletal tumor adjacent to the knee. An above-the-knee amputation was done in seven; a resection arthrodesis, in nine; and a replacement arthroplasty, in six. The patients all walked at a similar speed (sixty-one to sixty-six meters per minute), which is slower than normal (eighty meters per minute). They all walked with comparable efficiency at three velocities: the mean consumption of oxygen was 0.210 milliliter per kilogram of body weight per meter at free velocity, 0.215 milliliter per kilogram of body weight per meter when they walked 25 per cent faster, and 0.211 to 0.240 milliliter per kilogram of body weight per meter when they walked 50 per cent faster. The three groups of patients and a normal control group consumed oxygen at similar rates. The patients who had had an amputation were very active, and they were the least worried about damaging the affected limb, but they had difficulty walking on steep, rough, or slippery surfaces. The patients who had had an arthrodesis had a more stable limb and performed the most demanding physical work and recreational activities, but they had difficulty sitting. The patients who had had an arthroplasty led sedentary lives and were the most protective of the limb, but they were the least self-conscious about the limb.
Ureteral stump carcinoma incidentally found at cystectomy for bladder cancer. We report on a sixty-five-year-old man with hematuria secondary to superficial bladder cancer. Because of previous urethral trauma, a complete transurethral resection of his bladder tumor could not be done. He, therefore, underwent cystectomy, at which time we incidentally found a transitional cell carcinoma of the left ureteral stump that had been left from a previous left nephrectomy for a World War II-related injury. This case underscores the importance of a thorough investigation of the complete urinary tract in a patient with hematuria or other urinary tract symptoms even if an obvious cause is found for his symptoms.
Wives of coronary high-risk men--are they also at higher risk? The Tromso Heart Study. Blood lipids, blood pressure, body mass index (BMI), smoking, dietary and exercise habits were studied in 911 wives of men with high risk for coronary heart disease (CHD). Following the 1979/80 Tromso Survey, 1373 men, aged 30-54 years, were identified as having high risk for CHD (HDL-cholesterol/total cholesterol less than or equal to 17.6% and/or total cholesterol greater than or equal to 7.86 mmol l-1). Of the 1373 men, 911 individuals had wives who also attended the screening. These wives were compared to age-matched, married women in the general population. A significantly higher total cholesterol level (5.98 mmol l-1 vs. 5.78 mmol l-1), lower HDL-cholesterol/total cholesterol (30.01% vs. 31.58%), higher BMI and higher coronary risk score (4.55 vs. 3.82) was found among the wives of the high-risk men. Furthermore, a higher proportion of these individuals were daily cigarette smokers (47.3% vs. 42.1%), and had received fewer years of education. They also had more dietary habits associated with increased risk of CHD than other married women in the general population. Our findings support the hypothesis that members of the same household as a person with increased risk for CHD also have increased risk. This is most probably due to shared lifestyle.
Vascular hypertrophy, renin and blood pressure in the young spontaneously hypertensive rat. 1. Cardiovascular reactivity, blood vessel morphology, blood pressure and the activity of the renin-angiotensin system were determined in the 3-week-old spontaneously hypertensive (SHR), Wistar-Kyoto (WKY) and outbred Wistar (WIS) rat. 2. In an isolated perfused mesenteric artery preparation the SHR had a significantly increased maximum response to KCl and noradrenaline (P less than 0.02) compared with the WKY. Using a myograph, vascular structure was measured over a range of resistance arteries and showed a significant correlation between lumen diameter and both media cross-sectional area and thickness, with the regression line for the SHR shifted upwards indicating both increased media area and thickness. This was associated with a slight, but significant, narrowing of the lumen (P less than 0.01) and an increased media/lumen ratio (0.049 +/- 0.01, 0.034 +/- 0.007, 0.036 +/- 0.008 for SHR, WKY and WIS, respectively, means +/- SD P less than 0.001). The SHR had a greater heart/body weight ratio than either the WKY or the WIS (P less than 0.001). 3. Both mesenteric artery and membrane protein content were higher in the SHR, indicating an increase in cell size or number. 4. Plasma renin activity (means +/- SD) was lower in the SHR (1.0 +/- 0.7 pmol of angiotensin I h-1 ml-1) than in the WKY (2.2 +/- 1.2 pmol of angiotensin I h-1 ml-1, P less than 0.001) but not different from that in the WIS (1.2 +/- 0.8 pmol of angiotensin I h-1 ml-1). Mesenteric artery vascular renin concentration was also lower in the SHR (P = 0.06).
Indirect revascularization of the lower extremity by means of microvascular free-muscle flap--a preliminary report. We describe the treatment of a patient with end-stage peripheral vascular disease and ischemic ulceration of the lower extremity in whom an obliteration of the distal arterial bed precluded conventional arterial reconstruction. A nonhealing dorsal foot ulcer was debrided, and soft tissue reconstruction was accomplished by the free microsurgical transfer of a muscle flap to the distal lower extremity. Arterial inflow to this free flap was provided by a contralateral reversed saphenous vein graft from the proximal arterial tree of the leg. This procedure resulted in a healed wound, stable coverage, and limb salvage. The patient also noted complete relief of rest pain and improvement in his claudication symptoms. A follow-up arteriogram was done 2 months after surgery. Contrast injection directly into the artery of this flap showed new blood vessel growth from the muscle flap into the foot with anastomoses of these "new vessels" to the patient's native circulation. This experience suggests that limb salvage may be possible by the free microvascular transplantation of a muscle flap onto the limb in selected patients whose limbs are deemed "nonreconstructible.".
Management of renovascular disease. A surgical perspective. The role of surgical revascularization in the management of patients with renal artery disease has changed in recent years. This has occurred due to the advent of percutaneous transluminal angioplasty as an effective method of treatment for certain patients, improved results of surgical revascularization in older patients with atherosclerosis, an enhanced appreciation of advanced atherosclerotic renal artery disease as a correctable cause of renal failure, and the development of more effective surgical techniques for patients with severe aortic atherosclerosis and branch renal artery disease. Surgical revascularization is currently the treatment of choice for patients with branch renal artery disease, ostial atherosclerotic renal artery disease, a renal artery aneurysm, and patients in whom renal percutaneous transluminal angioplasty has been unsuccessful. Excellent clinical results continue to be achieved with surgical revascularization in properly selected patients.
The failure of serial pneumatic cuff venous occlusion plethysmography to predict patients at risk for pulmonary emboli after trauma. Over a three month period, attempts to perform serial Pneumatic Cuff Venous Occlusion Plethysmography (VP) were carried out in 51 severely injured patients felt to be at risk for Pulmonary Embolus (PE). Studies could not be performed in 25 of these patients due to the nature of their injuries. Of the remaining 26 patients, two showed evidence of deep vein thrombosis (DVT). Venography confirmed the diagnosis in only one of these patients. Serial VP failed to predict PE in all five patients in whom it was diagnosed. This article concludes that serial VP is not an effective predictor of PE in these patients.
Primary non-Hodgkin's T-cell lymphoma of the esophagus. A case with peculiar endoscopic ultrasonographic pattern. We report a case of primary esophageal non-Hodgkin's T-cell lymphoma in a young white female. At admission, endoscopy revealed large, irregularly shaped, esophageal ulcerations with super imposed candidiasis. Endoscopic ultrasonography to assess submucosal alterations and periesophageal involvement revealed a diffuse hypoechogenic thickening (up to 5 mm) of the esophageal wall, a pattern consistent with lymphomatous infiltration. Definitive diagnosis was made with the aid of histology and immunohistochemistry.
Thyroid crises. In the setting of characteristic features of thyrotoxicosis, the timely diagnosis and aggressive management of thyroid storm should result in a successful outcome. However, severe storm may lead to irreversible cardiovascular collapse, especially in the older patient who may have atypical features of thyrotoxicosis. The fundamental approach is prompt and optimal treatment in the emergency department once the presenting clinical features suggest its presence. Delay in the introduction of therapy while awaiting laboratory confirmation may result in further decompensation and death. The prevention of myxedema coma entails paying special attention to certain high-risk patient groups. These groups include older women with a history of Hashimoto's thyroiditis, or previous irradiation or thyroid surgery for hyperthyroidism. Inform such patients of the symptoms and signs of hypothyroidism, and perform annual thyroid function tests, such as a serum TSH, in order to provide early, adequate treatment once the test becomes positive.
Effect of intracoronary serotonin on coronary vessels in patients with stable angina and patients with variant angina BACKGROUND. Serotonin, a major product of platelet activation, has potent vasoactive effects in animal models, but its role in human coronary artery disease remains largely speculative. METHODS. Using quantitative coronary angiography, we compared the effects of the intracoronary infusion of graded concentrations of serotonin (10(-7) to 10(-4) mol per liter) on coronary vessels in two groups of patients with different clinical presentations of coronary disease (nine with stable angina and five with variant angina), with the effects in a control group of eight subjects with normal vessels on angiography. RESULTS. Normal coronary vessels had a biphasic response to intracoronary serotonin: dilation at concentrations up to 10(-5) mol per liter, but constriction at 10(-4) mol per liter. Vessels in patients with stable angina constricted at all concentrations, with mean (+/- SEM) maximal decreases in diameter of 23.9 +/- 3.6, 33.1 +/- 3.9, and 41.7 +/- 3.1 percent from base line in proximal, middle, and distal segments at a serotonin concentration of 10(-4) mol per liter. Smooth segments constricted more than irregular segments (42.0 +/- 4.6 vs. 21.1 +/- 1.6 percent). Four patients with stable angina had a marked reduction in collateral filling. All the patients with stable angina had angina during the intracoronary infusion of serotonin, and electrocardiographic changes were noted in six. All the patients with variant angina had angina, electrocardiographic changes, and localized occlusive epicardial coronary-artery spasm at concentrations of 10(-6) (n = 2) or 10(-5) (n = 3) mol per liter. CONCLUSIONS. Patients with stable coronary disease do not have the normal vasodilator response to intracoronary serotonin, but rather have progressive constriction, which is particularly intense in small distal and collateral vessels. Patients with variant angina have occlusive coronary-artery spasm at a dose that dilates normal vessels and causes only slight constriction in vessels from patients with stable angina. These findings suggest that serotonin, released after the intracoronary activation of platelets, may contribute to or cause myocardial ischemia in patients with coronary artery disease.
A consensus approach to electrolytes and blood pressure. Could we all be right? This commentary sets forth the hypothesis that the putative beneficial or detrimental effects of specific electrolytes on blood pressure regulation in fact reflect highly integrated responses to interactions among these cationic and anionic species. In this paradigm, the impact of any given intake of an electrolyte on arterial pressure will be influenced by the concurrent consumption of other electrolytes. Thus, the heterogeneous blood pressure response in humans to isolated manipulations of nutrients such as sodium, calcium, and potassium may be determined, in part, by the adequacy of the dietary intake of other mineral elements. If this hypothesis is validated by continued research in this area, we would have new strategies available to improve blood pressure control in humans. For example, treatment of "NaCl sensitivity" in some humans might be more effectively approached by correcting dietary deficiencies of either potassium or calcium than by restricting dietary NaCl.
Activated protooncogenes in human lung tumors from smokers. Fourteen primary human lung tumor DNAs from smokers were analyzed for transforming activity by two DNA transfection assays. Activated protooncogenes were detected in 3 of 11 tumor DNAs by the NIH 3T3 focus assay, whereas activated protooncogenes were detected in 11 of 13 tumor DNAs by the NIH 3T3 cotransfection-nude mouse tumorigenicity assay. K- or NRAS genes activated by point mutation at codons 12 or 61 were detected in a large cell carcinoma, a squamous cell carcinoma, and 5 adenocarcinomas. An HRAS oncogene activated by a different mechanism was detected in an epidermoid carcinoma. One adenocarcinoma was found to contain an activated RAF gene. Two unidentified transforming genes were detected in a squamous cell carcinoma DNA and two adenocarcinoma DNAs. Eight of 10 lung adenocarcinomas that had formed metastases at the time of surgery were found to contain RAS oncogenes. No significant increase in metastasis was observed in the lung adenocarcinomas that contained one or more 6-kilobase EcoRI alleles of the LMYC gene. Overall, 12 of 14 (86%) of the lung tumor DNAs from smokers were found to contain activated protooncogenes. RAS oncogenes appear to play a role in the development of metastases in lung adenocarcinomas.
Balloon angioplasty of stenosed Blalock-Taussig anastomosis: role of balloon-on-a-wire in dilating occluded shunts. Six children with cyanotic congenital heart defects, aged 6 to 60 months, underwent percutaneous balloon angioplasty of a narrowed Blalock-Taussig (BT) shunt to improve arterial oxygen saturation. The indication for angioplasty was a cyanotic heart defect not amenable to total surgical correction, either because of the age and size at presentation or because of anatomic complexity, but at the same time requiring palliation of pulmonary oligemia. Following balloon angioplasty, there was an increase in arterial oxygen saturation from 71 +/- 8% to 81 +/- 6% (p less than 0.05). In one child with long segment narrowing, there was no significant improvement in oxygen saturation, and this child underwent an additional BT shunt on the contralateral side. On follow-up 3 to 12 months after balloon angioplasty, the oxygen saturations remained improved (78 +/- 10%) in the remaining five patients. In two children with either complete or almost complete blockage of the BT shunt, we were unable to advance any catheter across the shunt but we were able to advance a 2 or 3 mm balloon on a wire and dilate the shunt, followed by introduction of a catheter carrying a larger balloon for angioplasty. This has permitted us to obtain the pulmonary artery pressure directly (this information was of obvious value in patient management) and resulted in an improvement in the arterial oxygen saturation. It is concluded that (1) balloon angioplasty of narrowed BT shunts is feasible, effective, and safe and (2) even completely occluded shunts can be cannulated and the balloon dilated with the newly available balloon-on-wire devices.
Sensitivity of a set of myocardial infarction screening criteria in patients with anatomically documented single and multiple infarcts. A subset of 3 screening criteria (Q wave greater than or equal to 30 ms in lead aVF, any Q or R wave less than or equal to 10 ms and less than or equal to 0.1 mV in lead V2, and R wave greater than or equal to 40 ms in V1) has been proposed to identify single nonacute myocardial infarcts. Cumulatively, these 3 criteria achieved 95% specificity, and 84 and 77% sensitivities for inferior and anterior myocardial infarcts, respectively, among patients identified by coronary angiography and left ventriculography. This study establishes the true sensitivities of the set of screening criteria in 71 patients with anatomically proven single myocardial infarcts and 32 patients with multiple myocardial infarcts. In the single inferior infarct group, the aVF criterion was 90% sensitive. The V2 criterion (any Q or R wave less than or equal to 10 ms and less than or equal to 0.1 mV) was 67% sensitive in the single anterior infarct group. No single criterion proved sensitive in identifying a posterolateral infarct. The set of screening criteria performed just as well for multiple infarcts as it did for single infarcts, with a cumulative sensitivity of 72%. The overall sensitivity of the screening set in the 103 patients in all groups was 71%.
Flexion-extension views in the evaluation of cervical-spine injuries. STUDY OBJECTIVE: To determine the efficacy of flexion-extension (F/E) cervical-spine radiographs in detecting acute cervical-spine instability in emergency patients. DESIGN: We retrospectively reviewed the charts of 141 consecutive trauma patients who had F/E views performed after a routine cervical-spine series (three views) was obtained in the emergency department. Interpretations of the routine series were compared with those of the F/E views to determine if additional useful information was provided by the latter. The charts also were reviewed to determine if any variables were associated with an increased use of F/E views, an increased likelihood of these views demonstrating instability, or any neurologic sequelae resulted from these studies. SETTING: An urban Level I adult trauma center. MEASUREMENTS: The interpretations of the routine series were noted to be either normal, abnormal but without demonstrable fracture/dislocation, or demonstrating a fracture/dislocation. The F/E views were categorized as stable, unstable, or uninterpretable. RESULTS: Cervical-spine instability was demonstrated by F/E views in 11 of the 141 patients (8%), four of whom had normal routine cervical-spine films. Three of these four patients required surgical stabilization. Prolonged neck pain (more than 24 hours), an initially abnormal spine series, and a neurosurgical consult were all associated with an increased use of F/E views. Ten of 11 patients with radiographic instability had significant neck pain by history; the remaining patient was intoxicated. No neurologic sequelae resulted from performing F/E studies. There was one false-negative F/E study, which raises concern about the reliability of this procedure in the ED. CONCLUSION: We believe that a large prospective study is required to determine which patients warrant F/E views.
Umbilical cord ulceration and intestinal atresia: a new association? In three fetuses, congenital intestinal atresia was associated with linear ulcerations of the umbilical cord. In two cases, hemorrhage was seen from the cord ulcer. Both fetuses required emergency cesarean section for fetal distress and were born anemic. The third fetus was mildly hydropic, attributed to hemorrhage, and was stillborn. The mechanism of the association could not be determined. These cases suggest a risk of prenatal umbilical cord hemorrhage in infants with intestinal atresia.
Germ-line transmission of a mutated p53 gene in a cancer-prone family with Li-Fraumeni syndrome Tumour suppressor genes, whose usual function seems to be controlling normal cell proliferation, have been implicated in many inherited and sporadic forms of malignancies Much evidence supports the concept of tumour formation by loss-of-function mutations in suppressor genes, as predicted by the two-hit model of Knudson and DeMars. The suppressor gene, p53, is affected in such a manner by numerous mutations, which occur in a variety of human tumours. These mutations usually represent the loss of one allele and the substitution of a single base in the other. We have now analysed the p53 gene in a family affected by Li-Fraumeni syndrome, a rare autosomal dominant syndrome characterized by the occurrence of diverse mesenchymal and epithelial neoplasms at multiple sites. In some instances the neoplasms seem to be related to exposure to carcinogens, including ionizing radiation. The Li-Fraumeni family that we studied had noncancerous skin fibroblasts (NSF) with an unusual radiation-resistant phenotype. DNA derived from the NSF cells of four family members, spanning two generations, had the same point mutation in codon 245 (GGC----GAC) of the p53 gene. This mutation leads to substitution of aspartic acid for glycine in one of the regions identified as a frequent target of point mutations in p53. The NSF cell lines with the mutation also retained the normal p53 allele. This inherited p53 mutation may predispose the members of this family to increased susceptibility to cancer.